Robotic-Assisted Navigation for Stereotactic Neurosurgery: A Cadaveric Investigation of Accuracy, Time, and Radiation.

Background And Objectives: Despite frequent use, stereotactic head frames require manual coordinate calculations and manual frame settings that are associated with human error. This study examines freestanding robot-assisted navigation (RAN) as a means to reduce the drawbacks of traditional cranial stereotaxy and improve targeting accuracy.

Methods: Seven cadaveric human torsos with heads were tested with 8 anatomic coordinates selected for lead placement mirrored in each hemisphere.

Metal contents and size distributions of brake and tire wear particles dispersed in the near-road environment.

Traffic related non-tailpipe particulate matter emissions can rival the continuously decreasing tailpipe emissions in modern fleets. Non-tailpipe emissions have become the dominating source of traffic emissions in California already. This study measured ambient PM and PM concentrations at near road environments for two major highways in California, I-5 in Anaheim and I-710 in Long Beach.

Lumit: A Homogeneous Bioluminescent Immunoassay for Detecting Diverse Analytes and Intracellular Protein Targets.

Traditional immunoassays to detect secreted or intracellular proteins can be tedious, require multiple washing steps, and are not easily adaptable to a high-throughput screening (HTS) format. To overcome these limitations, we developed Lumit, a novel immunoassay approach that combines bioluminescent enzyme subunit complementation technology and immunodetection. This bioluminescent immunoassay does not require washes or liquid transfers and takes less than 2 h to complete in a homogeneous "Add and Read" format.

Ablation of apparent diffusion coefficient hyperintensity clusters in mesial temporal lobe epilepsy improves seizure outcomes after laser interstitial thermal therapy.

Objective: Laser interstitial thermal therapy (LiTT) is a minimally invasive surgical procedure for intractable mesial temporal epilepsy (mTLE). LiTT is safe and effective, but seizure outcomes are highly variable due to patient variability, suboptimal targeting, and incomplete ablation of the epileptogenic zone. Apparent diffusion coefficient (ADC) is a magnetic resonance imaging (MRI) sequence that can identify potential epileptogenic foci in the mesial temporal lobe to improve ablation and seizure outcomes.

Traumatic sacral dermoid cyst rupture with intracranial subarachnoid seeding of lipid particles: illustrative case.

Background: Intracranial deposits of fat droplets are an unusual presentation of a spinal dermoid cyst after spontaneous rupture and are even more uncommon after trauma. Here, the authors present a case with this rare clinical presentation, along with a systematic review of the literature to guide decision making in these patients.

Observations: A 54-year-old woman with Lynch syndrome presented with severe headache and sacrococcygeal pain after a traumatic fall.

Robot-assisted atlantoaxial fixation: illustrative cases.

Background: Placing screws in the high cervical spine can be challenging because of the vital anatomical structures located in that region. Precision and accuracy with screw placement is needed. The use of robotics in the cervical spine has been described before; however, here the authors describe the use of a new robotic setup.

Prehospital Traumatic Brain Injury Management Clinical Pearls and Pathophysiology.

Traumatic brain injury (TBI) management is complex. The brain is a sensitive, high-maintenance organ that loses its ability to take care of itself upon injury, and our primary mission is to achieve and maintain optimal levels of cerebral blood flow (CBF) from the moment of injury until recovery. The authors provide a case and discuss prehospital patient management, including adequate oxygen saturation and blood pressure, early recognition of TBI, frequent exams, detailed charting and hand-off, and fast transport to the next echelon of care.

Piriform Cortex Ablation Volume Is Associated With Seizure Outcome in Mesial Temporal Lobe Epilepsy.

Background: Growing evidence suggests that piriform cortex resection during anterior temporal lobectomy is important for achieving good seizure outcome in mesial temporal lobe epilepsy (mTLE). However, the relationship between seizure outcome and piriform cortex ablation during MR-guided laser interstitial thermal therapy (MRgLITT) remains unclear.

Objective: To determine whether ablation of piriform cortex was associated with seizure outcome in patients with mTLE undergoing MRgLITT.

Apparent diffusion coefficient of piriform cortex and seizure outcome in mesial temporal lobe epilepsy after MR-guided laser interstitial thermal therapy: a single-institution experience.

Objective: Piriform cortex (PC) is one of the critical structures in the epileptogenesis of mesial temporal lobe epilepsy (mTLE), but its role is poorly understood. The authors examined the utility of apparent diffusion coefficient (ADC; an MR-based marker of tissue pathology) of the PC as a predictor of seizure outcome in patients with mTLE undergoing MR-guided laser interstitial thermal therapy (MRgLITT).

Methods: A total of 33 patients diagnosed with mTLE who underwent MRgLITT at the authors' institution were included in the study.

Advances in monitoring for acute spinal cord injury: a narrative review of current literature.

Spinal cord injury (SCI) is a devastating condition that affects about 17,000 individuals every year in the United States, with approximately 294,000 people living with the ramifications of the initial injury. After the initial primary injury, SCI has a secondary phase during which the spinal cord sustains further injury due to ischemia, excitotoxicity, immune-mediated damage, mitochondrial dysfunction, apoptosis, and oxidative stress. The multifaceted injury progression process requires a sophisticated injury-monitoring technique for an accurate assessment of SCI patients.

Development of a Smart Hospital Assistant: Integrating Artificial Intelligence and a Voice-User Interface for Improved Surgical Outcomes.

Patient safety and efficiency are top priorities in any surgical procedure. One effective way to achieve these objectives is to automate the logistical and routine tasks that occur in the operating suite. Inspired by smart assistant technology already widely used in the consumer sector, we engineered the Smart Hospital Assistant (SHA), a smart, voice-controlled virtual assistant that handles natural speech recognition while executing non-surgical functions to aid any surgery.

Association of intraoperative end-tidal carbon dioxide level with ablation volume during magnetic resonance-guided laser interstitial thermal therapy for mesial temporal lobe epilepsy.

Objective: Maximal safe ablation of target structures during magnetic resonance-guided laser interstitial thermal therapy (MRgLiTT) is critical to achieving good seizure outcome in patients with mesial temporal lobe epilepsy (mTLE). The authors sought to determine whether intraoperative physiological variables are associated with ablation volume during MRgLiTT.

Methods: Patients with mTLE who underwent MRgLiTT at our institution from 2014 to 2019 were retrospectively analyzed.

Phase- targeted stimulation modulates phase-amplitude coupling in the motor cortex of the human brain.

Background: Phase-amplitude coupling (PAC) in which the amplitude of a faster field potential oscillation is coupled to the phase of a slower rhythm, is one of the most well-studied interactions between oscillations at different frequency bands. In a healthy brain, PAC accompanies cognitive functions such as learning and memory, and changes in PAC have been associated with neurological diseases including Parkinson's disease (PD), schizophrenia, obsessive-compulsive disorder, Alzheimer's disease, and epilepsy.

Objective: /Hypothesis: In PD, normalization of PAC in the motor cortex has been reported in the context of effective treatments such as dopamine replacement therapy and deep brain stimulation (DBS), but the possibility of normalizing PAC through intervention at the cortex has not been shown in humans.

Apparent diffusion coefficient is associated with seizure outcome after magnetic resonance-guided laser interstitial thermal therapy for mesial temporal lobe epilepsy.

Background: Magnetic resonance-guided laser interstitial thermal therapy (MRgLiTT) is becoming a first-line surgical therapy for mesial temporal lobe epilepsy (mTLE) due to good seizure control and low complication risk. However, seizure outcomes after MRgLiTT remain highly variable and there is a need to improve patient selection and post-operative prognostication. In this retrospective study, we investigated whether the pre-operative MRI-derived apparent diffusion coefficient (ADC), used as a marker of tissue pathology in the mesial temporal structures could help predict seizure outcome.

Ultrasound in Traumatic Spinal Cord Injury: A Wide-Open Field.

Traumatic spinal cord injury (SCI) is a common and devastating condition. In the absence of effective validated therapies, there is an urgent need for novel methods to achieve injury stabilization, regeneration, and functional restoration in SCI patients. Ultrasound is a versatile platform technology that can provide a foundation for viable diagnostic and therapeutic interventions in SCI.

Opioid use and spinal cord stimulation therapy: The long game.

Spinal cord stimulation (SCS) has been considered as an alternative therapy to reduce opioid requirements in certain chronic pain disorders. However, information on long-term opioid consumption patterns and their impact on SCS device explantation is lacking. We conducted a retrospective study of 45 patients to characterize long-term patterns of opioid usage after SCS implantation.

Total Fasting and Dehydration in the Operating Room: How Can Surgeons Survive and Thrive?

Objectives: Hydration and nutrition are critical to achieving optimal performance. This study aimed to assess the impact of limited oral intake in the operating room environment on surgical resident health, well-being, and performance.

Design: Electronic survey was sent to 94 surgical trainees at our institution in 2020.

Surfactant Impact on Interfacial Protein Aggregation and Utilization of Surface Tension to Predict Surfactant Requirements for Biological Formulations.

Biological drug products are formulated with excipients to maintain stability over the shelf life of the product. Surfactants are added to the drug product to stabilize air-water interfaces known to induce protein aggregation. Early formulation development is focused on maintaining protein conformation and colloidal stability over the course of the drug product shelf life but rarely considers stability through dose preparation and administration.

Spinal cord stimulation and psychotropic medication use: Missing piece to the puzzle?

Psychotropic medications have modulatory effects on spinal cord stimulator (SCS) therapy and may play an important role in determining treatment success in chronic pain management. However, it remains unknown how SCS affects psychotropic use and whether the medications affect outcome. We performed a retrospective study to determine the prevalence of psychotropic medication (i.

Olfactory Testing in Temporal Lobe Epilepsy: a Systematic Review.

Purpose Of Review: Olfactory testing is a potentially safe, cost-effective, bedside evaluation tool for diagnosis, monitoring, and risk assessment for surgery in temporal lobe epilepsy (TLE) patients, but testing methods and relevant olfactory domains are not standardized. We conducted a systematic review to evaluate olfactory tests in TLE and summarize the results of the literature.

Recent Findings: Olfactory tests varied significantly in odorant administration tools and devices, target odorants, evaluation timing, and grading scales.

Perspective: Phase Amplitude Coupling-Based Phase-Dependent Neuromodulation in Parkinson's Disease.

Deep brain stimulation (DBS) is an effective surgical therapy for Parkinson's disease (PD). However, limitations of the DBS systems have led to great interest in adaptive neuromodulation systems that can dynamically adjust stimulation parameters to meet concurrent therapeutic demand. Constant high-frequency motor cortex stimulation has not been remarkably efficacious, which has led to greater focus on modulation of subcortical targets.

Quantification of Parkinson's Disease Motor Symptoms: A Wireless Motion Sensing Approach.

Parkinson's Disease (PD) is a neurodegenerative disease characterized by its hallmark motor symptoms of bradykinesia and tremor. Numerous studies have suggested novel quantification methods of its symptoms. However, there lacks the means to accurately assess improvements in an intraoperative setting during deep brain stimulation (DBS) electrode implantation.