Stability, Structure and Scale: Improvements in Multi-modal Vessel Extraction for SEEG Trajectory Planning

Purpose Brain vessels are among the most critical landmarks that need to be assessed for mitigating surgical risks in stereo-electroencephalography (SEEG) implantation. Intracranial haemorrhage is the most common complication associated with implantation, carrying signi cant associated morbidity. SEEG planning is done pre-operatively to identify avascular trajectories for the electrodes. In current practice, neurosurgeons have no assistance in the planning of electrode trajectories. There is great interest in developing computer assisted planning systems that can optimise the safety pro le of electrode trajectories, maximising the distance to critical structures. This paper presents a method that integrates the concepts of scale, neighbourhood structure and feature stability with the aim of improving robustness and accuracy of vessel extraction within a SEEG planning system. Methods The developed method accounts for scale and vicinity of a voxel by formulating the problem within a multi-scale tensor voting framework. Feature stability is achieved through a similarity measure that evaluates the multi-modal consistency in vesselness responses. The proposed measurement allows the combination of multiple images modalities into a single image that is used within the planning system to visualise critical vessels. Results Twelve paired datasets from two image modalities available within the planning system were used for evaluation. The mean Dice similarity coe cient was 0.89 ± 0.04, representing a statistically signi cantly improvement when compared to a semi-automated single human rater, single-modality segmentation protocol used in clinical practice (0.80 ±0.03). Conclusions Multi-modal vessel extraction is superior to semi-automated single-modality segmentation, indicating the possibility of safer SEEG planning, with reduced patient morbidity

Previous, current, and future stereotactic EEG techniques for localising epileptic foci

INTRODUCTION: Drug-resistant focal epilepsy presents a significant morbidity burden globally, and epilepsy surgery has been shown to be an effective treatment modality. Therefore, accurate identification of the epileptogenic zone for surgery is crucial, and in those with unclear noninvasive data, stereoencephalography is required. AREAS COVERED: This review covers the history and current practices in the field of intracranial EEG, particularly analyzing how stereotactic image-guidance, robot-assisted navigation, and improved imaging techniques have increased the accuracy, scope, and use of SEEG globally. EXPERT OPINION: We provide a perspective on the future directions in the field, reviewing improvements in predicting electrode bending, image acquisition, machine learning and artificial intelligence, advances in surgical planning and visualization software and hardware. We also see the development of EEG analysis tools based on machine learning algorithms that are likely to work synergistically with neurophysiology experts and improve the efficiency of EEG and SEEG analysis and 3D visualization. Improving computer-assisted planning to minimize manual input from the surgeon, and seamless integration into an ergonomic and adaptive operating theater, incorporating hybrid microscopes, virtual and augmented reality is likely to be a significant area of improvement in the near future

Late Summer Phytoplankton Blooms in the Changing Polar Environment of the Kongsfjorden (Svalbard, Arctic)

Kongsfjorden (Spitsbergen, Svalbard) is an inlet treated as a model site for studies on the impact of climate change in the Arctic due to its hydrological features. In this research, seven-days monitoring was carried out to evaluate the effects of hydrological variability on phytoplankton biomass and diversity in the late summer period. Temperature, salinity, nutrients, total suspended matter, phytoplankton abundance and biomass were determined for each sample. The thermo-haline properties of the column water seemed to affect phytoplankton communities. Their abundances and biomass were correlated with the amount of the total suspended matter. Moreover, species composition and biomass dramatically changed throughout the study period. Cold-water and Atlantic species were replaced by temperatewarm water dinoflagellates, including harmful species. An increase in phytoplankton biomass as well as the presence of dinoflagellate aggregations, mainly composed of Prorocentrum cf. gracile, were detected. This kind of algal accumulation is a new phenomenon in the Arctic and was probably related to the mobilization of sediment-rich glacial meltwaters. These findings, even if preliminary, suggest the need to study how additional biomass pulses and the increase of harmful species may alter the food web structure and the biogeochemical cycles, leading to major ecosystem changes

A case report of Vagus nerve stimulation for intractable hiccups

Introduction: Intractable hiccups frequently result from an underlying pathology and can cause considerable illness in the patients. Initial remedies such as drinking cold water, induction of emesis, carotid sinus massage or Valsalva manoeuvre all seem to work by over stimulating the Vagus nerve. Pharmacotherapy with baclofen, gabapentin and other centrally and peripherally acting agents such as chlorpromazine and metoclopramide are reserved as second line treatment. Medical refractory cases even indulge in unconventional therapies such as hypnosis, massages and acupuncture. Surgical intervention, although undertaken very rarely, predominantly revolves around phrenic nerve crushing, blockade or pacing. A novel surgical strategy is emerging in the form of Vagus nerve stimulator (VNS) placement with three cases cited in literature to date with varying degrees of success. Here the authors report a case of VNS placement for intractable hiccups with partial success, in accordance with SCARE-2018 guidelines. Presentation of the case: An 85-year-old gentleman with a 9-year history of intractable hiccups secondary to pneumonia came to our hospital. The hiccups were symptomatic causing anorexia, insomnia, irritability, depression, exhaustion, muscle wasting and weight loss. The patient underwent countless medical evaluations. All examinations and investigations yielded normal results. The patient underwent aggressive pharmacotherapy, home remedies and unconventional therapies for intractable hiccups but to no avail. He also underwent left phrenic nerve blocking and resection without therapeutic success. The patient presented to our hospital and decision for VNS insertion was taken for compassionate reasons considering patient morbidity. The patient demonstrated significant improvement in his symptoms following VNS insertion. Discussion: A temporary hiccup is an occasional happening experienced by everyone. However, intractable hiccups are associated with significant morbidity and often mortality. Several medical, pharmacological, surgical and novel treatment options are available for intractable hiccups. Conclusion: VNS insertion is a novel surgical option for the treatment of intractable hiccups

Water Masses Variability in Inner Kongsfjorden (Svalbard) During 2010–2020

Kongsfjorden is an Arctic fjord located in the Svalbard archipelago. Its hydrography is influenced by the warm and saline Atlantic Water (AW) in the West Spitsbergen Current and the cold and fresh Polar Water circulating on the shelf. We assess the so-called atlantification of Kongsfjorden in the 2010–2020 decade by inspecting modifications in water properties and water masses variability through moored data and summer CTD surveys. Atlantification in this fjord has emerged as an increasing temperature and salinity, resulting from enhanced advection of Atlantic waters from the West Spitsbergen Current. The water column in inner Kongsfjorden warmed by 0.13°C/yr at 35 m and 0.06°C/yr at 85 m depth from 2010 to 2020, while salinity increased by 0.3 PSU. Depth-averaged temperatures have increased by 0.26°C/yr in the warmest months of the year, whereas they appear relatively stable in the coldest months. Both temperature and salinity present a linear regression change point in January 2017, with latter years featuring decreasing values. Highly diluted AW is found at the beginning of the decade, which give way to more and more pure AW in latter years, culminating in extensive intrusions in 2016 and 2017 determining the warmest and saltiest conditions over the decade in inner Kongsfjorden. Observations in the 2010–2020 decade confirm that Kongsfjorden has transitioned to an Atlantic-type fjord, featuring depleted sea ice conditions and rather regular shallow intrusions of AW in summer and frequently also in winter. Although single intrusions of AW are associated with dynamical events on the shelf, we found that the long-term temperature evolution in the inner Kongsfjord is consistent with the meridional temperature transport of the West Spitsbergen Current. The AW current flowing northward from lower latitudes along the western Svalbard archipelago thus has profoundly driven local conditions in the inner fjord in this decade

Multi-scale spectrally resolved quantitative fluorescence imaging system: Towards neurosurgical guidance in glioma resection

In glioma resection surgery, the detection of tumour is often guided by using intraoperative fluorescence imaging notably with 5-ALA-PpIX, providing fluorescent contrast between normal brain tissue and the gliomas tissue to achieve improved tumour delineation and prolonged patient survival compared with the conventional white-light guided resection. However, the commercially available fluorescence imaging system relies on surgeon’s eyes to visualise and distinguish the fluorescence signals, which unfortunately makes the resection subjective. In this study, we developed a novel multi-scale spectrally-resolved fluorescence imaging system and a computational model for quantification of PpIX concentration. The system consisted of a wide-field spectrally-resolved quantitative imaging device and a fluorescence endomicroscopic imaging system enabling optical biopsy. Ex vivo animal tissue experiments as well as human tumour sample studies demonstrated that the system was capable of specifically detecting the PpIX fluorescent signal and estimate the true concentration of PpIX in brain specimen

Influence of distributary channels on sediment and organic matter supply in event-dominated coastal margins: the Po prodelta as a study case

From November 2008 through May 2009, the Po river (Italy) experienced several floods exceeding 5000 m<sup>3</sup> s<sup>−1</sup>. This long series of events ended with a large flood in early May 2009 (~8000 m<sup>3</sup> s<sup>−1</sup>). An event-response sampling was carried out in the Po prodelta in April–May 2009 to characterize the preservation of this series of floods in the sediment record and to describe the event-supply and deposition of riverborne particulate material during the May 2009 flood. The water sampling was carried out early in the event under conditions of moderate river flow (~5000 m<sup>3</sup> s<sup>−1</sup>) and 24 h later during the peak discharge (~8000 m<sup>3</sup> s<sup>−1</sup>). Sediment cores were collected in the prodelta before and after the peak flood. At each station, profiles of conductivity, transmittance, and fluorescence were acquired. Surface and bottom waters were sampled to collect sediments in suspension. In addition, a few days before the May 2009 event, suspended sediments were collected at Pontelagoscuro gauging station, ~90 km upstream from the coast. Biogeochemical compositions and sedimentological characteristics of suspended and sediment samples were investigated using bulk and biomarker analyses. Furthermore, <sup>7</sup>Be and radiographs were used to analyze the internal stratigraphy of sediment cores. <br><br> During moderate flow, the water column did not show evidence of plume penetration. Stations re-occupied 24 h later exhibited marked physical and biogeochemical changes during the peak flood. However, the concentration of terrestrially-derived material in surface waters was still less than expected. These results suggested that, since material enters the Adriatic as buoyancy-driven flow with a reduced transport capacity, settling and flocculation processes result in trapping a significant fraction of land-derived material in shallow sediments and/or within distributary channels. <br><br> Although numerous discharge peaks occurred from November 2008 through April 2009 (4000–6000 m<sup>3</sup> s<sup>−1</sup>), sediment cores collected in late April 2009 showed lack of event-strata preservation and reduced <sup>7</sup>Be penetrations. This suggested that only a small fraction of the sediment supply during ordinary events reaches the deepest region of the prodelta (12–20 m water depth). As a result, these event-strata have a thickness not sufficient to be preserved in the sediment record because of post-depositional processes that destroy the flood signal. <br><br> Stations in the northern and central prodelta were re-occupied after the peak of the May 2009 flood. Based on <sup>7</sup>Be and radiographs, we estimated event layers of 17 and 6 cm thickness, respectively. Selective trapping of coarse material occurred in the central prodelta likely because of the geomorphologic setting of the central outlet characterized by an estuary-like mouth. Despite these settling processes, lignin-based parameters indicated that the composition of the terrigenous OC was fairly homogenous throughout the network of channels and between size-fractions

The Effect of Vascular Segmentation Methods on Stereotactic Trajectory Planning for Drug-Resistant Focal Epilepsy: A Retrospective Cohort Study

Background: Stereotactic neurosurgical procedures carry a risk of intracranial hemorrhage, which may result in significant morbidity and mortality. Vascular imaging is crucial for planning stereotactic procedures to prevent conflicts with intracranial vasculature. There is a wide range of vascular imaging methods used for stereoelectroencephalography (SEEG) trajectory planning. Computer-assisted planning (CAP) improves planning time and trajectory metrics. We aimed to quantify the effect of different vascular imaging protocols on CAP trajectories for SEEG. Methods: Ten patients who had undergone SEEG (95 electrodes) following preoperative acquisition of gadolinium-enhanced magnetic resonance imaging (MR + Gad), magnetic resonance angiography and magnetic resonance angiography (MRV + MRA), and digital subtraction catheter angiography (DSA) were identified from a prospectively maintained database. SEEG implantations were planned using CAP using DSA segmentations as the gold standard. Strategies were then recreated using MRV + MRA and MR + Gad to define the “apparent” and “true” risk scores associated with each modality. Vessels of varying diameter were then iteratively removed from the DSA segmentation to identify the size at which all 3 vascular modalities returned the same safety metrics. Results: CAP performed using DSA vessel segmentations resulted in significantly lower “true” risk scores and greater minimum distances from vasculature compared with the “true” risk associated with MR + Gad and MRV + MRA. MRV + MRA and MR + Gad returned similar risk scores to DSA when vessels <2 mm and <4 mm were not considered, respectively. Conclusions: Significant variability in vascular imaging and trajectory planning practices exist for SEEG. CAP performed with MR + Gad or MRV + MRA alone returns “falsely” lower risk scores compared with DSA. It is unclear whether DSA is oversensitive and thus restricting potential trajectories

Breast cancer and communication: Monocentric experience of a self-assessment questionnaire

Background: The communication of the diagnosis of breast cancer induces to the patient a strong psychological trauma. Radiologists are at the forefront of communicating, either for a biopsy or the probable diagnosis of malignancy. This is a complex task, which requires the knowledge and application of correct “communicative models”, among which the SPIKES protocol rep-resents a fundamental reference. Design and methods: 110 patients, with a history of breast cancer, filled out a questionnaire consisting of six questions: five aimed at defining communication compliance with the SPIKES protocol, the sixth, consisting of six feelings, aimed at the knowledge of the next emotional state. Results: Regarding compliance with various “strategic points” of the SPIKES protocol, questionnaires show that 70% of patients reported no omissions, while the remaining 30% reported omissions relatively to perception (56%), emotions (23%), setting (13%), knowledge (6%) and invitation (2%). The results showed the existence of a correlation between the final emotional state and the correct application of the SPIKES protocol; in fact, patients who reacted with a positive final emotional state-reported greater adherence to the strategic points of the SPIKES protocol. Conclusions: In healthcare, knowing the communicative compliance of a team in giving “bad news” is fundamental, especially in breast cancer. The SPIKES protocol is recognized by the Literature as a fundamental reference able to affect “positively” the emotional state of patients. The proposed questionnaire is a valid tool to identify the weak points of communication and related criticalities, to improve clinical practice