Journal of neurosurgery
-
Journal of neurosurgery · May 2022
Utility of GPI+VIM dual-lead deep brain stimulation for Parkinson's disease patients with significant residual tremor on medication.
Randomized controlled trials have demonstrated that deep brain stimulation (DBS) of both the globus pallidus internus (GPI) and subthalamic nucleus (STN) for Parkinson's disease (PD) is superior to the best medical therapy. Tremor is particularly responsive to DBS, with reports of 70%-80% improvement. However, a small number of patients do not obtain the expected response with both STN and GPI targets. Indeed, the authors' patient population had a similar 81.2% tremor reduction with a 9.6% failure rate. In an analysis of these failures, they identified patients with preoperative on-medication tremor who subsequently received a GPI lead as a subpopulation at higher risk for inadequate tremor control. Thereafter, STN DBS was recommended for patients with on-medication tremor. However, for the patients with symptoms and comorbidities that favored GPI as the target, dual GPI and ventral intermediate nucleus of the thalamus (VIM) leads were proposed. This report details outcomes for those patients. ⋯ GPI+VIM stimulation was required to adequately control tremor in all but 2 patients in this series, substantiating the authors' hypothesis that, in their population, medication-resistant tremor does not completely respond to GPI stimulation. Dual stimulation of the GPI and VIM proved to be an effective option for the patients who had symptoms and comorbidities that favored GPI as a target and had medication-resistant tremor.
-
Dorothy Russell's contributions to neuropathology are pivotal in the evolution of modern neurosurgery. In an era preferential to men in medicine, she entered the second medical school class to include women at the London Hospital Medical College in 1919. In the laboratory of Hubert Turnbull, she met Hugh Cairns, who would become her professional neurosurgeon-neuropathologist partner. ⋯ Her textbook, Pathology of the Tumours of the Nervous System, written with Lucien Rubinstein, is considered a landmark text in neurosurgery, neuropathology, and neurooncology. Honored by Penfield and Cone as their first neurosurgery research fellow, Russell was considered a favorite of the Montreal Neurological Institute. Dorothy Russell's extraordinary career elucidating the mysteries of neurosurgical pathology has made an enduring mark on neurosurgery.
-
Journal of neurosurgery · May 2022
Targeting for stereotactic radiosurgical thalamotomy based on tremor treatment response.
Stereotactic radiosurgery (SRS) treats severe, medically refractory essential tremor and tremor-dominant Parkinson disease. However, the optimal target for SRS treatment within the thalamic ventral intermediate nucleus (VIM) is not clearly defined. This work evaluates the precision of the physician-selected VIM target, and determines the optimal SRS target within the VIM by correlation between early responders and nonresponders. ⋯ For tremor control in early responders, the Elements Basal Ganglia Atlas autocontour for the VIM provides the optimal SRS target location that is 0.7-0.9 mm lateral to the VIM center.
-
Journal of neurosurgery · May 2022
Stereotactic radiosurgery for prostate cancer cerebral metastases: an international multicenter study.
As novel therapies improve survival for men with prostate cancer, intracranial metastatic disease has become more common. The purpose of this multicenter study was to evaluate the safety and efficacy of stereotactic radiosurgery (SRS) in the management of intracranial prostate cancer metastases. ⋯ SRS appears to be a safe, well-tolerated, and effective management option for patients with prostate cancer intracranial metastases.
-
Journal of neurosurgery · May 2022
Quantification of tumor response of cystic vestibular schwannoma to Gamma Knife radiosurgery by using artificial intelligence.
Gamma Knife radiosurgery (GKRS) is a common treatment modality for vestibular schwannoma (VS). The ability to predict treatment response is important in patient counseling and decision-making. The authors developed an algorithm that can automatically segment and differentiate cystic and solid tumor components of VS. They also investigated associations between the quantified radiological features of each component and tumor response after GKRS. ⋯ Radiological features of VSs on pretreatment MRI that were quantified using fuzzy C-means were associated with tumor response after GKRS. Tumors with a higher tumor mean SI, a higher solid component mean SI, and a higher cystic component mean SI on T2W/T1WC images were more likely to regress in volume after GKRS. Those with a larger cystic component proportion also trended toward regression after GKRS. Further refinement of the algorithm may allow direct prediction of tumor response.