Whole Brain Atlas: This Online Whole Brain Atlas is a Treat for Advanced Clinicians and Researchers

Brain Structure and Anatomy:- 

The whole brain atlas created or compiled by two Harvard MDs Keith and Alex is a great collection of various brain areas or for that matter all levels and depths of whole brain.

From Whole Brain Atlas

Their digital work took me back to my graduate days, where at numerous occasions made cumbersome brain sections, whole brain sections, meticulous works through whole night or some time it ran through days of non stop brain sectioning, those were either fresh or fixed brains. What you will experience here on their collection is advanced imaging graphic presentation. Nevertheless the experience is reminiscent of my days in the research lab looking at Cross/Sagital or sections of brain as well as other planes through the entire brain.

The Whole Brain Atlas

Here are couple of Scnshots from their site:

Their work and data is a must visit for advanced Neurophysiologists, Radiologists and all the spine, neck and brain surgeons, besides medical students planning to specialize in Brain and Spine. Here is the Link:Website/Url. 

This digital wealth of information of whole brain structure and anatomy is a comprehensive work using various imaging such as MRI, CT and SPECT besides other anatomical tracing techniques put together to reveal the entire brain, along with images there are also videos such as video of the "Circle of Willis" and various vascular structures supplying brain areas, as I traveled through their site, it was like feasting euphorically!.

As you browse through the contents, there is so much to add besides whole brain atlas, the images revealing abnormal brain areas in various neurodegenerative/neurological disease is something clinicians can benefit a lot.
More updates after I review the whole site.....!!

Epilepsy: Drug Resistent Focal Epilepsy & Surgical Resection treatments, two Epilepsia Reports

Brain and Spine, 2014 Research Reports:

Fig from-Link: Human Epilepsy Patterns, focal epilepsy,

The following two new research reports published in Epilepsia journal [quoted Epilepsy current]might be of interest to those Epilepsy doctors and professionals, ofcourse to Neurophysiologists and long term intraoperative monitoring field.

Quoted: Current Literature In Clinical Science
Are HFOs Still UFOs? The Known and Unknown About High Frequency Oscillations in Epilepsy Surgery

High-Frequency Oscillations, Extent of Surgical Resection, and Surgical Outcome in Drug-Resistant Focal Epilepsy.

Haegelen C, Perucca P, Chatillon CE, Andrade-Valenca L, Zelmann R, Jacobs J, Collins DL, Dubeau F, Olivier A, Gotman J.

Epilepsia 2013;54:848–857.

PURPOSE: Removal of areas generating high-frequency oscillations (HFOs) recorded from the intracerebral electroencephalography
(iEEG) of patients with medically intractable epilepsy has been found to be correlated with improved surgical outcome. However, whether differences exist according to the type of epilepsy is largely unknown. We performed a comparative assessment of the impact of removing HFO-generating tissue on surgical outcome between temporal lobe epilepsy (TLE) and extratemporal lobe epilepsy (ETLE). We also assessed the relationship between the extent of surgical resectionand surgical outcome.

Read the full abstract at: http://www.aesnet.org/files/dmfile/epcu_13.6_273_ClinicalCommentary_Jobst.pdf#!
And the Full article at Epilesia journal.

Ripple Classification Helps to Localize the Seizure-Onset Zone in Neocortical Epilepsy.

Wang S, Wang IZ, Bulacio JC, Mosher JC, Gonzalez-Martinez J, Alexopoulos AV, Najm IM, So NK.

 Epilepsia 2013;54:370–376.

PURPOSE: Fast ripples are reported to be highly localizing to the epileptogenic or seizure-onset zone (SOZ) but may not be readily found in neocortical epilepsy, whereas ripples are insufficiently localizing. Herein we classified interictal neocortical ripples by associated characteristics to identify a subtype that may help to localize the SOZ in neocortical epilepsy. We hypothesize that ripples associated with an interictal epileptiform discharge (IED) are more pathologic,since the IED is not a normal physiologic event.

For full abstract and article, refer as the previous.

Review of Neuromonitoring field 32 Years Ago?.

The utilization and importance of Neuromonitoring in hospital or intensive care set up was reviewed elaborately 32 years ago during 1985. Did anything change or how much change has took place in this field is quite interesting, while basic principles and intraoperative modalities discussed remain pretty much same today as 32 years ago, IONM field did make lots of progress ever since, better tests, analysis and interpretation of results got savvy and reliable upto 96-99% accuracy than it was during1985. Advancements in terms of application in various surgical procedure and combinatorial tests to yield better results, some newer techniques, and the entire hardware/machine technology certainly been upgraded to fit the Operating Room environment.

W.Hacks, the author of this review from the then FRG (West Germany, no longer the case after 90s unified Germany) made a remarkable attempt to provide insights 32 years ago. The review has been published in "Journal of Neurology (interestingly, the very first issue of this journal was published way back in the year 1891 that continued till today with the same name Journal of Neurology Volume 1 / 1891 - Volume 259 / 2012), quite an respectable journal in the field of neurology, it is still exist with the same name with a significant impact factor score of 3.85, ranked 33 among 185 clinical neurology journals [The top five Neurology journals are rated as follows:  (Neurology, Brain, Annals of Neurology, Journal of Neurotrauma, and Stroke, for an interesting review of these top journals, click here LINK).

Here is the link to the partial or one page review available at the bottom of this abstract, it is a pay per view article, only one page is viewable for non subscribers.

Abstract

Neuromonitoring—the continuous or intermittent observation of nervous system functions—has become a field of interdisciplinary interest. Basically there are two major applications of neuromonitoring: in the operating theatre and the neurological or neurosurgical intensive care unit. Evoked potential recording, intracranial pressure measurement, serial EEG recording, cerebral blood flow measurement and ultrasound techniques have all been used as monitoring methods. The application of these techniques for operations, intensive care and the evaluation of brain death will be described.

Key words  Neuromonitoring - Intraoperative monitoring - Evoked potential monitoring - Spinal cord monitoring - Brain death

http://resources.metapress.com/pdf-preview.axd?code=kpj1622557hv431x&size=largest

IBIA-Brain Injury Conference?

 

NEWS

An Invitation to Washington D.C. As Chairperson and President of the IBIA 8th World Congress on Brain Injury to be held March 10 - 14, 2010 in Washington, D.C., USA, we would like to invite the participation of all professionals involved with serving persons with acquired brain injury to this international Congress and meeting of minds. We are very excited about having the meeting in the United States and in particular, its capital, Washington, D.C.  This is the first time in our history that a World Congress has been held in the USA.  Washington, D.C. is a culturally diverse city with many fine hotels, restaurants, museums, culture events and historical landmarks.  The meeting is expected to be the largest IBIA meeting in our history and in many ways the most exciting.  We hope that you will join us for this unprecedented event.

Regeneration: Sensory vs Motor nerves?

Comparison of the fastest regenerating motor and sensory myelinated axons in the same peripheral nerve
Mihai Moldovan1, Jesper Sørensen1,2 and Christian Krarup1,

Brain 2006 129(9):2471-2483; doi:10.1093/brain/awl184

Functional outcome after peripheral nerve regeneration is often poor, particularly involving nerve injuries far from their targets. Comparison of sensory and motor axon regeneration before target reinnervation is not possible in the clinical setting, and previous experimental studies addressing the question of differences in growth rates of different nerve fibre populations led to conflicting results. We developed an animal model to compare growth and maturation of the fastest growing sensory and motor fibres within the same mixed nerve after Wallerian degeneration. Regeneration of cat tibial nerve after crush (n = 13) and section (n = 7) was monitored for up to 140 days, using implanted cuff electrodes placed around the sciatic and tibial nerves and wire electrodes at plantar muscles. To distinguish between sensory and motor fibres, recordings were carried out from L6–S2 spinal roots using cuff electrodes. The timing of laminectomy was based on the presence of regenerating fibres along the nerve within the tibial cuff. Stimulation of unlesioned tibial nerves (n = 6) evoked the largest motor response in S1 ventral root and the largest sensory response in L7 dorsal root. Growth rates were compared by mapping the regenerating nerve fibres within the tibial nerve cuff to all ventral or dorsal roots and, regardless of the lesion type, the fastest growth was similar in sensory and motor fibres.

Research & Case Studies using Neuromonitoring!

Years: 2005-2007
Neuromonitoring in Infants:
Motor Evoked Potentials After Transcranial Magnetic Stimulation Support Hypothesis of Coexisting Central Mechanism in Obstetric Brachial Palsy.
Abstract:
Six infants with obstetric brachial palsy, ranging from 4 to 7 months of age, were investigated. One was suspected of having extensive brachial plexus lesions and five were suspected of having a unilateral lesion of both roots C5 and C6. All were referred to our center to investigate the possibility for reconstructive surgery. In all infants, even at this age, transcranial magnetic stimulation resulted in motor evoked potentials (MEP) in the biceps (in one, in the brachioradial) muscles. Averaging could not be done because of the intraindividual variation in latency. The MEP was easier to recognize if evoked when the infant had the arm bent. In all five infants suspected of upper brachial plexus lesion with avulsion of both roots C5 and C6 and/or complete rupture of the upper trunk, proven in four, an MEP on the lesioned side could be evoked. Combined with earlier investigations showing (almost) normal EMG and somatosensory evoked potentials in infants with upper plexus lesion, this leads us to the conclusion that the paralysis of these infants cannot only be attributed to the peripheral axonal damage alone but that central plasticity must also play an important role. As this is a slow process, some infants might not yet be able to use the paralytic muscles. Some theoretic issues are discussed.

Neuromonitoring in Young Child:
Improvement of Motor-Evoked Potentials by Ketamine and Spatial Facilitation During Spinal Surgery in a Young Child.
Anesth Analg 2005;100:1634-1636© 2005
International Anesthesia Research Society
Monitoring motor evoked potentials is desirable during spine surgery but may be difficult to obtain in small children. In addition, the recording of reliable signals is often hampered by the presence of various anesthetics. We report the case of a young child whose motor evoked potentials were successfully monitored using a ketamine-based anesthesia and a newly introduced stimulation technique consisting of combined spatial and temporal facilitation.






Journal of Clinical Neurophysiology.
24(1):48-51,
February 2007. Colon, A J. *; Vredeveld, J W. *+; Blaauw, G ++

Is MEP monitoring is superior to SSEP in detecting nerve damages?

Our data again confirm that MEP monitoring is superior to SSEP monitoring in detecting impending impairment of the functional integrity of cerebral and spinal cord motor pathways
during surgery. Detection of MEP changes and adjustment of the surgical strategy might allow to prevent irreversible pyramidal tract damage. Stable SSEP/MEP recordings reassure the surgeon that motor function is still intact and surgery can be continued safely. The combined SSEP/ MEP monitoring becomes advantageous, if one modality is not recordable.

Neurosurgical Review
Springer Berlin, Volume 30, Number 2 / April, 2007
M. R. Weinzierl, Email: Martin.Weinzierl@ukaachen.de

Posterior thoracic segmental pedicle screw instrumentation: Evolving methods of safe and effective placement
Intraoperative neuromonitoringIntraoperative neuromonitoring (IONM) has become an integral part of complex spine surgery. The primary objective of IONM is to provide the surgeon with early warning of a potential neurological event. IONM, in the form of somatosensory-evoked potentials (SSEP's), initially gained popularity with deformity surgeons who routinely relied on the Stagnara wake up test to monitor neurologic integrity. Monitoring techniques have become much more sophisticated since their inception affording a higher level of protection to the patient. At present, many centers employ SSEP's, motor-evoked potentials (MEP's), and spontaneous and triggered EMG responses during complex thoracic pedicle screw instrumentation procedures.

Neurology India
Year : 2005 Volume : 53 Issue : 4 Page : 458-465
Philadelphia, 19107 USA
zeiller@comcast.net

Years 2000-2005

Intraoperative Neuromonitoring.
Article Neurologist. 8(4):209-226, July 2002.
Minahan, Robert E. MD
Abstract:
BACKGROUND-: Intraoperative neuromonitoring (IONM) has been a valuable part of surgical procedures for over 25 years. Insight into the nervous system during surgery provides critical information to the surgeon allowing reversal or avoidance of neural insults.

REVIEW SUMMARY-: Electrophysiological tests including electroencephalography, electromyography, and multiple types of evoked potentials (somatosensory, auditory, and motor) are monitored during surgeries that involve risk to the nervous system. Deterioration of signals suggests a surgical insult and is associated with an increased risk of postoperative deficit. Intraoperative identification of this risk allows corrective action. In addition, IONM teams make use of their armamentarium of tests to evaluate anatomy or function of the nervous system in response to specific questions posed by the surgical team.

CONCLUSIONS-: Intraoperative recordings are now a routine part of many surgical procedures. Their correct application leads to improved surgical outcome.
(C) 2002 Lippincott Williams & Wilkins, Inc.



Years 1990- 2000


Years 1980-1990


Years 1970-1980



The Inception of Neuromonitoring: 1960
[1960-1970]