Deep brain stimulation (DBS) is a neurosurgical procedure that allows targeted circuit-based neuromodulation. DBS is a standard of care in Parkinson disease, essential tremor and dystonia, and is ...also under active investigation for other conditions linked to pathological circuitry, including major depressive disorder and Alzheimer disease. Modern DBS systems, borrowed from the cardiac field, consist of an intracranial electrode, an extension wire and a pulse generator, and have evolved slowly over the past two decades. Advances in engineering and imaging along with an improved understanding of brain disorders are poised to reshape how DBS is viewed and delivered to patients. Breakthroughs in electrode and battery designs, stimulation paradigms, closed-loop and on-demand stimulation, and sensing technologies are expected to enhance the efficacy and tolerability of DBS. In this Review, we provide a comprehensive overview of the technical development of DBS, from its origins to its future. Understanding the evolution of DBS technology helps put the currently available systems in perspective and allows us to predict the next major technological advances and hurdles in the field.
Transcranial MR-guided focused ultrasound (MRgFUS) is a minimally invasive treatment for movement disorders. Considerable interpatient variability in skull transmission efficiency exists with the ...current clinical devices, which is thought to be dependent on each patient's specific skull morphology. Lower skull density ratio (SDR) values are thought to impede acoustic energy transmission across the skull, attenuating or preventing the therapeutic benefits of MRgFUS. Patients with SDR values below 0.4 have traditionally been deemed poor candidates for MRgFUS. Although considerable anecdotal evidence has suggested that SDR is a reliable determinant of procedural and clinical success, relationships between SDR and clinical outcomes have yet to be formally investigated. Moreover, as transcranial MRgFUS is becoming an increasingly widespread procedure, knowledge of SDR distribution in the general population may enable improved preoperative counseling and preparedness.
A total of 98 patients who underwent MRgFUS thalamotomy at the authors' institutions between 2012 and 2018 were analyzed (cohort 1). The authors retrospectively assessed the relationships between SDR and various clinical outcomes, including tremor improvement and adverse effects, as well as procedural factors such as sonication parameters. An SDR was also prospectively obtained in 163 random emergency department patients who required a head CT scan for various clinical indications (cohort 2). Patients' age and sex were used to explore relationships with SDR.
In the MRgFUS treatment group, 17 patients with a thalamotomy lesion had an SDR below 0.4. Patients with lower SDRs required more sonication energy; however, their low SDR did not influence their clinical outcomes. In the emergency department patient group, about one-third of the patients had a low SDR (< 0.4). SDR did not correlate with age or sex.
Although lower SDR values correlated with higher energy requirements during MRgFUS thalamotomy, within the range of this study population, the SDR did not appreciably impact or provide the ability to predict the resulting clinical outcomes. Sampling of the general population suggests that age and sex have no relationship with SDR. Other variables, such as local variances in bone density, should also be carefully reviewed to build a comprehensive appraisal of a patient's suitability for MRgFUS treatment.
Water availability, which enables plant growth and animal activity, regulates dryland ecosystem function. In hyper-arid ecosystems, rain cannot support vascular plant growth. Therefore, hyper-arid ...vegetation is restricted to the lower topography, where runoff accumulates. Typically, food resources originating from areas of dense vegetation are dispersed across the desert floor, enabling animal life in areas lacking vascular plant growth. However, certain regions, such as the hyper-arid upper topography, may be devoid of plant-derived food resources. The present study examined arthropod activity in the upper topography of a hyper-arid desert, in comparison with arthropod activity in the lower topography. Pitfall traps were utilized to compare arthropod activity along unvegetated ridges with activity in parallel, vegetated riverbeds. Surprisingly, the study revealed dense arthropod communities in the barren upper topography. Arthropods collected in the upper topography represented 26% of total arthropod abundance. In addition, the overlap between arthropod identity in the ridges and wadis (i.e., riverbeds) was low, and certain arthropods were strongly affiliated with the ridges. The upper topographic communities included high numbers of silverfish (Zygentoma: Lepismatidae), malachite beetles (
Psiloderes
), and predatory mites (Acari: Anystidae), and these arthropods were present at various life stages. It remains unclear how arthropod communities can persist in the unvegetated upper topography of the hyper-arid study area. These results raise the possibility that other food sources, independent from vascular plants, may play a significant role in the life history of hyper-arid arthropods.
OBJECTIVE A surgical series of 201 benign and malignant peripheral nerve sheath tumors (PNSTs) was assessed to characterize the anatomical and clinical presentation of tumors and identify predictors ...of neurological outcome, recurrence, and extent of resection. METHODS All surgically treated PNSTs from the Division of Neurosurgery at Toronto Western Hospital from 1993 to 2010 were reviewed retrospectively. Data were collected on patient demographics, clinical presentation, surgical technique, extent of resection, postoperative neurological outcomes, and recurrence. RESULTS One hundred seventy-five patients with 201 tumors had adequate follow-up for analysis. There were 182 benign and 19 malignant PNSTs. Of the benign lesions, 133 were schwannomas, 21 of which were associated with a diagnosis of schwannomatosis. There were 49 neurofibromas, and 26 were associated with neurofibromatosis Type 1 (NF1). Patients presenting with schwannomas were significantly older than those with neurofibromas. Schwannomas were more readily resected than neurofibromas, with the extent of resection of the former influenced by tumor location. Patients with benign PNSTs typically presented with a painful mass and less frequently with motor deficits. The likelihood of worsened postoperative motor function was decreased in patients with fully resected tumors or preoperative deficits. Recurrence of schwannomas and neurofibromas were seen more frequently in patients diagnosed with NF3 and NF1, respectively. Subtotal resection was associated with the increased recurrence of all benign lesions. CONCLUSIONS Outcomes following resection of benign PNSTs depend on tumor histopathology, tumor location, and genetic predisposition syndrome. Gross-total resection should be attempted for benign lesions where possible. The management of malignant PNSTs remains challenging, requiring a multimodal approach.
Deep Brain Stimulation (DBS) has been investigated as a treatment option for patients with refractory psychiatric illness. Over the past two decades, neuroimaging developments have helped to advance ...the field, particularly the use of diffusion tensor imaging (DTI) and tractographic reconstruction of white-matter pathways. In this article, we review translational considerations and how DTI and tractography have been used to improve targeting during DBS surgery for depression, obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD).
Abstract Spontaneous intracranial hypotension (SIH) is a condition of low cerebrospinal fluid (CSF) volume and pressure caused by a leak of CSF through a dural defect. Diagnosis and management can be ...difficult, often requiring coordination between multiple disciplines for myelography, blood patching, and possible surgical repair. Patients should be monitored closely, as they can deteriorate into a coma or even death. There are no widely accepted guidelines for the management of SIH. Herein, we review the existing SIH literature, illustrate management challenges via a case review, and propose an algorithm developed by neurosurgeons, radiologists, and anesthesiologists intended to simplify and streamline the management of SIH.
This review article summarizes the extensive research works carried out on welding parameters (tool rotational speed, traverse speed, pin profile, axial force and tilt angle) effect on mechanical ...properties of FSW of dissimilar alloys. Extensive studies were being carried out by joining different materials using friction stir welding for different automobile and aerospace applications. FSW process takes place in the solid stage below the melting point of the metals to be joined and numerous materials including, aluminum, bronze, copper, titanium, steel, magnesium, and plastic can be welded. FS welded joints gives more strength and toughness when compared to fusion welded joints. FS welding technique is being used in many research institutes and production companies in the world.
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