Acta neurochirurgica
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Acta neurochirurgica · Dec 2010
Diffusion tensor imaging (DTI) and colored fractional anisotropy (FA) mapping of the subthalamic nucleus (STN) and the globus pallidus interna (GPi).
The subthalamic nucleus (STN) and the globus pallidus internus (GPi) are the most common surgical targets for the treatment of Parkinson's disease. We studied directionally colored fractional anisotropy (FA) and diffusion tensor imaging (DTI) sequences to better target these anatomical regions. ⋯ Colored FA maps allow a potential method to identify the STN and GPi accurately. DTI has proven to be a powerful tool that can be used to augment identification of the STN nucleus and GPi used for stereotactic surgery.
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Acta neurochirurgica · Dec 2010
Case ReportsA role of diffusion tensor imaging in movement disorder surgery.
The safe and reversible nature of deep brain stimulation (DBS) has allowed movement disorder neurosurgery to become commonplace throughout the world. Fundamental understanding of individual patient's anatomy is critical for optimizing the effects and side effects of DBS surgery. Three patients undergoing stereotactic surgery for movement disorders, at the institution's intraoperative magnetic resonance imaging operating suite, were studied with fiber tractography. ⋯ This represents a possible mechanism of the increased effects and side effects observed with higher stimulation voltages. Currently available diffusion tensor imaging techniques allow potential methods to characterize the effects and side effects of DBS. This technology has the potential of being a powerful tool to optimize DBS neurosurgery.
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Acta neurochirurgica · Dec 2010
Case ReportsPreserved cognition after deep brain stimulation (DBS) in the subthalamic area for Parkinson's disease: a case report.
At present, subthalamic nucleus (STN) stimulation is the preferred procedure for the amelioration of motor symptoms in medication refractory Parkinson's disease. Results are however impaired by negative impacts on mood, cognition, incentive, and social judgment. ⋯ We describe a case with stimulation of subthalamic fibre tracts that showed clear improvement of cognitive and social abilities. Avoiding the STN may be advantageous in progressive Parkinson's disease to avoid non-motor complications and enhance quality of life.
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Acta neurochirurgica · Dec 2010
Surgical treatment of trigeminal neuralgia. Results from the use of glycerol injection, microvascular decompression, and rhizotomia.
The study aims to assess the efficacy and safety of surgical treatment of trigeminal neuralgia (TN) in our department and to identify prognostic factors. ⋯ Regarding prognosis and outcome, we find that it is very important to classify TN in subgroups (types 1 and 2). Dealing with medically treatment-resistant type 1 TN, MVD and RIZ are reasonably safe and effective interventions. The surgical results dealing with type 2 TN are still very poor. All patients with medically treatment-resistant TN should be offered referral to a neurosurgical unit with experience in treating this painful disease. We recommend using a vector-based pain diagram when evaluating the outcome of multiple interventions.
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Acta neurochirurgica · Dec 2010
Comparative StudyPostoperative MRI examinations in patients treated by deep brain stimulation using a non-standard protocol.
MRI in patients bearing deep brain stimulation (DBS) electrodes may induce cerebral lesions due to electrode heating. To avoid neurological deficits related to MRI, post-operative MRI protocol was installed in our institution. However, our protocol comprised a higher specific absorption rate (SAR) and different positioning of lead excess than the later released electrode manufacturer's guidelines. The objective was to evaluate the safety using this protocol. ⋯ No complications were observed using this MRI protocol in DBS patients. Our results suggest that, within this setting, higher SAR values may be feasible for DBS patients than in the manufacturer's guidelines.