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Objectives: This study aimed to indicate the feasibility of a prototype electrical neuromodulation system using a closed-loop energy-efficient ultrasound-based mechanism for communication, data transmission, and recharging., Materials and Methods: Closed-loop deep brain stimulation (DBS) prototypes were designed and fabricated with ultrasonic wideband (UsWB) communication technology and miniaturized custom electronics. Two devices were implanted short term in anesthetized Göttingen minipigs (N = 2). Targeting was performed using preoperative magnetic resonance imaging, and locations were confirmed postoperatively by computerized tomography. DBS systems were tested over a wide range of stimulation settings to mimic minimal, typical, and/or aggressive clinical settings, and evaluated for their ability to transmit data through scalp tissue and to recharge the DBS system using UsWB., Results: Stimulation, communication, reprogramming, and recharging protocols were successfully achieved in both subjects for amplitude (1V-6V), frequency (50-250 Hz), and pulse width (60-200 μs) settings and maintained for ≥six hours. The precision of pulse settings was verified with <5% error. Communication rates of 64 kbit/s with an error rate of 0.05% were shown, with no meaningful throughput degradation observed. Time to recharge to 80% capacity was <9 minutes. Two DBS systems also were implanted in the second test animal, and independent bilateral stimulation was successfully shown., Conclusions: The system performed at clinically relevant implant depths and settings. Independent bilateral stimulation for the duration of the study with a 4F energy storage and full rapid recharge were achieved. Continuous function extrapolates to six days of continuous stimulation in future design iterations implementing application specific integrated circuit level efficiency and 15F storage capacitance. UsWB increases energy efficiency, reducing storage requirements and thereby enabling device miniaturization. The device can enable intelligent closed-loop stimulation, remote system monitoring, and optimization and can serve as a power/data gateway to interconnect the intrabody network with the Internet of Medical Things., Competing Interests: Conflict of Interest Emrecan Demirors, Tommaso Melodia, and Jorge Jimenez are cofounders of Bionet Sonar Inc and hold equity interest. Raffaele Guida and Ryan Burke were employees of the company at the time of the study. Bionet Sonar holds all rights for the technology and its personnel, and its founders led the design, development, fabrication, and feasibility testing of prototype devices, including data collection and analysis, decision to publish, and preparation of this manuscript. Joseph S. Neimat serves as a consultant for Medtronic and on a scientific advisory board for Abbott. Steven C. Koenig reports one conflict of interest (spouse is paid by Bionet Sonar for her assistance with grants administration activities but did not participate in any research and development activities and/or participation in the preparation of the manuscript)., (Copyright © 2024 International Neuromodulation Society. Published by Elsevier Inc. All rights reserved.)

Background: Peripheral neurostimulation (PNS) for medically refractory trigeminal pain is an emerging alternative to traditional surgical approaches, with safety and efficacy demonstrated in several retrospective series and a prospective trial currently in progress. Many existing studies suffer from relatively small numbers and short or inconsistent follow-up, making balanced treatment assessment difficult., Materials and Methods: Consecutive cases of trial and permanent placement of trigeminal branch stimulation electrodes by a single surgeon from May 2014 through January 2019 were retrospectively reviewed from a prospectively collected database, following the PROCESS guidelines for surgical case series. Outcomes were assessed at six months and at last follow-up., Results: Ninteen patients underwent trial electrode placement, with 15 patients undergoing permanent system placement. The most common diagnoses were idiopathic trigeminal neuralgia Type 2 (N = 8) and trigeminal neuropathic pain (N = 7). Median follow-up was 14 months (range 6-58 months). At last follow-up, 12 of 15 implanted patients (80%) were still receiving stimulation, with mean (median) pain reduction of 52.3% (47.5%). Infection and revision rates were high, although erosion and migration, which have typically plagued trigeminal PNS surgery, did not occur. Implanted systems were well-tolerated, with excellent cosmetic outcomes and high patient satisfaction that proved durable over long follow-up., Conclusions: We present a single-institution series of PNS for complex craniofacial pain involving the trigeminal nerve. The procedure is safe, effective and durable over at least one year in the large majority of a well-selected patient population., (© 2020 International Neuromodulation Society.)

Background: Thrombectomy has become established as a successful treatment strategy for ischemic stroke, and consequently, more patients are undergoing this procedure. Due to comorbid conditions, chronic disease states, and advanced age, many patients have anatomy which complicates revascularization, specifically difficult aortic arch anatomy, or tortuous common and internal artery anatomy, or both., Methods: In the present study, these unfavorable anatomic parameters were analyzed for 53 patients undergoing acute thrombectomy for ischemic stroke. Statistical analysis was performed and the outcome TICI scores were compared. 26 of the patients analyzed had features of difficult femoral access., Results: Difficult arch anatomy was associated with unsuccessful revascularization ( p = 0.03, Fisher's exact) with only 53% of patients with this feature having favorable TICI scores. Difficult common carotid access was also associated with unsuccessful revascularization ( p = 0.004, Fisher's exact) with 38% success. There was a trend toward significance for unsuccessful revascularization for difficult internal carotid artery access ( p = 0.06, Fisher's exact)., Conclusion: Any combination of the aforementioned anatomic parameters was associated with the decreased success of treatment which was an independent predictor in multivariate analysis ( p = 0.009). As difficult access anatomy is commonly encountered in patients undergoing emergent thrombectomy, it is important for the treating physician to be prepared and to adapt access strategies to increase the likelihood of successful revascularization.