In vivo Visualization of Pig Vagus Nerve “Vagotopy” Using Ultrasound

Background: Placement of the clinical vagus nerve stimulating cuff is a standard surgical procedure based on anatomical landmarks, with limited patient specificity in terms of fascicular organization or vagal anatomy. As such, the therapeutic effects are generally limited by unwanted side effects of...

Descripción completa

Guardado en:

Detalles Bibliográficos
Autores principales:	Megan L. Settell, Aaron C. Skubal, Rex C. H. Chen, Maïsha Kasole, Bruce E. Knudsen, Evan N. Nicolai, Chengwu Huang, Chenyun Zhou, James K. Trevathan, Aniruddha Upadhye, Chaitanya Kolluru, Andrew J. Shoffstall, Justin C. Williams, Aaron J. Suminski, Warren M. Grill, Nicole A. Pelot, Shigao Chen, Kip A. Ludwig
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	vagotopy histology vagus nerve vagus nerve stimulation bioelectronic medicine electroceutical Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571
Acceso en línea:	https://doaj.org/article/4411a1b983b442e0b0fb7d939fb91530
Etiquetas:	Agregar Etiqueta Sin Etiquetas, Sea el primero en etiquetar este registro!

id	oai:doaj.org-article:4411a1b983b442e0b0fb7d939fb91530
record_format	dspace
institution	DOAJ
collection	DOAJ
language	EN
topic	vagotopy histology vagus nerve vagus nerve stimulation bioelectronic medicine electroceutical Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571
spellingShingle	vagotopy histology vagus nerve vagus nerve stimulation bioelectronic medicine electroceutical Neurosciences. Biological psychiatry. Neuropsychiatry RC321-571 Megan L. Settell Megan L. Settell Aaron C. Skubal Aaron C. Skubal Rex C. H. Chen Rex C. H. Chen Maïsha Kasole Maïsha Kasole Bruce E. Knudsen Bruce E. Knudsen Evan N. Nicolai Evan N. Nicolai Evan N. Nicolai Chengwu Huang Chenyun Zhou Chenyun Zhou James K. Trevathan James K. Trevathan Aniruddha Upadhye Aniruddha Upadhye Chaitanya Kolluru Chaitanya Kolluru Andrew J. Shoffstall Andrew J. Shoffstall Justin C. Williams Justin C. Williams Justin C. Williams Aaron J. Suminski Aaron J. Suminski Aaron J. Suminski Warren M. Grill Warren M. Grill Warren M. Grill Warren M. Grill Nicole A. Pelot Shigao Chen Kip A. Ludwig Kip A. Ludwig Kip A. Ludwig In vivo Visualization of Pig Vagus Nerve “Vagotopy” Using Ultrasound
description	Background: Placement of the clinical vagus nerve stimulating cuff is a standard surgical procedure based on anatomical landmarks, with limited patient specificity in terms of fascicular organization or vagal anatomy. As such, the therapeutic effects are generally limited by unwanted side effects of neck muscle contractions, demonstrated by previous studies to result from stimulation of (1) motor fibers near the cuff in the superior laryngeal and (2) motor fibers within the cuff projecting to the recurrent laryngeal.Objective: Conventional non-invasive ultrasound, where the transducer is placed on the surface of the skin, has been previously used to visualize the vagus with respect to other landmarks such as the carotid and internal jugular vein. However, it lacks sufficient resolution to provide details about the vagus fascicular organization, or detail about smaller neural structures such as the recurrent and superior laryngeal branch responsible for therapy limiting side effects. Here, we characterize the use of ultrasound with the transducer placed in the surgical pocket to improve resolution without adding significant additional risk to the surgical procedure in the pig model.Methods: Ultrasound images were obtained from a point of known functional organization at the nodose ganglia to the point of placement of stimulating electrodes within the surgical window. Naïve volunteers with minimal training were then asked to use these ultrasound videos to trace afferent groupings of fascicles from the nodose to their location within the surgical window where a stimulating cuff would normally be placed. Volunteers were asked to select a location for epineural electrode placement away from the fascicles containing efferent motor nerves responsible for therapy limiting side effects. 2-D and 3-D reconstructions of the ultrasound were directly compared to post-mortem histology in the same animals.Results: High-resolution ultrasound from the surgical pocket enabled 2-D and 3-D reconstruction of the cervical vagus and surrounding structures that accurately depicted the functional vagotopy of the pig vagus nerve as confirmed via histology. Although resolution was not sufficient to match specific fascicles between ultrasound and histology 1 to 1, it was sufficient to trace fascicle groupings from a point of known functional organization at the nodose ganglia to their locations within the surgical window at stimulating electrode placement. Naïve volunteers were able place an electrode proximal to the sensory afferent grouping of fascicles and away from the motor nerve efferent grouping of fascicles in each subject (n = 3).Conclusion: The surgical pocket itself provides a unique opportunity to obtain higher resolution ultrasound images of neural targets responsible for intended therapeutic effect and limiting off-target effects. We demonstrate the increase in resolution is sufficient to aid patient-specific electrode placement to optimize outcomes. This simple technique could be easily adopted for multiple neuromodulation targets to better understand how patient specific anatomy impacts functional outcomes.
format	article
author	Megan L. Settell Megan L. Settell Aaron C. Skubal Aaron C. Skubal Rex C. H. Chen Rex C. H. Chen Maïsha Kasole Maïsha Kasole Bruce E. Knudsen Bruce E. Knudsen Evan N. Nicolai Evan N. Nicolai Evan N. Nicolai Chengwu Huang Chenyun Zhou Chenyun Zhou James K. Trevathan James K. Trevathan Aniruddha Upadhye Aniruddha Upadhye Chaitanya Kolluru Chaitanya Kolluru Andrew J. Shoffstall Andrew J. Shoffstall Justin C. Williams Justin C. Williams Justin C. Williams Aaron J. Suminski Aaron J. Suminski Aaron J. Suminski Warren M. Grill Warren M. Grill Warren M. Grill Warren M. Grill Nicole A. Pelot Shigao Chen Kip A. Ludwig Kip A. Ludwig Kip A. Ludwig
author_facet	Megan L. Settell Megan L. Settell Aaron C. Skubal Aaron C. Skubal Rex C. H. Chen Rex C. H. Chen Maïsha Kasole Maïsha Kasole Bruce E. Knudsen Bruce E. Knudsen Evan N. Nicolai Evan N. Nicolai Evan N. Nicolai Chengwu Huang Chenyun Zhou Chenyun Zhou James K. Trevathan James K. Trevathan Aniruddha Upadhye Aniruddha Upadhye Chaitanya Kolluru Chaitanya Kolluru Andrew J. Shoffstall Andrew J. Shoffstall Justin C. Williams Justin C. Williams Justin C. Williams Aaron J. Suminski Aaron J. Suminski Aaron J. Suminski Warren M. Grill Warren M. Grill Warren M. Grill Warren M. Grill Nicole A. Pelot Shigao Chen Kip A. Ludwig Kip A. Ludwig Kip A. Ludwig
author_sort	Megan L. Settell
title	In vivo Visualization of Pig Vagus Nerve “Vagotopy” Using Ultrasound
title_short	In vivo Visualization of Pig Vagus Nerve “Vagotopy” Using Ultrasound
title_full	In vivo Visualization of Pig Vagus Nerve “Vagotopy” Using Ultrasound
title_fullStr	In vivo Visualization of Pig Vagus Nerve “Vagotopy” Using Ultrasound
title_full_unstemmed	In vivo Visualization of Pig Vagus Nerve “Vagotopy” Using Ultrasound
title_sort	in vivo visualization of pig vagus nerve “vagotopy” using ultrasound
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/4411a1b983b442e0b0fb7d939fb91530
work_keys_str_mv	AT meganlsettell invivovisualizationofpigvagusnervevagotopyusingultrasound AT meganlsettell invivovisualizationofpigvagusnervevagotopyusingultrasound AT aaroncskubal invivovisualizationofpigvagusnervevagotopyusingultrasound AT aaroncskubal invivovisualizationofpigvagusnervevagotopyusingultrasound AT rexchchen invivovisualizationofpigvagusnervevagotopyusingultrasound AT rexchchen invivovisualizationofpigvagusnervevagotopyusingultrasound AT maishakasole invivovisualizationofpigvagusnervevagotopyusingultrasound AT maishakasole invivovisualizationofpigvagusnervevagotopyusingultrasound AT bruceeknudsen invivovisualizationofpigvagusnervevagotopyusingultrasound AT bruceeknudsen invivovisualizationofpigvagusnervevagotopyusingultrasound AT evannnicolai invivovisualizationofpigvagusnervevagotopyusingultrasound AT evannnicolai invivovisualizationofpigvagusnervevagotopyusingultrasound AT evannnicolai invivovisualizationofpigvagusnervevagotopyusingultrasound AT chengwuhuang invivovisualizationofpigvagusnervevagotopyusingultrasound AT chenyunzhou invivovisualizationofpigvagusnervevagotopyusingultrasound AT chenyunzhou invivovisualizationofpigvagusnervevagotopyusingultrasound AT jamesktrevathan invivovisualizationofpigvagusnervevagotopyusingultrasound AT jamesktrevathan invivovisualizationofpigvagusnervevagotopyusingultrasound AT aniruddhaupadhye invivovisualizationofpigvagusnervevagotopyusingultrasound AT aniruddhaupadhye invivovisualizationofpigvagusnervevagotopyusingultrasound AT chaitanyakolluru invivovisualizationofpigvagusnervevagotopyusingultrasound AT chaitanyakolluru invivovisualizationofpigvagusnervevagotopyusingultrasound AT andrewjshoffstall invivovisualizationofpigvagusnervevagotopyusingultrasound AT andrewjshoffstall invivovisualizationofpigvagusnervevagotopyusingultrasound AT justincwilliams invivovisualizationofpigvagusnervevagotopyusingultrasound AT justincwilliams invivovisualizationofpigvagusnervevagotopyusingultrasound AT justincwilliams invivovisualizationofpigvagusnervevagotopyusingultrasound AT aaronjsuminski invivovisualizationofpigvagusnervevagotopyusingultrasound AT aaronjsuminski invivovisualizationofpigvagusnervevagotopyusingultrasound AT aaronjsuminski invivovisualizationofpigvagusnervevagotopyusingultrasound AT warrenmgrill invivovisualizationofpigvagusnervevagotopyusingultrasound AT warrenmgrill invivovisualizationofpigvagusnervevagotopyusingultrasound AT warrenmgrill invivovisualizationofpigvagusnervevagotopyusingultrasound AT warrenmgrill invivovisualizationofpigvagusnervevagotopyusingultrasound AT nicoleapelot invivovisualizationofpigvagusnervevagotopyusingultrasound AT shigaochen invivovisualizationofpigvagusnervevagotopyusingultrasound AT kipaludwig invivovisualizationofpigvagusnervevagotopyusingultrasound AT kipaludwig invivovisualizationofpigvagusnervevagotopyusingultrasound AT kipaludwig invivovisualizationofpigvagusnervevagotopyusingultrasound
_version_	1718405954822733824
spelling	oai:doaj.org-article:4411a1b983b442e0b0fb7d939fb915302021-12-01T01:28:44ZIn vivo Visualization of Pig Vagus Nerve “Vagotopy” Using Ultrasound1662-453X10.3389/fnins.2021.676680https://doaj.org/article/4411a1b983b442e0b0fb7d939fb915302021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fnins.2021.676680/fullhttps://doaj.org/toc/1662-453XBackground: Placement of the clinical vagus nerve stimulating cuff is a standard surgical procedure based on anatomical landmarks, with limited patient specificity in terms of fascicular organization or vagal anatomy. As such, the therapeutic effects are generally limited by unwanted side effects of neck muscle contractions, demonstrated by previous studies to result from stimulation of (1) motor fibers near the cuff in the superior laryngeal and (2) motor fibers within the cuff projecting to the recurrent laryngeal.Objective: Conventional non-invasive ultrasound, where the transducer is placed on the surface of the skin, has been previously used to visualize the vagus with respect to other landmarks such as the carotid and internal jugular vein. However, it lacks sufficient resolution to provide details about the vagus fascicular organization, or detail about smaller neural structures such as the recurrent and superior laryngeal branch responsible for therapy limiting side effects. Here, we characterize the use of ultrasound with the transducer placed in the surgical pocket to improve resolution without adding significant additional risk to the surgical procedure in the pig model.Methods: Ultrasound images were obtained from a point of known functional organization at the nodose ganglia to the point of placement of stimulating electrodes within the surgical window. Naïve volunteers with minimal training were then asked to use these ultrasound videos to trace afferent groupings of fascicles from the nodose to their location within the surgical window where a stimulating cuff would normally be placed. Volunteers were asked to select a location for epineural electrode placement away from the fascicles containing efferent motor nerves responsible for therapy limiting side effects. 2-D and 3-D reconstructions of the ultrasound were directly compared to post-mortem histology in the same animals.Results: High-resolution ultrasound from the surgical pocket enabled 2-D and 3-D reconstruction of the cervical vagus and surrounding structures that accurately depicted the functional vagotopy of the pig vagus nerve as confirmed via histology. Although resolution was not sufficient to match specific fascicles between ultrasound and histology 1 to 1, it was sufficient to trace fascicle groupings from a point of known functional organization at the nodose ganglia to their locations within the surgical window at stimulating electrode placement. Naïve volunteers were able place an electrode proximal to the sensory afferent grouping of fascicles and away from the motor nerve efferent grouping of fascicles in each subject (n = 3).Conclusion: The surgical pocket itself provides a unique opportunity to obtain higher resolution ultrasound images of neural targets responsible for intended therapeutic effect and limiting off-target effects. We demonstrate the increase in resolution is sufficient to aid patient-specific electrode placement to optimize outcomes. This simple technique could be easily adopted for multiple neuromodulation targets to better understand how patient specific anatomy impacts functional outcomes.Megan L. SettellMegan L. SettellAaron C. SkubalAaron C. SkubalRex C. H. ChenRex C. H. ChenMaïsha KasoleMaïsha KasoleBruce E. KnudsenBruce E. KnudsenEvan N. NicolaiEvan N. NicolaiEvan N. NicolaiChengwu HuangChenyun ZhouChenyun ZhouJames K. TrevathanJames K. TrevathanAniruddha UpadhyeAniruddha UpadhyeChaitanya KolluruChaitanya KolluruAndrew J. ShoffstallAndrew J. ShoffstallJustin C. WilliamsJustin C. WilliamsJustin C. WilliamsAaron J. SuminskiAaron J. SuminskiAaron J. SuminskiWarren M. GrillWarren M. GrillWarren M. GrillWarren M. GrillNicole A. PelotShigao ChenKip A. LudwigKip A. LudwigKip A. LudwigFrontiers Media S.A.articlevagotopyhistologyvagus nervevagus nerve stimulationbioelectronic medicineelectroceuticalNeurosciences. Biological psychiatry. NeuropsychiatryRC321-571ENFrontiers in Neuroscience, Vol 15 (2021)

In vivo Visualization of Pig Vagus Nerve “Vagotopy” Using Ultrasound

Ejemplares similares