"Staying Home"-Early Changes in Patterns of Neurotrauma in New York City During the COVID-19 Pandemic.

OBJECTIVE: New York City is the epicenter of the novel coronavirus disease 2019 (COVID-19) pandemic in the United States. Traumatic brain injury accounts for a significant proportion of admissions to our trauma center. We sought to characterize the effect of the pandemic on neurotraumas, given the cancellation of nonessential activities during the crisis. METHODS: Retrospective and prospective reviews were performed from November 2019 to April 2020. General demographics, clinical status, mechanism of trauma, diagnosis, and treatment instituted were recorded. We dichotomized the data between pre-COVID-19 (before 1 March) and COVID-19 periods and compared the differences between the 2 groups. We present the timeline of events since the beginning of the crisis in relation to the number of neurotraumas. RESULTS: A total of 150 patients composed our cohort with a mean age of 66.2 years (standard deviation ±18.9), and 66% were male. More males sustained neurotrauma in the COVID-19 period compared with the pre-COVID-19 (60.4% vs. 77.6%, P = 0.03). The most common mechanism of trauma was mechanical fall, but it was observed less frequently compared with the pre-COVID-19 period (61.4% vs. 40.8; P = 0.03). Subdural hematoma, traumatic subarachnoid hemorrhage, and intracerebral contusion accounted for the most common pathologies in both periods. Nonoperative management was selected for most patients (79.2 vs. 87.8%, P = 0.201) in both periods. CONCLUSIONS: A decrease in the frequency of neurotraumas was observed during the COVID-19 crisis concomitant with the increase in COVID-19 patients in the city. This trend began after the cancellation of nonessential activities and implementation of social distancing recommendations.

Robotic surgical rehearsal on patient-specific 3D-printed skull models for stereoelectroencephalography (SEEG).

PURPOSE: Medically refractory epilepsy patients commonly require surgical alternatives for diagnosis and treatment. Stereoelectroencephalography (SEEG) is a useful diagnostic procedure in seizure focus elucidation. Modern techniques involve the use of robotics and neuronavigation for SEEG. A steep learning curve combined with multiple complex technologies employed during the case makes this procedure a perfect candidate for surgical rehearsal. This paper tests the feasibility of the use of patient-specific 3D-printed model for surgical rehearsal of robotic SEEG. METHODS: A 3D-printed model was created using the patient's cranial computed tomography and computed tomography angiography radiological imaging. A rehearsal in an operating room (OR) prior to the actual procedure date was used for surgical planning of SEEG electrodes, education of the residents and fellows as well as training of the support staff. Attention was paid to assure precise recreation of the surgical procedure. RESULTS: The patient-specific 3D-printed model tolerated each step of the procedure from facial registration, to drilling, bolt insertion and lead placement. Accuracy of the designed trajectory to the electrode final position was visually confirmed at the end of procedure. Important modification to the plan of eventual surgery improved the efficiency of the real operation. CONCLUSION: For surgical planning, education and training purposes in robotic SEEG, 3D-printed models may be utilized as a realistic anatomy tool. Potential applications of this technique include trajectory feasibility evaluation, patient positioning optimization, increasing OR efficiency, as well as neurosurgical education and patient counseling.

Approach Angle Affects Accuracy in Robotic Stereoelectroencephalography Lead Placement.

BACKGROUND: One third of patients with epilepsy fail to gain optimal control using antiepileptic drugs. New advances in epilepsy surgery have reshaped some diagnostic and therapeutic modalities into less invasive approaches. To understand the cortical epileptogenic networks, stereoelectroencephalography uses depth electrodes as a tool for invasive intracranial monitoring. These electrodes are now being placed using a robot instead of the traditional Talairach stereotactic grid and frame with comparable accuracy and the advantage of shortened surgical time. Whereas accuracy is important for correct cortical sampling and surgical morbidity, the factors that play a role in the deviation of the electrode's trajectory are not yet understood. The aim of this study was to determine if the angle the planned trajectory makes with the skull impacts the final accuracy of placement. METHODS: Twenty-five patients with 319 stereotactic trajectories were examined. Skew angle and accuracy measurements were computed based on preoperative and postoperative computed tomography scans fused with trajectories planned using ROSA robot software. RESULTS: Trajectories with a planned angle of >30° (oblique group) had significantly higher radial error (2.05 mm vs. 1.45 mm, P < 0.001) than trajectories with planned angles <30° (orthogonal group). CONCLUSIONS: The ROSA robotic system is a powerful tool that increases the speed and efficiency of stereotactic neurosurgery. Care should be taken when planning trajectories to avoid high skew angles. If a high skew angle is unavoidable, care should be taken to ensure a larger margin of safety.

Quantitative Signal Characteristics of Electrocorticography and Stereoelectroencephalography: The Effect of Contact Depth.

PURPOSE: Patients undergoing epilepsy surgery often require invasive EEG, but few studies have examined the signal characteristics of contacts on the surface of the brain (electrocorticography, ECOG) versus depth contacts, used in stereoelectroencephalography (SEEG). As SEEG and ECOG have significant differences in complication rates, it is important to determine whether both modalities produce similar signals for analysis, to ultimately guide management of medically intractable epilepsy. METHODS: Twenty-seven patients who underwent SEEG (19), ECOG (6), or both (2) were analyzed for quantitative measures of activity including spectral power and phase-amplitude coupling during approximately 1 hour of wakefulness. The position of the contacts was calculated by coregistering the postoperative computed tomography with a reconstructed preoperative MRI. Using two types of referencing schemes-local versus common average reference-the brain regions where any quantitative measure differed systematically with contact depth were established. RESULTS: Using even the most permissive statistical criterion, few quantitative measures were significantly correlated with contact depth in either ECOG or SEEG contacts. The factors that predicted changes in spectral power and phase-amplitude coupling with contact depth were failing to baseline correct spectral power measures, use of a local rather than common average reference, using baseline correction for phase-amplitude coupling measures, and proximity of other grey matter structures near the region where the contact was located. CONCLUSIONS: The signals recorded by ECOG and SEEG have very similar spectral power and phase-amplitude coupling, suggesting that both modalities are comparable from an electrodiagnostic standpoint in delineation of the epileptogenic network.

Performance of language tasks in patients with ruptured aneurysm of the left hemisphere worses in the post-surgical evaluation.

OBJECTIVE: To assess the language and verbal fluency performance in aneurismal SAH pre- and post-surgery in patients caused by an aneurysm of the anterior communicating artery (AcomA), left middle cerebral artery (L-MCA) and left posterior comunicating artery (L-PcomA). METHODS: Assessment in 79 patients with SAH, on two occasions: pre- and post surgical treatment. They were divided into three groups by the aneurysms' location. RESULTS: Deterioration is detected in the performance of all patients during the post-surgical period; L-MCA aneurysm patients displayed a reduction in verbal naming and fluency; L-PcomA patients deteriorated in the written language and fluency tasks. CONCLUSION: After the surgical procedure the patients decreased in various language tasks and these differences in performance being directly related to the location of the aneurysm.

Cognitive changes in patients with aneurysmal subarachnoid hemorrhage before and early posttreatment: differences between surgical and endovascular.

INTRODUCTION: The main purpose of occluding a ruptured aneurysm is preventing rebleeding, which may be fatal. Microsurgical or endovascular treatments are the main approaches adopted to prevent new bleeding. Among patients presenting with aneurysmal subarachnoid hemorrhage, about 50% had permanent injuries. Cognitive changes are one of the main morbidities from that illness. The type of treatment for the aneurysm (clipping or coil embolization) can also contribute to the genesis of those complications. OBJECTIVE: Assessing language and verbal memory changes resulting from the aneurysmal lesion occlusion procedures, as well as establish which treatment offers less cognitive sequels. METHOD: This investigation was carried out in Hospital da Restauraão, Recife-PE, from May 2007 to November 2009. One hundred fifty-one patients were divided into two groups, surgical and endovascular, and had their language, fluency, and verbal memory functions tested at two time points, pre- and postoperation. The results of the initial assessment and of the one occurring after the treatment were compared, between both groups and to each other. RESULTS AND CONCLUSIONS: One hundred fifty-one patients were assessed, distributed as 122 surgical and 29 coil embolized. The performances in both groups did not differ in the initial assessment. However, endovascular treatment does not show additional cognitive impairment and had a better performance in language and verbal memory, compared with patients submitted to surgical treatment in an early postoperative period.

Language, memory, and verbal fluency changes in patients with aneurysmal subarachnoid hemorrhage: results of a preoperative investigation.

OBJECTIVE: To detect changes in speech, verbal fluency, and memory in patients with subarachnoid hemorrhage (SAH) caused by ruptured aneurysms and to analyze the results before surgical or embolization procedure. METHODS: During the period May 2007 to November 2009, 193 patients with anterior aneurysmal SAH admitted to the Department of Neurosurgery, Hospital da Restauração, Recife, Brazil, were tested for speech, verbal fluency, and memory disturbances after the first week of bleeding and compared with a control group with similar demographics. RESULTS: Patients with aneurysmal SAH differed significantly from the control group in language, verbal fluency, and memory functions before clipping or coiling procedures. There were differences in cognitive performance between patients with different aneurysm sites. CONCLUSIONS: It was possible to characterize the cognitive impairments of each area affected early on in the preoperative period, confirming the assumptions that the aneurysm site could be a determining factor of cognitive impairment.