Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 1999
Gamma knife radiosurgery for trigeminal neuralgia: experience at the Barrow Neurological Institute.
Forty-three patients with trigeminal neuralgia (TN) unresponsive to pharmacologic treatment and/or prior invasive procedures underwent stereotactic radiosurgery with the Gamma Knife (GK). Outcome was evaluated by a standardized questionnaire mailed to each patient. The mean follow-up was 9 months. ⋯ Three patients (7%) described new facial numbness, but in none was this bothersome. GK radiosurgery for TN appears to have minimal morbidity, although the success rate may be slightly lower than that of other operative procedures. More patients and longer follow-up are needed before drawing final conclusions regarding efficacy and complications.
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Stereotact Funct Neurosurg · Jan 1999
Clinical TrialEfficacy of transverse tripolar stimulation for relief of chronic low back pain: results of a single center.
The goal of this study was to evaluate the efficacy of the transverse tripolar spinal cord stimulation system (TTS) in providing relief of low back pain in patients with chronic non-malignant pain. Transverse tripolar electrodes were implanted in the lower thoracic region (T(8-9) to T(12)-L(1)) in 10 patients with chronic neuropathic pain, all of whom reported a significant component of low back pain in combination with unilateral or bilateral leg pain. ⋯ Similarly, functional disability evaluated using Oswestry Low Back Pain Questionnaire was not improved (p = 0. 46; paired t test). We conclude that chronic low back pain is not particularly responsive to the transverse stimulation provided by the TTS system.
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Stereotact Funct Neurosurg · Jan 1999
Stereotactic radiosurgery of cerebral arteriovenous malformations: appearance of perinidal T(2) hyperintensity signal as a predictor of favorable treatment response.
The purpose of this study was to analyze the significance of perinidal T(2) hyperintensity appearance after radiosurgery of arteriovenous malformations (AVMs), as a predictor of treatment response. Our initial experience with linear accelerator (LINAC) radiosurgery at University of California, Los Angeles, between 1990 and 1997 involved treatment of 129 patients affected by cerebral AVMs. Based upon availability of neuroimaging follow-up, 48 patients with 50 AVMs were selected for review. ⋯ Ten (20%) of 50 AVMs (average volume 23.1 cm(3), ranging 7.5-46.5) were unchanged. Furthermore, only 3 AVMs in this group showed reversible T(2) signal changes. In patients with complete nidal obliteration, appearance of T(2) hyperintensity signal achieves 72% sensitivity in predicting successful treatment response.
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Stereotact Funct Neurosurg · Jan 1999
The role of Gamma Knife radiosurgery in arteriovenous malformation with aneurysms.
A review of 217 patients treated with Gamma knife radiosurgery (GKRS), at Hospital Na Homolce, Prague, between October 1992 and January 1998 for arteriovenous malformation (AVM) is presented. Forty-one patients (18.9%) with an AVM and associated aneurysm are the subjects of special interest for this study. ⋯ Ten patients out of 14, who had an aneurysm close to or within the nidus, showed a complete obliteration of their AVM and aneurysm, although the latter was not always included within the irradiated volume. Thus, this study indicates that radiosurgery alone could be the method of choice for the treatment of a combination of AVM and aneurysm, if the aneurysm is close to or within the nidus.
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Stereotact Funct Neurosurg · Jan 1999
Placement of deep brain stimulators into the subthalamic nucleus.
We present our technique for deep brain stimulation (DBS) of the subthalamic nucleus (STN) and include information which may be helpful in general DBS. With the patient in a stereotactic head frame, the anterior and posterior commissures are identified on SPGR-sequence magnetic resonance imaging (MRI). ⋯ Electromyography is used to quantitatively measure tremor responses to macrostimulation. Permanent lead placement is confirmed with intraoperative fluoroscopy and postoperative MRI.