Implantation Of Stimulation Electrodes Research Articles

Subthalamic nucleus neurons encode syllable sequence and phonetic characteristics during speech.

Speech is a complex behavior that can be used to study unique contributions of the basal ganglia to motor control in the human brain. Computational models suggest that the basal ganglia encode either the phonetic content or the sequence of speech elements. To explore this question, we investigated the relationship between phoneme and sequence features of a spoken syllable triplet and the firing rate of subthalamic nucleus (STN) neurons recorded during the implantation of deep brain stimulation (DBS) electrodes in individuals with Parkinson's disease. Patients repeated aloud a random sequence of three consonant-vowel (CV) syllables in response to audio cues. Single-unit extracellular potentials were sampled from the sensorimotor STN; a total of 227 unit recordings were obtained from the left STN of 25 subjects (4 females). Of these, 113 (50%) units showed significant task-related increased firing and 53 (23%) showed decreased firing (t test relative to inter-trial period baseline, P < 0.05). Linear regression analysis revealed that both populations of STN neurons encode phoneme and sequence features of produced speech. Maximal phoneme encoding occurred at the time of phoneme production, suggesting efference copy- or sensory-related processing, rather than speech motor planning (-50 ms and +175 ms relative to CV transition for consonant and vowel encoding, respectively). These findings demonstrate that involvement of the basal ganglia in speaking includes separate single unit representations of speech sequencing and phoneme selection in the STN.NEW & NOTEWORTHY Speech is a unique human behavior that requires dynamic execution of precisely timed and coordinated movements, resulting in intelligible vocalizations. Here, we demonstrate that activity of individual neurons in the subthalamic nucleus (STN) of the basal ganglia encode syllable sequence order and phoneme identity during a speech production task. These findings advance our understanding of neural substrates of human speech and shed light on potential involvement of the STN in complex human behaviors.

Percutaneous Endoscope-assisted Visualized Implantation of Puncture Cylindrical Electrodes for Spinal Cord Stimulation: A Cadaveric Feasibility Study

Percutaneous Endoscope-assisted Visualized Implantation of Puncture Cylindrical Electrodes for Spinal Cord Stimulation: A Cadaveric Feasibility Study

Clinical Effects of Implantable Sacral Neuromodulation Combined with Floating Needle Reperfusion in the Treatment of Patients with Functional Defecation Disorders

Objective: To investigate the clinical effect of implantable sacral neuromodulation combined with floating needle reperfusion in treating patients with functional defecation disorder. Methods: 40 eligible constipated patients with defecation disorder were screened according to the criteria of Rome IV for chronic constipation, and were divided into 20 cases each in the control group and the study group according to the random number table method. The control group was given oral lactulose combined with mosapride treatment, and the study group was given implantation of sacral nerve stimulation electrodes and floating needle reperfusion treatment. The clinical symptoms, visual analog scale (VAS) score, Wexner score for constipation, quality of life score, anorectal manometry, adverse reactions, and complications were observed in both groups. Results: After treatment, the median number of voluntary feces per week and the median number of days of voluntary feces per week in the study group were higher than those in the control group, and the median duration of defecation was lower than that in the control group (P &lt; 0.05); the median VAS score of the study group was significantly higher than that of the control group (P &lt; 0.05); the constipation Wexner score of the study group was significantly lower than that of the control group (P &lt; 0.001); the quality of life scores of the study group were overall better than those of the control group (P &lt; 0.05); the anal resting pressure, anal residual pressure, and rectal propulsion of the study group were significantly better than those of the control group (P &lt; 0.05); liquefaction of the incision occurred in only one patient during treatment in the study group, which was healed after changing the medication and did not have any serious complications, and two patients in the control group had abdominal pain, and there was no significant difference between the two groups (P &gt; 0.05). Conclusion: In the treatment of patients with functional defecation disorder, implantable sacral neuromodulation combined with floating needle reperfusion therapy can effectively improve the clinical symptoms and quality of life of patients.

Generalisation capabilities of machine-learning algorithms for the detection of the subthalamic nucleus in micro-electrode recordings.

Micro-electrode recordings (MERs) are a key intra-operative modality used during deep brain stimulation (DBS) electrode implantation, which allow for a trained neurophysiologist to infer the anatomy in which the electrode is placed. As DBS targets are small, such inference is necessary to confirm that the electrode is correctly positioned. Recently, machine learning techniques have been used to augment the neurophysiologist's capability. The goal of this paper is to investigate the generalisability of these methods with respect to different clinical centres and training paradigms. Five deep learning algorithms for binary classification of MER signals have been implemented. Three databases from two different clinical centres have also been collected with differing size, acquisition hardware, and annotation protocol. Each algorithm has initially been trained on the largest database, then either directly tested or fine-tuned on the smaller databases in order to estimate their generalisability. As a reference, they have also been trained from scratch on the smaller databases as well in order to estimate the effect of the differing database sizes and annotation systems. Each network shows significantly reduced performance (on the order of a 6.5% to 16.0% reduction in balanced accuracy) when applied out-of-distribution. This reduction can be ameliorated through fine-tuning the network on the new database through transfer learning. Although, even for these small databases, it appears that retraining from scratch may still offer equivalent performance as fine-tuning with transfer learning. However, this is at the expense of significantly longer training times. Generalisability is an important criterion for the success of machine learning algorithms in clinic. We have demonstrated that a variety of recent machine learning algorithms for MER classification are negatively affected by domain shift, but that this can be quickly ameliorated through simple transfer learning procedures that can be readily performed for new centres.

Cerebral Intraparenchymal Hemorrhage due to Implantation of Electrodes for Deep Brain Stimulation: Insights from a Large Single-Center Retrospective Cross-Sectional Analysis

Cerebral intraparenchymal hemorrhage due to electrode implantation (CIPHEI) is a rare but serious complication of deep brain stimulation (DBS) surgery. This study retrospectively investigated a large single-center cohort of DBS implantations to calculate the frequency of CIPHEI and identify patient- and procedure-related risk factors for CIPHEI and their potential interactions. We analyzed all DBS implantations between January 2013 and December 2021 in a generalized linear model for binomial responses using bias reduction to account for sparse sampling of CIPHEIs. As potential risk factors, we considered age, gender, history of arterial hypertension, level of invasivity, types of micro/macroelectrodes, and implanted DBS electrodes. If available, postoperative coagulation and platelet function were exploratorily assessed in CIPHEI patients. We identified 17 CIPHEI cases across 839 electrode implantations in 435 included procedures in 418 patients (3.9%). Exploration and cross-validation analyses revealed that the three-way interaction of older age (above 60 years), high invasivity (i.e., use of combined micro/macroelectrodes), and implantation of directional DBS electrodes accounted for 82.4% of the CIPHEI cases. Acquired platelet dysfunction was present only in one CIPHEI case. The findings at our center suggested implantation of directional DBS electrodes as a new potential risk factor, while known risks of older age and high invasivity were confirmed. However, CIPHEI risk is not driven by the three factors alone but by their combined presence. The contributions of the three factors to CIPHEI are hence not independent, suggesting that potentially modifiable procedural risks should be carefully evaluated when planning DBS surgery in patients at risk.

Lead placement in cardiac implantable electronic devices

The implantation of electrodes for cardiac implantable electronic devices (CIED) requires profound technical understanding and precise execution. The positioning of electrodes in the right ventricle and atrium has significant implications for patient safety and the effectiveness of CIED therapy. Particular focus is given to the distinction between apical and septal stimulation in ventricular positioning. Based on current data, this article provides apractice-oriented guide that leads implanters through the individual steps of electrode positioning. The implantation of electrodes for physiological stimulation (cardiac resynchronization therapy, CRT, and conduction system pacing, CSP) is not addressed in this article.

Thalamic segmentation based on diffusion tensor imaging in patients with trigeminal neuralgia

Classical trigeminal neuralgia (CTN) refers to episodic pain that is strictly confined to the trigeminal distribution area, and the thalamus is an important component of the trigeminal sensory pathway. Probabilistic tracking imaging algorithm was used to identify specific connections between the thalamus and the cortex, in order to identify structural changes in the thalamus of patients with CTN and perform thalamic segmentation. A total of 32 patients with CTN and 32 healthy controls underwent DTI-MRI scanning (3.0 T). Differences in fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD) and mean diffusivity (MD) between the groups were studied. Correlation analysis was performed with clinical course and pain level. Compared to the healthy controls, patients in the CTN group had significantly reduced FA, increased AD, RD and MD in somatosensory subregion of the bilateral thalamus, increased RD in frontal subregion, increased RD and MD in motor subregion. Correlation analysis showed that patient history was positively correlated with pain grading, and that medical history was positively correlated with significantly reduced FA in somatosensory subregion, negatively correlated with increased RD and MD in motor subregion. We used DTI-based probabilistic fiber tracking to discover altered structural connectivity between the thalamus and cerebral cortex in patients with CTN and to obtain a thalamic segmentation atlas, which will help to further understand the pathophysiology of CTN and serve as a future reference for thalamic deep brain stimulation electrode implantation for the treatment of intractable pain.

Neural activity of the subthalamic nucleus during voluntary movements in patients with Parkinson’s disease

Microelectrode recording (MER) during electrode implantation for deep brain stimulation (DBS) can determine the boundaries of the subthalamic nucleus (STN), and track neural activity during rest and voluntary movement in Parkinson’s disease (PD) patients. However, the functional role of STN in motor control remains unclear, despite its effectiveness in stimulation. Single unit activity of STN was recorded in 16 patients with PD during implantation of deep brain stimulation electrodes. Electromyograms of forearm muscles and a phonogram featuring verbal commands were simultaneously recorded with MER. The patients were instructed to perform motor tests involving clenching their hand into a fist. Out of the 560 neurons studied, 93 (16.6%) responded to motor tasks. The registered neurons were classified into three patterns using the hierarchical clustering method of histograms of interspike interval density — namely, tonic, burst, and pause patterns. Sensitive neurons were classified according to their responses, with activation (76.9%) and inhibition (23.1%) being the two identified types. In 90% of cases, neuron activation preceded movement. Of the responses, 53.8% were classified as tonic and 46.2% as phasic. Two thirds of inhibitory responses were advanced, occurring 0.2–0.3 seconds before movement onset. One third of neurons were activated after movement initiation with a delay of 0.05–0.2 seconds. 83.3% of the inhibitory neurons responded tonically, while the remaining 16.7% responded phasically. Notably, all phasic reactions occurred before the onset of movement. A comparison of the parameters of sensitive and non-sensitive neurons revealed several differences. The findings suggest a potential physiological distinction between the two neuron types. All three patterns of activity were present in both types of neurons, but sensitive neurons exhibited a wider representation of pause neurons (57.9% vs. 49.5%). Additionally, burst and pause neurons responded to movements that featured significantly lower variance of multiple activity parameters, such as firing rate, burst index, mean burst length, and oscillation scores in the 8–12 and 12–20 Hz range. The distribution of sensitive neurons along the electrode trajectory through the subthalamic nucleus was analyzed. Sensitive neurons were located significantly more dorsally compared to non-sensitive neurons, and no sensitive pause cells were observed in the ventral half of the STN. Based on our findings, it is presumed that the pause pattern plays a critical role in both motor control and its related disorders in Parkinson’s disease. A diverse range of neuronal responses suggests a high degree of heterogeneity among STN neurons implicated in motor control. The presence of both delayed and advanced neural responses suggests that STN involvement in motor control encompasses both the preparation and initiation of movement, as well as the regulation of ongoing movements via afferent feedback. The range of neural responses aligns with the dynamic model of basal ganglia, which suggests that STN can perform distinct functional roles during different stages of movement, including initiation, control, and completion.

Review of the targeting accuracy of frameless and frame-based robot-assisted deep brain stimulation electrode implantation in pediatric patients using the Neurolocate module.

The Neurolocate module is a 3D frameless patient registration module that is designed for use with the Neuromate stereotactic robot. Long-term electrical stimulation of the globus pallidus internus (GPi) and subthalamic nucleus (STN) via deep brain electrode implantation is particularly successful in a select group of movement disorders in pediatric patients. This study aimed to review the targeting accuracy of deep brain stimulation (DBS) electrode implantation in a single center, comparing standard frame-based techniques to the frameless Neurolocate module. Twenty-four pediatric patients underwent implantation of bilateral DBS electrodes under general anesthesia during the period of August 2018-August 2022. All patients underwent robot-assisted stereotactic implantation of DBS electrodes using an intraoperative O-arm 3D scanner to confirm the final electrode position. These coordinates were compared with the planned entry and target, with attention to depth, radial, directional, and absolute errors, in addition to Euclidean distance (ED). The primary outcome evaluated the accuracy and safety of the Neurolocate frameless technology compared with standard frame-based techniques. Of the 24 bilateral DBS electrode implantations performed, 62.5% used Neurolocate technology: 87.5% were delivered to the GPi and the remaining 12.5% to the STN. The mean patient age was 11.0 (range 4-18) years and 70.8% were male. The median absolute errors in x-, y-, and z-axes were 0.35, 0.75, and 0.9 mm, respectively, using the Neurolocate module compared with 0.30, 0.95, and 1.1 mm using the standard frame-based technique. The median ED from the planned target to the actual electrode position with the Neurolocate module was 1.28 mm versus 1.69 mm using standard frame-based techniques. No major perioperative complications occurred. Stereotactic robot-assisted DBS implantation with the frameless Neurolocate module is safe for use in the pediatric population, showing good surgical accuracy and no inferiority to standard frame-based techniques. The Neurolocate module for robotic DBS surgery has the potential to improve surgical targeting accuracy, surgical time, patient comfort, and safety.

Does Temporary Externalization of Electrodes After Deep Brain Stimulation Surgery Result in a Higher Risk of Infection?

ObjectivesDeep brain stimulation (DBS) is a well-established surgical therapy for movement disorders that comprises implantation of stimulation electrodes and a pacemaker. These procedures can be performed separately, leaving the possibility of externalizing the electrodes for local field potential recording or testing multiple targets for therapeutic efficacy. It is still debated whether the temporary externalization of DBS electrodes leads to an increased risk of infection. We therefore aimed to assess the risk of infection during and after lead externalization in DBS surgery. Materials and MethodsIn this retrospective study, we analyzed a consecutive series of 624 DBS surgeries, including 266 instances with temporary externalization of DBS electrodes for a mean of 6.1 days. Patients were available for follow-up of at least one year, except in 15 instances. In 14 patients with negative test stimulation, electrodes were removed. All kinds of infections related to implantation of the neurostimulation system were accounted for. ResultsOverall, infections occurred in 22 of 624 surgeries (3.5%). Without externalization of electrodes, infections were noted after 7 of 358 surgeries (2.0%), whereas with externalization, 15 of 252 infections were found (6.0%). This difference was significant (p = 0.01), but it did not reach statistical significance when comparing groups within different diagnoses. The rate of infection with externalized electrodes was highest in psychiatric disorders (9.1%), followed by Parkinson’s disease (7.3%), pain (5.7%), and dystonia (5.5%). The duration of the externalization of the DBS electrodes was comparable in patients who developed an infection (6.1 ± 3.1 days) with duration in those who did not (6.0 ± 3.5 days). ConclusionsAlthough infection rates were relatively low in our study, there was a slightly higher infection rate when DBS electrodes were externalized. On the basis of our results, the indication for electrode externalization should be carefully considered, and patients should be informed about the possibility of a higher infection risk when externalization of DBS electrodes is planned.

DYT1 dystonia: Neurophysiological properties of the pallidal activity

ObjectivesThe aim of this paper is to find the differences in the physiology of the pallidal neurons in DYT1 and non-DYT1 dystonia. MethodsWe performed microelectrode recording of the single unit activity in both segments of the globus pallidus during stereotactic implantation of electrodes for deep brain stimulation (DBS). ResultsWe found a reduced firing rate, reduced burst rate, and increased pause index in both pallidal segments in DYT1. Also, in DYT1 the activity in both pallidal segments was similar, but not so in non-DYT1. ConclusionThe results suggest a common pathological focus for both pallidal segments, located in the striatum. We also speculate that strong striatal influence on GPi and GPe overrides other input sources to the pallidal nuclei causing similarity in neuronal activity. SignificanceWe found significant differences in neuronal activity between DYT1 and non-DYT1 neurons. Our findings shed light on the pathophysiology of DYT-1 dystonia which can be very different from non-DYT1 dystonia and have other efficient treatment tactics.

Simultaneous Multisite Extracellular Electrophysiological Recordings During Electrical Stimulation in Anesthetized Rats.

Analyzing neuronal activities is essential to deciphering the function of neural circuits. In anesthetized rodents, simultaneous multisite recording of extracellular electrophysiological activity with defined electrical stimulation is a powerful tool to dissect reciprocal relationships between brain structures. Here, we present a protocol to simultaneously record from the subthalamic nucleus and substantia nigra pars reticulata while stimulating the pedunculopontine tegmental nucleus in anesthetized rats. This protocol describes the preparation of recording and stimulating electrodes, surgery setup, and detailed recording techniques. Basic post-recording data analysis methods are included as well. This protocol can be adapted to other brain areas of interest following the outlined procedures. © 2023 Wiley Periodicals LLC. Basic Protocol 1: Assembly of recording and stimulating electrodes Basic Protocol 2: Implantation of recording and stimulating electrodes in an anesthetized rat Basic Protocol 3: Simultaneous recording from the STN and SNr with PPTg stimulation Basic Protocol 4: Histological verification of recording sites Basic Protocol 5: Analysis of electrophysiological data.

Beta band oscillations in the motor thalamus are modulated by visuomotor coordination in essential tremor patients.

Beta oscillations in sensorimotor structures contribute to the planning, sequencing, and stopping of movements, functions that are typically associated with the role of the basal ganglia. The presence of beta oscillations (13-30 Hz) in the cerebellar zone of the thalamus (the ventral intermediate nucleus - Vim) indicates that this rhythm may also be involved in cerebellar functions such as motor learning and visuomotor adaptation. To investigate the possible role of Vim beta oscillations in visuomotor coordination, we recorded local field potential (LFP) and multiunit activity from the Vim of essential tremor (ET) patients during neurosurgery for the implantation of deep brain stimulation (DBS) electrodes. Using a computer, patients performed a visuomotor adaptation task that required coordinating center-out movements with incongruent visual feedback imposed by inversion of the computer display. The results show that, in ET, Vim beta oscillations of the LFP were lower during the incongruent center-out task than during the congruent orientation. Vim firing rates increased significantly during periods of low beta power, particularly on approach to the peripheral target. In contrast, beta power in the subthalamic nucleus of Parkinson's disease (PD) patients did not differ significantly between the incongruent and the congruent orientation of the center-out task. The findings support the hypothesis that beta oscillations of the Vim are modulated by novel visuomotor tasks. The inverse relationship between the power of Vim-LFP beta oscillations and Vim firing rates suggest that the suppression of beta oscillations may facilitate information throughput to the thalamocortical circuit by modulation of Vim firing rates.

Intracranial subsecond dopamine measurements during a "sure bet or gamble" decision-making task in patients with alcohol use disorder suggest diminished dopaminergic signals about relief.

To the authors' knowledge, no data have been reported on dopamine fluctuations on subsecond timescales in humans with alcohol use disorder (AUD). In this study, dopamine release was monitored in 2 patients with and 2 without a history of AUD during a "sure bet or gamble" (SBORG) decision-making task to begin to characterize how subsecond dopamine responses to counterfactual information, related to psychological notions of regret and relief, in AUD may be altered. Measurements of extracellular dopamine levels were made once every 100 msec using human voltammetric methods. Measurements were made in the caudate during deep brain stimulation electrode implantation surgeries (for treatment of movement disorders) in patients who did (AUD, n = 2) or did not (non-AUD, n = 2) have a history of AUD. Participants performed an SBORG decision-making task in which they made choices between sure bets and 50%-chance monetary gamble outcomes. Fast changes were found in dopamine levels that appear to be modulated by "what could have been" and by patients' AUD status. Positive counterfactual prediction errors (related to relief) differentiated patients with versus without a history of AUD. Dopaminergic encoding of counterfactual information appears to differ between patients with and without AUD. The current study has a major limitation of a limited sample size, but these data provide a rare insight into dopaminergic physiology during real-time decision-making in humans with an addiction disorder. The authors hope future work will expand the sample size and determine the generalizability of the current results.

Septum Pellucidum Cyst in Patient with Parkinson’s Disease-minimally Invasive Staged Therapy

Background: The aim of the case report is to present the minimally invasive staged treatment of a patient with motor complications of Parkinson’s disease with a large septum pellucidum cyst.&#x0D; Material and Method: A two-stage surgical strategy was proposed by the movement disorders team: neuroendoscopic cyst fenestration with subsequent implantation of deep brain stimulation electrodes (subthalamic nucleus) depending on the effect of neuroendoscopic treatment.&#x0D; Results: Despite the technical success of a neuroendoscopic cyst fenestration, as evidenced by a reduction in cyst volume, intraoperative ventriculocystography and postoperative CT showing free communication between the cyst and the ventricular system the motor symptoms caused by Parkinson’s disease remained unchanged. A bilateral subthalamic deep brain stimulation system was implanted with good functional results as documented by her UPRDS III score in the off-medication state (52 points preoperative and 34 point after 6 years postoperative) and reduction of L-DOPA equivalent dose (60% of the pre-deep brain stimulation level). &#x0D; Conclusion: Minimally invasive therapy-neuroendoscopic cyst fenestration, followed by a bilateral subthalamic stimulation implantation-led to the substantial and lasting improvement of the patient’s symptoms.&#x0D;

Alterations of resting-state networks of Parkinson‘s disease patients after subthalamic DBS surgery

The implantation of deep brain stimulation (DBS) electrodes in Parkinson’s disease (PD) patients can lead to a temporary improvement in motor symptoms, known as the stun effect. However, the network alterations induced by the stun effect are not well characterized. As therapeutic DBS is known to alter resting-state networks (RSN) and subsequent motor symptoms in patients with PD, we aimed to investigate whether the DBS-related stun effect also modulated RSNs.Therefore, we analyzed RSNs of 27 PD patients (8 females, 59.0 +- 8.7 years) using magnetoencephalography and compared them to RSNs of 24 age-matched healthy controls (8 females, 62.8 +- 5.1 years). We recorded 30 min of resting-state activity two days before and one day after implantation of the electrodes with and without dopaminergic medication. RSNs were determined by use of phase-amplitude coupling between a low frequency phase and a high gamma amplitude and examined for differences between conditions (i.e., pre vs post surgery).We identified four RSNs across all conditions: sensory-motor, visual, fronto-occipital, and frontal. Each RSN was altered due to electrode implantation. Importantly, these changes were not restricted to spatially close areas to the electrode trajectory.Interestingly, pre-operative RSNs corresponded better with healthy control RSNs regarding the spatial overlap, although the stun effect is associated with motor improvement.Our findings reveal that the stun effect induced by implantation of electrodes exerts brain wide changes in different functional RSNs.

Attenuation of neural responses in subthalamic nucleus during internally guided voluntary movements in Parkinson's disease.

The proposed models of segregated functional loops describe the organization of motor control over externally triggered (ET) and internally guided (IG) movements. The dopamine deficiency in Parkinson’s disease (PD) is considered to cause a disturbance in the functional loop regulating IG movements. At the same time, the neural mechanisms of movement performance and the role of basal ganglia in motor control remain unclear.The aim of this study was to compare neuronal responses in the subthalamic nucleus (STN) during ET and IG movements in PD. We found and analyzed 26 sensitive neurons in 12 PD patients who underwent surgery for implantation of electrodes for deep brain stimulation. We also analyzed the local field potentials (LFP) of the STN of six patients during the postoperative period. Patients were asked to perform voluntary movements (clenching and unclenching the fist) evoked by verbal command (ET) or self-initiated (IG). We showed heterogeneity of neuronal responses and did not find sensitive neurons associated with only one type of movement. Most cells were characterized by leading responses, indicating that the STN has an important role in movement initiation. At the same time, we found attenuation of motor responses during IG movement vs. stable responses during ET movements. LFP analysis also showed attenuation of beta desynchronization during multiple IG movements.We propose that stable neuronal response to ET movements is associated with the reboot of the motor program for each movement, while attenuation of responses to IG movement is associated with single motor program launching for multiple movements.

Dexmedetomidine depresses neuronal activity in the subthalamic nucleus during deep brain stimulation electrode implantation surgery.

Micro-electrode recordings are often necessary during electrode implantation for deep brain stimulation of the subthalamic nucleus. Dexmedetomidine may be a useful sedative for these procedures, but there is limited information regarding its effect on neural activity in the subthalamic nucleus and on micro-electrode recording quality. We recorded neural activity in five patients undergoing deep brain stimulation implantation to the subthalamic nucleus. Activity was recorded after subthalamic nucleus identification while patients received dexmedetomidine sedation (loading - 1 μg kg-1 over 10-15 min, maintenance - 0.7 μg kg-1 h-1). We compared the root-mean square (RMS) and beta band (13-30 Hz) oscillation power of multi-unit activity recorded by microelectrode before, during and after recovery from dexmedetomidine sedation. RMS was normalised to values recorded in the white matter. Multi-unit activity decreased during sedation in all five patients. Mean normalised RMS decreased from 2.8 (1.5) to 1.6 (1.1) during sedation (43% drop, p = 0.056). Beta band power dropped by 48.4%, but this was not significant (p = 0.15). Normalised RMS values failed to return to baseline levels during the time allocated for the study (30 min). In this small sample, we demonstrate that dexmedetomidine decreases neuronal firing in the subthalamic nucleus as expressed in the RMS of the multi-unit activity. As multi-unit activity is a factor in determining the subthalamic nucleus borders during micro-electrode recordings, dexmedetomidine should be used with caution for sedation during these procedures. NCT01721460.

Targeting the Future: Developing a Training Curriculum for Robotic Assisted Neurosurgery

Technological advances have significantly fostered the use of robotics in neurosurgery. Due to their novelty, there is a need to develop training methods within neurosurgical residency programs that provide trainees the skills to utilize these systems in their future practices safely and effectively. We describe a detailed curriculum for trainees with significant responsibilities in the operating room, as well as hands-on and theoretical didactics. The curriculum for robot-assisted stereotactic electroencephalography (SEEG) and deep brain stimulation (DBS) electrode implantation technique and assessment tool has been designed based on Accreditation Council for Graduate Medical Education's (ACGME's) milestone requirement for surgical treatment of epilepsy and movement disorders. Residents were surveyed to assess their use of robotics in their surgical training. Since 2019, more than 100 patients have undergone robot-assisted SEEG and DBS depth electrode implantations at our institution. Residents and fellows were involved in all aspects of surgical planning and execution and were encouraged to take an active role during procedures. Didactic sessions led by experienced faculty are emphasized as important learning tools prior to hands-on experience in the operating room. The results of the survey show that residents receive more training intraoperatively as compared to training sessions, yet trainees would benefit from more instruction on informative cadaveric simulation sessions. Our curriculum was developed to become a structured tool for assessment of robotic education in neurosurgical training. This curriculum based on ACGME milestone requirements serve as a template for resident and fellow education in robotics in neurosurgery.

MRI-guided DBS of STN under general anesthesia for Parkinson's disease: results and microlesion effect analysis.

The efficacy of the subthalamic nucleus (STN) stimulation for Parkinson's disease has been widely established. The microlesion effect (MLE) due to deep brain stimulation (DBS) electrode implantation has been reputed to be a good predictor for long-term efficacy of the procedure but its analysis in asleep implantation is still unclear. We thus analyzed MLE rate in our strategy of targeting the STN on MRI under general anesthesia and its correlation with our long-term results. We retrospectively analyzed 32 consecutive parkinsonian patients implanted with a DBS targeting the STN bilaterally under general anesthesia between October 2013 and December 2020. Targeting was performed after head frame and localizer placement using a stereotactic peroperative robotic 3D fluoroscopy (Artis Zeego, Siemens) fused with preoperative CT and MRI data. We collected intraoperative data, postoperative occurrence of MLE, modification of Unified Parkinson Disease Rating Scale item III (UPDRS III) postoperatively and at subsequent visit, as well as reduction of medication. The mean operative time was 223min. No permanent complication occurred. MLE was observed in 90.7%. The mean follow-up time was 17months. The UPDRS III for the off medication/on stimulation condition improved by 64.8% from baseline. The mean dose reduction of Prolopa after the surgical procedure was 31.3%. Direct targeting of STN under general anesthesia based on preoperative CT and MRI data fused with a preoperative 3D fluoroscopy is safe. It allows for a high rate of postoperative MLE (90.7%) and results in prolonged clinical improvement.