Neurosurgical review
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Neurosurgical review · Oct 2015
Deep brain stimulation of the globus pallidus internus or ventralis intermedius nucleus of thalamus for Holmes tremor.
Holmes tremor (HT) is a difficult-to-treat, very disabling symptomatic condition which characteristically appears weeks to years after a brain lesion. It features a unique combination of rest, action, and postural tremors. Pharmacotherapy is mostly not effective. ⋯ DBS demonstrated in this case series adequate tremor control in 10 patients unresponsive to medical therapy. Presurgical planning of two targets allowed choosing best optimal response. Gpi stimulation could be considered as an alternative target for cases in which thalamic anatomy is considerably altered or Vim intraoperative stimulation does not produce satisfactory results.
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Pain following spine surgery is often difficult to control and can persist. Reduction of this pain requires a multidisciplinary approach that depends on contributions of both surgeons and anesthesiologists. ⋯ Anesthesiologists, on the other hand, must focus on preemptive, multimodal analgesic treatment regimens. In this review, we first discuss anatomic sources of pain within the spine, before delving into a specific literature-supported pain management protocol intended for use with spinal surgery.
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Neurosurgical review · Jul 2015
ReviewMinimally invasive endoscopic surgery for treatment of spontaneous intracerebral haematomas.
Spontaneous intracerebral haemorrhage (ICH) is a devastating disease with a mortality rate of more than 40 % and a high morbidity rate with 10-15 % of survivors remaining fully dependent [11]. The role of surgical treatment of ICH remains a matter of controversy and ongoing investigation. Advances in neurosurgical techniques such as endoscopy and neuronavigation have been established in various fields of neurosurgery. ⋯ In this article, we focus on the pathophysiologic rationales behind minimally invasive haematoma evacuation through endoscopic surgery and provide an overview of technical developments and reported patient series. In addition, the modalities of the surgical procedure at the authors' institution are described. Controlled clinical trials are needed to evaluate the full potential and limitations of this promising technique.
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Neurosurgical review · Jul 2015
Case ReportsSurgery in extensive vertebral hemangioma: case report, literature review and a new algorithm proposal.
Hemangiomas are benign dysplasias or vascular tumors consisting of vascular spaces lined with endothelium. Nowadays, radiotherapy for vertebral hemangiomas (VHs) is widely accepted as primary treatment for painful lesions. Nevertheless, the role of surgery is still unclear. ⋯ We recommend radiotherapy only for small lesions in which vertebral stability is not concerned. Kyphoplasty can be proposed for asymptomatic patients in which VHs are small and in patients affected by VHs determining pain without spinal canal invasion in which the VH is small. In patients affected by pain without spinal canal invasion but in which the VH is wide or presented with spinal canal invasion and in patients affected by neurological deficits, we propose surgery.
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Neurosurgical review · Apr 2015
Modern Gamma Knife radiosurgery of vestibular schwannomas: treatment concept, volumetric tumor response, and functional results.
The objective of the present study was longitudinal evaluation of the volumetric tumor response and functional results after Gamma Knife radiosurgery of vestibular schwannomas, performed according to the modern standards of treatment. From October 2003 to September 2007, 133 consecutive patients with vestibular schwannomas were treated according to the concept of robotic Gamma Knife microradiosurgery, which is based on precise irradiation of the lesion, sparing adjacent structures, and delivery of the high radiation energy to the target. Multiple small-sized isocenters located within the border of the neoplasm were applied. ⋯ Overall, 77% of patients with serviceable hearing before treatment preserved it 3 years thereafter. In conclusion, modern Gamma Knife radiosurgery provides effective and safe management of vestibular schwannomas. Nevertheless, possible temporary tumor enlargement, delay of its growth arrest, transient dysfunction of the cranial nerves, and gradual deterioration of hearing after irradiation should be always taken into consideration.