Journal of neurological surgery. Part A, Central European neurosurgery
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J Neurol Surg A Cent Eur Neurosurg · Jul 2017
Distance between Active Electrode Contacts and Dentatorubrothalamic Tract in Patients with Habituation of Stimulation Effect of Deep Brain Stimulation in Essential Tremor.
Background Some patients under thalamic deep brain stimulation (DBS) for essential tremor (ET) experience habituation of tremor reduction. The nucleus ventralis intermedius (Vim) is the current main target side for ET in DBS. However, the dentatorubrothalamic tract (DRTT) is considered the relevant structure to stimulate. ⋯ Results The distance between the active contact and the DRTT in patients with better and constant clinical tremor reduction was shorter (mean distance: 2.9 ± 2.2 mm standard deviation [SD]) than in patients who showed habituation of their response (mean distance: 6.1 ± 3.9 mm SD). After re-placement of a thalamic electrode inside the DRTT in one patient who experienced unsatisfying tremor reduction due to habituation of stimulation, the tremor alleviation was significant and persistent at a 13-month follow-up. Conclusion This retrospective analysis suggests that recurrence of ET tremor under chronic DBS might be associated with a larger distance between the DRTT and the active lead contact, in comparison with the smaller distances in patients with persistently good tremor control.
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J Neurol Surg A Cent Eur Neurosurg · Jul 2017
Transoral Atlantoaxial Release and Posterior Reduction by Occipitocervical Plate Fixation for the Treatment of Basilar Invagination with Irreducible Atlantoaxial Dislocation.
Background Prior studies have mainly assessed transoral odontoidectomy for basilar invagination with irreducible atlantoaxial dislocation. However, studies evaluating transoral release and posterior reduction with occipitocervical fixation in this setting are scarce. Methods From 2008 to 2013, 11 patients (6 men and 5 women; 23-67 years of age) with basilar invagination and irreducible atlantoaxial dislocation underwent surgery. ⋯ These findings indicated an improvement rate of 76.1%. The efficiency rate was 90.9%. Conclusions Anterior transoral atlantoaxial release without odontoidectomy and posterior fixation is an efficient treatment of basilar invagination with irreducible atlantoaxial dislocation.