Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2000
Clinical TrialContinuous intrathecal clonidine administration for the treatment of neuropathic pain.
In many cases, the treatment of neuropathic pain by intrathecal opioids fails to meet expectations. In a trial involving 10 patients, the intrathecal administration of clonidine combined with opioids in the treatment of chronic pain was introduced in our department for the first time. ⋯ Residual non-neuropathic pain in 4 of 8 patients was successfully treated with clonidine and low doses of opioids. On the basis of the results achieved so far, we recommend that clonidine should be routinely tested for intrathecal drug administration, especially in patients with a prominent neuropathic pain component.
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Stereotact Funct Neurosurg · Jan 2000
Comparative StudyIn vivo proton magnetic resonance spectroscopy of brain tumors.
The ability of magnetic resonance spectroscopy (MRS) to differentiate neoplastic brain cells and their metabolic and structural characteristics is evaluated. We examined 120 patients with brain tumors using a 1.5-tesla MRI unit and MRS. The peak areas of N-acetyl-aspartate (NAA), phosphocreatine-creatine (Pcr-Cr), choline-containing compounds (Cho), lactate, lipids, myoinositol, amino acids and the ratios of NAA/Pcr-Cr, NAA/Cho and Cho/Pcr-Cr were calculated by a standard integral algorithm. ⋯ The greater this ratio, the higher the grade of the astrocytoma. NAA/Pcr-Cr together with Cho/Pcr-Cr help specify the presence or absence of a neoplasm. Proton MRS is a useful and promising diagnostic modality not only in diagnosing but also in grading solid brain tumors.
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We treated 126 patients with different neurosurgical diseases by performing endoscopic neurosurgery, endoscopy-controlled microneurosurgery and endoscopy-assisted microneurosurgery. The indications were intracranial cysts in 51 patients, brain cysticercosis in 10 patients, hydrocephalus in 31 patients, and epidermoid cysts in 34 patients. ⋯ After operation, 115 of 126 patients had improvement in their initial symptoms, 7 had no change and 4 developed complications, including subarachnoid hemorrhage (SAH), intraventricular hemorrhage, and transient cardiopulmonary dysfunction. It is concluded that (1) neuroendoscopic techniques show a distinct value in the treatment of deep-seated, intracranial diseases, or ventricle and cistern lesions; (2) neuroendoscopic techniques play an important role in microneurosurgery and consequently improve surgical quality; (3) the benefits of neuroendoscopic techniques include less surgical manipulation and trauma, milder postoperative reaction, decreased expenses and shortened hospitalizations.
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Stereotact Funct Neurosurg · Jan 2000
Clinical TrialThe significance of intrathecal opioid therapy for the treatment of neuropathic cancer pain conditions.
The effectiveness of intrathecal opioid therapy when applied to different pain mechanisms, in particular neuropathic and nociceptive pain conditions, was studied retrospectively in 43 patients suffering from cancer pain. On the basis of clinical and radiological data, the pain mechanisms were categorized as nociceptive (n = 23) and neuropathic (n = 20). The average duration of treatment of nociceptive pain was 5 months, of neuropathic pain only 2.5 months. ⋯ Patients suffering from neuropathic pain showed poor long-term results (11.1% median pain reduction). Neuropathic pain in the extremities reacted least to the application of intrathecal opioids. Optimal results were obtained for nociceptive pain in the trunk area of the body.