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Background: Subdural electrode (SDE) implantation is an important method of diagnosing epileptogenic lesions and mapping brain function, even with the current preference for stereoelectroencephalography. We developed a novel method to assess SDEs and the brain surface during the electrode implantation procedure using brain images printed onto permeable films and intraoperative fluoroscopy. This method can help verify the location of the electrode during surgery and improve the accuracy of SDE implantation. Methods: We performed preoperative imaging by magnetic resonance imaging and computed tomography. Subsequently, the images were edited and fused to visualize the gyrus and sulcus better. We printed the images on permeable films and superimposed them on the intraoperative fluoroscopy display. The intraoperative and postoperative coordinates of the electrodes were obtained after the implantation surgery, and the differences in the locations were calculated. Results: Permeable films were created for a total of eight patients with intractable epilepsy. The median difference of the electrodes between the intraoperative and postoperative images was 4.6 mm (Interquartile range 2.9-7.1). The locations of electrodes implanted outside the operation field were not significantly different from those implanted inside. Conclusion: Our new method may guide the implantation of SDEs into their planned location.

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Targeted muscle reinnervation has been proposed for reconstruction of neuromuscular function in amputees. However, it is unknown whether performing delayed targeted muscle reinnervation after nerve injury will affect restoration of function. In this rat nerve injury study, the median and musculocutaneous nerves of the forelimb were transected. The proximal median nerve stump was sutured to the distal musculocutaneous nerve stump immediately and 2 and 4 weeks after surgery to reinnervate the biceps brachii. After targeted muscle reinnervation, intramuscular myoelectric signals from the biceps brachii were recorded. Signal amplitude gradually increased with time. Biceps brachii myoelectric signals and muscle fiber morphology and grooming behavior did not significantly differ among rats subjected to delayed target muscle innervation for different periods. Targeted muscle reinnervation delayed for 4 weeks can acquire the same nerve function restoration effect as that of immediate reinnervation.

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OBJECTIVEThe accuracy of stereoelectroencephalography (SEEG) electrode implantation is an important factor in maximizing its safety. The authors established a quality assurance (QA) process to aid advances in implantation accuracy.METHODSThe accuracy of three consecutive modifications of a frameless implantation technique was quantified in three cohorts comprising 22, 8, and 23 consecutive patients. The modifications of the technique aimed to increase accuracy of the bolt placement.RESULTSThe lateral shift of the axis of the implanted bolt at the level of the planned entry point was reduced from a mean of 3.0 ± 1.6 mm to 1.4 ± 0.8 mm. The lateral shift of the axis of the implanted bolt at the level of the planned target point was reduced from a mean of 3.8 ± 2.5 mm to 1.6 ± 0.9 mm.CONCLUSIONSThis QA framework helped to isolate and quantify the factors introducing inaccuracy in SEEG implantation, and to monitor ongoing accuracy and the effect of technique modifications.

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The development of chronically implanted electrodes attracts much attention since these electrodes are much favorable for monitoring changes of neurotransmitters in brain science. The research in this field focused mainly on chemical modification to improve the potential stability and less on the biocompatibility. In this work, for the first time, we proposed the concept of cell-membrane electrodes based on a basic hypothesis using animal's self-cell membrane to reduce animal exclusiveness (hyperacute rejection and chronic rejection). As a proof of concept, we first studied cell-membrane reference electrodes for chronically implanted electrodes. Red cell membrane (RCM) was extracted from rat blood and coated on the chemically modified Ag/AgCl electrodes. It was found that ionic liquid (IL) 1-butyl-2,3-dimethylimidazolium hexafluorophosphate (BDMI) showed good performance rather than Nafion used as coating film for protection of silver chloride on Ag wire and support of the cell membrane. Electrochemical impedance spectra supported that charge-transfer resistance nearly kept constant before and after the electrodes were implanted into the rat's brain tissues for 28 days. Immunohistochemical analysis of the implant sites in the rat's brain tissues indicated that the extent of glial scarring arising from the Ag/AgCl/BDMI/RCM electrodes was smaller than that of both Ag/AgCl/Nafion and Ag/AgCl/Nafion/RCM electrodes after 28 days of implantation. The RCM-coated Ag/AgCl/IL electrodes showed a relatively potential stability compared to RCM-noncoated Ag/AgCl/IL electrodes after 28 days of implantation. Additionally, the current-voltage curve demonstrated that the RCM-coated electrodes can be used as polarized electrodes. This work demonstrated that the RCM, which was coated on the Ag/AgCl/IL electrodes, can significantly improve the biocompatibility and potential stability of the RCM-noncoated Ag/AgCl/IL electrodes implanted in the rat brain. The cell-membrane-coated electrodes will serve as a lighthouse in guiding the design of chronically implanted electrodes for in vivo electrochemical detection.

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Electrical stimulation could enhance nerve regeneration and functional recovery. The objective of this study was to evaluate the regenerative effects of implanted electrodes with different contacts in resected sciatic nerve. Sciatic nerve resection and microsurgical repair models were established and randomly divided into four groups (point contact, 1/4 circle contact; whole-circle contact; no electrodes as control). Electrical stimulation was performed and electrophysiological, morphological and histological exams (of the sciatic nerve and muscle) were conducted at 4 and 10 weeks post-implantation. Point and 1/4 circle contact groups showed significantly higher scores in the sciatic functional index (SFI), increased amplitude of compound muscle action potential (AMP) and motor nerve conduction velocity (MNCV) compared to the control group at both 4 and 10 weeks post-implantation. Point and 1/4 circle contact morphologically promoted sciatic nerve regeneration and reduced muscular atrophy with less mechanical injury to the nerve trunk observed compared with the whole-circle contact group at both 4 and 10 weeks post-implantation. Electrodes with point and 1/4 circle contacts represented an alternatively portable and effective method of electrical stimulation to facilitate injured sciatic nerve regeneration and reduce subsequent muscular atrophy, which might offer a promising approach for treating peripheral nerve injuries.

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In this paper various types of electrodes for stimulation and recording activity of peripheral nerves for the control of neuroprosthetic limbs are reviewed. First, an overview of interface devices for (feedback-) controlled movement of a prosthetic device is given, after which the focus is on peripheral nervous system (PNS) electrodes. Important electrode properties, i.e., longevity and spatial resolution, are defined based upon the usability for neuroprostheses. The cuff electrode, longitudinal intrafascicular electrodes (LIFE), transverse intrafascicular multichannel electrode (TIME), Utah slanted electrode array (USEA), and the regenerative electrode are discussed and assessed on their longevity and spatial resolution. The cuff electrode seems to be a promising electrode for the control of neuroprostheses in the near future, because it shows the best longevity and good spatial resolution and it has been used on human subjects in multiple studies. The other electrodes may be promising in the future, but further research on their longevity and spatial resolution is needed. A more quantitatively uniform study protocol used for all electrodes would allow for a proper comparison of recording and stimulation performance. For example, the discussed electrodes could be compared in a large in vivo study, using one uniform comparison protocol.

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OBJECTIVE: To assess the usefulness of cone beam computed tomography (CBCT) for characterizing electrode insertion and evaluate the influence of electrode insertion status on post-cochlear implantation (CI) outcomes. DESIGN: Twenty-six ears with post-CI CBCT scans were included. The devices were MED-EL Flex28 (n = 21) and Nucleus slim straight (n = 5). The parameters including cochlear duct length (CDL), insertion depth angle (IDA), insertion length of electrode (IL), and cochlear coverage (CC) were analyzed and compared with aided pure-tone threshold (PTA) with implant in free field, and open-set sentence score. RESULTS: The mean CDL was 36.8 ± 1.4 mm. Electrode array was dislocated into scala tympani in two ears. The mean IL and IDA were 26.5 ± 1.9 mm and 541.4 ± 70.2°. The mean linear CC (IL/CDL, 0.73 ± 0.06) was larger than the mean angular CC (IDA/900, 0.60 ± 0.08). The CBCT parameters showed correlation one another. While the aided pure-tone threshold was correlated with IL and IDA, there were no significant correlations in the open-set sentence score. For the postlingually deaf patients with single electrode (Flex 28), the sentence score had no significant correlation and the aided PTA was positively correlated with IL (R = 0.517, p = .028). CONCLUSIONS: This study validated the CBCT evaluating the electrode array position. The CBCT could be helpful for the preoperative selection of the optimal array and prediction of the CC.

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OBJECTIVE: To evaluate infective complications with intracranial electroencephalography (EEG) recording so as to lessen them. METHODS: A database of intracranial monitoring cases with subdural electrodes at Kyoto University Hospital between May 1992 and March 2012 was retrospectively reviewed. RESULTS: This analysis included 46 EEG monitoring sessions. Infective complications related to intracranial electrodes occurred in 4 monitoring sessions (8.7%; 3 male patients). Causative agents were identified as Staphylococcus aureus in 3 monitoring sessions and Staphylococcus epidermidis in 1 session. In univariate analysis, the season of monitoring was identified as the sole significant risk factor. More infective complications occurred when monitoring occurred in autumn. More infective complications tended to occur in patients who had implantation in the right side or discontinuation of intravenously administered prophylactic antibiotics, although these factors were not statistically significant. Age, sex, duration of monitoring, number of electrodes, and pathologic diagnosis did not seem to be associated with an increased risk of infective complications. Infective complications had no significant influence on seizure outcome. CONCLUSIONS: Invasive EEG monitoring during autumn might be a risk factor in terms of infective complications. S aureus was a common pathogen.

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OBJECTIVE: It is unclear how brain growth with age affects electrode position in relation to target for children undergoing deep brain stimulation surgery. We aimed to model projected change in the distance between the entry point of the electrode into the brain and target during growth to adulthood. METHODS: Modeling was performed using a neurodevelopmental magnetic resonance imaging database of age-specific templates in 6-month increments from 4 to 18 years of age. Coordinates were chosen for a set of entry points into both cerebral hemispheres and target positions within the globus pallidus internus on the youngest magnetic resonance imaging template. The youngest template was nonlinearly registered to the older templates, and the transformations generated by these registrations were applied to the original coordinates of entry and target positions, mapping these positions with increasing age. Euclidean geometry was used to calculate the distance between projected electrode entry and target with increasing age. RESULTS: A projected increase in distance between entry point and target of 5-10 mm was found from age 4 to 18 years. Most change appeared to occur before 7 years of age, after which minimal change in distance was found. CONCLUSIONS: Electrodes inserted during deep brain stimulation surgery are tethered at the point of entry to the skull. Brain growth, which could result in a relative retraction with respect to the original target position, appears to occur before 7 years of age, suggesting careful monitoring is needed for children undergoing implantation before this age. Reengineering of electrode design could avoid reimplantation surgery in young children undergoing deep brain stimulation.

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