作者没有确认。

伦理声明:我们的协议，遵循我们的机构人类研究伦理委员会制定的准则。 1.药物难治性癫痫患者的识别<ol><li>此前创监测，评估在1描述的多学科会议讨论决定是否要继续与SEEG创监测必须经过allpatientswith非侵入性技术，如视频脑电图监测，MRI，PET，ictalSPECT，以及神经心理学研究制作。1,6,7,11,14 </li><li>形成有关的EZ的位置的假设。之前介入开发推定EZincorporating的发病发作区和癫痫（发作）的早期（ 即快速）传播的地区活动的植入前假说。 注:此步骤可与在作出决定追求微创montitoring多学科会议共同完成。 注意:SEEG VS的EZ假设硬膜下网格为基础，SEEG和硬膜下电网监控之间做出选择。标准要考虑可能包括:1）可能的深层次EZ; 2）以前不成功的硬膜下网格监控; 3）双边监督的迹象; 4）非皮损外颞叶癫痫之嫌。还应当指出，在硬膜网格SEEG的额外的好处，包括SEEG的记录和当有力地区域被假设是在EZ邻近刺激临界皮质下区域的能力。 </li><li>开发基于虚拟EZ（ 图1）量身定制的植入策略。1,7,8 注:足够的植入策略必须评估1）解剖病变（如果存在）; 2）结构（多个）最有可能参与inictal发病;和/或3）发作传播的可能途径（S）的功能性网络内。除了解剖考虑，后勤方面的考虑也必须加以考虑。对于由于这个原因，正交轨迹是在一般的优惠，以促进植入和，以后，电极的位置的解释。 </li><li>开发基于虚拟EZ注入策略之后，创建一个使用机器人辅助的计划。首先，创建一个新的相遇，选择"新病人"，然后点击"创建轨迹"，然后选择合适的"切入点"和"终点"，这与期望轨迹一致。 注:根据植入前假说，电极的数量通常之间的八个十二名。轨迹和兴趣点正在使用对比MRI或旋转血管造影典型的计划。这不仅显示脑部问题，但脑血管这些图像允许在无血管走廊轨迹计划，以避免血管损伤，出血。 </li></ol> 2.手术过程<ol><li>苏的前一天rgery，获得14对比，体积T1加权MRI由Kuzniecky 等人所描述的序列。 注:此图片是用于与机器人辅助登记，并且必须有1个mm层厚。然后将图像传送到立体定向神经导航软件，其中轨迹是基于前面讨论注入策略计划作为由Kuzniecky 等人所述。14 </li><li>一旦在手术室，放在手术台上的患者在仰卧位。然后获取气管插管全身麻醉根据麻醉师"协议。 注:当务之急是，他们是普通静脉麻醉和完整的药物麻痹下。然后剃病人头部，与抗生素外科应用预习皮肤，然后将病人的头部在头部神经外科头支架。全身麻醉不同于患者与患者。 </li><li>完成后，定位用的机器人系统连接至框架并完成注册。在机器人辅助设备选择"注册"，然后按照提示完成注册过程。根据面部特征或植入基准标记完成注册使用面的标志性注册。 </li><li>插入（ 图2） <ol><li>使用2.5毫米的钻头从机器人立体定向系统深入的指导协助头骨。将单极电凝探头打开硬脑膜。螺钉植入螺栓插入颅骨，也是由机器人立体定向系统的指导。 </li><li>计算使用下面的测量电极（D3）的最终深度距离:[（目标-杜拉距离）+（D1 - D2）= D3]。使用导航系统测量目标-硬脑膜距离。 注:D1被测量为引导系统到硬脑膜的长度，D2被测量为所述引导系统的长度，以在螺栓的端。的D 1 - D 2不同的是将螺栓的长度。螺栓和靶 - 硬脑膜距离的长度的总和是电极深度的长度。 </li><li>通过插入stylette探针，通过植入螺栓引导创建初始轨迹。然后插入电极并固定到螺栓。这可以防止进一步的位移和脑脊液（CSF）泄漏。 </li><li>放置并连接所有电极后，将绕螺栓帽碘溶液浸泡的纱布。而且，当时包住头部。 </li></ol></li></ol> 3.监测/记录<ol><li>整理的情况之前，将电极连接到脑电图记录机，以保证正常运行。在手术室中的最后一步是术中成像（ 图3）。执行术的X射线或荧光成像在横向和前后头骨。 注:获得这些以确保电极的适当轨迹。这些图像是不是obtained，来确保立体定向安置，而它们确保电极的一般正确轨迹和位置。 </li><li>手术后，转移患者癫痫监测单位监测癫痫发作临床和通过SEEG电极记录electrographically病人。 注:住宿天数不同，这取决于数量，质量和发作期和录音的发作模式。虽然监控患者可有轻微的疼痛，治疗这种对乙酰氨基酚。通常情况下，停留时间的长短是7天（范围为3 - 28天）。 </li><li>去除电极之前，讨论多学科会议关于患者审查录音和假设。 </li><li>记录足够的发作数据之后（步骤3.2）和病人在发布会上进行了讨论，同时等待或去除电极重启患者事先抗癫痫药物。 </li></ol> 4.返回或准备卸下<ol><li>房颤之三足记录数据的发作，病人返回手术室切除SEEG电极。在清醒镇静执行此;通常为2毫克咪达唑仑IV是足够了。 </li><li>麻醉获得足够的镇静后（通常与咪达唑仑[剂量推迟到麻醉师]），去除患者裹头，并切断电极线。通过电极去除或缝线插入报道的疼痛程度临床监测病人的镇静作用。然后预习使用碘化凝胶电极的其余螺栓和尾巴。 </li><li>个别地，通过扭曲其关闭除去每个螺栓帽，其次是电极，最后取出的螺栓。轻轻拉出来沿其插入轴取出电极。然后通过扭动它拆卸螺栓，通常这样做用手指。 </li><li>上移动到下一个电极之前，关闭由螺栓离开缺陷用尼龙缝合线中的一个线圈。重复这些步骤为每个电极。 REM后oving所有电极，覆盖抗生素软膏和一个松散的裹头针脚领域。 </li><li>取出后，获得进一步的成像CT或A / P和侧位X光片，以确保无残留的硬件。 注意:可能切除-如果手术切除被认为是有利于患者的癫痫然后要开颅和切除除去后大致6周计划。该延迟是由于相同的住院作为监视时段期间操作的传染性的担忧。 </li></ol>

<ol>
	<li>Serletis, D., Bulacio, J., Bingaman, W., Gonzalez-Martinez, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+stereotactic+approach+for+mapping+epileptic+networks:+a+prospective+study+of+200+patients.">The stereotactic approach for mapping epileptic networks: a prospective study of 200 patients.</a> J Neurosurg. 121, 1239-1246 (2014).</li><li>Bancaud, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Epilepsy+after+60+years+of+age.+Experience+in+a+functional+neurosurgical+department.">Epilepsy after 60 years of age. Experience in a functional neurosurgical department.</a> Sem Hop. 46, 3138-3140 (1970).</li><li>Bancaud, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Functional+stereotaxic+exploration+(SEEG)+of+epilepsy.">Functional stereotaxic exploration (SEEG) of epilepsy.</a> Electroencephalogr Clin Neurophysiol. 28, 85-86 (1970).</li><li>Talairach, J., Bancaud, J., Bonis, A., Szikla, G., Trottier, S., Vignal, J. P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Surgical+therapy+for+frontal+epilepsies.">Surgical therapy for frontal epilepsies.</a> Adv Neurol. 57, 707-732 (1992).</li><li>Vadera, S., Mullin, J., Bulacio, J., Najm, I., Bingaman, W., Gonzalez-Martinez, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stereo+electroencephalography+following+subdural+grid+placement+for+difficult+to+localize+epilepsy.">Stereo electroencephalography following subdural grid placement for difficult to localize epilepsy.</a> Neurosurgery. 72, 723-729 (2013).</li><li>Munari, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stereo-electroencephalography+methodology:+advantages+and+limits.">Stereo-electroencephalography methodology: advantages and limits.</a> Acta Neurol Scand Suppl. 152, 56-69 (1994).</li><li>Gonzalez-Martinez, J., Bulacio, J., Alexopoulos, A., Jehi, L., Bingaman, W., Najm, I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stereoelectroencephalography+in+the+"difficult+to+localize"+refractory+focal+epilepsy+early+experience+from+a+North+American+epilepsy+center.">Stereoelectroencephalography in the "difficult to localize" refractory focal epilepsy early experience from a North American epilepsy center.</a> Epilepsia. 54, 323-330 (2013).</li><li>Gonzalez-Martinez, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stereotactic+placement+of+depth+electrodes+in+medically+intractable+epilepsy.+Technicalnote.">Stereotactic placement of depth electrodes in medically intractable epilepsy. Technicalnote.</a> J Neurosurg. 120, 639-664 (2014).</li><li>Nathoo, N., Lu, M. C., Vogelbaum, M., Barnett, G. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=In+Touch+with+Robotics:+Neurosurgery+for+the+Future.">In Touch with Robotics: Neurosurgery for the Future.</a> Neurosurgery. 56, 421-433 (2005).</li><li>De Almeida, A. N., Olivier, A., Quesney, F., Dubeau, F., Savard, G., Andermann, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+of+and+morbidity+associated+with+stereoelectroencephalography+using+computerized+tomography-or+magnetic+resonance+imaging-guided+electrode+implantation.">Efficacy of and morbidity associated with stereoelectroencephalography using computerized tomography-or magnetic resonance imaging-guided electrode implantation.</a> J Neurosurg. 104, 483-487 (2006).</li><li>Cossu, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stereoelectroencephalography+in+the+presurgical+evaluation+of+focal+epilepsy+a+retrospective+analysis+of+215+procedures.">Stereoelectroencephalography in the presurgical evaluation of focal epilepsy a retrospective analysis of 215 procedures.</a> Neurosurgery. 57, 706-718 (2005).</li><li>Gonzalez-Martinez, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Robot-assisted+stereotactic+laser+ablation+in+medically+intractable+epilepsy:+operative+technique.">Robot-assisted stereotactic laser ablation in medically intractable epilepsy: operative technique.</a> Neurosurgery. 10, 167-172 (2014).</li><li>Guenot, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Neurophysiological+monitoring+for+epilepsy+surgery:+the+Talairach+SEEG+method.+Indications,+results,+complications+and+therapeutic+applications+in+a+series+of+100+consecutive+cases.">Neurophysiological monitoring for epilepsy surgery: the Talairach SEEG method. Indications, results, complications and therapeutic applications in a series of 100 consecutive cases.</a> Stereotact Funct Neurosurg. 77, 29-32 (2001).</li><li>Kuzniecky, R. I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Multimodality+MRI+in+mesial+temporal+sclerosis:+relative+sensitivity+and+specificity.">Multimodality MRI in mesial temporal sclerosis: relative sensitivity and specificity.</a> Neurology. 49 (3), 774-778 (1997).</li><li>Cardinale, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Stereoelectroencephalography:+surgical+methodology,+safety,+and+stereotacticapplication+accuracy+in+500+procedures.">Stereoelectroencephalography: surgical methodology, safety, and stereotacticapplication accuracy in 500 procedures.</a> Neurosurgery. 72 (3), 353-366 (2013).</li></ol>

作者什么都没有透露。

在这里，提出利用机器人立体定向援助SEEG插入技术。同时采用基于帧的立体定位等方法最初描述SEEG，机器人辅助SEEG不仅提供类似的安全性，更高的精度和效率。在个案当中，超过76％，这与使用替代技术。6,13其他以往的研究同情本地化EZ文献报道的成功。 正如任何侵​​入颅内程序，SEEG并非没有风险。幸运的是，SEEG插入报道非常低的并发症的危险。15</...

In medically refractory epilepsy there are many non-invasive pre-surgical tools (scalp EEG., magnetic resonance imaging (MRI), functional MRI, single photon emission computed tomography, positron emission topography, and magnetoencephalography). If these non-invasive evaluations fail to sufficiently localize or define the epileptic zone (EZ) then invasive recording may be indicated. Currently, subdural grids or Stereo-electro-encephalo-graphy (SEEG) are the two most prevalent methods of invasive monitoring. SEEG was originally developed in France in the 1950's by Jean Talairach and Jean Bancaud; recently it has mostly been used for invasive monitoring of refractory epilepsy patients in France.2-4 SEEG is the consists of stereotactically inserting intracerebral electrodes into the brain parenchyma to record brain electrical activity for an extended period of time. With the intracerebral electrical recordings many patients are able to have their EZ defined to allow for surgical resection. 
Despite this long history of success SEEG remains relatively rarely used for invasive recording in America. However, SEEG does offer several significant advantages; SEEG allows for 1) recording of deep structures, 2) bihemispheric recordings, 3) another recording option if subdural grids failed, and 4) mapping of epileptic networks in three dimensions, mainly in patients where non-lesional extra-temporal epilepsy is suspected.5-7 All of these benefits are achieved without requiring a large craniotomy. A recent technologic advance in SEEG surgery is the used of robotic guidance. This sophisticated development allows for improved operative times but safer and more accurate surgical implantation of electrodes.Recently published literature reviews the results of using two different techniques for SEEG insertion; a more traditional method utilizing stereotactic frames and a newer technique using robotic assistante for SEEG insertion.1, 8,15 the results were similarly successful with each method. 
With the advent of improved robotic assistance, the SEEG insertion technique has resulted in improved operative times. The robotic system is classified as a supervisory controlled system which means the surgeon plans the operation off line and implicitly specifies the motion the robot must follow to perform the operation.9 The robotic assist results in expedient transitions from one trajectory to the next for the placement of each intracranial electrode.

<table><tbody><tr><td>ROSA</td><td>ROSA</td><td></td><td>robotic implantation system</td></tr><tr><td>electrodes</td><td>adtech</td><td></td><td></td></tr></tbody></table>

stereo-electro-encephalo-graphy (seeg) with robotic assistance in the presurgical evaluation of medical refractory epilepsy: a technical note

SEEG是通过三维录音用于癫痫发作的准确，微创记录的方法和技术。在谁是认为合适的候选人有创记录癫痫病人，监察决定硬膜下格栅与SEEG之间进行。癫痫神经监测侵入患者复杂，难治性癫痫的追求。中创监测的目标是提供切除手术以使癫痫发作自由的希望。 SEEG的优势，包括进入深皮质结构，本地化的致痫区（EZ）时，硬膜下网格都未能做到这一点，并在患者的非皮损额外的时空性癫痫的能力。在这个手稿中，我们提出了SEEG的简要历史回顾和我们的下机器人立体定向无框体验报告。 SEEG插入当务之急步骤规划电极轨迹。为了最有效地记录通过SEEG轨迹发作活动应该基于对那里的癫痫发作起源推测的致痫灶（EZ）假设规划。在EZ假说是基于一个标准的术前后处理包括视频脑电图监测，MRI（磁共振成像），PET（正电子发射断层摄影术），发作SPECT（单光子发射计算机断层扫描），和神经心理学评估。使用EZ嫌疑，SEEG电极可以放在最小侵入性的同时保持准确度和精密度。临床结果表明本地化EZ在难以定位癫痫患者78％的能力。1

最近的研究结果表明，在一个连续的一系列78例谁通过机器人辅助进行SEEG插入有EZ成功的本土化患者76.2％。1这同一项研究显示，谁去拥有EZ手术切除有1级的患者患者67.8％恩格尔扣押自由（ 图4）。发病率是2.5％。永久的发病率被注意到的是1例（1.2％）。每电极，它显示出具有为0.08％的伤口感染和颅内血肿率，每个。 <p class="jove_content" fo:keep-together...

Watch this Scientific Journal Video about Stereo-Electro-Encephalo-Graphy SEEG With Robotic Assistance in the Presurgical Evaluation of Medical Refractory Epilepsy: A Technical Note at JoVE.com

Stereo-Electro-Encephalo-Graphy SEEG With Robotic Assistance in the Presurgical Evaluation of Medical Refractory Epilepsy: A Technical Note

Stereo-electroencephalography (SEEG) aids in localization of epileptogenic zones, however, remains relatively underutilized in the United States. The goal of this abstract is to provide a brief introduction to the technique of SEEG and further a detailed technique of using robotic assistance in the placement of SEEG electrodes.

立体声电Encephalo-造影（SEEG）随着医学难治性癫痫的术前评估机器人辅助:技术说明

SEEG is a method and technique which is used for accurate, invasive recording of seizure activity via three dimensional recordings. In epilepsy patients ...

stereo-electro-encephalo-graphy-seeg-with-robotic-assistance

Universidad de Cartagena UDEC

Research

JoVE Journal

Medicine

Stereo-Electro-Encephalo-Graphy (SEEG) With Robotic Assistance in the Presurgical Evaluation of Medical Refractory Epilepsy: A Technical Note

17.1K 次观看.  Cleveland Clinic. Stereo-electroencephalography (SEEG) aids in localization of epileptogenic zones, however, remains relatively underutilized in the United States. The goal of this abstract is to provide a brief introduction to the technique of SEEG and further a detailed technique of using robotic assistance in the placement of SEEG electrodes. 

视频: Stereo-Electro-Encephalo-Graphy SEEG With Robotic Assistance in the Presurgical Evaluation of Medical Refractory Epilepsy: A Technical Note

Performing Behavioral Tasks in Subjects with Intracranial Electrodes

Patients having stereo-electroencephalography (SEEG) electrode, subdural grid or depth electrode implants have a multitude of electrodes implanted in different areas of their brain for the localization of their seizure focus and eloquent areas. After implantation, the patient must remain in the hospital until the pathological area of brain is found and possibly resected. During this time, these patients offer a unique opportunity to the research community because any number of behavioral paradigms can be performed to uncover the neural correlates that guide behavior. Here we present a method for recording brain activity from intracranial implants as subjects perform a behavioral task designed to assess decision-making and reward encoding. All electrophysiological data from the intracranial electrodes are recorded during the behavioral task, allowing for the examination of the many brain areas involved in a single function at time scales relevant to behavior. Moreover, and unlike animal studies, human patients can learn a wide variety of behavioral tasks quickly, allowing for the ability to perform more than one task in the same subject or for performing controls. Despite the many advantages of this technique for understanding human brain function, there are also methodological limitations that we discuss, including environmental factors, analgesic effects, time constraints and recordings from diseased tissue. This method may be easily implemented by any institution that performs intracranial assessments; providing the opportunity to directly examine human brain function during behavior.

Patients implanted with intracranial electrodes provide a unique opportunity to record neurological data from multiple areas of the brain while the patient performs behavioral tasks. Here, we present a method of recording from implanted patients that can be reproducible at other institutions with access to this patient population.

执行任务的行为与颅内电极主题

Patients having stereo-electroencephalography (SEEG) electrode, subdural grid or depth electrode implants have a multitude of electrodes implanted in ...

科研

行为学

Technical Aspects of the Mouse Aortocaval Fistula

Technical aspects of creating an arteriovenous fistula in the mouse are discussed. Under general anesthesia, an abdominal incision is made, and the aorta and inferior vena cava (IVC) are exposed. The proximal infrarenal aorta and the distal aorta are dissected for clamp placement and needle puncture, respectively. Special attention is paid to avoid dissection between the aorta and the IVC. After clamping the aorta, a 25 G needle is used to puncture both walls of the aorta into the IVC. The surrounding connective tissue is used for hemostatic compression. Successful creation of the AVF will show pulsatile arterial blood flow in the IVC. Further confirmation of successful AVF can be achieved by post-operative Doppler ultrasound.

The goal is to produce an arteriovenous fistula that is simple and reproducible. This method does not use sutures or glue adhesive. Therefore the samples can be used with the least amount of foreign materials for analysis.

在的鼠标Aortocaval瘘的技术方面

Technical aspects of creating an arteriovenous fistula in the mouse are discussed. Under general anesthesia, an abdominal incision is made, and the aorta ...

医学

Operative Technique and Nuances for the Stereoelectroencephalographic (SEEG) Methodology Utilizing a Robotic Stereotactic Guidance System

The SEEG methodology has gained favor in North America over the last decade as a means of localizing the epileptogenic zone (EZ) prior to epilepsy surgery. Recently, the application of a robotic stereotactic guidance system for implantation of SEEG electrodes has become more popular in many epilepsy centers. The technique for the use of the robot requires extreme precision in the pre-surgical planning phase and then the technique is streamlined during the operative portion of the methodology, as the robot and surgeon work in concert to implant the electrodes. Herein is detailed precise operative methodology of using the robot to guide implantation of SEEG electrodes. A major limitation of the procedure, namely its heavy reliance on the ability to register the patient to a preoperative volumetric magnetic resonance image (MRI), is also discussed. Overall, this procedure has been shown to have a low morbidity rate and an extremely low mortality rate. The use of a robotic stereotactic guidance system for the implantation of SEEG electrodes is an efficient, fast, safe, and accurate alternative to conventional manual implantation strategies.

Operative Technique and Nuances for the Stereoelectroencephalographic SEEG Methodology Utilizing a Robotic Stereotactic Guidance System

The SEEG methodology is simplified and made faster with a stereotactic robot. Careful attention must be paid to the registration of the preoperative volumetric MRI to the patient prior to use of the robot in the OR. The robot streamlines the procedure, leading to decreased operative times and accurate implantations.

利用机器人立体定向引导系统的立体脑电图（SEEG）方法的操作技术和细微差别

The SEEG methodology has gained favor in North America over the last decade as a means of localizing the epileptogenic zone (EZ) prior to epilepsy ...

Investigating the Function of Deep Cortical and Subcortical Structures Using Stereotactic Electroencephalography: Lessons from the Anterior Cingulate Cortex

Stereotactic Electroencephalography (SEEG) is a technique used to localize seizure foci in patients with medically intractable epilepsy. This procedure involves the chronic placement of multiple depth electrodes into regions of the brain typically inaccessible via subdural grid electrode placement. SEEG thus provides a unique opportunity to investigate brain function. In this paper we demonstrate how SEEG can be used to investigate the role of the dorsal anterior cingulate cortex (dACC) in cognitive control. We include a description of the SEEG procedure, demonstrating the surgical placement of the electrodes. We describe the components and process required to record local field potential (LFP) data from consenting subjects while they are engaged in a behavioral task. In the example provided, subjects play a cognitive interference task, and we demonstrate how signals are recorded and analyzed from electrodes in the dorsal anterior cingulate cortex, an area intimately involved in decision-making. We conclude with further suggestions of ways in which this method can be used for investigating human cognitive processes.

Stereotactic Electroencephalography (SEEG) is an operative technique used in epilepsy surgery to help localize seizure foci. It also affords a unique opportunity to investigate brain function. Here we describe how SEEG can be used to investigate cognitive processes in human subjects.

调查深皮层的功​​能和皮层下结构采用立体定向脑电图:由前扣带皮层的经验教训

Stereotactic Electroencephalography (SEEG) is a technique used to localize seizure foci in patients with medically intractable epilepsy. This procedure ...

神经科学

Brain Source Imaging in Preclinical Rat Models of Focal Epilepsy using High-Resolution EEG Recordings

Electroencephalogram (EEG) has been traditionally used to determine which brain regions are the most likely candidates for resection in patients with focal epilepsy. This methodology relies on the assumption that seizures originate from the same regions of the brain from which interictal epileptiform discharges (IEDs) emerge. Preclinical models are very useful to find correlates between IED locations and the actual regions underlying seizure initiation in focal epilepsy. Rats have been commonly used in preclinical studies of epilepsy1; hence, there exist a large variety of models for focal epilepsy in this particular species. However, it is challenging to record multichannel EEG and to perform brain source imaging in such a small animal. To overcome this issue, we combine a patented-technology to obtain 32-channel EEG recordings from rodents2 and an MRI probabilistic atlas for brain anatomical structures in Wistar rats to perform brain source imaging. In this video, we introduce the procedures to acquire multichannel EEG from Wistar rats with focal cortical dysplasia, and describe the steps both to define the volume conductor model from the MRI atlas and to uniquely determine the IEDs. Finally, we validate the whole methodology by obtaining brain source images of IEDs and compare them with those obtained at different time frames during the seizure onset.

This video introduces the preparation, recording, and source analysis procedures of high-resolution EEG on sedated rats with a particular preclinical model of focal epilepsy under noninvasive conditions.

采用高分辨率脑电图记录脑源成像局灶性癫痫的临床前模型大鼠

Electroencephalogram (EEG) has been traditionally used to determine which brain regions are the most likely candidates for resection in patients with ...

A Pipeline for 3D Multimodality Image Integration and Computer-assisted Planning in Epilepsy Surgery

Epilepsy surgery is challenging and the use of 3D multimodality image integration (3DMMI) to aid presurgical planning is well-established. Multimodality image integration can be technically demanding, and is underutilised in clinical practice. We have developed a single software platform for image integration, 3D visualization and surgical planning. Here, our pipeline is described in step-by-step fashion, starting with image acquisition, proceeding through image co-registration, manual segmentation, brain and vessel extraction, 3D visualization and manual planning of stereoEEG (SEEG) implantations. With dissemination of the software this pipeline can be reproduced in other centres, allowing other groups to benefit from 3DMMI. We also describe the use of an automated, multi-trajectory planner to generate stereoEEG implantation plans. Preliminary studies suggest this is a rapid, safe and efficacious adjunct for planning SEEG implantations. Finally, a simple solution for the export of plans and models to commercial neuronavigation systems for implementation of plans in the operating theater is described. This software is a valuable tool that can support clinical decision making throughout the epilepsy surgery pathway.

We describe the steps to use our custom designed software for image integration, visualization and planning in epilepsy surgery.

管道在癫痫手术3D多模图像集成和计算机辅助规划

Epilepsy surgery is challenging and the use of 3D multimodality image integration (3DMMI) to aid presurgical planning is well-established. Multimodality ...

A Multimodal Imaging- and Stimulation-based Method of Evaluating Connectivity-related Brain Excitability in Patients with Epilepsy

Resting-state functional connectivity MRI (rs-fcMRI) is a technique that identifies connectivity between different brain regions based on correlations over time in the blood-oxygenation level dependent signal. rs-fcMRI has been applied extensively to identify abnormalities in brain connectivity in different neurologic and psychiatric diseases. However, the relationship among rs-fcMRI connectivity abnormalities, brain electrophysiology and disease state is unknown, in part because the causal significance of alterations in functional connectivity in disease pathophysiology has not been established. Transcranial Magnetic Stimulation (TMS) is a technique that uses electromagnetic induction to noninvasively produce focal changes in cortical activity. When combined with electroencephalography (EEG), TMS can be used to assess the brain's response to external perturbations. Here we provide a protocol for combining rs-fcMRI, TMS and EEG to assess the physiologic significance of alterations in functional connectivity in patients with neuropsychiatric disease. We provide representative results from a previously published study in which rs-fcMRI was used to identify regions with abnormal connectivity in patients with epilepsy due to a malformation of cortical development, periventricular nodular heterotopia (PNH). Stimulation in patients with epilepsy resulted in abnormal TMS-evoked EEG activity relative to stimulation of the same sites in matched healthy control patients, with an abnormal increase in the late component of the TMS-evoked potential, consistent with cortical hyperexcitability. This abnormality was specific to regions with abnormal resting-state functional connectivity. Electrical source analysis in a subject with previously recorded seizures demonstrated that the origin of the abnormal TMS-evoked activity co-localized with the seizure-onset zone, suggesting the presence of an epileptogenic circuit. These results demonstrate how rs-fcMRI, TMS and EEG can be utilized together to identify and understand the physiological significance of abnormal brain connectivity in human diseases.

Resting-state functional-connectivity MRI has identified abnormalities in patients with a wide range of neuropsychiatric disorders, including epilepsy due to malformations of cortical development. Transcranial Magnetic Stimulation in combination with EEG can demonstrate that patients with epilepsy have cortical hyperexcitability in regions with abnormal connectivity.

评价中的连接有关的大脑兴奋患者癫痫多式联运Imaging-和激励为基础的方法

Resting-state functional connectivity MRI (rs-fcMRI) is a technique that identifies connectivity between different brain regions based on correlations ...

Network Analysis of Foramen Ovale Electrode Recordings in Drug-resistant Temporal Lobe Epilepsy Patients

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control seizures. However, a significant minority of patients continues to exhibit post-operative seizures, even in those cases in which the suspected source of seizures has been correctly localized and resected. The protocol presented here combines a clinical procedure routinely employed during the pre-operative evaluation of temporal lobe epilepsy (TLE) patients with a novel technique for network analysis. The method allows for the evaluation of the temporal evolution of mesial network parameters. The bilateral insertion of foramen ovale electrodes (FOE) into the ambient cistern simultaneously records electrocortical activity at several mesial areas in the temporal lobe. Furthermore, network methodology applied to the recorded time series tracks the temporal evolution of the mesial networks both interictally and during the seizures. In this way, the presented protocol offers a unique way to visualize and quantify measures that considers the relationships between several mesial areas instead of a single area.

This protocol describes a procedure to track the evolution of mesial network measures in temporal lobe epilepsy (TLE) patients. It is based on the combination of intracranial recordings with a novel numerical technique for data analysis. Specifically, we present a protocol for network analyses of foramen ovale recordings.

在耐药性颞叶癫痫患者卵圆孔电极记录的网络分析

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control ...

Interictal High Frequency Oscillations Detected with Simultaneous Magnetoencephalography and Electroencephalography as Biomarker of Pediatric Epilepsy

Crucial to the success of epilepsy surgery is the availability of a robust biomarker that identifies the Epileptogenic Zone (EZ). High Frequency Oscillations (HFOs) have emerged as potential presurgical biomarkers for the identification of the EZ in addition to Interictal Epileptiform Discharges (IEDs) and ictal activity. Although they are promising to localize the EZ, they are not yet suited for the diagnosis or monitoring of epilepsy in clinical practice. Primary barriers remain: the lack of a formal and global definition for HFOs; the consequent heterogeneity of methodological approaches used for their study; and the practical difficulties to detect and localize them noninvasively from scalp recordings. Here, we present a methodology for the recording, detection, and localization of interictal HFOs from pediatric patients with refractory epilepsy. We report representative data of HFOs detected noninvasively from interictal scalp EEG and MEG from two children undergoing surgery.
The underlying generators of HFOs were localized by solving the inverse problem and their localization was compared to the Seizure Onset Zone (SOZ) as this was defined by the epileptologists. For both patients, Interictal Epileptogenic Discharges (IEDs) and HFOs were localized with source imaging at concordant locations. For one patient, intracranial EEG (iEEG) data were also available. For this patient, we found that the HFOs localization was concordant between noninvasive and invasive methods. The comparison of iEEG with the results from scalp recordings served to validate these findings. To our best knowledge, this is the first study that presents the source localization of scalp HFOs from simultaneous EEG and MEG recordings comparing the results with invasive recordings. These findings suggest that HFOs can be reliably detected and localized noninvasively with scalp EEG and MEG. We conclude that the noninvasive localization of interictal HFOs could significantly improve the presurgical evaluation for pediatric patients with epilepsy.

High Frequency Oscillations (HFOs) have emerged as presurgical biomarkers for the identification of the epileptogenic zone in pediatric patients with medically refractory epilepsy. A methodology for the noninvasive recording, detection, and localization of HFOs with simultaneous scalp electroencephalography (EEG) and magnetoencephalography (MEG) is presented.

同时用脑磁图和脑电图为小儿癫痫的生物标志物检测发作间期高频振动

Crucial to the success of epilepsy surgery is the availability of a robust biomarker that identifies the Epileptogenic Zone (EZ). High Frequency ...

<meta charset="utf8"></head><body>将 MEG 和 HD-EEG 整合到儿科癫痫定位中

Electromagnetic Source Imaging in Presurgical Evaluation of Children with Drug-Resistant Epilepsy

For children with drug-resistant epilepsy (DRE), seizure freedom relies on the delineation and resection (or ablation/disconnection) of the epileptogenic zone (EZ) while preserving the eloquent brain areas. The development of a reliable and noninvasive localization method that provides clinically useful information for the localization of the EZ is, therefore, crucial to achieving successful surgical outcomes. Electric and magnetic source imaging (ESI and MSI) have been increasingly utilized in the presurgical evaluation of these patients showing promising findings in the delineation of epileptogenic as well as eloquent brain areas. Moreover, the combination of ESI and MSI into a single solution, namely electromagnetic source imaging (EMSI), performed on simultaneous high-density electroencephalography (HD-EEG) and magnetoencephalography (MEG) recordings has shown higher source localization accuracy than either modality alone. Despite these encouraging findings, such techniques are performed in only a few tertiary epilepsy centers, are rarely recorded simultaneously, and are underutilized in pediatric cohorts. This study illustrates the experimental setup for recording simultaneous MEG and HD-EEG data as well as the methodological framework for analyzing these data aiming to localize the irritative zone, the seizure onset zone, and eloquent brain areas in children with DRE. More specifically, the experimental setups are presented for (i) recording and localizing interictal and ictal epileptiform activity during sleep and (ii) recording visual-, motor-, auditory-, and somatosensory-evoked responses and mapping relevant eloquent brain areas (i.e., visual, motor, auditory, and somatosensory) during visuomotor task, as well as auditory and somatosensory stimulations. Detailed steps of the data analysis pipeline are further presented for performing EMSI as well as individual ESI and MSI using equivalent current dipole (ECD) and dynamic statistical parametric mapping (dSPM).

<meta charset="utf8"></head><body>作者聚焦:通过新型生物标志物和增强定位推进儿童癫痫手术

Magnetoencephalography (MEG) and high-density electroencephalography (HD-EEG) are rarely recorded simultaneously, although they yield confirmatory and complementary information. Here, we illustrate the experimental setup for recording simultaneous MEG and HD-EEG and the methodology for analyzing these data aiming to localize epileptogenic and eloquent brain areas in children with drug-resistant epilepsy.

电磁源显像在儿童耐药性癫痫术前评估中的应用

For children with drug-resistant epilepsy (DRE), seizure freedom relies on the delineation and resection (or ablation/disconnection) of the epileptogenic ...

立体声电Encephalo-造影（SEEG）随着医学难治性癫痫的术前评估机器人辅助:技术说明

摘要

探索更多视频

执行任务的行为与颅内电极主题

在的鼠标Aortocaval瘘的技术方面

利用机器人立体定向引导系统的立体脑电图（SEEG）方法的操作技术和细微差别

调查深皮层的功能和皮层下结构采用立体定向脑电图:由前扣带皮层的经验教训

采用高分辨率脑电图记录脑源成像局灶性癫痫的临床前模型大鼠

管道在癫痫手术3D多模图像集成和计算机辅助规划

评价中的连接有关的大脑兴奋患者癫痫多式联运Imaging-和激励为基础的方法

在耐药性颞叶癫痫患者卵圆孔电极记录的网络分析

同时用脑磁图和脑电图为小儿癫痫的生物标志物检测发作间期高频振动

电磁源显像在儿童耐药性癫痫术前评估中的应用

立体声电Encephalo-造影（SEEG）随着医学难治性癫痫的术前评估机器人辅助:技术说明

摘要

探索更多视频

执行任务的行为与颅内电极主题

在的鼠标Aortocaval瘘的技术方面

利用机器人立体定向引导系统的立体脑电图（SEEG）方法的操作技术和细微差别

调查深皮层的功​​能和皮层下结构采用立体定向脑电图:由前扣带皮层的经验教训

采用高分辨率脑电图记录脑源成像局灶性癫痫的临床前模型大鼠

管道在癫痫手术3D多模图像集成和计算机辅助规划

评价中的连接有关的大脑兴奋患者癫痫多式联运Imaging-和激励为基础的方法

在耐药性颞叶癫痫患者卵圆孔电极记录的网络分析

同时用脑磁图和脑电图为小儿癫痫的生物标志物检测发作间期高频振动

电磁源显像在儿童耐药性癫痫术前评估中的应用

调查深皮层的功能和皮层下结构采用立体定向脑电图:由前扣带皮层的经验教训