scholarly journals Resting-state functional magnetic resonance imaging for surgical planning in pediatric patients: a preliminary experience

2017 ◽  
Vol 20 (6) ◽  
pp. 583-590 ◽  
Author(s):  
Jarod L. Roland ◽  
Natalie Griffin ◽  
Carl D. Hacker ◽  
Ananth K. Vellimana ◽  
S. Hassan Akbari ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Resting State ◽  
Surgical Planning ◽  
Pediatric Patients ◽  
Clinical Decision Making ◽  
Case Series ◽  
Individual Basis ◽  
Wide Range ◽  
Neurosurgical Patients ◽  
State Analysis

OBJECTIVECerebral mapping for surgical planning and operative guidance is a challenging task in neurosurgery. Pediatric patients are often poor candidates for many modern mapping techniques because of inability to cooperate due to their immature age, cognitive deficits, or other factors. Resting-state functional MRI (rs-fMRI) is uniquely suited to benefit pediatric patients because it is inherently noninvasive and does not require task performance or significant cooperation. Recent advances in the field have made mapping cerebral networks possible on an individual basis for use in clinical decision making. The authors present their initial experience translating rs-fMRI into clinical practice for surgical planning in pediatric patients.METHODSThe authors retrospectively reviewed cases in which the rs-fMRI analysis technique was used prior to craniotomy in pediatric patients undergoing surgery in their institution. Resting-state analysis was performed using a previously trained machine-learning algorithm for identification of resting-state networks on an individual basis. Network maps were uploaded to the clinical imaging and surgical navigation systems. Patient demographic and clinical characteristics, including need for sedation during imaging and use of task-based fMRI, were also recorded.RESULTSTwenty patients underwent rs-fMRI prior to craniotomy between December 2013 and June 2016. Their ages ranged from 1.9 to 18.4 years, and 12 were male. Five of the 20 patients also underwent task-based fMRI and one underwent awake craniotomy. Six patients required sedation to tolerate MRI acquisition, including resting-state sequences. Exemplar cases are presented including anatomical and resting-state functional imaging.CONCLUSIONSResting-state fMRI is a rapidly advancing field of study allowing for whole brain analysis by a noninvasive modality. It is applicable to a wide range of patients and effective even under general anesthesia. The nature of resting-state analysis precludes any need for task cooperation. These features make rs-fMRI an ideal technology for cerebral mapping in pediatric neurosurgical patients. This review of the use of rs-fMRI mapping in an initial pediatric case series demonstrates the feasibility of utilizing this technique in pediatric neurosurgical patients. The preliminary experience presented here is a first step in translating this technique to a broader clinical practice.

scholarly journals Awareness, Knowledge, and Utility of RCT Data vs RWE: Results From a Survey of US Cardiologists: Real-world Evidence in Clinical Decision Making

2020 ◽  
Vol 14 ◽  
pp. 117954682095341 ◽  
Author(s):  
Todd C Villines ◽  
Mark J Cziraky ◽  
Alpesh N Amin
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Real World ◽  
Randomized Clinical Trials ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
The Body ◽  
Representative Sampling ◽  
Real World Evidence ◽  
Wide Range

Real-world evidence (RWE) provides a potential rich source of additional information to the body of data available from randomized clinical trials (RCTs), but there is a need to understand the strengths and limitations of RWE before it can be applied to clinical practice. To gain insight into current thinking in clinical decision making and utility of different data sources, a representative sampling of US cardiologists selected from the current, active Fellows of the American College of Cardiology (ACC) were surveyed to evaluate their perceptions of findings from RCTs and RWE studies and their application in clinical practice. The survey was conducted online via the ACC web portal between 12 July and 11 August 2017. Of the 548 active ACC Fellows invited as panel members, 173 completed the survey (32% response), most of whom were board certified in general cardiology (n = 119, 69%) or interventional cardiology (n = 40, 23%). The survey results indicated a wide range of familiarity with and utilization of RWE amongst cardiologists. Most cardiologists were familiar with RWE and considered RWE in clinical practice at least some of the time. However, a significant minority of survey respondents had rarely or never applied RWE learnings in their clinical practice, and many did not feel confident in the results of RWE other than registry data. These survey findings suggest that additional education on how to assess and interpret RWE could help physicians to integrate data and learnings from RCTs and RWE to best guide clinical decision making.

scholarly journals Operationalization of the learned non-use phenomenon - A Delphi study

2020 ◽  
Author(s):  
Theresa Hirsch ◽  
Maria Barthel ◽  
Pauline Aarts ◽  
Yi-An Chen ◽  
Susanna Freivogel ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Delphi Study ◽  
Clinical Decision Making ◽  
Negative Reinforcement ◽  
Brain Lesion ◽  
Clinical Decision ◽  
Diagnostic Process ◽  
Sources Of Information ◽  
Wide Range

AbstractThe discrepancy between residual functional capacity and reduced use of the contralesional hand, frequently observed after a brain lesion, has been termed Learned Non-Use (LNU) and is thought to depend on the interaction of neuronal mechanisms during recovery and learning-dependent mechanisms such as negative reinforcement. Despite the generally accepted existence of the LNU phenomenon among clinicians and researchers, no unequivocal and transdisciplinary definition exists to date. Furthermore, although therapeutic approaches are implemented in clinical practice to explicitly target LNU, no standardized diagnostic routine is described in the current literature.Based on a structured group communication following the Delphi method among clinical and scientific experts in the field of LNU, knowledge from both, the work with patient populations and with animal models, was synthesized and integrated to reach consensus regarding a transdisciplinary definition of the LNU phenomenon. Furthermore, the mode and strategy of the diagnostic process, as well as the sources of information and outcome parameters relevant for the clinical decision making, were described with a wide range showing the current lack of a consistent universal diagnostic approach. Building on these results, the need for the development of a structured diagnostic procedure and its implementation into clinical practice is emphasized. Moreover, it exists a striking gap between the prevailing hypotheses regarding the mechanisms underlying the LNU phenomenon and the actual evidence. Therefore, basic research is needed to bridge between bedside and bench and eventually improve clinical decision making and further development of interventional strategies beyond the field of stroke rehabilitation.

Complications following intracranial pressure monitoring in children: a 6-year single-center experience

2018 ◽  
Vol 21 (3) ◽  
pp. 278-283 ◽  
Author(s):  
Ruichong Ma ◽  
David Rowland ◽  
Andrew Judge ◽  
Amedeo Calisto ◽  
Jayaratnam Jayamohan ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Case Series ◽  
Complication Rates ◽  
Safe Procedure ◽  
Icp Monitoring ◽  
Retrospective Case ◽  
Wide Range ◽  
Neurosurgical Patients ◽  
Significant Difference ◽  
Csf Leakage

OBJECTIVEIntracranial pressure (ICP) monitoring is an important tool in the neurosurgeon’s armamentarium and is used for a wide range of indications. There are many different ICP monitors available, of which fiber-optic intraparenchymal devices are very popular. Here, the authors document their experience performing ICP monitoring from 2005 to 2015 and specifically complication rates following insertion of the Microsensor ICP monitor.METHODSA retrospective case series review of all patients who underwent ICP monitoring over a 10-year period from 2005 to 2015 was performed.RESULTSThere were 385 separate operations with an overall complication rate of 8.3% (32 of 385 cases). Hardware failure occurred in 4.2% of cases, the CSF leakage rate was 3.6%, the postoperative hemorrhage rate was 0.5%, and there was 1 case of infection (0.3% of cases). Only patients with hardware problems required further surgery as a result of their complications, and no patient had any permanent morbidity or mortality from the procedure. Younger patients (p = 0.001) and patients with pathologically high ICP (13% of patients with high ICP vs 6.5% of patients with normal ICP; p = 0.04) were significantly more likely to have complications. There was no significant difference in the complication rates between general neurosurgical patients and craniofacial patients (7.6% vs 8.8%, respectively; p = 0.67).CONCLUSIONSIntraparenchymal ICP monitoring is a safe procedure associated with low complications and morbidity in the pediatric craniofacial and neurosurgical population and should be offered to appropriate patients to assess ICP with the reassurance of the safety record reported in this study.

scholarly journals Effects of Thresholding on Voxel-Wise Correspondence of Breath-Hold and Resting-State Maps of Cerebrovascular Reactivity

2021 ◽  
Vol 15 ◽  
Author(s):  
Nooshin J. Fesharaki ◽  
Amy B. Mathew ◽  
Jedidiah R. Mathis ◽  
Wendy E. Huddleston ◽  
James L. Reuss ◽  
...  
Keyword(s):  
Gray Matter ◽  
Resting State ◽  
Surgical Planning ◽  
Cerebrovascular Reactivity ◽  
Breath Hold ◽  
Good Correspondence ◽  
Spatial Correspondence ◽  
Wide Range ◽  
Cortical Gray Matter ◽  
A Site

Functional magnetic resonance imaging for presurgical brain mapping enables neurosurgeons to identify viable tissue near a site of operable pathology which might be at risk of surgery-induced damage. However, focal brain pathology (e.g., tumors) may selectively disrupt neurovascular coupling while leaving the underlying neurons functionally intact. Such neurovascular uncoupling can result in false negatives on brain activation maps thereby compromising their use for surgical planning. One way to detect potential neurovascular uncoupling is to map cerebrovascular reactivity using either an active breath-hold challenge or a passive resting-state scan. The equivalence of these two methods has yet to be fully established, especially at a voxel level of resolution. To quantitatively compare breath-hold and resting-state maps of cerebrovascular reactivity, we first identified threshold settings that optimized coverage of gray matter while minimizing false responses in white matter. When so optimized, the resting-state metric had moderately better gray matter coverage and specificity. We then assessed the spatial correspondence between the two metrics within cortical gray matter, again, across a wide range of thresholds. Optimal spatial correspondence was strongly dependent on threshold settings which if improperly set tended to produce statistically biased maps. When optimized, the two CVR maps did have moderately good correspondence with each other (mean accuracy of 73.6%). Our results show that while the breath-hold and resting-state maps may appear qualitatively similar they are not quantitatively identical at a voxel level of resolution.

scholarly journals Open-mouth jaw locking in cats: a literature review and use of CT in three cases

2017 ◽  
Vol 20 (12) ◽  
pp. 1180-1191 ◽  
Author(s):  
Anna E Nutt ◽  
Thomas Anderson ◽  
Margherita Gracis ◽  
Ivan Doran ◽  
Chris Warren-Smith ◽  
...  
Keyword(s):  
Ct Scan ◽  
Surgical Planning ◽  
Case Series ◽  
Canine Tooth ◽  
Maxillary Canine ◽  
Open Mouth ◽  
Wide Range ◽  
Long Term Follow Up

Case series summary This report summarises and reviews the published cases of open-mouth jaw locking in cats and describes three further cases. Case 1 was a 5-year-old, 5.3 kg male neutered domestic shorthair cat. CT identified changes consistent with temporomandibular joint (TMJ) dysplasia with osseous degenerative changes, and the cat subsequently underwent bilateral partial zygomectomy with bilateral partial coronoidectomy. Case 2 was a 10-year-old, 6.0 kg male neutered Exotic Shorthair. Aside from a fracture of the left maxillary canine tooth crown and absence of the left maxillary fourth premolar tooth, no abnormalities were found on CT scan. The cat also underwent bilateral partial zygomectomy with bilateral partial coronoidectomy. The third case was a 1-year-old, 4.0 kg male neutered Persian cat. Changes on CT were consistent with bilateral TMJ dysplasia, and the cat underwent staged bilateral partial zygomectomy with bilateral partial coronoidectomy. There was no recurrence of open-mouth jaw locking in any of the cases on long-term follow-up. Relevance and novel information Open-mouth jaw locking has been reported in cats of a wide range of ages, from 1–10 years. Cats with all skull types (brachycephalic, mesaticephalic and dolichocephalic) may be affected, but brachycephalic breeds seem to be over-represented. A CT scan with the jaw locked in place is recommended for diagnosis and surgical planning purposes; two of the cases reported here document the first cases of TMJ dysplasia in cats to be definitively diagnosed using CT. Trauma and symphyseal or TMJ laxity may also predispose to development of the condition. Partial coronoidectomy and partial zygomatic arch resection performed alone or in combination are generally successful at preventing recurrence. Bilateral partial zygomectomy with bilateral partial coronoidectomy has not previously been reported as a surgical treatment, and is recommended when open-mouth jaw locking occurs bilaterally.

scholarly journals Epilepsy as an initial factor of the clinical presentation of arteriovenous malformations of the brain - natural history and risk factors

2014 ◽  
Vol 61 (4) ◽  
pp. 27-31
Author(s):  
Marina Radosavljevic ◽  
Nikola Repac ◽  
Igor Nikolic ◽  
Igor Djoric ◽  
Aleksandar Janicijevic ◽  
...  
Keyword(s):  
Case Series ◽  
Good Control ◽  
Response To Treatment ◽  
Results Of Treatment ◽  
Clinical Center ◽  
Brain Avm ◽  
Wide Range ◽  
Neurosurgical Patients ◽  
Significant Difference ◽  
The Brain

We present the results of treatment of 15 patients with brain arteriovenous malformation initially presented by epilepsy in Neurosurgery, Clinical Center of Serbia in Belgrade, in the period 2004-2010 year. Results: Most of the patients had a grand mall type of epilepsy, 14 of them, while one was present petit mall epilepsy. The attacks are manifested individually in 14, and in 1 case series. Response to treatment was good in 11 and 4 patients with refractory. In 26.7% of cases, seizures alternated with bleeding. Anatomical features of malformations did not show a significant difference in the predisposition to epilepsy treatment response . Conclusion: Good control of epilepsy by medication supports the view that there is no need for urgent surgical treatment of brain AVM so we can generally conclude that brain AVM in relation to a wide range of neurosurgical patients are in benign lesions, which requires patience and good workmanship and strategic therapeutic approach.

scholarly journals A First Step Toward the Operationalization of the Learned Non-Use Phenomenon: A Delphi Study

2021 ◽  
pp. 154596832199906
Author(s):  
Theresa Hirsch ◽  
Maria Barthel ◽  
Pauline Aarts ◽  
Yi-An Chen ◽  
Susanna Freivogel ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Delphi Study ◽  
Clinical Decision Making ◽  
Brain Lesion ◽  
Basic Research ◽  
Clinical Decision ◽  
Diagnostic Process ◽  
Sources Of Information ◽  
Wide Range

Background The negative discrepancy between residual functional capacity and reduced use of the contralesional hand, frequently observed after a brain lesion, has been termed Learned Non-Use (LNU) and is thought to depend on the interaction of neuronal mechanisms during recovery and learning-dependent mechanisms. Objective Albeit the LNU phenomenon is generally accepted to exist, currently, no transdisciplinary definition exists. Furthermore, although therapeutic approaches are implemented in clinical practice targeting LNU, no standardized diagnostic routine is described in the available literature. Our objective was to reach consensus regarding a definition as well as synthesize knowledge about the current diagnostic procedures. Methods We used a structured group communication following the Delphi method among clinical and scientific experts in the field, knowledge from both, the work with patient populations and with animal models. Results Consensus was reached regarding a transdisciplinary definition of the LNU phenomenon. Furthermore, the mode and strategy of the diagnostic process, as well as the sources of information and outcome parameters relevant for the clinical decision making, were described with a wide range showing the current lack of a consistent universal diagnostic approach. Conclusions The need for the development of a structured diagnostic procedure and its implementation into clinical practice is emphasized. Moreover, it exists a striking gap between the prevailing hypotheses regarding the mechanisms underlying the LNU phenomenon and the actual evidence. Therefore, basic research is needed to bridge between bedside and bench and eventually improve clinical decision making and further development of interventional strategies beyond the field of stroke rehabilitation.

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

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