Robot-assisted image-guided transcranial magnetic stimulation for somatotopic mapping of the motor cortex: a clinical pilot study

Shape and exact location of motor cortical areas varies among individuals. The exact knowledge of these locations is crucial for planning of neurosurgical procedures. In this study, we have used robot-assisted image-guided transcranial magnetic stimulation (Ri-TMS) to elicit MEP response recorded for individual muscles and reconstruct functional motor maps of the primary motor cortex

Quantification of Optic Disc Edema during Exposure to High Altitude Shows No Correlation to Acute Mountain Sickness

BACKGROUND: The study aimed to quantify changes of the optic nerve head (ONH) during exposure to high altitude and to assess a correlation with acute mountain sickness (AMS). This work is related to the Tuebingen High Altitude Ophthalmology (THAO) study. METHODOLOGY/PRINCIPAL FINDINGS: A confocal scanning laser ophthalmoscope (cSLO, Heidelberg Retina Tomograph, HRT3®) was used to quantify changes at the ONH in 18 healthy participants before, during and after rapid ascent to high altitude (4559 m). Slitlamp biomicroscopy was used for clinical optic disc evaluation; AMS was assessed with Lake Louise (LL) and AMS-cerebral (AMS-c) scores; oxygen saturation (SpO₂) and heart rate (HR) were monitored. These parameters were used to correlate with changes at the ONH. After the first night spent at high altitude, incidence of AMS was 55% and presence of clinical optic disc edema (ODE) 79%. Key stereometric parameters of the HRT3® used to describe ODE (mean retinal nerve fiber layer [RNFL] thickness, RNFL cross sectional area, optic disc rim volume and maximum contour elevation) changed significantly at high altitude compared to baseline (p<0.05) and were consistent with clinically described ODE. All changes were reversible in all participants after descent. There was no significant correlation between parameters of ODE and AMS, SpO₂ or HR. CONCLUSIONS/SIGNIFICANCE: Exposure to high altitude leads to reversible ODE in the majority of healthy subjects. However, these changes did not correlate with AMS or basic physiologic parameters such as SpO₂ and HR. For the first time, a quantitative approach has been used to assess these changes during acute, non-acclimatized high altitude exposure. In conclusion, ODE presents a reaction of the body to high altitude exposure unrelated to AMS

High-resolution maps of magnetization transfer with inherent correction for RF inhomogeneity and T1 relaxation obtained from 3D FLASH MRI

An empirical equation for the magnetization transfer (MT) FLASH signal is derived by analogy to dual-excitation FLASH, introducing a novel semiquantitative parameter for MT, the percentage saturation imposed by one MT pulse during TR. This parameter is obtained by a linear transformation of the inverse signal, using two reference experiments of proton density and T1 weighting. The influence of sequence parameters on the MT saturation was studied. An 8.5-min protocol for brain imaging at 3T was based on nonselective sagittal 3D-FLASH at 1.25mm isotropic resolution using partial acquisition techniques (TR/TE/flipangle = 25ms/4.9ms/5° or 11ms/4.9ms/15° for the T1 reference). A 12.8 ms Gaussian MT pulse was applied 2.2 kHz off-resonance with 540° flip angle. The MT saturation maps showed an excellent contrast in the brain due to clearly separated distributions for white and gray matter and cerebrospinal fluid. Within the limits of the approximation (excitation <15°, TR/T1<<1) the MT term depends mainly on TR, the energy and offset of the MT pulse, but hardly on excitation and T1 relaxation. It is inherently compensated for inhomogeneities of receive and transmit RF fields. The MT saturation appeared to be a sensitive parameter to depict MS lesions and alterations of normal-appearing white matter

Novel technique for intraoperative imaging of the vertebral artery in patients undergoing dorsal osteosynthesis of the cervical spine

Background: The incidence of fractures in the upper cervical spine is a common entity among elderly patients. The incidence depends on the health care system and the adopted protocols for a computer tomogram in the emergency unit, in order to assure an easier and earlier detection. Injuries to the vertebral artery could occur with devastating consequences, due to this type of fracture. The aim of the current surgical strategies is to stabilize the fractures and avoid further injuries to the vertebral arteries. Methods: We adopted a previously hypothesized method for intraoperative imaging of the vertebral artery when performing an O-Arm navigated cervical osteosynthesis. Three patients were included in this group: one patient with dens fracture type II after Anderson and D’Alonzo, one patient with a complex C1/C2 fracture and dissection of the vertebral artery on the left side and one patient with a kyphotic deformity due to Larynx carcinoma Metastasis in C4-C6. After positioning the patients, a 100 ml contrast was applied prior to the primary O-Arm scan, thus obtaining real-time imaging of the vertebral artery in the navigational CT series. Results: A total of 18 screws were placed. None of the screws bridged the vertebral canal. The average operative time was 174 mins. No new neurological deterioration was observed in the postoperative period. Conclusions: With the development of this technique, it is possible to reduce the surgery-related injury of the vertebral artery to 0%. Further studies are necessary to assess the feasibility of this technique. This technique could be especially helpful in the cases of distorted anatomical relations

Transcranial doppler sonography is not a valid diagnostic tool for detection of basilar artery stenosis or in-stent restenosis: a retrospective diagnostic study

Abstract Background There are contradictory reports concerning the validity of transcranial sonography (TCD and TCCS) for examinations of the basilar artery. Here we investigated sensitivity and specificity of transcranial sonography for the detection of basilar artery stenosis and in-stent-restenosis compared to cerebral angiography. Methods We analyzed data of 104 examinations of the basilar artery. The association between sonographic peak systolic velocity (PSV) and degree of stenosis obtained by cerebral angiography was evaluated applying Spearman’s correlation coefficient. Receiver Operating Characteristics (ROC) curves and areas under the curve (AUC) were calculated for the detection of a ≥50% stenosis defined by angiography. Optimal cut-off was derived using the Youden-index. Results A weak but statistically significant correlation between PSV and the degree of stenosis was found (n=104, rho=0.35, p<0.001). ROC analysis for a detection of ≥50% stenosis showed an AUC of 0.70, a sensitivity of 74.0% and a specificity of 65.0% at the optimal cut off of 124 cm/s. Results were consistent when analyzing examinations done in stented and unstented arteries separately (TCD VS DSA/CTA in unstented artery: AUC=0.66, sensitivity 61.0%, specificity 65.0%, TCD/TCCS VS DSA in stented artery: AUC=0.63, sensitivity 71.0%, specificity 82.0%). Comparing TCCS measurements exclusively to angiography, ROC analysis showed an AUC of 1.00 for the detection of an in-stent-restenosis ≥50% with a sensitivity and specificity of 100% when a PSV of 132 cm/s was used as a cut off value. Conclusion Validity of TCD in the assessment of basilar artery stenosis or in-stent restenosis is poor. First results for TCCS are promising, but due to the small samplesize further studies with larger samples sizes are warranted