RNA-programmable cell type monitoring and manipulation in the human cortex with CellREADR.

Reliable and systematic experimental access to diverse cell types is necessary for understanding the neural circuit organization, function, and pathophysiology of the human brain. Methods for targeting human neural populations are scarce and currently center around identifying and engineering transcriptional enhancers and viral capsids. Here we demonstrate the utility of CellREADR, a programmable RNA sensor-effector technology that couples cellular RNA sensing to effector protein translation, for accessing, monitoring, and manipulating specific neuron types in human cortical tissues.

Augmented reality for epilepsy surgery: Examining usability and efficacy in presurgical planning.

Objective: The aim of this paper was to visualize 3-dimensional (3-D) brain and electrode placement data for epilepsy surgery within an augmented reality (AR) environment using a wearable headset, with the ultimate goal of enhancing presurgical planning for epilepsy surgery and understanding the efficiency and utility of such a program in a clinical setting. The evaluation process for surgical intervention in epilepsy cases involves a series of extensive tests, including EEG, MRI, PET, SPECT, and fMRI. A second phase of assessment incorporates the placement of depth electrodes within the brain to record seizure activity.

Revisiting the Endoscopic Third Ventriculostomy Success Score using machine learning: can we do better?

Objective: The Endoscopic Third Ventriculostomy Success Score (ETVSS) is a useful decision-making heuristic when considering the probability of surgical success, defined traditionally as no repeat cerebrospinal fluid diversion surgery needed within 6 months. Nonetheless, the performance of the logistic regression (LR) model in the original 2009 study was modest, with an area under the receiver operating characteristic curve (AUROC) of 0.68.

Multiparameter quantitative analyses of diagnostic cells in brain tissues from tuberous sclerosis complex.

The advent of high-dimensional imaging offers new opportunities to molecularly characterize diagnostic cells in disorders that have previously relied on histopathological definitions. One example case is found in tuberous sclerosis complex (TSC), a developmental disorder characterized by systemic growth of benign tumors. Within resected brain tissues from patients with TSC, detection of abnormally enlarged balloon cells (BCs) is pathognomonic for this disorder.

A Novel Technique for Intraoperative Mapping of the Somatosensory Cortex.

Objective: Intraoperative mapping of the nervous system is used to identify "eloquent" cortical areas. In this technical report, we describe a novel way of mapping the somatosensory cortex so that injury to those critical pathways can be avoided.

Methods: An 8-year-old female with drug resistant epilepsy presented for resection of a right posterior parietal focal cortical dysplasia.

A feasibility study of several 3D printing methods for applications in epilepsy surgery.

Objective: To describe the process of three-dimensional printing in epilepsy surgery using three different methods: low-force stereolithography (SLA), filament deposition modeling (FDM), and Polyjet Stratasys, while comparing them in terms of printing efficiency, cost, and clinical utility. MRI and CT images of patient anatomy have been limited to review in the two-dimensional plane, which provides only partial representation of intricate intracranial structures. There has been growing interest in 3D printing of physical models of this complex anatomy to be used as an educational tool and for surgical visualization.

Flexible, high-resolution cortical arrays with large coverage capture microscale high-frequency oscillations in patients with epilepsy.

Objective: Effective surgical treatment of drug-resistant epilepsy depends on accurate localization of the epileptogenic zone (EZ). High-frequency oscillations (HFOs) are potential biomarkers of the EZ. Previous research has shown that HFOs often occur within submillimeter areas of brain tissue and that the coarse spatial sampling of clinical intracranial electrode arrays may limit the accurate capture of HFO activity.

Predictors of Blood Transfusion for Endoscopic Assisted Craniosynostosis Surgery.

Blood loss is a main cause of morbidity after craniofacial procedures. The purpose of this study is to identify the incidence and predictors for transfusion of blood products in the endoscopic assisted strip craniectomy population. Data was prospectively collected from a single-center multi-surgeon cohort of 78 consecutive patients who underwent endoscopic assisted strip craniectomy for craniosynostosis between July 2013 and December 2020.

Antibacterial prophylaxis for gram-positive and gram-negative infections in cranial surgery: A meta-analysis.

Background: Perioperative antibiotic prophylaxis against gram positive and gram negative infections is considered standard of care in the perioperative management of patients undergoing cranial surgery. The antibiotic regimen which best reduces the risk of surgical site infections (SSIs) remains controversial.

Objectives: A systematic literature review and meta-analysis were conducted to examine the effect of various prophylactic antibiotics on infection incidence among patients undergoing cranial surgeries.

The Efficacy of Antibacterial Prophylaxis Against the Development of Meningitis After Craniotomy: A Meta-Analysis.

Objective: Prophylactic antibiotics are widely used before craniotomy to prevent postoperative infections. A systematic review and meta-analysis was conducted to examine the effect of prophylactic antibiotics on meningitis after craniotomy.

Methods: PubMed, EMBASE, and Cochrane databases were searched through October 2014 for randomized controlled trials that evaluated the effect of prophylactic antibiotics on meningitis after craniotomy.

Effect of Hospital Safety-Net Burden on Cost and Outcomes After Surgery.

Importance: Safety-net hospitals provide broad services for a vulnerable population of patients and are financially at risk owing to impending reimbursement penalties and policy changes.

Objective: To determine the effect of patient and hospital factors on surgical outcomes and cost at safety-net hospitals.

Design, Setting, And Participants: Hospitals in the University HealthSystem Consortium database from January 1, 2009, through December 31, 2012 (n =  31), were grouped according to their safety-net burden, defined as the proportion of Medicaid and uninsured patient charges for all hospitalizations during that time (n = 12,638,166).

MALDI mass spectrometry imaging analysis of pituitary adenomas for near-real-time tumor delineation.

We present a proof of concept study designed to support the clinical development of mass spectrometry imaging (MSI) for the detection of pituitary tumors during surgery. We analyzed by matrix-assisted laser desorption/ionization (MALDI) MSI six nonpathological (NP) human pituitary glands and 45 hormone secreting and nonsecreting (NS) human pituitary adenomas. We show that the distribution of pituitary hormones such as prolactin (PRL), growth hormone (GH), adrenocorticotropic hormone (ACTH), and thyroid stimulating hormone (TSH) in both normal and tumor tissues can be assessed by using this approach.

Intraoperative mass spectrometry mapping of an onco-metabolite to guide brain tumor surgery.

For many intraoperative decisions surgeons depend on frozen section pathology, a technique developed over 150 y ago. Technical innovations that permit rapid molecular characterization of tissue samples at the time of surgery are needed. Here, using desorption electrospray ionization (DESI) MS, we rapidly detect the tumor metabolite 2-hydroxyglutarate (2-HG) from tissue sections of surgically resected gliomas, under ambient conditions and without complex or time-consuming preparation.

Cerebral melioidosis for the first time in the western hemisphere.

This report is the first published case of cerebral melioidosis in the western hemisphere. In this paper the authors review the literature on neurological melioidosis and its presentation and treatment in endemic areas, describe the clinical course of this unique case of a presentation of the disease with cranial abscess in the US, review the pathological and radiological findings associated with this seminal case, and put forth recommendations for recognizing and treating possible future instances of the disease within the western hemisphere.

Symptoms of anxiety and depression in childhood absence epilepsy.

Childhood absence epilepsy (CAE) has been recently linked to a number of cognitive, behavioral, and emotional disorders. Identification of affective disorders (anxiety and depression) presents unique challenges in pediatric populations, and successful early intervention may significantly improve long-term developmental outcomes. The current study examined the specific anxiety and depression symptoms children with CAE experience, and explored the role of disease factors in the severity of their presentation.

Impaired attention and network connectivity in childhood absence epilepsy.

Patients with childhood absence epilepsy (CAE) often demonstrate impaired interictal attention, even with control of their seizures. No previous study has investigated the brain networks involved in this impairment. We used the continuous performance task (CPT) of attentional vigilance and the repetitive tapping task (RTT), a control motor task, to examine interictal attention in 26 children with CAE and 22 matched healthy controls.

Differentiation of attention-related problems in childhood absence epilepsy.

The current study examined the specific types of attention-related problems children with childhood absence epilepsy (CAE) experience and the role of disease factors in the development of attention-related problems. Thirty-eight subjects with CAE and 46 healthy controls, aged 6 to 16, participated in the study. The Behavior Assessment System for Children (BASC) was completed by parents, and the Attention Problems and Hyperactivity subscales were used to characterize the problems of children with CAE.

Simultaneous EEG, fMRI, and behavior in typical childhood absence seizures.

Purpose: Absence seizures cause transient impairment of consciousness. Typical absence seizures occur in children, and are accompanied by 3-4-Hz spike-wave discharges (SWDs) on electroencephalography (EEG). Prior EEG-functional magnetic resonance imaging (fMRI) studies of SWDs have shown a network of cortical and subcortical changes during these electrical events.

Dynamic time course of typical childhood absence seizures: EEG, behavior, and functional magnetic resonance imaging.

Absence seizures are 5-10 s episodes of impaired consciousness accompanied by 3-4 Hz generalized spike-and-wave discharge on electroencephalography (EEG). The time course of functional magnetic resonance imaging (fMRI) changes in absence seizures in relation to EEG and behavior is not known. We acquired simultaneous EEG-fMRI in 88 typical childhood absence seizures from nine pediatric patients.

Early treatment suppresses the development of spike-wave epilepsy in a rat model.

Purpose: Current treatments for epilepsy may control seizures, but have no known effects on the underlying disease. We sought to determine whether early treatment in a model of genetic epilepsy would reduce the severity of the epilepsy phenotype in adulthood.

Methods: We used Wistar albino Glaxo rats of Rijswijk (WAG/Rij) rats, an established model of human absence epilepsy.