Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2001
Comparative StudyMotor cortex stimulation for phantom limb pain: comprehensive therapy with spinal cord and thalamic stimulation.
The effects of spinal cord stimulation (SCS), deep brain stimulation (DBS) of the thalamic nucleus ventralis caudalis (VC) and motor cortex stimulation (MCS) were analyzed in 19 patients with phantom limb pain. All of the patients underwent SCS and, if the SCS failed to reduce the pain, the patients were considered for DBS and/or MCS. Satisfactory pain control for the long-term was achieved in 6 of 19 (32%) by SCS, 6 of 10 (60%) by DBS and 1 (20%) of 5 by MCS. ⋯ The effects of both DBS of the VC and MCS were tested in four. One patient of them reported better pain control by MCS than by DBS, whereas two reported the opposite results. There is no evidence at present for an advantage of MCS over SCS and DBS of the VC in controlling phantom limb pain.
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Stereotact Funct Neurosurg · Jan 2001
Neurophysiological monitoring for epilepsy surgery: the Talairach SEEG method. StereoElectroEncephaloGraphy. Indications, results, complications and therapeutic applications in a series of 100 consecutive cases.
In some candidates for epilepsy surgery in whom the decision to operate is difficult to make, invasive presurgical investigations, namely depth electrode recordings, may be needed. The SEEG (StereoElectroEncephaloGraphy) method consists of stereotactic orthogonal implantation of depth electrodes (5 to 15, 11 on average). The object of this study is to clarify the indications for SEEG, to expose its complications, and to display its usefulness in terms of surgical strategy and results. ⋯ SEEG proved to be a relatively safe and a very useful method in 'difficult' candidates for epilepsy surgery. In addition, in some cases the implanted electrodes can be used to perform therapeutic RF thermocoagulation of epileptic foci or networks.
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Stereotact Funct Neurosurg · Jan 2001
Radiosurgery and stereotactic radiation therapy of skull base meningiomas: proposal of a grading system.
The development of a grading system to guide treatment selection, and predict treatment difficulty and outcome of skull base meningiomas infiltrating the cavernous sinus which are managed by stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT), based on an 8-year experience with stereotactic radiation of skull base meningiomas. ⋯ This grading system correlated with outcome and difficulty in planning radiosurgery. Failure of treatment was more likely to occur in patients with higher Grade tumors.
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The history of open and subsequently stereotactic brain lesions for the relief of pain is traced. Important steps included recognition of the importance of the non-specific pain pathways and the differential effects of lesioning on nociceptive pain and on different elements of neuropathic pain. Although the advent of morphine infusion and deep brain stimulation has greatly eroded the number of destructive lesions made, new technical and conceptual advances must be carefully evaluated.
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With the improved utilisation and widespread availability of opiates, the oral treatment of pain due to malignancy has changed radically, so that the expected need for intrathecal (IT) delivery systems for this pain has largely failed to materialise. Instead, the lack of equal progress in the design and production of non-opiates for treating non-malignant pain, in the long term, has resulted in a greater interest in the development of these IT systems in this non-malignant area.