scholarly journals Navigated Brain Stimulation (NBS) for Pre-Surgical Planning of Brain Lesion in Critical Areas: Basic Principles and Early Experience

10.5772/53216 ◽  
2013 ◽  
Author(s):  
Concetta Alafaci ◽  
Alfredo Conti ◽  
Francesco Tomasello
Keyword(s):  
Brain Stimulation ◽  
Surgical Planning ◽  
Brain Lesion ◽  
Early Experience ◽  
Basic Principles ◽  
Navigated Brain Stimulation ◽  
Critical Areas

Eloquent and epileptogenic brain: advantages of navigated brain stimulation in focal neocortical epilepsy?

2009 ◽  
Vol 40 (01) ◽  
Author(s):  
S Schmidt ◽  
E Holst ◽  
K Irlbacher ◽  
M Merschhemke ◽  
SA Brandt
Keyword(s):  
Brain Stimulation ◽  
Navigated Brain Stimulation ◽  
Neocortical Epilepsy

scholarly journals Deep Brain Stimulation of the Posterior Insula in Chronic Pain: A Theoretical Framework

2021 ◽  
Vol 11 (5) ◽  
pp. 639
Author(s):  
David Bergeron ◽  
Sami Obaid ◽  
Marie-Pierre Fournier-Gosselin ◽  
Alain Bouthillier ◽  
Dang Khoa Nguyen
Keyword(s):  
Chronic Pain ◽  
Electrical Stimulation ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
High Frequency ◽  
Brain Lesion ◽  
Low Frequency ◽  
Posterior Insula ◽  
Deep Brain ◽  
Stimulation Of

Introduction: To date, clinical trials of deep brain stimulation (DBS) for refractory chronic pain have yielded unsatisfying results. Recent evidence suggests that the posterior insula may represent a promising DBS target for this indication. Methods: We present a narrative review highlighting the theoretical basis of posterior insula DBS in patients with chronic pain. Results: Neuroanatomical studies identified the posterior insula as an important cortical relay center for pain and interoception. Intracranial neuronal recordings showed that the earliest response to painful laser stimulation occurs in the posterior insula. The posterior insula is one of the only regions in the brain whose low-frequency electrical stimulation can elicit painful sensations. Most chronic pain syndromes, such as fibromyalgia, had abnormal functional connectivity of the posterior insula on functional imaging. Finally, preliminary results indicated that high-frequency electrical stimulation of the posterior insula can acutely increase pain thresholds. Conclusion: In light of the converging evidence from neuroanatomical, brain lesion, neuroimaging, and intracranial recording and stimulation as well as non-invasive stimulation studies, it appears that the insula is a critical hub for central integration and processing of painful stimuli, whose high-frequency electrical stimulation has the potential to relieve patients from the sensory and affective burden of chronic pain.

Technical and Practical Aspects of Invasive Recordings and Brain Stimulation

2018 ◽  
pp. 26-37
Author(s):  
Gholam K. Motamedi ◽  
Jean Gotman ◽  
Ronald P. Lesser
Keyword(s):  
Charge Density ◽  
Surface Area ◽  
Brain Stimulation ◽  
Electrode Surface ◽  
Cortical Stimulation ◽  
Basic Principles ◽  
Depth Electrodes ◽  
Cortical Stimulation Mapping ◽  
Drug Resistant Epilepsy ◽  
Intracranial Electrodes

This chapter discusses the technical and practical issues involved in invasive recording and cortical stimulation mapping in patients with drug-resistant epilepsy. It reviews the way in which EEG signals are generated, circumstances when intracranial electrodes are needed, and how such electrodes operate. It also discusses the basic principles of cortical stimulation mapping and different methods of using intracranial electrodes for stimulation purposes, and relevant concepts involved in the process such as charge density and electrode surface area. It reviews different electrodes used for mapping including subdural surface electrodes and depth electrodes.

Tractography-Guided Deep Brain Stimulation of the Anteromedial Globus Pallidus Internus for Refractory Obsessive-Compulsive Disorder: Case Report

Neurosurgery ◽  
2019 ◽  
Author(s):  
Amit Azriel ◽  
Sarah Farrand ◽  
Maria Di Biase ◽  
Andrew Zalesky ◽  
Elaine Lui ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Obsessive Compulsive Disorder ◽  
Globus Pallidus ◽  
Brain Stimulation ◽  
Surgical Planning ◽  
Globus Pallidus Internus ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Treatment Refractory ◽  
Deep Brain

AbstractBACKGROUND AND IMPORTANCEObsessive-compulsive disorder (OCD) is a disabling psychiatric disorder, mainly treated with psychotherapy and pharmacotherapy. Surgical intervention may be appropriate for patients with treatment-refractory OCD. Deep brain stimulation (DBS) is an alternative for previously common ablative surgical procedures. Tractography has been proposed as a method for individualizing DBS treatment and may have the potential to improve efficacy.CLINICAL PRESENTATIONWe present a patient with treatment-refractory OCD previously treated with bilateral leucotomies, who underwent DBS surgery with targeting informed by tractography. Preoperative tractography to identify suitable DBS targets was undertaken. Structural images were also utilized for standard stereotactic surgical planning. The anteromedial globus pallidus internus (amGPi) was chosen as the target bilaterally after consideration of white matter projections to frontal cortical regions and neurosurgical approach. Bilateral amGPi DBS surgery was undertaken without adverse events. At 16-mo follow-up, there was a 48.5% reduction in OCD symptom severity as measured by the Yale-Brown Obsessive Compulsive Scale.CONCLUSIONThe amGPi can be a successful DBS target for OCD. This is the first known case to report on DBS surgery postleucotomies for OCD and highlights the utility of tractography for surgical planning in OCD.

FC5.3 Navigated brain stimulation for exact mapping of several discrete motor areas

2006 ◽  
Vol 117 ◽  
pp. 1-2
Author(s):  
S. Teitti ◽  
S. Määttä ◽  
L. Eskola ◽  
M. Könönen ◽  
R. Vanninen ◽  
...  
Keyword(s):  
Brain Stimulation ◽  
Navigated Brain Stimulation ◽  
Motor Areas

Integration of navigated brain stimulation data into radiosurgical planning: potential benefits and dangers

2014 ◽  
Vol 156 (6) ◽  
pp. 1125-1133 ◽  
Author(s):  
Thomas Picht ◽  
Sarah Schilt ◽  
Dietmar Frey ◽  
Peter Vajkoczy ◽  
Markus Kufeld
Keyword(s):  
Brain Stimulation ◽  
Navigated Brain Stimulation ◽  
Potential Benefits

SUSCEPTIBILITY-ENHANCED 3-TESLA T1-WEIGHTED SPOILED GRADIENT ECHO OF THE MIDBRAIN NUCLEI FOR GUIDANCE OF DEEP BRAIN STIMULATION IMPLANTATION

Neurosurgery ◽  
2009 ◽  
Vol 65 (4) ◽  
pp. 809-815 ◽  
Author(s):  
Geoffrey S. Young ◽  
Feng Feng ◽  
Hao Shen ◽  
Nan-kuei Chen
Keyword(s):  
Steady State ◽  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Surgical Planning ◽  
Spin Echo ◽  
Fast Spin Echo ◽  
Data Set ◽  
3 Dimensional ◽  
Deep Brain

Abstract SURGICAL PLANNING FOR deep brain stimulation implantation procedures requires T1-weighted imaging (T1WI) for stereotactic navigation. Because the subthalamic nucleus, the main target for deep brain stimulation, and other midbrain nuclei cannot be visualized on the stereotactic guidance T1WI, additional T2-weighted imaging (T2WI) is generally obtained and registered to the T1WI for surgical targeting. Surgical planning based on the registration of the 2 data sets is subject to error resulting from inconsistent geometric distortions and any subject movement between the 2 scans. In this article, we propose a new method to produce susceptibility-enhanced, contrast-optimized T1-weighted 3-dimensional spoiled gradient recalled acquisition in steady state images with enhanced contrast for midbrain nuclei within the volumetric T1WI data set itself, eliminating the need for additional T2WI. The scan parameters of 3-dimensional spoiled gradient recalled acquisition in steady state are chosen in a way that T1WI can be obtained from conventional magnitude reconstruction and images with improved contrast between midbrain nuclei and surrounding tissues can be produced from the same data by performing susceptibility-weighted imaging reconstruction on a chosen region of interest. In addition, our preliminary experience suggests that the resulting contrast between the midbrain nuclei is superior to the current state-of-the-art fast spin echo T2WI in depicting the subthalamic nucleus as distinct from the substantia nigra pars reticulata and clear depiction of the nucleus ventrointermedius externus of thalamus.

Abstract 104: Navigated Brain Stimulation for Upper Limb Recovery After Stroke: A Randomized Sham Controlled Clinical Trial of Low Frequency r-TMS to Non-injured Hemisphere Combined With Upper Limb Rehabilitation

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Richard L Harvey ◽  
Charles Liu ◽  
Dylan Edwards ◽  
Kari Dunning ◽  
Felipe Fregni ◽  
...  
Keyword(s):  
Upper Limb ◽  
Brain Stimulation ◽  
Repeated Measures ◽  
Low Frequency ◽  
Post Treatment ◽  
Upper Limb Rehabilitation ◽  
Navigated Brain Stimulation ◽  
Significant Difference ◽  
Limb Rehabilitation

Introduction: Upper limb function following stroke is limited, with only 50% regaining some function and less than 20% regaining normal function. Repetitive TMS has promise as an adjunct to upper limb therapy after stroke. We aimed to determine if navigated brain stimulation (NBS) with a low-frequency (1 Hz) protocol to non-injured hemisphere combined with upper limb rehabilitation would improve arm motor function better than rehabilitation alone. Method: We enrolled 199 patients with hemiplegia from ischemic or hemorrhagic stroke within 3-12 m post ictus. Randomization was in a 2:1 ratio to NBS with 18 sessions of rehabilitation over 6 weeks, or to sham NBS with therapy. The primary end-point was rate of achieving a 5-point improvement on the upper limb Fugl-Myer (ULFM) score at 6 m post-treatment and safety. Secondary outcomes included post-treatment, 1 m, 3 m and 6 m change on ULFM, action research arm test (ARAT), and EQ-5D-3L health questionnaire. Results: Of 199 subjects enrolled, 167 completed treatment and follow-up due to early stoppage of data collection after interim futility analysis. All subjects improved significantly on each outcome measure at each point of follow up, including 6 m post-treatment ULFM: treatment (8.1±7.4, p<0.001) and sham (8.5±8.7, p<0.001). In the ITT analysis, there was no difference on achievement of 5 points on ULFM at 6 m post-treatment: 67% treatment vs. 65% sham (chi-sq 1.105, p=0.76). Repeated measures ANCOVA group*time interaction showed no significant difference between groups for ULFM (p=0.87), ARAT (p=0.80) and the EQ 5D (p=0.96). There were no study or device related serious adverse events and no difference in SAE’s between groups. Conclusion: NBS can be safely used in the clinical setting. Clinically important gains were observed in both study arms suggesting no additional effect of 1 Hz NBS in stroke subjects within 3-12 m post ictus. The lack of NBS effects may be explained by the large effect size (ceiling effect) or potentially that the sham coil unintentionally induced cortical currents. Further analysis of the sham method and also secondary subgroup analyses will provide further insights and generate novel hypothesis to be confirmed in future NBS trials.

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