Diffusion Tensor Imaging Tractography of the Facial Nerve for the Pre-Surgical Plan in Patients with Vestibular Schwannoma

Patients with vestibular schwannoma (VS) may experience facial nerve (FN) damage after surgery. The aim of this thesis is to evaluate the feasibility to use DTI fiber tracking for the preoperative determination of FN course in patients with VS and to optimize the DTI sequence to decrease the acquisition time. The results show that the probabilistic iFOD2 algorithm, applied to multi-shell DTI protocol, is the most suitable for FN reconstruction in all the five patients analyzed

Brain Computer Interfaces and Emotional Involvement: Theory, Research, and Applications

This reprint is dedicated to the study of brain activity related to emotional and attentional involvement as measured by Brain–computer interface (BCI) systems designed for different purposes. A BCI system can translate brain signals (e.g., electric or hemodynamic brain activity indicators) into a command to execute an action in the BCI application (e.g., a wheelchair, the cursor on the screen, a spelling device or a game). These tools have the advantage of having real-time access to the ongoing brain activity of the individual, which can provide insight into the user’s emotional and attentional states by training a classification algorithm to recognize mental states. The success of BCI systems in contemporary neuroscientific research relies on the fact that they allow one to “think outside the lab”. The integration of technological solutions, artificial intelligence and cognitive science allowed and will allow researchers to envision more and more applications for the future. The clinical and everyday uses are described with the aim to invite readers to open their minds to imagine potential further developments

Expanding neurosurgery

pre-printThe history of medicine is replete with innovations in neurosurgery that have spurred further developments across the medical spectrum. Surgeons treating pathologies in the head and spine have broken ground with new approaches, techniques, and technologies since ancient times. Neurosurgeons occupy a vital nexus in patient care, interfacing with the clinical symptoms and signs afflicting patients, the pathology at surgery, and imaging studies. No other physicians occupy this role within the nervous system. This power of observation and the ability to intercede place neurosurgeons in a unique position for impacting disease. Yet despite these pioneering achievements, more recently, forces in the workplace may be challenging neurosurgery's opportunities to contribute to the future growth of the neurosciences and medicine. The authors posit that, in the current health care climate, revenue generation by neurosurgical clinical activity is valued by the system more than neurosurgical research and academic output. Without providing the talented stream of new neurosurgeons with the opportunities and, in fact, the directive to achieve beyond simple financial success, the specialty is missing the opportunity to optimize its progress. The authors contend that the key to remaining relevant with the incorporation of new technologies to the treatment of neurosurgical patients will be to be flexible, open-minded, and nimble with the adaptation of new procedures by training and encouraging neurosurgical residents to pursue new or neglected areas of the specialty. Only by doing so can neurosurgery continue to expand

ENCODING OF SALTATORY TACTILE VELOCITY IN THE ADULT OROFACIAL SOMATOSENSORY SYSTEM

Processing dynamic tactile inputs is a key function of somatosensory systems. Spatial velocity encoding mechanisms by the nervous system are important for skilled movement production and may play a role in recovery of motor function following neurological insult. Little is known about tactile velocity encoding in trigeminal networks associated with mechanosensory inputs to the face, or the consequences of movement. High resolution functional magnetic resonance imaging (fMRI) was used to investigate the neural substrates of velocity encoding in the human orofacial somatosensory system during unilateral saltatory pneumotactile inputs to perioral hairy skin in 20 healthy adults. A custom multichannel, scalable pneumotactile array consisting of 7 TAC-Cells was used to present 5 stimulus conditions: 5 cm/s, 25 cm/s, 65 cm/s, ALL-ON synchronous activation, and ALL-OFF. The spatial organization of cerebral and cerebellar blood oxygen level-dependent (BOLD) response as a function of stimulus velocity was analyzed using general linear modeling (GLM) of pooled group fMRI signal data. The sequential saltatory inputs to the lower face produced localized, predominantly contralateral BOLD responses in primary somatosensory (SI), secondary somatosensory (SII), primary motor (MI), supplemental motor area (SMA), posterior parietal cortices (PPC), and insula, whose spatial organization and intensity were highly dependent on velocity. Additionally, ipsilateral sensorimotor, insular and cerebellar BOLD responses were prominent during the lowest velocity (5 cm/s). Advisor: Steven M. Barlo

ENCODING OF SALTATORY TACTILE VELOCITY IN THE ADULT OROFACIAL SOMATOSENSORY SYSTEM

Processing dynamic tactile inputs is a key function of somatosensory systems. Spatial velocity encoding mechanisms by the nervous system are important for skilled movement production and may play a role in recovery of motor function following neurological insult. Little is known about tactile velocity encoding in trigeminal networks associated with mechanosensory inputs to the face, or the consequences of movement. High resolution functional magnetic resonance imaging (fMRI) was used to investigate the neural substrates of velocity encoding in the human orofacial somatosensory system during unilateral saltatory pneumotactile inputs to perioral hairy skin in 20 healthy adults. A custom multichannel, scalable pneumotactile array consisting of 7 TAC-Cells was used to present 5 stimulus conditions: 5 cm/s, 25 cm/s, 65 cm/s, ALL-ON synchronous activation, and ALL-OFF. The spatial organization of cerebral and cerebellar blood oxygen level-dependent (BOLD) response as a function of stimulus velocity was analyzed using general linear modeling (GLM) of pooled group fMRI signal data. The sequential saltatory inputs to the lower face produced localized, predominantly contralateral BOLD responses in primary somatosensory (SI), secondary somatosensory (SII), primary motor (MI), supplemental motor area (SMA), posterior parietal cortices (PPC), and insula, whose spatial organization and intensity were highly dependent on velocity. Additionally, ipsilateral sensorimotor, insular and cerebellar BOLD responses were prominent during the lowest velocity (5 cm/s). Advisor: Steven M. Barlo

PRELIMINARY FINDINGS OF A POTENZIATED PIEZOSURGERGICAL DEVICE AT THE RABBIT SKULL

The number of available ultrasonic osteotomes has remarkably increased. In vitro and in vivo studies have revealed differences between conventional osteotomes, such as rotating or sawing devices, and ultrasound-supported osteotomes (Piezosurgery®) regarding the micromorphology and roughness values of osteotomized bone surfaces. Objective: the present study compares the micro-morphologies and roughness values of osteotomized bone surfaces after the application of rotating and sawing devices, Piezosurgery Medical® and Piezosurgery Medical New Generation Powerful Handpiece. Methods: Fresh, standard-sized bony samples were taken from a rabbit skull using the following osteotomes: rotating and sawing devices, Piezosurgery Medical® and a Piezosurgery Medical New Generation Powerful Handpiece. The required duration of time for each osteotomy was recorded. Micromorphologies and roughness values to characterize the bone surfaces following the different osteotomy methods were described. The prepared surfaces were examined via light microscopy, environmental surface electron microscopy (ESEM), transmission electron microscopy (TEM), confocal laser scanning microscopy (CLSM) and atomic force microscopy. The selective cutting of mineralized tissues while preserving adjacent soft tissue (dura mater and nervous tissue) was studied. Bone necrosis of the osteotomy sites and the vitality of the osteocytes near the sectional plane were investigated, as well as the proportion of apoptosis or cell degeneration. Results and Conclusions: The potential positive effects on bone healing and reossification associated with different devices were evaluated and the comparative analysis among the different devices used was performed, in order to determine the best osteotomes to be employed during cranio-facial surgery

Clinical features and prognosis of ‘scan negative’ uro-neurological disorders

Uro-neurological disorders are those in which there is a disturbance of bladder function related to a neurological cause. However, many patients with a combination of urological and neurological symptoms, such as bladder voiding dysfunction and leg weakness or numbness, are not found to have explanatory abnormalities despite adequate clinical and radiological investigation, so-called ‘scan negative’ patients. In this PhD patients with ‘scan negative’ uro-neurological diagnoses were primarily investigated through studies of patients presenting with suspected Cauda Equina Syndrome and to a lesser extent Chronic Urinary Retention (including Fowler’s syndrome). The PhD goal was to deeply phenotype patients with ‘scan negative’ Uro- neurological disorders and in so doing, to improve our scientific understanding of these presentations and inform the development of clinical trials. The PhD explores the historical literature linking patients with idiopathic urological dysfunction and functional disorders, reviews the incidence, research and definitions of cauda equina syndrome and phenotypes patients in a retrospective and prospective manner who present with acute scan negative urological dysfunction (‘scan negative’ cauda equina syndrome) as well as investigates for evidence of functional disorders in chronic scan negative urological dysfunction (Fowler’s syndrome) and evidence of urological dysfunction in patients with functional disorders and neurological dysfunction

Determining normal and abnormal lip shapes during movement for use as a surgical outcome measure

Craniofacial assessment for diagnosis, treatment planning and outcome has traditionally relied on imaging techniques that provide a static image of the facial structure. Objective measures of facial movement are however becoming increasingly important for clinical interventions where surgical repositioning of facial structures can influence soft tissue mobility. These applications include the management of patients with cleft lip, facial nerve palsy and orthognathic surgery. Although technological advances in medical imaging have now enabled three-dimensional (3D) motion scanners to become commercially available their clinical application to date has been limited. Therefore, the aim of this study is to determine normal and abnormal lip shapes during movement for use as a clinical outcome measure using such a scanner. Lip movements were captured from an average population using a 3D motion scanner. Consideration was given to the type of facial movement captured (i.e. verbal or non-verbal) and also the method of feature extraction (i.e. manual or semi-automatic landmarking). Statistical models of appearance (Active Shape Models) were used to convert the video motion sequences into linear data and identify reproducible facial movements via pattern recognition. Average templates of lip movement were created based on the most reproducible lip movements using Geometric Morphometrics (GMM) incorporating Generalised Procrustes Analysis (GPA) and Principal Component Analysis (PCA). Finally lip movement data from a patient group undergoing orthognathic surgery was incorporated into the model and Discriminant Analysis (DA) employed in an attempt to statistically distinguish abnormal lip movement. The results showed that manual landmarking was the preferred method of feature extraction. Verbal facial gestures (i.e. words) were significantly more reproducible/repeatable over time when compared to non-verbal gestures (i.e. facial expressions). It was possible to create average templates of lip movement from the control group, which acted as an outcome measure, and from which abnormalities in movement could be discriminated pre-surgery. These abnormalities were found to normalise post-surgery. The concepts of this study form the basis of analysing facial movement in the clinical context. The methods are transferrable to other patient groups. Specifically, patients undergoing orthognathic surgery have differences in lip shape/movement when compared to an average population. Correcting the position of the basal bones in this group of patients appears to normalise lip mobility

Celebration of Learning 2014: Full Program

Full program of the 2014 Celebration of Learning at Augustana College