Neurosurgical review
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Neurosurgical review · Jun 2019
ReviewDeep brain stimulation of the anterior nucleus of the thalamus for drug-resistant epilepsy.
Despite the use of first-choice anti-epileptic drugs and satisfactory seizure outcome rates after resective epilepsy surgery, a considerable percentage of patients do not become seizure free. ANT-DBS may provide for an alternative treatment option in these patients. This literature review discusses the rationale, mechanism of action, clinical efficacy, safety, and tolerability of ANT-DBS in drug-resistant epilepsy patients. ⋯ Based on the available evidence ANT-DBS and VNS therapies are currently both superior compared to non-invasive neuromodulation techniques such as t-VNS and rTMS. Additional in-vivo research is necessary in order to gain more insight into the mechanism of action of ANT-DBS in localization-related epilepsy which will allow for treatment optimization. Randomized clinical studies in search of the optimal target in well-defined epilepsy patient populations, will ultimately allow for optimal patient stratification when applying DBS for drug-resistant patients with epilepsy.
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Neurosurgical review · Jun 2019
Comparative StudyComparison of radiological and clinical characteristics between blood blister-like aneurysms (BBAs) and non-blister aneurysms at the supraclinoid segment of internal carotid artery.
Blood blister-like aneurysms (BBAs) were considered a therapeutic challenge for both microsurgeons and endovascular therapists. While a great deal of efforts had been put to refining the treatment of BBAs, the diagnostic criteria had not been established yet. In this study, we reviewed data of 43 suspicious, small (< 1 cm), broad-necked aneurysms at supraclinoid segment of internal carotid artery (ICA) in 41 patients who had been treated with microsurgery in our hospital during the past 5 years. ⋯ BBAs and non-blister aneurysms were difficult to differentiate by clinical and radiological features as they share many characteristics in common. Dome/neck ratio < 1 did not guarantee accurate diagnosis of BBAs. A discriminant function incorporating dome/neck ratio and degree of distal angle as factors might increase the accuracy of pre-surgical diagnosis of BBAs.
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Neurosurgical review · Jun 2019
What is the best therapeutic approach to a pediatric patient with a deep-seated brain AVM?
Although brain arteriovenous malformations (bAVMs) account for a very small proportion of cerebral pathologies in the pediatric population, they are the cause of roughly 50% of spontaneous intracranial hemorrhages. Pediatric bAVMs tend to rupture more frequently and seem to have higher recurrence rates than bAVMs in adults. Thus, the management of pediatric bAVMs is particularly challenging. ⋯ GKRS has a low risk of complication, but the obliteration rates still leave much to be desired. Finally, PSRS offers promising results with a more accurate radiation that avoids the surrounding tissue, but data is limited due to its recent introduction. Overall, a multi-modal approach, or even an active surveillance, might be the most suitable when facing deep-seated bAVM, considering the difficulty of their management and the high risk of complications in the pediatric population.
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Neurosurgical review · Mar 2019
Vascular assessment after clipping surgery using four-dimensional CT angiography.
Recent advances in computed tomography angiography (CTA) enable repeated imaging follow up for post-clipping surgery. The purpose of this study was to clarify the critical volume and configuration of the aneurysmal clip in the postoperative evaluation using volume rendering (VR) imaging, and present four-dimensional (4D)-CTA for these larger metal artifacts. A total of 44 patients with cerebral aneurysm, treated using clipping surgery, were included in this study. ⋯ In group 2, the imaging quality of post-clipping status on 4D-CTA was superior in 92.9% of patients. The metal artifact volume was dependent on the number, size, or configuration of the clip used. In group 2, evaluation using a 4D-CTA eliminated the effect of the metal artifacts.
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Neurosurgical review · Mar 2019
The emerging role of gamma knife radiosurgery in the management of glossopharyngeal neuralgia.
Glossopharyngeal neuralgia (GPN) represents a rare craniofacial disorder accounting for about 1% of all craniofacial pain syndromes. GPN shares several pathophysiologic and clinical features with the more common trigeminal neuralgia. Medical therapy and microvascular decompression, in case of vascular nerve compression, represented the mainstay of GPN management. ⋯ Radiosurgical treatment data, pain control and recurrence rate have been analysed and compared. GKRS represented a valuable and effective treatment option for the management of GPN. Pain control and complication rates are better than those reported by other ablative procedures and microvascular decompression; however, future studies should be focused on the long-term efficacy of GKRS.