Imagined Musical Scale Relationships Decoded from Auditory Cortex.

Notes in a musical scale convey different levels of stability or incompleteness, forming what is known as a tonal hierarchy. Levels of stability conveyed by these scale degrees are partly responsible for generating expectations as a melody proceeds, for emotions deriving from fulfillment (or not) of those expectations, and for judgments of overall melodic well-formedness. These functions can be extracted even during imagined music. We investigated whether patterns of neural activity in fMRI could be used to identify heard and imagined notes, and if patterns associated with heard notes could identify notes that were merely imagined. We presented trained musicians with the beginning of a scale (key and timbre were varied). The next note in the scale was either heard or imagined. A probe tone task assessed sensitivity to the tonal hierarchy, and state and trait measures of imagery were included as predictors. Multivoxel classification yielded above-chance results in primary auditory cortex (Heschl's gyrus) for heard scale-degree decoding. Imagined scale-degree decoding was successful in multiple cortical regions spanning bilateral superior temporal, inferior parietal, precentral, and inferior frontal areas. The right superior temporal gyrus yielded successful cross-decoding of heard-to-imagined scale-degree, indicating a shared pathway between tonal-hierarchy perception and imagery. Decoding in right and left superior temporal gyrus and right inferior frontal gyrus was more successful in people with more differentiated tonal hierarchies and in left inferior frontal gyrus among people with higher self-reported auditory imagery vividness, providing a link between behavioral traits and success of neural decoding. These results point to the neural specificity of imagined auditory experiences-even of such functional knowledge-but also document informative individual differences in the precision of that neural response.

40-Hz auditory stimulation for intracranial interictal activity: A pilot study.

OBJECTIVES: To study the effects of auditory stimuli on interictal epileptiform discharge (IED) rates evident with intracranial monitoring. MATERIALS AND METHODS: Eight subjects undergoing intracranial EEG monitoring for refractory epilepsy participated in this study. Auditory stimuli consisted of a 40-Hz tone, a 440-Hz tone modulated by a 40-Hz sinusoid, Mozart's Sonata for Two Pianos in D Major (K448), and K448 modulated by a 40-Hz sinusoid (modK448). Subjects were stratified into high- and low-IED rate groups defined by baseline IED rates. Subject-level analyses identified individual responses to auditory stimuli, discerned specific brain regions with significant reductions in IED rates, and examined the influence auditory stimuli had on whole-brain sigma power (12-16 Hz). RESULTS: All subjects in the high baseline IED group had a significant 35.25% average reduction in IEDs during the 40-Hz tone; subject-level reductions localized to mesial and lateral temporal regions. Exposure to Mozart K448 showed significant yet less homogeneous responses. A post hoc analysis demonstrated two of the four subjects with positive IED responses had increased whole-brain power at the sigma frequency band during 40-Hz stimulation. CONCLUSIONS: Our study is the first to evaluate the relationship between 40-Hz auditory stimulation and IED rates in refractory epilepsy. We reveal that 40-Hz auditory stimuli may be a noninvasive adjunctive intervention to reduce IED burden. Our pilot study supports the future examination of 40-Hz auditory stimuli in a larger population of subjects with high baseline IED rates.

Development of Halo Nevi in a Lung Cancer Patient: A Novel Immune-Related Cutaneous Event from Atezolizumab.

Immunotherapy-induced vitiligo is an immune-related adverse event (irAE) observed in metastatic melanoma patients treated with immune checkpoint inhibitors that target the cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed cell death-1 (PD-1) pathways. To date, the development of leukoderma, poliosis, and halo nevi during immunotherapy has largely been reported in metastatic melanoma patients. We report a case of immunotherapy-induced leukoderma presenting as halo nevi in a patient with non-small cell lung cancer (NSCLC) treated with atezolizumab, a programmed cell death ligand (PD-L1) antibody. Immunotherapy-induced vitiligo in metastatic melanoma patients may be associated with improved survival, but it remains to be determined whether its occurrence in non-melanoma cancers has the same prognostic significance.

J Drugs Dermatol. 2017;16(10):1047-1049.

Transposition of the paraclival carotid artery: a novel concept of self-retaining vascular retraction during endoscopic endonasal skull base surgery technical report.

BACKGROUND: Fixed retraction of the internal carotid artery (ICA) has previously been described for use during transcranial microscopic surgery. We report the novel use of a self-retaining microvascular retractor for static repositioning and protection of the ICA during expanded endonasal endoscopic approaches to the paramedian skull base. METHODS: The transmaxillary, transpterygoid approach was performed in five cadaver heads (ten sides). The self-retaining microvascular retractor was used to laterally reposition the pterygopalatine fossa contents during exposure of the pterygoid base/plates and the paraclival ICA to expose the petrous apex. Maximum ICA retraction distance was measured in the x-axis for all ten sides. RESULTS: The average horizontal distance of ICA retraction measured at the mid-paraclival segment for all ten sides was 4.75 mm. In all cases, the carotid artery was repositioned without injury to the vessel or disruption of the surrounding neurovascular structures. CONCLUSIONS: Static repositioning of the ICA and other delicate neurovascular structures was effectively performed during endonasal, endoscopic cadaveric surgery of the skull base and has potential merits in live patients.

Evoked responses to note onsets and phrase boundaries in Mozart's K448.

Understanding the neural correlates of perception of hierarchical structure in music presents a direct window into auditory organization. To examine the hypothesis that high-level and low-level structures-i.e. phrases and notes-elicit different neural responses, we collected intracranial electroencephalography (iEEG) data from eight subjects during exposure to Mozart's K448 and directly compared Event-related potentials (ERPs) due to note onsets and those elicited by phrase boundaries. Cluster-level permutation tests revealed that note-onset-related ERPs and phrase-boundary-related ERPs were significantly different at [Formula: see text], 200, and 450 ms relative to note onset and phrase markers. We also observed increased activity in frontal brain regions when processing phrase boundaries. We relate these observations to (1) a process which syntactically binds notes together hierarchically to form larger phrases; (2) positive emotions induced by successful prediction of forthcoming phrase boundaries and violations of melodic expectations at phrase boundaries.

Musical components important for the Mozart K448 effect in epilepsy.

There is growing evidence for the efficacy of music, specifically Mozart's Sonata for Two Pianos in D Major (K448), at reducing ictal and interictal epileptiform activity. Nonetheless, little is known about the mechanism underlying this beneficial "Mozart K448 effect" for persons with epilepsy. Here, we measured the influence that K448 had on intracranial interictal epileptiform discharges (IEDs) in sixteen subjects undergoing intracranial monitoring for refractory focal epilepsy. We found reduced IEDs during the original version of K448 after at least 30-s of exposure. Nonsignificant IED rate reductions were witnessed in all brain regions apart from the bilateral frontal cortices, where we observed increased frontal theta power during transitions from prolonged musical segments. All other presented musical stimuli were associated with nonsignificant IED alterations. These results suggest that the "Mozart K448 effect" is dependent on the duration of exposure and may preferentially modulate activity in frontal emotional networks, providing insight into the mechanism underlying this response. Our findings encourage the continued evaluation of Mozart's K448 as a noninvasive, non-pharmacological intervention for refractory epilepsy.

Endovascular Management of Distal Anterior Cerebral Artery Aneurysms: A Multicenter Retrospective Review.

INTRODUCTION: Distal anterior cerebral artery aneurysms (DACAA) are a rare and difficult entity to manage. Endovascular treatment has evolved for safe and durable treatment of these lesions. The objective of this study is to report the safety, efficacy, and outcomes of endovascular treatment of DACAA. METHODS: A retrospective review of DACAA endovascularly treated at 5 different institutions was performed. Data included demographics, rupture status, radiographic features, endovascular technique, complication rates, and long-term angiographic and clinical outcomes. A primary endpoint was a good clinical outcome (modified Rankin scale 0-2). Secondary endpoints included complications and radiographic occlusion at follow-up. RESULTS: A total of 84 patients were reviewed. The mean age was 56, and 64 (71.4%) were female. Fifty-two (61.9%) aneurysms were ruptured. A good functional outcome was achieved in 59 patients (85.5%). Sixty (71.4%) aneurysms were treated with primary coiling, and the remaining 24 were treated with flow diversion. Adequate occlusion was achieved in 41 (95.3%) aneurysms treated with coiling, and 17 (89.5%) with flow diversion. There were total 11 (13%) complications. In the flow diversion category, there were 2, both related to femoral access. In the coiling category, there were 9: 5 thromboembolic, 3 ruptures, and 1 related to femoral access. CONCLUSION: Endovascular treatment, and in particular, flow diversion for DACAA, is safe, feasible, and associated with good long-term angiographic and clinical outcomes.

Assessing Feedback Response With a Wearable Electroencephalography System.

Background: Event related potential (ERP) components, such as P3, N2, and FRN, are potential metrics for assessing feedback response as a form of performance monitoring. Most research studies investigate these ERP components using clinical or research-grade electroencephalography (EEG) systems. Wearable EEGs, which are an affordable alternative, have the potential to assess feedback response using ERPs but have not been sufficiently evaluated. Feedback-related ERPs also have not been scientifically evaluated in interactive settings that are similar to daily computer use. In this study, a consumer-grade wearable EEG system was assessed for its feasibility to collect feedback-related ERPs through an interactive software module that provided an environment in which users were permitted to navigate freely within the program to make decisions. Methods: The recording hardware, which costs < $1,500 in total, incorporated the OpenBCI Cyton Board with Daisy chain, a consumer-grade EEG system that costs $949 USD. Seventeen participants interacted with an oddball paradigm and an interactive module designed to elicit feedback-related ERPs. The features of interests for the oddball paradigm were the P3 and N2 components. The features of interests for the interactive module were the P3, N2, and FRN components elicited in response to positive, neutral, and two types of negative feedback. The FRN was calculated by subtracting the positive feedback response from the negative feedback responses. Results: The P3 and N2 components of the oddball paradigm indicated statistically significant differences between infrequent targets and frequent targets which is in line with current literature. The P3 and N2 components elicited in the interactive module indicated statistically significant differences between positive, neutral, and negative feedback responses. There were no significant differences between the FRN types and significant interactions with channel group and FRN type. Conclusion: The OpenBCI Cyton, after some modifications, shows potential for eliciting and assessing P3, N2, and FRN components, which are important indicators for performance monitoring, in an interactive setting.

Expanding the endoscopic transpterygoid corridor to the petroclival region: anatomical study and volumetric comparative analysis.

OBJECTIVE The endoscopic endonasal transmaxillary transpterygoid (TMTP) approach has been the gateway for lateral skull base exposure. Removal of the cartilaginous eustachian tube (ET) and lateral mobilization of the internal carotid artery (ICA) are technically demanding adjunctive steps that are used to access the petroclival region. The gained expansion of the deep working corridor provided by these maneuvers has yet to be quantified. METHODS The TMTP approach with cartilaginous ET removal and ICA mobilization was performed in 5 adult cadaveric heads (10 sides). Accessible portions of the petrous apex were drilled during the following 3 stages: 1) before ET removal, 2) after ET removal but before ICA mobilization, and 3) after ET removal and ICA repositioning. Resection volumes were calculated using 3D reconstructions generated from thin-slice CT scans obtained before and after each step of the dissection. RESULTS The average petrous temporal bone resection volumes at each stage were 0.21 cm3, 0.71 cm3, and 1.32 cm3 (p < 0.05, paired t-test). Without ET removal, inferior and superior access to the petrous apex was limited. Furthermore, without ICA mobilization, drilling was confined to the inferior two-thirds of the petrous apex. After mobilization, the resection was extended superiorly through the upper extent of the petrous apex. CONCLUSIONS The transpterygoid corridor to the petroclival region is maximally expanded by the resection of the cartilaginous ET and mobilization of the paraclival ICA. These added maneuvers expanded the deep window almost 6 times and provided more lateral access to the petroclival region with a maximum volume of 1.5 cm3. This may result in the ability to resect small-to-moderate sized intradural petroclival lesions up to that volume. Larger lesions may better be approached through an open transcranial approach.

Music of the 7Ts: Predicting and Decoding Multivoxel fMRI Responses with Acoustic, Schematic, and Categorical Music Features.

Underlying the experience of listening to music are parallel streams of auditory, categorical, and schematic qualia, whose representations and cortical organization remain largely unresolved. We collected high-field (7T) fMRI data in a music listening task, and analyzed the data using multivariate decoding and stimulus-encoding models. Twenty subjects participated in the experiment, which measured BOLD responses evoked by naturalistic listening to twenty-five music clips from five genres. Our first analysis applied machine classification to the multivoxel patterns that were evoked in temporal cortex. Results yielded above-chance levels for both stimulus identification and genre classification-cross-validated by holding out data from multiple of the stimuli during model training and then testing decoding performance on the held-out data. Genre model misclassifications were significantly correlated with those in a corresponding behavioral music categorization task, supporting the hypothesis that geometric properties of multivoxel pattern spaces underlie observed musical behavior. A second analysis employed a spherical searchlight regression analysis which predicted multivoxel pattern responses to music features representing melody and harmony across a large area of cortex. The resulting prediction-accuracy maps yielded significant clusters in the temporal, frontal, parietal, and occipital lobes, as well as in the parahippocampal gyrus and the cerebellum. These maps provide evidence in support of our hypothesis that geometric properties of music cognition are neurally encoded as multivoxel representational spaces. The maps also reveal a cortical topography that differentially encodes categorical and absolute-pitch information in distributed and overlapping networks, with smaller specialized regions that encode tonal music information in relative-pitch representations.

Pediatric holohemispheric developmental venous anomaly: definitive characterization by 3D susceptibility weighted magnetic resonance angiography.

We present a case of an incidentally discovered holohemispheric developmental venous anomaly (DVA) in a 12 year old, conclusively characterized by 3D T2* multi-echo sequence susceptibility weighted angiographic imaging (SWAN). For the evaluation of head trauma, abnormal right intraparenchymal and periventricular vascularity was identified by a non contrast head CT scan. Conventional MRI sequences revealed prominent veins with findings suspicious of a DVA. A definitive diagnosis was made by identifying angiographic features typical for DVA by augmented susceptibility weighted angiographic imaging. Using this sequence the entire hemispheric extent of the anomaly without complicating features was definitively characterized, negating the need for a catheter based angiographic study. A holohemispheric DVA in a child to our knowledge has not been previously described.