Acta neurochirurgica
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Acta neurochirurgica · Aug 2011
Clinical TrialForamen ovale cannulation guided by intra-operative computed tomography with integrated neuronavigation for the treatment of trigeminal neuralgia.
Radiofrequency rhizotomy of the Gasserian ganglion for the treatment of trigeminal neuralgia via percutaneous cannulation of the foramen ovale is facilitated by various localization modalities. In our preliminary study, we described the feasibility of computed tomography (CT) using an integrated neuronavigation system to cannulate the foramen ovale. ⋯ These data demonstrate that neuronavigation-guided cannulation of the foramen ovale can be executed both quickly and safely on an outpatient basis. Additionally, the use of CT with integrated neuronavigation technology provides superior visual-spatial information compared to conventional fluoroscopy, the process of CT scanning, object planning, and neuronavigation-guided intervention can be completed in the same locale, and its application is easy to master and has the potential to enhance procedure tolerability of awake patients.
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Acta neurochirurgica · Aug 2011
Case ReportsA role of diffusion tensor imaging fiber tracking in deep brain stimulation surgery: DBS of the dentato-rubro-thalamic tract (drt) for the treatment of therapy-refractory tremor.
Deep brain stimulation (DBS) can alleviate tremor of various origins. A number of regions are targeted. In recent work our group was able to show the involvement of the dentato-rubro-thalamic tract (drt) in tremor control with fiber tracking techniques. Here we report for the first time the successful use of magnetic resonance tractography in combination with traditional landmark-based targeting techniques to perform the implantation of a bilateral DBS system in a patient with dystonic head tremor. ⋯ This is the first time that direct visualization of fiber tracts has been employed for direct targeting and successful movement disorder tremor surgery. In the reported case, additional knowledge about the position of the drt, which previously has been shown to be a structure for modulation to achieve tremor control, led to a successful implantation of a DBS system, although there was a lack of intra-operatively testable tremor symptoms. In concordance with studies in optogenetic neuromodulation, fiber tracts are the emerging target structures for DBS. The routine integration of DTI tractography into surgical planning might be a leading path into the future of DBS surgery and will add to our understanding of the pathophysiology of movement disorders. Larger study populations will have to prove these concepts in future research.
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Acta neurochirurgica · Aug 2011
Case ReportsBypass of the maxillary to proximal middle cerebral artery or proximal posterior cerebral artery with radial artery graft.
The authors report three cases of radial artery (RA) graft bypass from the maxillary artery (MA) to either the middle cerebral artery (MCA) or the posterior cerebral artery (PCA). The first two cases presented with the features of basal ganglion ischemia, and magnetic resonance imaging (MRI) revealed left and right basal ganglion ischemia respectively, whereas angiogram showed MCA occlusion. Computed tomography angiography (CTA) of the third case, who presented with headache and dysphasia, showed a giant basilar artery aneurysm with an absence of the left posterior communicating artery (PComA). ⋯ Postoperative angiogram disclosed patent RA graft and refilling of the ischemic segment. Follow-up at 7-9 months showed marked clinical improvement in all cases. To our knowledge, MA bypass has not been performed clinically till the date and this method may be a safe, effective and new surgical technique for the extracranial-intracranial (EC-IC) bypass surgery.
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Acta neurochirurgica · Aug 2011
ReviewSurgical management of glioneuronal tumors with drug-resistant epilepsy.
In this review, we discuss the options for the surgical management of glioneuronal tumors (GNTs) associated with drug-resistant epilepsy, with an emphasis on the surgical issues involved in addressing the epileptogenic nature of these lesions. We briefly summarize the pathological hallmarks of these lesions in order to outline how these tumors contribute to seizure activity. Understanding the pathophysiology of these lesions is important in discussing the advantages and disadvantages of different surgical strategies. There have been a number of studies that have investigated the utility of different surgical approaches in improving seizure outcome, and we highlight some of these studies in order to shed light on surgical issues related to these tumors.