Using magnetoencephalography to investigate brain activity during high frequency deep brain stimulation in a cluster headache patient

PURPOSE: Treatment-resistant cluster headache can be successfully alleviated with deep brain stimulation (DBS) of the posterior hypothalamus [1]. Magnetoencephalography (MEG) is a non-invasive functional imaging technique with both high temporal and high spatial resolution. However, it is not known whether the inherent electromagnetic (EM) noise produced by high frequency DBS is compatible with MEG. MATERIALS AND METHODS: We used MEG to record brain activity in an asymptomatic cluster headache patient with a DBS implanted in the right posterior hypothalamus while he made small movements during periods of no stimulation, 7 Hz stimulation and 180 Hz stimulation. RESULTS: We were able to measure brain activity successfully both during low and high frequency stimulation. Analysis of the MEG recordings showed similar activation in motor areas in during the patient's movements as expected. We also observed similar activations in cortical and subcortical areas that have previously been reported to be associated with pain when the patient's stimulator was turned on or off [2,3]. CONCLUSION: These results show that MEG can be used to measure brain activity regardless of the presence of high frequency deep brain stimulation

Deep-brain stimulation

Deep-brain stimulation (DBS) is a clinical intervention that has provided remarkable therapeutic benefits for otherwise treatment-resistant movement and affective disorders. The resulting direct causal manipulation of both local and distributed brain networks is not only clinically helpful but can also help to provide novel fundamental insights into brain function. In particular, DBS can be used in conjunction with methods such as local field potentials and magnetoencephalography to map the underlying mechanisms of normal and abnormal oscillatory synchronization in the brain. The precise mechanisms of action for DBS remain uncertain but here we present an overview of the clinical efficacy of DBS, its neural mechanisms and potential future applications. © 2007 Future Medicine Ltd

Shifting paradigms in surgical training - initial experience with the University Malaya neurosurgical simulation system

In the past, neurosurgical training was essentially "See one, do one and teach one". In the current environment with reduction in training hours, less exposure to real operating environment and unusual surgical cases, the need for hands on training in a realistic environment is critical for surgeons and theatre staff. With modern technology using scanned images and 3-D laser printing techniques, it is possible to create near realistic surgical models for trainees to develop surgical skills. This technique also allows assessment of surgical competency by objective scoring to quantify training. We present our early experience in the use of such techniques at the University of Malaya in training residents in image guided neurosurgery

Shifting paradigms in surgical training - initial experience with the University Malaya neurosurgical simulation system

In the past, neurosurgical training was essentially "See one, do one and teach one". In the current environment with reduction in training hours, less exposure to real operating environment and unusual surgical cases, the need for hands on training in a realistic environment is critical for surgeons and theatre staff. With modern technology using scanned images and 3-D laser printing techniques, it is possible to create near realistic surgical models for trainees to develop surgical skills. This technique also allows assessment of surgical competency by objective scoring to quantify training. We present our early experience in the use of such techniques at the University of Malaya in training residents in image guided neurosurgery

Deep brain stimulation for chronic pain

As a clinical intervention, deep brain stimulation (DBS) has provided remarkable therapeutic benefits for otherwise treatment-resistant movement and affective disorders including chronic pain. In this review, we concentrate on the experience of using DBS to treat chronic pain in Oxford. We provide a brief historical background as well as details of our methods for patient selection, surgical techniques and assessment. While the precise mechanisms of action for DBS remain uncertain, we describe how DBS can help for treatment-resistant chronic pain and have great potential to advance our general understanding of the human brain. In particular, we show how DBS can be used in conjunction with methods such as local field potentials and magnetoencephalography to map the underlying mechanisms of normal and abnormal oscillatory synchronization in the brain related to the pleasure of pain relief. © 2010 by Nova Science Publishers, Inc. All rights reserved

Deep brain stimulation for chronic pain

As a clinical intervention, deep brain stimulation (DBS) has provided remarkable therapeutic benefits for otherwise treatment-resistant movement and affective disorders including chronic pain. In this review, we concentrate on the experience of using DBS to treat chronic pain in Oxford. We provide a brief historical background as well as details of our methods for patient selection, surgical techniques and assessment. While the precise mechanisms of action for DBS remain uncertain, we describe how DBS can help for treatment-resistant chronic pain and have great potential to advance our general understanding of the human brain. In particular, we show how DBS can be used in conjunction with methods such as local field potentials and magnetoencephalography to map the underlying mechanisms of normal and abnormal oscillatory synchronization in the brain related to the pleasure of pain relief. © 2010 by Nova Science Publishers, Inc. All rights reserved

Injecting realism in surgical training - Initial simulation experience with custom 3D models

The traditionally accepted form of training is direct supervision by an expert; however, modern trends in medicine have made this progressively more difficult to achieve. A 3-dimensional printer makes it possible to convert patients imaging data into accurate models, thus allowing the possibility to reproduce models with pathology. This enables a large number of trainees to be trained simultaneously using realistic models simulating actual neurosurgical procedures. The aim of this study was to assess the usefulness of these models in training surgeons to perform standard procedures that require complex techniques and equipment. Methods Multiple models of the head of a patient with a deep-seated small thalamic lesion were created based on his computed tomography and magnetic resonance imaging data. A workshop was conducted using these models of the head as a teaching tool. The surgical trainees were assessed for successful performance of the procedure as well as the duration of time and number of attempts taken to learn them. Findings All surgical candidates were able to learn the basics of the surgical procedure taught in the workshop. The number of attempts and time taken reflected the seniority and previous experience of each candidate. Discussion Surgical trainees need multiple attempts to learn essential procedures. The use of these models for surgical-training simulation allows trainees to practice these procedures repetitively in a safe environment until they can master it. This would theoretically shorten the learning curve while standardizing teaching and assessment techniques of these trainees. © 2014 Association of Program Directors in Surgery