Video-Based Motion Analysis Use: A National Survey of Orthopedic Physical Therapists.

OBJECTIVES: Motion analysis is performed by physical therapists to assess and improve movement. Two-dimensional video-based motion analysis (VBMA) is available for smartphones/tablets and requires little to no equipment or cost. Research on VBMA use in clinical practice is limited. The purpose of this study was to examine the current use of VBMA in orthopedic physical therapist practice. METHODS: Members of the Academy of Orthopaedic Physical Therapy completed an online survey. Questions examined frequency of VBMA use, reasons for use, facilitators/barriers, device/apps used, practice patterns, other certificates/degrees, and demographic information. RESULTS: Among the final analysis sample of 477 respondents, 228 (47.8%) use VBMA. Of 228 VBMA users, 91.2% reported using it for ≤25% of their caseload, and 57.9% reported using their personal device to capture movement. Reasons for using VBMA included visual feedback for patient education (91.7%), analysis of movement (91.2%), and assessment of progress (51.8%). Barriers to use included lack of device/equipment (48.8%), lack of space (48.6%), and time restraint (32.1%). Those with ≤20 years of clinical experience (odds ratio [OR] = 1.83, 95% CI = 1.21-2.76), residency training (OR = 2.49, 95% CI = 1.14-5.43), and fellowship training (OR = 2.97, 95% CI = 1.32-6.66), and those from the West region of the United States (OR = 1.66, 95% CI = 1.07-2.56) were more likely to use VBMA. CONCLUSIONS: More than 50% of surveyed orthopedic physical therapists do not use VBMA in clinical practice. Future research should be directed toward assessing reliability and validity of VBMA use by smartphones, tablets, and apps and examining whether VBMA use enhances treatment outcomes. Data security, patient confidentiality, and integration into the electronic medical record should be addressed. IMPACT: This study is the first to our knowledge to describe the use of VBMA in orthopedic physical therapist practice in the United States. It is the first step in understanding how VBMA is used and might be used to enhance clinical assessment and treatment outcomes.

Low-Cost Active Thermography using Cellphone Infrared Cameras: from Early Detection of Dental Caries to Quantification of THC in Oral Fluid.

Active thermography (AT) is a widely studied non-destructive testing method for the characterization and evaluation of biological and industrial materials. Despite its broad range of potential applications, commercialization and wide-spread adaption of AT has long been impeded by the cost and size of infrared (IR) cameras. In this paper, we demonstrate that this cost and size limitation can be overcome using cell-phone attachment IR cameras. A software development kit (SDK) is developed that controls camera attributes through a simple USB interface and acquires camera frames at a constant frame rate up to 33 fps. To demonstrate the performance of our low-cost AT system, we report and discuss our experimental results on two high impact potential applications. The first set of experiments is conducted on a dental sample to investigate the clinical potential of the developed low-cost technology for detecting early dental caries, while the second set of experiments is conducted on the oral-fluid based lateral flow immunoassay to determine the viability of our technology for detecting and quantifying cannabis consumption at the point-of-care. Our results suggest achievement of reliable performance in the low-cost platform, comparable to those of costly and bulky research-grade systems, paving the way for translation of AT techniques to market.

A comparative analysis using flowmeter, laser-Doppler |spectrophotometry, and indocyanine green-videoangiography for detection of vascular stenosis in free flaps.

The effects of gradual vascular occlusion on the blood supply of perfused areas are poorly described. Information relating to the comparison of flap monitoring techniques is lacking. Varying stenotic conditions (0%, 25%, 50%, 75% and 100%) were generated on purpose at the A. and V. femoralis in the rat model. Analyses included flowmeter, simultaneous laser-Doppler flowmetry and tissue spectrophotometry (O2C) and indocyanine green- (ICG-) videoangiography with integrated FLOW 800 tool. A Random Forests prediction model was used to analyse the importance of each method to diagnose the stenotic conditions. The ability to discriminate and to accurately estimate the probability of stenosis was assessed by Receiver Operating Characteristic (ROC) curves and calibration plots. Blood flow changes for all modalities were described in detail. Flowmeter displayed earliest a linear decrease as a result of increasing stenosis. A stenosis of 50% degrees was most difficult to detect correctly. The combination of flowmeter and ICG-videoangiography showed high diagnostic power for each stenotic situation (area under the ROC > 0.79). Flowmeter and ICG-videoangiography showed to be most relevant in detection of varying stenotic conditions and may change the clinical outcome. The O2C showed less effect on varying stenotic situations as the only surface monitoring device.

Effects of the Digital Transformation: Qualitative Study on the Disturbances and Limitations of Using Video Visits in Outpatient Care.

BACKGROUND: Video mediated meetings with patients were introduced in outpatient care at a hospital in Sweden. New behaviours and tasks emerged due to changes of roles, work processes and responsibilities. The study investigates effects of digital transformation, in this case how video visits in outpatient care change work processes and introduces new tasks, in order to further improve the concept of video visits. OBJECTIVE: Through real-time, social interactional features of preparing for and conducting video visits, the study examines clinicians' perceived limitations and disturbances, and how the conditions between patients and clinicians may change when using video visits instead of face-to-face meetings in outpatient care. METHODS: Qualitative methods have been used including 14 observations of video visits at two different clinics and 14 followup interviews with clinicians. Transcriptions of interviews and field notes were thematically analysed, discussed and synthesised into themes. RESULTS: Disturbances and limitations related to the technology were related to time; a flexibility to schedule the meeting unbound of place, frustrations when the other part was late for the scheduled meeting, and that more experienced users of video visits usually waited longer before logging in. They were also related to sound; problems getting the sound to work satisfactory during the video visits, and problems with the image. Disturbances and limitations related to the surroundings were related to both the patient's and the clinician's environment; the principle of video technology in itself may affect the experience and the content of the consultation, and the surrounding chosen changes the conditions for and reduces the participants' field of view. CONCLUSIONS: We could see 1) a transformation of roles and responsibilities when turning from face-to-face meetings to video visits, 2) that video visits add new circumstances, with a risk of introducing disturbances and limitations, that in turn affects the content of the meeting, 3) that avoiding negative disturbances during a video visit, requires a sensibility from the clinician's side as well as a trust in the patient's judgement, 4) that both expected and unexpected disturbances and limitations during a video visit affect the clinician's behaviour, feelings, the content of the meeting and how the clinician's relate to the different components of the concept, and 5) that there is a change of roles introduced when conducting video visits, eg, the clinician taking the first line support if both (s)he and the patient encounter problems with the technology.

Real-time teleophthalmology video consultation: an analysis of patient satisfaction in rural Western Australia.

BACKGROUND: Teleophthalmology, particularly real-time video consultation, holds great potential in Australia and similar countries worldwide, where geography, population and medical workforce distribution make it difficult to provide specialist eye services outside of major cities. Assessment and referrals from rural optometrists are vital to the success of teleophthalmology. While there is good evidence for the efficacy of such services, there is limited evidence for patient satisfaction with video consultation. METHODS: To evaluate patient satisfaction with teleophthalmology, the current study recruited patients who underwent a video consultation with Lions Outback Vision, for a follow-up telephone-based questionnaire assessing satisfaction. Regression analysis was performed assessing which demographic features and which features of the video consultation itself were associated with highest overall satisfaction. RESULTS: One hundred and nine of the 137 eligible patients completed the questionnaire (79.6 per cent; 55 per cent male; mean age 64.61 years). The majority of the participants were either 'Very satisfied' (69.1 per cent) or 'Satisfied' (24.5 per cent) with the service. No one reported being either 'Dissatisfied' or 'Very dissatisfied'. Linear regression did not reveal any demographic or follow-up variables as predictive of greater total satisfaction; however, participants who were older, felt they could easily explain their medical problems to the doctor in the video consultation and believed that telemedicine enabled them to save money and time, and were more likely to report higher overall satisfaction. CONCLUSION: Teleophthalmology is a promising new way to overcome barriers to the delivery of eye care services to rural and remote populations. This study demonstrates a high level of overall satisfaction with teleophthalmological video consultation and patients are accepting of this emerging consultation modality, regardless of age.

A comparison of animated versus static images in an instructional multimedia presentation.

Sophisticated three-dimensional animation and video compositing software enables the creation of complex multimedia instructional movies. However, if the design of such presentations does not take account of cognitive load and multimedia theories, then their effectiveness as learning aids will be compromised. We investigated the use of animated images versus still images by creating two versions of a 4-min multimedia presentation on vascular neuroeffector transmission. One version comprised narration and animations, whereas the other animation comprised narration and still images. Fifty-four undergraduate students from level 3 pharmacology and physiology undergraduate degrees participated. Half of the students watched the full animation, and the other half watched the stills only. Students watched the presentation once and then answered a short essay question. Answers were coded and marked blind. The "animation" group scored 3.7 (SE: 0.4; out of 11), whereas the "stills" group scored 3.2 (SE: 0.5). The difference was not statistically significant. Further analysis of bonus marks, awarded for appropriate terminology use, detected a significant difference in one class (pharmacology) who scored 0.6 (SE: 0.2) versus 0.1 (SE: 0.1) for the animation versus stills group, respectively (P = 0.04). However, when combined with the physiology group, the significance disappeared. Feedback from students was extremely positive and identified four main themes of interest. In conclusion, while increasing student satisfaction, we do not find strong evidence in favor of animated images over still images in this particular format. We also discuss the study design and offer suggestions for further investigations of this type.

Improving physical functional and quality of life in older adults with multiple sclerosis via a DVD-delivered exercise intervention: a study protocol.

INTRODUCTION: There is a need to identify innovative, low-cost and broad-reaching strategies for promoting exercise and improving physical function in older adults with multiple sclerosis (MS). METHODS AND ANALYSIS: This randomised controlled pilot trial will test the efficacy of a 6-month, DVD-delivered exercise intervention to improve functional performance and quality of life in older adults with MS. Participants will be randomised either into a DVD-delivered exercise condition or an attentional control condition. This novel approach to programme delivery provides participants with detailed exercise instructions which are presented in a progressive manner and includes a variety of modifications to better meet varying levels of physical abilities. The targeted exercises focus on three critical elements of functional fitness: flexibility, strength and balance. It is hypothesised that participants who are randomised to the exercise DVD condition will demonstrate improvements in physical function compared with participants assigned to the attentional control condition. Data analysis will include a 2 (condition)×2 (time) mixed factor analysis of variance (ANOVA) that follows intent-to-treat principles, as well as an examination of effect sizes. Participants will take part in qualitative interviews about perspectives on physical activity and programme participation. ETHICS AND DISSEMINATION: The study protocol was approved by a university institutional review board and registered with a federal database. Participants will be asked to read and sign a detailed informed consent document and will be required to provide a physician's approval to participate in the study. The exercise DVDs include an overview of safety-related concerns and recommendations relative to exercise participation, as well as detailed instructions highlighting the proper execution of each exercise presented on screen. Following completion of this trial, data will be immediately analysed and results will be presented at scientific meetings and published in scholarly journals. TRIAL REGISTRATION NUMBER: Clinical Trials NCT01993095.

Digital video recording in the inpatient setting: a tool for improving care experiences and efficiency while decreasing waste and cost.

The need to significantly improve patient centeredness and efficiency, while reducing waste and cost, in health care is an area of focus for health policy leaders. We employed digital video recording on a postsurgical inpatient unit as a method of understanding care delivery through the eyes of patients, families, and caregivers. Key findings of the study included identification of the total number of staff (by function)-to-patient contacts and the percentage of time patients spent in their room during recovey. The use of digital video recording eliminated the impracticality of real-time observation in the inpatient setting and should be considered as a tool for helping to achieve necessary transformation in care delivery.

Comparative intralimb coordination in avian bipedal locomotion.

Analyses of how intralimb coordination during locomotion varies within and across different taxa are necessary for understanding the morphological and neurological basis for locomotion in general. Previous findings suggest that intralimb proportions are the major source of kinematic variation that governs intralimb coordination across taxa. Also, independence of kinematics from habitat preference and phylogenetic position has been suggested for mammals. This leads to the hypothesis that among equally sized bird species exhibiting equal limb proportions, similar kinematics can be observed. To test this hypothesis, the bipedal locomotion of two distantly related ground-dwelling bird species (Eudromia elegans and Coturnix coturnix) and of a less terrestrial species (Corvus monedula) was investigated by means of a biplanar high-speed X-ray videographic analysis. Birds exhibited similar intralimb proportions and were filmed over a broad range of speed while moving on a treadmill. Joint and limb element angles, as well as pelvic rotations, were quantified. Regarding fore-aft motions of the limb joints and elements, a congruent pattern of intralimb coordination was observed among all experimental species. The sample of species suggests that this is largely independent of their habitat preference and systematic position and seems to be related to demands for coping with an irregular terrain with a minimum of necessary control. Hence, the initial hypothesis was confirmed. However, this congruence is not found when looking at medio-lateral limb motions and pelvic rotations, showing distinct differences between ground-dwellers (e.g. largely restricted to a parasagittal plane) and C. monedula (e.g. increased mobility of the hip joint).

Randomized trial of a DVD intervention to improve readiness to self-manage joint pain.

A DVD (digital video disk) intervention to increase readiness to self-manage joint pain secondary to hemophilia was informed by a 2-phase, motivational-volitional model of readiness to self-manage pain, and featured the personal experiences of individuals with hemophilia. The DVD was evaluated in a randomized controlled trial in which 108 men with hemophilia completed measures of readiness to self-manage pain (Pain Stages of Change Questionnaire) before and 6 months after receiving the DVD plus information booklet (n=57) or just the booklet (n=51). The effect of the DVD was assessed by comparing changes in Pain Stages of Change Questionnaire scores (precontemplation, contemplation, and action/maintenance) between groups. The impact on pain coping, pain acceptance, and health-related quality of life was tested in secondary analyses. Repeated-measures analysis of variance, including all those with complete baseline and follow-up data regardless of use of the intervention, showed a significant, medium-sized, group×time effect on precontemplation, with reductions among the DVD group but not the booklet group. Significant use×time effects showed that benefits in terms of contemplation and action/maintenance were restricted to those who used the interventions at least once. The results show that low-intensity interventions in DVD format can improve the motivational impact of written information, and could be used to help prepare people with chronic pain for more intensive self-management interventions. The findings are consistent with a 2-phase, motivational-volitional model of pain self-management, and provide the first insights to our knowledge of readiness to self-manage pain in hemophilia.

Intraoperative near-infrared indocyanine green-videoangiography (ICG-VA) and graphic analysis of fluorescence intensity in cerebral aneurysm surgery.

We present our preliminary experience with intraoperative near-infrared indocyanine green-videoangiography (ICG-VA) and analysis of blood flow dynamics using fluorescence intensity assessment in cerebral aneurysm clipping surgery. Thirty-nine patients with 43 intracranial aneurysms underwent microsurgical clipping. Intraoperative ICG-VA was performed before and after clip application. An infrared fluorescence module integrated into a surgical microscope was used to visualize fluorescence in the surgical field and we recorded the emitted fluorescent light. An integrated analytical visualization tool simultaneously analyzed the video sequence and converted it into an intensity diagram, which allowed an objective evaluation of the results rather than the subjective assessment of fluorescence using ICG-VA. Overall, ICG-VA was performed 137 times. Incomplete clipping was detected in four patients, which allowed suitable adjustment to completely obliterate the aneurysm. In 12 patients, perforators arising close to, or from, the aneurysmal neck were identified in the surgical field. In three patients, the ICG-VA intensity diagram provided valuable information leading to modification of the primary surgical maneuver. ICG-VA provides high resolution images allowing real-time assessment of the blood flow in the parent artery and arterial branches, including the perforators. The intensity diagram is useful for providing a more objective record of the hemodynamics than the traditional ICG-VA, which relies more on subjective assessment and may allow interobserver variability. We conclude that ICG-VA, combined with the intensity diagram, can reduce the morbidity and complications associated with aneurysm clipping and improve patient outcomes.

Toe function and dynamic pressure distribution in ostrich locomotion.

The ostrich is highly specialized in terrestrial locomotion and is the only extant bird that is both didactyl and exhibits a permanently elevated metatarsophalangeal joint. This extreme degree of digitigrady provides an excellent opportunity for the study of phalangeal adaptation towards fast, sustained bipedal locomotion. Data were gathered in a semi-natural setting with hand-raised, cooperative specimens. Dynamic pressure distribution, centre of pressure (CoP) trajectory and the positional inter-relationship of the toes during stance phase were investigated using pedobarography. Walking and running trials shared a J-shaped CoP trajectory with greater localization of CoP origin as speed increased. Slight variations of 4th toe position in walking affect CoP origin and modulation of 4th toe pressure on the substrate allows correction of balance, primarily at the beginning of stance phase at lower speeds. Load distribution patterns differed significantly between slow and fast trials. In walking, the 3rd and particularly the 4th toe exhibited notable variation in load distribution with minor claw participation only at push-off. Running trials yielded a distinctly triangular load distribution pattern defined by the 4th toe tip, the proximal part of the 3rd toe and the claw tip, with the sharp point of the claw providing an essential traction element at push-off. Consistency of CoP trajectory and load distribution at higher speeds arises from dynamic stability effects and may also reflect stringent limitations to degrees of freedom in hindlimb joint articulation that contribute to locomotor efficiency. This novel research could aid in the reconstruction of theropod locomotor modes and offers a systemic approach for future avian pedobarographic investigations.

Intraoperative indocyanine green videoangiography for spinal vascular lesions: case report.

BACKGROUND AND IMPORTANCE: In surgery of spinal vascular lesions such as spinal arteriovenous fistula or vascular tumors, assessment of feeding arteries and draining veins is important. Intraoperative digital subtraction angiography is useful but is invasive and sometimes technically demanding. Near-infrared indocyanine green (ICG) videoangiography is less invasive and has been reported as an intraoperative diagnosis of arterial patency during clipping surgery of cerebral aneurysms or bypass surgeries. We present our experience with intraoperative ICG videoangiography in 3 cases of spinal vascular lesions. CLINICAL PRESENTATION: Two patients had spinal arteriovenous fistula (perimedullary, n = 1; dural, n = 1), and 1 patient had spinal cord hemangioblastoma at the thoracic or thoracolumbar level. The surgical microscope was an OPMI Pentero (Carl Zeiss, Oberkochen, Germany). After laminectomy and opening of the dura, ICG (5 mg) was injected intravenously. The ICG angiography clearly demonstrated feeding and draining vessels. The ICG findings greatly helped successful interruption of arteriovenous fistula and total removal of the tumor. CONCLUSION: Intraoperative ICG videoangiography for spinal vascular lesions was useful by providing information on vascular dynamics directly. However, the diagnostic area is limited to the field of the surgical microscope. Although intraoperative digital subtraction angiography is still needed in cases of complex spinal vascular lesions, ICG videoangiography will be an important diagnostic modality in the field of spinal vascular surgeries.

Indocyanin green videoangiography study of hemangioblastomas.

OBJECTIVE: We present herein the intraoperative indocyanin green videoangiography (ICGVAG) findings for three cases of cerebellar hemangioblastoma (HB). CASES: Cerebellar HB was detected in three patients presenting with symptoms of vertigo and/or headaches and diagnosed on the basis of preoperative magnetic resonance imaging (MRI) and cerebral angiographic findings. Preoperative embolization of the tumor feeding artery was not performed in any of the patients. None of the patients underwent any procedure prior to ICGVAG that would affect the ICG findings, such as perilesional hemostatic coagulation or ablation. In each patient, it was possible to judge the approximate location of the tumor in relation to the brain surface and to distinguish the feeding and draining vessels. Following resection of the tumor, ICGVAG images confirmed that the mural nodule had been eliminated. None of the patients required blood transfusion, either during or after the surgery. For each patient, the lesion was pathologically confirmed as HB, postoperative contrast-enhanced MRI confirmed the absence of residual tumor, and diffusion-weighted MRI revealed no ischemic changes. RESULTS: Differentiation of feeding and draining vessels in the region of the lesion is particularly important for successful surgical removal of HB. In the present three patients, ICGVAG findings enabled easy vascular differentiation and were also useful for confirming that there was no residual tumor. Indocyanin green videoangiography was concluded to be useful for safe resection of HB.

Application of intraoperative indocyanine green angiography for CNS tumors: results on the first 100 cases.

PURPOSE: To investigate the application of indocyanine green (ICG) videoangiography during microsurgery for central nervous system (CNS) tumors. METHODS: One hundred patients with CNS tumors who underwent microsurgical resection from December 2006 to December 2008 were retrospectively analyzed. The diagnosis was high grade glioma in 54 cases, low grade in 17 cases, meningioma in 14 cases, metastasis in 12 cases and hemangioblastoma in 3 cases. Overall, ICG was injected intraoperatively 194 times. The standard dose of 25mg of dye was injected intravenously and intravascular fluorescence from within the blood vessels was imaged through an ad hoc microscope with dedicated software (Pentero, Carl Zeiss Co., Oberkochen, Germany). Pre-resection and post-resection arterial, capillary and venous ICG videoangiographic phases were intraoperatively observed and recorded. RESULTS: ICG videangiography allowed for a good evaluation of blood flow in the tumoral and peritumoral exposed vessels in all cases. No side effects due to ICG were observed. CONCLUSIONS: ICG video-angiography is a significant method for monitoring blood flow in the exposed vessels during microsurgical removal of CNS tumors. Pre-resection videoangiography provides useful information on the tumoral circulation and the pathology-induced alteration in surrounding brain circulation. Post-resection examination allows for an immediate check of patency of those vessels that are closely related to the tumor mass and that the surgeon does not want to damage.

Automated image analysis for the detection of benthic crustaceans and bacterial mat coverage using the VENUS undersea cabled network.

The development and deployment of sensors for undersea cabled observatories is presently biased toward the measurement of habitat variables, while sensor technologies for biological community characterization through species identification and individual counting are less common. The VENUS cabled multisensory network (Vancouver Island, Canada) deploys seafloor camera systems at several sites. Our objective in this study was to implement new automated image analysis protocols for the recognition and counting of benthic decapods (i.e., the galatheid squat lobster, Munida quadrispina), as well as for the evaluation of changes in bacterial mat coverage (i.e., Beggiatoa spp.), using a camera deployed in Saanich Inlet (103 m depth). For the counting of Munida we remotely acquired 100 digital photos at hourly intervals from 2 to 6 December 2009. In the case of bacterial mat coverage estimation, images were taken from 2 to 8 December 2009 at the same time frequency. The automated image analysis protocols for both study cases were created in MatLab 7.1. Automation for Munida counting incorporated the combination of both filtering and background correction (Median- and Top-Hat Filters) with Euclidean Distances (ED) on Red-Green-Blue (RGB) channels. The Scale-Invariant Feature Transform (SIFT) features and Fourier Descriptors (FD) of tracked objects were then extracted. Animal classifications were carried out with the tools of morphometric multivariate statistic (i.e., Partial Least Square Discriminant Analysis; PLSDA) on Mean RGB (RGBv) value for each object and Fourier Descriptors (RGBv+FD) matrices plus SIFT and ED. The SIFT approach returned the better results. Higher percentages of images were correctly classified and lower misclassification errors (an animal is present but not detected) occurred. In contrast, RGBv+FD and ED resulted in a high incidence of records being generated for non-present animals. Bacterial mat coverage was estimated in terms of Percent Coverage and Fractal Dimension. A constant Region of Interest (ROI) was defined and background extraction by a Gaussian Blurring Filter was performed. Image subtraction within ROI was followed by the sum of the RGB channels matrices. Percent Coverage was calculated on the resulting image. Fractal Dimension was estimated using the box-counting method. The images were then resized to a dimension in pixels equal to a power of 2, allowing subdivision into sub-multiple quadrants. In comparisons of manual and automated Percent Coverage and Fractal Dimension estimates, the former showed an overestimation tendency for both parameters. The primary limitations on the automatic analysis of benthic images were habitat variations in sediment texture and water column turbidity. The application of filters for background corrections is a required preliminary step for the efficient recognition of animals and bacterial mat patches.

Description of a media campaign about alcohol use during pregnancy.

OBJECTIVE: This study describes the development and testing of a multicomponent media campaign aimed at increasing discussions of alcohol use during pregnancy. METHOD: Women, Infants, and Children (WIC) programs in Iowa were paired and, within each pair, were randomly assigned to a usual-care group (advice not to consume alcohol while pregnant and the opportunity to watch a 30-second television commercial about the effects of drinking during pregnancy) or intervention group (usual care plus a 10-minute videotape/DVD and a printed pamphlet. Among the 700 research participants in those outreach programs, interpersonal communication about alcohol use during pregnancy was assessed both before and after intervention, and participants were surveyed for knowledge of the effects of alcohol use during pregnancy. RESULTS: More women in the intervention group than in the usual-care group talked to friends about alcohol use during pregnancy. Also, only women in the intervention group demonstrated an increase in relative knowledge about the effects of drinking during pregnancy. CONCLUSIONS: A multimedia campaign may be an effective way to increase interpersonal discussions and awareness of the dangers of alcohol use during pregnancy.

Arteriovenous micromalformation of the trigeminal root: intraoperative diagnosis with indocyanine green videoangiography: case report.

BACKGROUND AND IMPORTANCE: To report on a single case of arteriovenous micromalformation (micro-AVM) of the trigeminal root that was diagnosed during microvascular decompression for trigeminal neuralgia with the use of indocyanine green (ICG) videoangiography. CLINICAL PRESENTATION: A 52-year-old woman with drug-resistant trigeminal neuralgia underwent a key hole suboccipital cerebellopontine angle exploration after the usual magnetic resonance imaging (MRI) screening had raised the suspicion of a vascular compression. In surgery, the petrosal vein was found to be bigger than usual and arterialized; the trigeminal root was embedded in a tangle of abnormal arterialized vessels. Intraoperative ICG videoangiography showed that the direction of flow in the arterialized petrosal vein was anterograde, thus allowing for the differential diagnosis between micro-AVM and tentorial dural fistula. It was possible to achieve only a partial nerve decompression because of the intimate relationship between the trigeminal root and the pathological vessels. Postoperative angiography and MRI with contrast administration confirmed the intraoperative diagnosis of micro-AVM. The patient was discharged neurologically intact on postoperative day 4. One month after surgery, she remains pain-free despite a 50% reduction in antiepileptic drugs. CONCLUSION: Surgeons performing microvascular decompression should be aware that a diagnosis of vascular compression based on MRI without contrast administration could not exclude the presence of a pontine micro-AVM. ICG videoangiography provides an elegant means of showing the flow dynamics of these pathological vessels. An MRI protocol that is suitable to avoid this kind of intraoperative drawback should be defined and systematically used in the preoperative evaluation of all such surgical candidates.

Preliminary personal experiences with the application of near-infrared indocyanine green videoangiography in extracranial vertebral artery surgery.

INTRODUCTION: We evaluated the feasibility, usefulness, and limitations of near-infrared indocyanine green (ICG) videoangiography during procedures involving the extracranial vertebral artery (VA). METHODS: Nine patients (2 women, 7 men; mean age, 55 years) were evaluated at 2 neurosurgical centers. Near-infrared ICG videoangiography was applied during transposition and rerouting of the first segment of VA (V1; n = 6) and during resection of neurinomas near the second (V2; n = 1) and third (V3; n = 2) segments of VA. RESULTS: Early after ICG injection, V1 fluoresced homogenously. The fluorescence of V2 and V3 varied. Without extrinsic compression, these segments appeared as noncontiguous hot spots because the VA runs freely in a periosteal sheath surrounded by a venous plexus that attenuates the fluorescent light. Hot spots corresponded to areas where the artery neared the surface. With extrinsic compression, VA enhanced homogenously because it was pushed against the periosteal layer. During the late phase, the V1 signal was attenuated, whereas the venous plexus surrounding V2 and V3 enhanced homogeneously, thereby masking the VA itself. Near-infrared ICG videoangiography helped to confirm VA patency during transposition and rerouting but was not helpful during VA exposure because the periosteal sheath must already be exposed to detect the VA or its surrounding plexus. After exposure, videoangiography can help to determine the position of the VA within its periosteal sheath. CONCLUSION: Videoangiography can be used to provide information about the patency of the VA and its location within the periosteal sheath to prevent injury during resection of tumor adherent to the periosteal sheath.

Comparing noninvasive dense array and intracranial electroencephalography for localization of seizures.

OBJECTIVE: To compare the localization of the seizure onset zone estimated from ictal recordings with high spatial resolution, 256-channel scalp dense array electroencephalographic video long-term monitoring (LTM) with the aid of source analysis with that obtained from subsequent intracranial ictal recordings. METHODS: Ten patients with medically refractory epilepsy, all surgical candidates, underwent intracranial LTM after standard noninvasive evaluation failed to provide adequate localizing information regarding ictal origins. Before invasive studies, all patients underwent dense array electroencephalographic LTM in which habitual clinical seizures were recorded for each patient. Source analysis was applied to ictal onsets. Intracranial electrode placement followed conventional guidelines, although the neurosurgeon was aware of the dense array electroencephalographic results. Patients ranged in age from 10 to 49 years (mean age, 24 y); 7 were male. Identified risk factors included closed head injury in 1 patient and childhood meningitis in another. No focal neurological signs were found in any patient. Magnetic resonance imaging findings were normal in 6 patients; 1 patient had cerebellar hypoplasia, 1 had right frontoparietal dysplasia, 1 had bilateral nonspecific white matter abnormalities, and 1 had bilateral cavernous angiomas. RESULTS: Ictal onsets, based on invasive recordings, were in the mesiotemporal lobe (3 patients), lateroparietal (2 patients), mesioparietal (1 patient), laterofrontal (1 patient), superolateral frontocentral (1 patient), frontopolar (1 patient), and posteroinferior temporo-occipital neocortex (1 patient). Dense array electroencephalography localized ictal onsets to the same region as intracranial monitoring in 8 of 10 cases; invasive studies disclosed an additional ictal focus in 2 of these patients. Surgical resections were based only on intracranial electroencephalographic findings. CONCLUSION: Dense array electroencephalography has the potential to assist in the noninvasive localization of epileptic seizures and to guide the placement of invasive electrodes for localizing seizure onset.