Search Results

You are looking at 1 - 10 of 11 items for

  • Author or Editor: Eric Behnke x
  • Refine by Access: all x
Clear All Modify Search
Restricted access

Leonardo Frighetto, Antonio A. F. De Salles, Eric Behnke, Zachary A. Smith, and Dennis Chute

✓ Interactive image-guided neuronavigation was used to obtain biopsy specimens of cavernous sinus (CS) tumors via the foramen ovale. In this study the authors demonstrated a minimally invasive approach in the management of these lesions.

In four patients, whose ages ranged from 29 to 89 years (mean 61.2 years) and who harbored undefined lesions invading the CS, neuronavigation was used to perform frameless stereotactic fine-needle biopsy sampling through the foramen ovale. The biopsy site was confirmed on postoperative computerized tomography scanning.

The frameless technique was accurate in displaying a real-time trajectory of the biopsy needle throughout the procedure. The lesions within the CS were approached precisely and safely. Diagnostic tissue was obtained in all cases and treatment was administered with the aid of stereotactic radiosurgery or fractionated stereotactic radiotherapy. The patients were discharged after an overnight stay with no complications.

Neuronavigation is a precise and useful tool for image-guided biopsy sampling of CS tumors via the foramen ovale.

Restricted access

Alessandra Gorgulho, Antonio A. F. De Salles, Leonardo Frighetto, and Eric Behnke

Object. The goal of this study was to analyze the incidence of intracranial bleeding in patients who underwent procedures guided by microelectrode recording (MER) rather than by macroelectrode stimulation alone.

Methods. Between March 1994 and July 2001, 178 patients underwent 248 functional neurosurgical procedures performed by the same team at the University of California at Los Angeles. The procedures included pallidotomy (122 patients), thalamotomy (19 patients), and implantation of deep brain stimulation electrodes in the subthalamic nucleus (36 patients), globus pallidus internus (17 patients), and ventralis intermedius nucleus (54 patients). One hundred forty-four procedures involved macroelectrode stimulation and 104 involved MER. Groups were analyzed according to the presence of arterial hypertension, MER or macroelectrode stimulation use, and occurrence of hemorrhage. Nineteen patients with arterial hypertension underwent 28 surgical procedures.

Five cases of hemorrhage (2.02%) occurred. One patient presented with hemiparesis and dysphasia but no surgery was required. The incidence of hemorrhage in patients in whom MER was performed was 2.9%, whereas the incidence in patients in whom MER was not used was 1.4% (p = 0.6529). Bleeding occurred in 10.71% of patients with hypertension and 0.91% of those who were nonhypertensive (p = 0.0111). Among the 104 patients in whom MER was performed, 12 had hypertension. Bleeding occurred in two (16.67%) of these 12 patients. An increased incidence of bleeding in hypertensive patients who underwent MER (p = 0.034) was noticed when compared with nonhypertensive patients who underwent MER. A higher number of electrode passes through the parenchyma was observed when MER was used (p = 0.0001). A positive trend between the occurrence of hemorrhage and multiple passes was noticed.

Conclusions. Based on the data the authors suggest that a higher incidence of hemorrhage occurs in hypertensive patients, and a higher incidence as well in hypertensive patients who underwent MER rather than macroeletrode stimulation. Special attention should be given to MER use in hypertensive patients and particular attention should be made to multiple passes.

Restricted access

Arne Ekstrom, Nanthia Suthana, Eric Behnke, B.S.E., Noriko Salamon, Susan Bookheimer, and Itzhak Fried

✓Localization and targeting of depth electrodes in specific regions of the human brain is critical for accurate clinical diagnoses and treatment as well as for neuroscientific electrophysiological research. By using high-resolution magnetic resonance imaging combined with 2D computational unfolding, the authors present a method that improves electrode localization in the medial temporal lobe. This method permits visualization of electrode placements in subregions of the hippocampus and parahippocampal gyrus, allowing for greater specificity in relating electrophysiological and anatomical features in the human medial temporal lobe. Such methods may be extended to therapeutic procedures targeting specific neuronal circuitry in subfields of structures deep in the human brain.

Restricted access

Donald C. Shields, Alessandra Gorgulho, Eric Behnke, Dennis Malkasian, and Antonio A. F. Desalles

Object

Deep brain stimulation of the subthalamic nucleus (STN) in patients with Parkinson disease is often very effective for treatment of debilitating motor symptoms. Nevertheless, the small size of the STN and its proximity to axonal projections results in multiple side effects during high-frequency stimulation. Contralateral eye deviation is produced in a small percentage of patients, but the precise mechanism of this side effect is at present poorly understood.

Methods

Contralateral eye deviation was produced by high-frequency stimulation of 22 contact sites in nine patients undergoing deep brain stimulation of the STN. The precise locations of these contacts were calculated and compiled in order to locate the stimulated structure responsible for eye deviation.

Results

The mean x, y, and z coordinates associated with contralateral eye deviation were found to be 11.57, 2.03, and 3.83 mm lateral, posterior, and inferior to the anterior commissure–posterior commissure midpoint, respectively. The point described by these coordinates is located within the lateral anterosuperior border of the STN.

Conclusions

Given that stimulation of frontal eye field cortical regions produces similar contralateral conjugate eye deviation, these results are best explained by electrical current spread to nearby frontal eye field axons coursing lateral to the STN within the internal capsule. Thus, placement of the implanted electrode in a more medial, posterior, and inferior position may bring resolution of these symptoms by reducing the amount of current spread to internal capsule axons.

Restricted access

Peter M. Intemann, Donna Masterman, Indu Subramanian, Antonio DeSalles, Eric Behnke, Robert Frysinger, and Jeff M. Bronstein

Object. Several investigators have described the motor benefits derived from performing unilateral stereotactic pallidotomy for the treatment of Parkinson disease (PD), but little is known about the efficacy and complication rates of bilateral procedures. The goal of this study was to assess both these factors in 12 patients.

Methods. Eleven patients with medically intractable PD underwent staged bilateral pallidotomy and one patient underwent a simultaneous bilateral procedure. Unilateral pallidotomy resulted in an improvement in the patients' Unified Parkinson Disease Rating Scale (UPDRS) total scores and motor subscores, Hoehn and Yahr stages, and Schwab and England Activities of Daily Living scores. There were no complications. The second procedures were performed 5 to 25 months after the first, and nearly complete 3-month follow-up data are available for eight of these patients. Staged bilateral pallidotomy did result in further improvements in some symptoms, but the patients proved to be less responsive to levodopa. In contrast to outcomes of the initial unilateral pallidotomy, there were significant complications. One patient suffered an acute stroke, two patients suffered delayed infarctions of the internal capsule, four patients had mild-to-moderate worsening of speech and increased drooling, and one patient complained of worsening memory.

Conclusions. Bilateral pallidotomy results in modest benefits but is associated with an increased risk of complications.

Restricted access

Alessandra A. Gorgulho, Donald C. Shields, Dennis Malkasian, Eric Behnke, and Antonio A. F. DeSalles

Object

High-frequency stimulation of the subthalamic nucleus (STN) in patients with parkinsonian symptoms is often used to ameliorate debilitating motor symptoms associated with this condition. However, individual variability in the shape and orientation of this relatively small nucleus results in multiple side effects related to the spread of electrical current to surrounding structures. Specifically, contraction of the muscles of facial expression is noted in a small percentage of patients, although the precise mechanism remains poorly understood.

Methods

Facial muscle contraction was triggered by high-frequency stimulation of 49 contacts in 18 patients undergoing deep brain stimulation of the STN. The mean coordinates of these individual contacts relative to the anterior commissure–posterior commissure midpoint (also called the midcommissural point) were calculated to determine the location or structure(s) most often associated with facial contraction during physiological macrostimulation.

Results

The x, y, and z coordinates associated with contraction of the facial musculature were found to be 11.52, 1.29, and 1.15 mm lateral, posterior, and inferior to the midcommissural point, respectively. This location, along the lateral-anterior-superior border of the STN, may allow for the spread of electrical current to the fields of Forel, zona incerta, and/or descending corticospinal/corticobulbar tracts. Because stimulation of corticobulbar tracts produces similar findings, these results are best explained by the spread of electrical current to nearby internal capsule axons coursing lateral to the STN.

Conclusions

Thus, if intraoperative deep brain stimulation lead testing results in facial musculature contraction, placement of the electrode in a more medial, posterior position may reduce the amount of current spread to corticobulbar fibers and resolve this side effect.

Restricted access

Nader Pouratian, Zhong Zheng, Ausaf A. Bari, Eric Behnke, W. Jeff Elias, and Antonio A. F. DeSalles

Object

Due to the lack of internal anatomical detail with traditional MR imaging, preoperative stereotactic planning for the treatment of tremor usually relies on indirect targeting based on atlas-derived coordinates. The object of this study was to preliminarily investigate the role of probabilistic tractography–based thalamic segmentation for deep brain stimulation (DBS) targeting for the treatment of tremor.

Methods

Six patients undergoing bilateral implantation of DBS electrodes in the thalamus for the treatment of upper-extremity tremor were studied. All patients underwent stereotactic surgical implantation using traditional methods (based on indirect targeting methodologies and intraoperative macrostimulation findings) that were programmed for optimal efficacy, independent of tractography-based segmentations described in this report. Connectivity-based thalamic segmentations were derived by identifying with which of 7 cortical target regions each thalamic voxel had the highest probability of connectivity. The authors retrospectively analyzed the location of the optimal contact for treatment of tremor with connectivity-based thalamic segmentations. Findings from one institution (David Geffen School of Medicine at UCLA) were validated with results from 4 patients at another institution (University of Virginia Health System).

Results

Of 12 electrodes implanted using traditional methodologies, all but one resulted in efficacious tremor control. Connectivity-based thalamic segmentation consistently revealed discrete thalamic regions having unique connectivity patterns with distinct cortical regions. Although the authors initially hypothesized that the most efficacious DBS contact for controlling tremor would colocalize with the thalamic region most highly connected with the primary motor cortex, they instead found it to highly colocalize with those thalamic voxels demonstrating a high probability of connectivity with premotor cortex (center-to-center distance: 0.36 ± 0.55 mm). In contrast to the high degree of colocalization with optimal stimulation site, the precise localization of the premotor cortex–defined thalamic region relative to the anterior and posterior commissures was highly variable. Having defined a connectivity-based target for thalamic stimulation in a cohort of patients at David Geffen School of Medicine at UCLA, the authors validated findings in 4 patients (5 electrodes) who underwent surgery at a different institution (University of Virginia Health System) by a different surgeon.

Conclusions

This report identifies and provides preliminary external validation of a novel means of targeting a patient-specific therapeutic thalamic target for the treatment of tremor based on individualized analysis of thalamic connectivity patterns. This novel thalamic targeting approach is based on identifying the thalamic region with the highest probability of connectivity with premotor and supplementary motor cortices. This approach may prove to be advantageous over traditional preoperative methods of indirect targeting, providing patient-specific targets that could improve the precision, efficacy, and efficiency of deep brain stimulation surgery. Prospective evaluation and development of methodologies to make these analyses more widely available to neurosurgeons are likely warranted.

Restricted access

Goran Laćan, Antonio A. F. De Salles, Alessandra A. Gorgulho, Scott E. Krahl, Leonardo Frighetto, Eric J. Behnke, and William P. Melega

Object

Deep brain stimulation (DBS) has become an effective therapy for an increasing number of brain disorders. Recently demonstrated DBS of the posterior hypothalamus as a safe treatment for chronic intractable cluster headaches has drawn attention to this target, which is involved in the regulation of diverse autonomic functions and feeding behavior through complex integrative mechanisms. In this study, the authors assessed the feasibility of ventromedial hypothalamus (VMH) DBS in freely moving vervet monkeys to modulate food intake as a model for the potential treatment of eating disorders.

Methods

Deep brain stimulation electrodes were bilaterally implanted into the VMH of 2 adult male vervet monkeys by using the stereotactic techniques utilized in DBS in humans. Stimulators were implanted subcutaneously on the upper back, allowing ready access to program stimulation parameters while the animal remained conscious and freely moving. In anesthetized animals, intraoperatively and 6–10 weeks postsurgery, VMH DBS parameters were selected according to minimal cardiovascular and autonomic nervous system responses. Thereafter, conscious animals were subjected to 2 cycles of VMH DBS for periods of 8 and 3 days, and food intake and behavior were monitored. Animals were then killed for histological verification of probe placement.

Results

During VMH DBS, total food consumption increased. The 3-month bilateral implant of electrodes and subsequent periods of high-frequency VMH stimulation did not result in significant adverse behavioral effects.

Conclusions

This is the first study in which techniques of hypothalamic DBS in humans have been applied in freely moving nonhuman primates. Future studies can now be conducted to determine whether VMH DBS can change hypothalamic responsivity to endocrine signals associated with adiposity for long-term modulation of food intake.

Restricted access

Michel F. Lévesque, Jingxi Zhang, Charles L. Wilson, Eric J. Behnke, Ronald M. Harper, Robert B. Lufkin, Jerome Engel Jr., and Paul H. Crandall

✓ A methodology has been developed for stereotactic investigation of limbic epilepsy using an image-analysis system that simultaneously displays different structural and functional images of the brain. The validity and accuracy of this system were established with phantom studies. Surgical planning and electrode implantation are guided by stereotactic magnetic resonance imaging, digital subtraction angiography, and positron emission tomography. This methodology provides the spatiotemporal relationship of cerebral structure and function necessary to identify seizure onset and propagation in human limbic system epilepsy.

Restricted access

Itzhak Fried, Charles L. Wilson, Nigel T. Maidment, Jerome Engel Jr., Eric Behnke, Tony A. Fields, Katherine A. Macdonald, Jack W. Morrow, and Larry Ackerson

✓ Monitoring physiological changes in the brain parenchyma has important applications in the care of neurosurgical patients. A technique is described for measuring extracellular neurochemicals by cerebral microdialysis with simultaneous recording of electroencephalographic (EEG) and single-unit (neuron) activity in selected targets in the human brain. Forty-two patients with medically intractable epilepsy underwent stereotactically guided implantation of a total of 423 intracranial depth electrodes to delineate potentially resectable seizure foci. The electrodes had platinum alloy contacts for EEG recordings and four to nine 40-µm microwires for recording single-unit neuron activity. Eighty-six electrodes also included microdialysis probes introduced via the electrode lumens. During monitoring on the neurosurgical ward, electrophysiological recording and cerebral microdialysis sampling were performed during seizures, cognitive tasks, and sleep—waking cycles. The technique described here could be used in developing novel approaches for evaluation and treatment in a variety of neurological conditions such as head injury, subarachnoid hemorrhage, epilepsy, and movement disorders.