Movement-Related Sensorimotor High-Gamma Activity Mainly Represents Somatosensory Feedback.

Somatosensation plays pivotal roles in the everyday motor control of humans. During active movement, there exists a prominent high-gamma (HG >50 Hz) power increase in the primary somatosensory cortex (S1), and this provides an important feature in relation to the decoding of movement in a brain-machine interface (BMI). However, one concern of BMI researchers is the inflation of the decoding performance due to the activation of somatosensory feedback, which is not elicited in patients who have lost their sensorimotor function. In fact, it is unclear as to how much the HG component activated in S1 contributes to the overall sensorimotor HG power during voluntary movement. With regard to other functional roles of HG in S1, recent findings have reported that these HG power levels increase before the onset of actual movement, which implies neural activation for top-down movement preparation or sensorimotor interaction, i.e., an efference copy. These results are promising for BMI applications but remain inconclusive. Here, we found using electrocorticography (ECoG) from eight patients that HG activation in S1 is stronger and more informative than it is in the primary motor cortex (M1) regardless of the type of movement. We also demonstrate by means of electromyography (EMG) that the onset timing of the HG power in S1 is later (49 ms) than that of the actual movement. Interestingly, we show that the HG power fluctuations in S1 are closely related to subtle muscle contractions, even during the pre-movement period. These results suggest the following: (1) movement-related HG activity in S1 strongly affects the overall sensorimotor HG power, and (2) HG activity in S1 during voluntary movement mainly represents cortical neural processing for somatosensory feedback.

Surgical Outcome of Percutaneous Endoscopic Interlaminar Lumbar Discectomy for Highly Migrated Disk Herniation.

STUDY DESIGN: Technical report. OBJECTIVE: To present a detailed surgical technique for percutaneous endoscopic interlaminar discectomy (PEID) for highly migrated disk herniation. SUMMARY OF BACKGROUND DATA: Percutaneous lumbar endoscopic discectomy for highly migrated disk herniation is still challenging even for an experienced surgeon. Because of the risk of failure and technical difficulty, open discectomy is recommended for a high-grade migration. However, past reports focused on the transforaminal approach (percutaneous endoscopic transforaminal discectomy) and may give a biased impression. We may overlook the merit of PEID. The surgical procedure for PEID is similar to a traditional open discectomy and the range of approach could be widened by the inclined introduction and pivoting motion of an endoscope. METHODS: Eighteen consecutive patients (M:F=12:6; age, 56±15 y) with highly migrated disk herniation were enrolled for the present study. The disk material was migrated superiorly in 7 patients (L4-5, 4; L5-S1, 2; L2-3, 1) and inferiorly in 11 patients (L4-5, 6; L3-4, 4; L5-S1, 1). PEID was applied in 17 patients and PETD was performed for L2-3 disk herniation. The follow-up period was 16±12 months. The outcome was graded using the MacNab criteria. RESULTS: Complete removal of the disk material was confirmed with magnetic resonance imaging in 16 patients (success rate 89%). Revision operation was necessary in 2 patients with inferior migration from L4-5. The residual disk was removed through the L5-S1 laminar window 2 days after surgery with excellent outcome at the last follow-up. The outcome at the last follow-up was excellent in 12 patients, good in 3, fair in 2, and poor in 1. Dural tear was suspected in 1 patient without any further problems and there was no recurrence during follow-up. CONCLUSIONS: PEID may be applied comfortably even for less-experienced surgeons because of the familiar anatomy with open surgery.

X-Ray-based Kinematic Analysis of Cervical Spine According to Prosthesis Designs: Analysis of the Mobi C, Bryan, PCM, and Prestige LP.

STUDY DESIGN: A retrospective study. OBJECTIVE: To identify significant kinematic changes in the cervical spine after cervical artificial disk replacement (ADR) using prostheses with diverse designs. SUMMARY OF BACKGROUND DATA: Various types of artificial disks are used for cervical ADR. However, few clinical studies with a follow-up of 2 or more years have reported on the change in the curvatures and range of motion (ROM) of the cervical spine after cervical ADR in relation to different designs. METHODS: The cohort comprised 58 patients who underwent single-level cervical ADR for radiculopathy. The patients were divided into 4 groups according to the device they received: Mobi-C, Bryan, PCM, and Prestige LP. The radiographs of the cervical spine were obtained preoperatively and at 12, 24, and 36 months after surgery. Several kinematic parameters, including lordotic angles and ROM of the cervical spine, index level, and superior and inferior adjacent disk levels, were assessed preoperatively and at predefined follow-up time points. RESULTS: Cervical sagittal lordosis in patients who received Bryan and PCM prostheses increased at the last follow-up period. The 4 patient groups showed a trend toward an increase of lordosis in the superior adjacent segment with time. The patients who received the Bryan device lost their preoperative lordotic angle at the inferior adjacent level. The ROM of the cervical spine in patients who received Bryan and PCM prostheses increased at the last follow-up compared with preoperative values. The incidence of adjacent segment degeneration in the Mobi-C, Bryan, Prestige LP, and PCM groups were 14.2%, 25%, 9.0%, and 7.6%, respectively. CONCLUSIONS: These results suggest preservation of sagittal ROM and increased superior adjacent segment kinematics, regardless of prosthesis design. Devices with an unconstrained design may not be beneficial to adjacent segment kinematics compared with semiconstrained prostheses.

Symmetrically medial bony gutters for open-door laminoplasty.

STUDY DESIGN: Observational cohort study. OBJECTIVE: The authors modified open-door laminoplasty in a manner that creates a bony gutter symmetrically and more medially away from the medial border of the lateral mass. SUMMARY OF BACKGROUND DATA: Cervical laminoplasty is becoming popular, but there was no definite position of bony gutter in performing open-door laminoplasty. METHODS: All of the patients underwent our modified open-door laminoplasty with medial bony gutters. The bony gutter on the open side was made 3 mm medially apart from the medial border of the lateral mass, and an opposite gutter on the hinge side was drilled symmetrically to that on the open side while preserving the ventral cortex. The lamina was kept elevated using titanium miniplates bridging the lamina and facet joint on the open side. On the computed tomography, distance of the bony gutters and the cross-sectional area were measured from C4 to C6. RESULTS: This study included consecutive 61 patients (46 men and 15 women; mean age, 61.6 y old). The average distance of the right bony gutter was 3.43 mm and that of left bony gutter was 3.35 mm. The average cross-sectional area of preoperative and postoperative computed tomography was 189.9 and 281.8 mm in all patients, respectively. In all patients, although bony gutter was placed medially, the spinal canal area was expanded significantly (P < 0.0001). Postoperative C5 palsy developed in one of the 61 patients (1.6%). Compared with patients without C5 palsy, the right bony gutter was placed much closer to the medial border of the lateral mass in a patient with C5 palsy in whom we opened the lamina on the right side. CONCLUSIONS: Our modified open-door laminoplasty with symmetrically and medially placed bony gutters produced low incidence of postoperative C5 palsy with effective expansion of the spinal canal area.

Epilepsy with dual pathology: surgical treatment of cortical dysplasia accompanied by hippocampal sclerosis.

PURPOSE: The presence of two or more epileptogenic pathologies in patients with epilepsy is often observed, and the coexistence of focal cortical dysplasia (FCD) with hippocampal sclerosis (HS) is one of the most frequent clinical presentations. Although surgical resection has been an important treatment for patients with refractory epilepsy associated with FCD, there are few studies on the surgical treatment of FCD accompanied by HS, and treatment by resection of both neocortical dysplastic tissue and hippocampus is still controversial. METHODS: We retrospectively recruited epilepsy patients who had undergone surgical treatment for refractory epilepsy with the pathologic diagnosis of FCD and the radiologic evidence of HS. We evaluated the prognostic roles of clinical factors, various diagnostic modalities, surgical procedures, and the severity of pathology. RESULTS: A total of 40 patients were included, and only 35.0% of patients became seizure free. Complete resection of the epileptogenic area (p = 0.02), and the presence of dysmorphic neurons or balloon cells on histopathology (p = 0.01) were associated with favorable surgical outcomes. Patients who underwent hippocampal resection were more likely to have a favorable surgical outcome (p = 0.02). CONCLUSIONS: We show that patients with complete resection of epileptogenic area, the presence of dysmorphic neurons or balloon cells on histopathology, or resection of hippocampus have a higher chance of a favorable surgical outcome. We believe that this observation is useful in planning of surgical procedures and predicting the prognoses of individual patients with FCD patients accompanied by HS.

Sclerosing meningioma: clinicopathological study of four cases.

Sclerosing meningioma is a distinct histologic subtype of meningioma, however, it is often confused with other tumors, especially malignant tumors. To widen our knowledge of sclerosing meningioma and to help neurosurgeons and neuropathologists diagnose this clinically and pathologically unfamiliar disease entity, we reviewed four such cases, which were originally misdiagnosed. Sclerosing meningiomas were assessed for cellularity, cellular pleomorphism, mitotic activity, brain invasion, and necrosis. Immunohistochemical staining was performed on paraffin-embedded sections using the avidin-biotin-peroxidase complex method. The histologic appearance of the underlying cerebral parenchyma invasion by tumor cells led to a diagnosis of malignant meningioma or to the completely erroneous diagnosis of ganglioglioma. The most conspicuous histologic finding of these four sclerosing meningiomas was extensive collagen deposition, so called 'sclerosis' and an intermingled small population of spindle or round cells with clear cytoplasmic halos, giving a 'fried egg' appearance. However, a typical meningothelial whorl pattern was identified in all cases. Tumor cells exhibited positive immunoreactivity for epithelial membrane antigen and vimentin, but were negative for glial fibrillary acidic protein, p53, S-100, and neuronal markers. Proliferative indices, using Ki-67, ranged from 0% to 4%, and brain invasion was present in three of four tumors. All four patients are doing well with no evidence of tumor recurrence (follow-up duration of 25 months to 12 years). Brain invasion needs to be re-evaluated as a criterion of malignancy in meningioma. Special attention should be paid to the diagnosis of this subtype of meningioma to prevent unnecessary postoperative radiotherapy and to ensure correct therapeutic decision.