, such as the latest generation of pacemakers and implantable defibrillators, can wirelessly send and receive signals up to a range of 5 m. Wireless communications are a valuable convenience in clinical settings and surgical environments. In the home, these implantable devices can connect to a wireless bedside monitor and provide nonintrusive monitoring while the patient sleeps. Wireless communication capabilities for neural devices are similarly attractive. 19 Some of the neural devices that are being developed in research labs today can already connect wirelessly to
Tamara Denning, Yoky Matsuoka and Tadayoshi Kohno
Mark G. Luciano, Stephen M. Dombrowski, Sara Qvarlander, Serge El-Khoury, Jun Yang, Suraj Thyagaraj and Francis Loth
unprecedented. A previous experimental report by DiRocco et al. described a balloon experimentally placed in the lateral CSF ventricle and timed to expand during systole in an attempt to demonstrate a mechanism of ventricular expansion. 4 , 5 , 23 The present system was developed for more diversity in shape, location, timing, and waveform of volume change, and for the potential alteration of various physiological systems. With different cardiac-gated balloon volume waveforms, the system can augment, reduce, or reverse the normal ICP waveform. In addition, the implantable
Michael F. Barbaro, Kelsi Chesney, Daniel R. Kramer, Spencer Kellis, Terrance Peng, Zack Blumenfeld, Angad S. Gogia, Morgan B. Lee, Janet Greenwood, George Nune, Laura A. Kalayjian, Christianne N. Heck, Charles Y. Liu and Brian Lee
Closed-loop brain-responsive neurostimulation via the RNS System is a treatment option for adults with medically refractory focal epilepsy. Using a novel technique, 2 RNS Systems (2 neurostimulators and 4 leads) were successfully implanted in a single patient with bilateral parietal epileptogenic zones. In patients with multiple epileptogenic zones, this technique allows for additional treatment options. Implantation can be done successfully, without telemetry interference, using proper surgical planning and neurostimulator positioning.
Trajectories for the depth leads were planned using neuronavigation with CT and MR imaging. Stereotactic frames were used for coordinate targeting. Each neurostimulator was positioned with maximal spacing to avoid telemetry interference while minimizing patient discomfort. A separate J-shaped incision was used for each neurostimulator to allow for compartmentalization in case of infection. In order to minimize surgical time and risk of infection, the neurostimulators were implanted in 2 separate surgeries, approximately 3 weeks apart.
The neurostimulators and leads were successfully implanted without adverse surgical outcomes. The patient recovered uneventfully, and the early therapy settings over several months resulted in preliminary decreases in aura and seizure frequency. Stimulation by one of the neurostimulators did not result in stimulation artifacts detected by the contralateral neurostimulator.
Donald L. Erickson
stimulation have been previously employed but have had the shortcoming of being very brief in duration and not therefore, allowing the patient to establish the effectiveness under a variety of activities. 1, 2 We have employed a flexible electrode which can be inserted percutaneously adjacent to the spinal cord or peripheral nerve and left in place for several days during which time the patient uses a stimulating system which closely mimics the implantable device. The patient is therefore able to be fully active during the testing period and is better able to determine
Kristian J. Bulluss, Erlick A. Pereira, Carole Joint and Tipu Z. Aziz
popularization of DBS, surgeon experience and confidence with stereotactic lesion-creating surgery has declined. Infection of the implanted device poses a significant risk in DBS, more so for patients with limited mobility and ability to care for themselves. Furthermore, it is common for the population of patients with implanted DBS systems to survive into the late stages of PD, when implantable pulse generators continue to require replacement long after they have ceased to provide a benefit because of the natural history of the patient's cognitive decline. We propose that
John R. Little
simple implanted device is used to occlude the MCA. Cerebral angiography performed in a group of cats confirmed occlusion when the occluding stylet was inserted. 12 The artery also was shown to reopen promptly when the stylet was withdrawn 3 to 4 hours following occlusion. This has proven to be particularly useful in those animals perfused with fixative and carbon solutions. This model provides an opportunity to study the effects of therapeutic agents without the associated influence of a general anesthetic. Unlike most models of acute focal ischemia, the cranium is
William S. Anderson, Eric H. Kossoff, Gregory K. Bergey and George I. Jallo
both predict the onset of a seizure as well as attempt to stop it, all in a closed-loop format. Efforts toward creating an implantable device have been further spurred by studies of patients in whom subdural strips are in place. These have involved the use of external closed-loop detection and stimulation systems that are connected to the externalized leads of the subdural strips placed close to seizure foci. 16 , 21 , 22 Kossoff and colleagues 16 have described in detail an open multicenter trial of such an external closed-loop system in 27 individuals. In 41
Thomas R. Marotta, Thorsteinn Gunnarsson, Ian Penn, Donald R. Ricci, Ian Mcdougall, Alexei Marko, Gyasi Bourne and Leodante Da Costa
, orientation, and activation of the device are discussed, as are the results of immediate and 30-day posttreatment angiography studies and histopathological analyses. Materials and Methods Device Description and Technology The eCLIPs comprises a partially covered, flexible hybrid implantable device and a balloon catheter delivery system for the endovascular treatment of cerebral aneurysms. The device is laser cut from a piece of 316 stainless steel tubing and can be considered in 2 distinct parts: an independently movable polymer-covered leaf and an anchor ( Fig. 1
Krishna Kumar, Gary Hunter and Denny D. Demeria
surgical fees for implantation, complications related to the implant and its maintenance, and the drug used in the pump. All economically relevant data for both groups were extracted from each patient's flow chart. The costs tabulated in this study were the actual costs based on the year 2000 Canadian dollar. This is applicable to the costs of implantable devices, professional services, hospital admissions, investigations, drugs, and alternative therapies used in this study. This study design was submitted to our Health District Research and Ethics Committee and
Richard B. North, Kim Fowler, Daniel J. Nigrin and Richard Szymanski
paresthesias. Each data point represents paired values for a single stimulus presentation at the maximum amplitude selected by the patient. By linear regression analysis, there is a highly significant (p < 0.000001) and close (R = 0.79) relationship between patient ratings and values calculated by quantitative image analysis. Discussion In over two decades' experience with electrical stimulation of the nervous system, using standard commercially available implantable devices, stimulation has been controlled manually by the patient or physician. Feedback from