Neurosurgery
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: Triple decompression surgery has been advocated as a treatment for diabetic peripheral neuropathy (DPN). A practice advisory published in 2006 by the American Academy of Neurology concluded that "this treatment alternative should be considered unproven." Since then, multiple cohort studies involving several thousands of patients and 1 nonblind, randomized, controlled trial have been published, suggesting that surgical treatment of DPN has become commonplace in many centers globally. The results of these observational studies suggest that decompressive surgery could result in a substantial reduction of pain and the restoration of sensation in patients with DPN. ⋯ This design would eliminate a large number of possible confounders and would therefore require only a small number of patients. Such a trial is currently being performed at the University of Texas. The true beneficiaries will be patients with DPN: either decompressive surgery will be established as an evidence-based treatment for millions of patients or they will be spared from potentially harmful surgery with no significant benefit.
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Review Case Reports
Functional Gonadotroph Adenomas: Case Series and Report of Literature.
Functional gonadotroph adenomas (FGAs) are rare tumors of the pituitary gland that secrete biologically active gonadotropins. ⋯ FGA, functional gonadotroph adenomaFSH, follicle-stimulating hormoneLH, luteinizing hormoneTSH, thyroid-stimulating hormone.
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Review Historical Article
Laser Interstitial Thermal Therapy for Mesial Temporal Lobe Epilepsy.
Approximately one-third of patients with epilepsy do not achieve adequate seizure control through medical management alone. Mesial temporal lobe epilepsy (MTLE) is one of the most common forms of medically refractory epilepsy referred for surgical management. Stereotactic laser amygdalohippocampotomy using magnetic resonance-guided laser interstitial thermal therapy (MRg-LITT) is an important emerging therapy for MTLE. ⋯ We provide a historical overview of laser interstitial thermal therapy development and the technological advancements that led to the currently available commercial systems. Current applications of MRg-LITT for MTLE, reported outcomes, and technical issues of the surgical procedure are reviewed. Although initial reports indicate that stereotactic laser amygdalohippocampotomy may be a safe and effective therapy for medically refractory MTLE, further research is required to establish its long-term effectiveness and its cost/benefit profile.
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Laser-induced thermal therapy has become a powerful tool in the neurosurgical armamentarium. The physics of laser therapy are complex, but a sound understanding of this topic is clinically relevant, as many centers have incorporated it into their treatment algorithm, and educated patients are demanding consideration of its use for their disease. ⋯ There are many technical nuances for laser placement, and, to date, there is not a clear understanding of whether any one technique is better than the other. In this review, we describe the basic physics of magnetic resonance-guided laser-induced thermal therapy and describe the several common techniques for accurate Visualase laser catheter placement in a stepwise fashion.
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Radiation necrosis and tumor recurrence are common sequelae after radiation therapy for brain metastasis. The differentiation of radiation necrosis and recurrent brain metastases continues to remain a difficult task despite a number of diagnostic methods. Techniques including magnetic resonance imaging, diffusion-weighted imaging, nuclear studies, and the gold standard of biopsy have all been studied for their effectiveness in accurately diagnosing the postradiation condition. ⋯ This further emphasizes the necessity to accurately diagnose the condition to start appropriate and effective treatment. Despite both pathologies being pathophysiologically distinct, controversies exist as to whether there should be a distinction made at all or if the two can be perceived as a single condition if treatment and presentation are similar enough. Furthermore, a single treatment option such as magnetic resonance-guided, laser-induced thermal therapy (MRgLITT) can be used, potentially eliminating the need to differentiate the 2 entities because it successfully treats both conditions while being minimally invasive.