Sakas D E, Panourias I G, Simpson B A
P. S. Kokkalis Hellenic Center for Neurosurgical Research, Athens, Greece.
Acta Neurochir Suppl. 2007;97(Pt 2):3-13. doi: 10.1007/978-3-211-33081-4_1.
Operative Neuromodulation is the field of altering electrically or chemically the signal transmission in the nervous system by implanted devices in order to excite, inhibit or tune the activities of neurons or neural networks and produce therapeutic effects. The present article reviews relevant literature on procedures or devices applied either in contact with the cerebral cortex or cranial nerves or in deep sites inside the brain in order to treat various refractory neurological conditions such as: a) chronic pain (facial, somatic, deafferentation, phantom limb), b) movement disorders (Parkinson's disease, dystonia, Tourette syndrome), c) epilepsy, d) psychiatric disease, e) hearing deficits, and f) visual loss. These data indicate that in operative neuromodulation, a new field emerges that is based on neural networks research and on advances in digitised stereometric brain imaging which allow precise localisation of cerebral neural networks and their relay stations; this field can be described as Neural networks surgery because it aims to act extrinsically or intrinsically on neural networks and to alter therapeutically the neural signal transmission with the use of implantable electrical or electronic devices. The authors also review neurotechnology literature relevant to neuroengineering, nanotechnologies, brain computer interfaces, hybrid cultured probes, neuromimetics, neuroinformatics, neurocomputation, and computational neuromodulation; the latter field is dedicated to the study of the biophysical and mathematical characteristics of electrochemical neuromodulation. The article also brings forward particularly interesting lines of research such as the carbon nanofibers electrode arrays for simultaneous electrochemical recording and stimulation, closed-loop systems for responsive neuromodulation, and the intracortical electrodes for restoring hearing or vision. The present review of cerebral neuromodulatory procedures highlights the transition from the conventional neurosurgery of resective or ablative techniques to a highly selective "surgery of networks". The dynamics of the convergence of the above biomedical and technological fields with biological restorative approaches have important implications for patients with severe neurological disorders.
手术神经调节是通过植入设备以电或化学方式改变神经系统信号传输,从而激发、抑制或调节神经元或神经网络活动并产生治疗效果的领域。本文综述了有关与大脑皮层或颅神经接触或在脑深部部位应用的程序或设备的相关文献,以治疗各种难治性神经系统疾病,如:a)慢性疼痛(面部、躯体、去传入性、幻肢痛),b)运动障碍(帕金森病、肌张力障碍、图雷特综合征),c)癫痫,d)精神疾病,e)听力缺陷,f)视力丧失。这些数据表明,在手术神经调节中,一个基于神经网络研究和数字化立体脑成像进展的新领域正在出现,这些进展使大脑神经网络及其中继站能够精确定位;这个领域可被描述为神经网络手术,因为它旨在通过可植入的电气或电子设备对神经网络进行外在或内在作用,并治疗性地改变神经信号传输。作者还综述了与神经工程、纳米技术、脑机接口、混合培养探针、神经模拟物、神经信息学、神经计算和计算神经调节相关的神经技术文献;后者致力于研究电化学神经调节的生物物理和数学特性。本文还特别提出了一些有趣的研究方向,如用于同时进行电化学记录和刺激的碳纳米纤维电极阵列、用于响应性神经调节的闭环系统以及用于恢复听力或视力的皮层内电极。本文对大脑神经调节程序的综述突出了从传统的切除或消融技术神经外科向高度选择性的“网络手术”的转变。上述生物医学和技术领域与生物修复方法融合的动态过程对患有严重神经系统疾病的患者具有重要意义。
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