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DONG-THESIS-2016.Pdf (4.790Mb) Beyond Conventional Stereotaxic Targeting: Using Multiplanar Computed Tomography, Optical Coherence Tomography and Intracranial/Extravascular Ultrasound of the Subarachnoid Space to Locate the Rhesus Vestibular Nerve for Single Unit Recording By Shiyao Dong A thesis submitted to Johns Hopkins University in conformity with the requirements for the degree of Master of Science in Engineering Baltimore, Maryland August, 2016 © 2016 Shiyao Dong All Rights Reserv Abstract Single-neuron electrophysiologic recording of activity in the vestibular nerve and vestibular nuclei of alert rhesus monkeys is a uniquely informative technique in the arsenal of neurophysiologists who seek to elucidate adaptive neuronal signal processing that mediate learning within vestibulo-ocular and vestibulo-spinal reflex pathways. The traditional approach to targeting these structures with a recording microelectrode - stereotactic guidance based on atlas coordinates - has changed little over the past half century and is made difficult by the vestibular nerve’s mobility, mechanical compliance, small caliber and relatively long distance from where a microelectrode enters the cranium (typically at the base of a recording chamber surgically affixed to the parietal aspect of the skull). The goal of the present study was to determine whether imaging techniques that have recently gained prominence in clinical care might augment or replace the traditional neurophysiologic method. Toward that end, we evaluated 3D multiplanar computed tomography (3DCT), optical coherence tomography (OCT) and an intracranial/cisternal adaptation of intravascular ultrasound (IVUS) as adjuncts to facilitate targeting the rhesus vestibular nerve. Image guidance using CT scans acquired after recording chamber implantation proved to be a simple and useful complement to traditional atlas-based stereotaxis; however, atlas-based stereotaxis, 3DCT, OCT and IVUS offer complementary advantages and disadvantages for targeting cranial nerves. Although OCT and IVUS ultimately proved needlessly complex for our application, adaptation of those techniques for intracranial/cisternal or intracranial imaging of cranial nerves, spinal nerves and other structures adjacent to cerebrospinal fluid spaces may hold promise for intraoperative guidance during minimal-access rhizotomy, biopsy and other neurosurgical procedures. ii Keywords: CT-guidance, vestibular nerve, stereotactic surgery, OCT, ultrasound Thesis Review Committee: Advisor: Charles C. Della Santina, Ph.D. M.D. Thesis Reviewer: Chenkai Dai, Ph.D. M.D. Kathleen Cullen, Ph.D. iii Acknowledgement I really appreciate those people who help me a lot throughout my Master research, especially members of Vestibular NeuroEngineering Laboratory. Without their help, this thesis project wouldn’t be possible. I would like to thank Dr. Paul Bottomley, Dr. Jon Resar, Dr. Caroline Garret, Dr. Yu Chen, Cardiac Cath lab at Johns Hopkins Hospital, Shashank Sathyanarayana Hegde, Kelly Lane, and Nicole McIntosh for the help with equipment and animals. I would like to thank Pengyu Ren for the help with animal surgery. I would like to thank Dr. Chenkai Dai for the valuable advice and helpful guidance on my research project. I would like thank Dr. Kathleen Cullen for reviewing my thesis. Most of all, I’m really thankful to Dr. Charley Della Santina, my friendly, helpful and responsible advisor, mentor and friend. He shared his experience and vision with me, and provided me with essential skills and tools for research. His guidance helped me get through lots of difficulties during my master research. I would like to thank my family who taught me, loved me and supported me throughout my life endeavors. The project described was supported by NIH/NIDCD (R01-DC2390, R01DC9255) and donors to the Johns Hopkins Vestibular NeuroEngineering Laboratory. iv Table of contents Abstract .............................................................................................................................. ii Acknowledgement ............................................................................................................ iv Table of contents ............................................................................................................... v List of tables..................................................................................................................... vii List of Figures ................................................................................................................. viii Chapter 1 Introduction ................................................................................................. 1 1.1 Challenge in Single-Unit Recording in Rhesus Vestibular Nerve ................... 3 1.2 Current approaches to targeting a cranial nerve .............................................. 7 1.2.1 Conventional Stereotaxic Procedure .................................................... 8 1.2.2 Image-guided Stereotaxis ..................................................................... 9 1.3 Potential imaging techniques for nerve targeting .......................................... 12 1.3.1 Intravascular Ultrasound .................................................................... 13 1.3.2 Optical Coherence Tomography ........................................................ 15 1.4 Project Aims .................................................................................................. 20 Chapter 2 Post-operative CT Guidance for Single-unit Recording in Rhesus Vestibular Nerve ............................................................................................................. 22 2.1 Experimental Subjects ................................................................................... 22 2.2 Materials and Methods .................................................................................. 22 2.2.1 Recording Chamber Implantation Surgical Procedures ..................... 23 2.2.2 CT Imaging and Analysis .................................................................. 26 2.3 Results............................................................................................................ 31 2.3.1 Measurement of Vestibular Nerve Location ...................................... 31 2.3.2 Experimental Validation and Errors Calibration ............................... 32 2.4 Discussion ...................................................................................................... 37 Chapter 3 Intracranial/Extravascular Application of OCT and IVUS for Imaging the Subarachnoid Space ................................................................................................. 41 3.1 Experimental Subjects ................................................................................... 41 3.1.1 Phantom ............................................................................................. 41 3.1.2 Chinchilla Subject .............................................................................. 41 3.1.3 Rhesus Monkey Subjects ................................................................... 42 3.2 Surgical Procedures ....................................................................................... 42 3.2.1 Chinchilla Surgery ............................................................................. 42 v 3.3 Intracranial/Extravascular Optical Coherence Tomography ......................... 43 3.3.1 Method ............................................................................................... 43 3.3.2 Results ................................................................................................ 46 3.4 Intracranial/Extravascular Ultrasound Imaging of the Subarachnoid Space . 52 3.4.1 Method ............................................................................................... 52 3.4.2 Results ................................................................................................ 52 3.5 Discussion ...................................................................................................... 55 Chapter 4 Conclusion ................................................................................................. 58 4.1 Post-Operative CT Guidance ......................................................................... 58 4.2 Intracranial Imaging of the Subarachnoid Space Using OCT and IVUS ...... 58 4.3 Future Directions ........................................................................................... 59 Reference List .................................................................................................................. 61 Curriculum Vitae ............................................................................................................ 68 vi List of tables Table 1-1 Comparison of OCT and IVUS ........................................................................ 17 Table 2-1. General information of experimental subjects ................................................ 22 Table 2-2. Location of porus acusticus in CT stereotaxic coordinate............................... 36 Table 2-3. Location of porus acusticus in CT chamber coordinate .................................. 36 Table 3-1.Comparison of OCT and IC/EVUS .................................................................. 55 vii List of Figures Figure 1-1. Rhesus Monkey Brain Atlas (Interaural -6.00 mm) ......................................... 5 Figure 1-2. Rhesus Monkey Brain Atlas (Interaural -5.55 mm) ......................................... 6 Figure 1-3.MRI-guided
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