Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2007
Comparative StudyComparison of accuracy and precision between frame-based and frameless stereotactic navigation for deep brain stimulation electrode implantation.
The accuracy and precision of frameless neuronavigation as compared to conventional frame-based stereotaxy for implantation of deep brain stimulation (DBS) electrodes were studied in 14 patients with essential tremor. DBS electrodes were implanted bilaterally in the ventrolateral thalamus [ventrointermediate nucleus (VIM)] in one procedure. Frameless neuronavigation was used on one side and the conventional frame-based technique on the other. ⋯ At clinical follow-ups, tremor reduction was similar irrespective of the implantation technique. It is concluded that conventional frame-based stereotaxy has higher accuracy/precision for hitting a small brain target than the frameless technique. However, the difference is relatively small and does not influence the clinical result of DBS electrode implantations in the VIM when treating tremor.
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Stereotact Funct Neurosurg · Jan 2007
Comparative Study Clinical TrialRegional cerebral perfusion differences between periventricular grey, thalamic and dual target deep brain stimulation for chronic neuropathic pain.
Regional cerebral blood flow changes were evaluated in different subcortical brain targets following deep brain stimulation (DBS) for chronic pain. Three patients with intractable neuropathic pain were assessed; one had stimulating electrodes in the ventroposterolateral thalamic nucleus (VPL), one in the periventricular grey (PVG) area, and one had electrodes in both targets. Pain relief was achieved in all patients. ⋯ Furthermore, thalamic and dual target DBS increased thalamic perfusion, yet PVG DBS decreased perfusion in the PVG-containing midbrain region and thalamus. Dual target stimulation decreased anterior cingulate and insular cortex perfusion. The study demonstrates regional differences in cerebral perfusion between three accepted and efficacious targets for analgesic DBS.
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Stereotact Funct Neurosurg · Jan 2007
Clinical TrialMicrovascular decompression vs. gamma knife radiosurgery for typical trigeminal neuralgia: preliminary findings.
Patients with typical trigeminal neuralgia were treated by one neurosurgeon with either microvascular decompression (MVD) or Gamma Knife radiosurgery (GKRS) and were prospectively evaluated with a uniform protocol. ⋯ Although many trigeminal neuralgia patients treated with either MVD or GKRS have pain relief, MVD is more likely than GKRS to result in complete pain relief.
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Stereotact Funct Neurosurg · Jan 2007
Clinical TrialLong-term evaluation of treatment of chronic, therapeutically refractory tinnitus by neurostimulation.
Long-term evaluation of treatment of chronic, therapeutically refractory tinnitus by means of chronic electrical stimulation of the vestibulocochlear nerve. ⋯ The long-term follow-up of neurostimulation treatment for chronic tinnitus shows promising results. Long-term results were better than those determined after a 3-month follow-up. In all patients the tinnitus was replaced by another sound, which was perceived as pleasant. Further studies are needed before accepting neurostimulation as a treatment modality for chronic, therapeutically refractory tinnitus.
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Stereotact Funct Neurosurg · Jan 2007
Safety of anterior commissure-posterior commissure-based target calculation of the subthalamic nucleus in functional stereotactic procedures.
The subthalamic nucleus (STN) is a common target of functional stereotactic surgeries. High-field magnetic resonance imaging and sophisticated computer systems provide precise identification of the nucleus location in stereotactic space. However, it is unclear what additional benefit these techniques provide over traditional anterior commissure-posterior commissure (AC-PC)-based standard atlas coordinate calculation methods based on the AC-PC plane. ⋯ The accuracy of the position of the STN calculated with state-of-the-art imaging systems was not significantly better than that obtained using traditional AC-PC-based standard atlas coordinate calculation if the frame was aligned with the AC-PC plane. The mean difference was 0.45 mm, 0.72 mm, and 0.98 mm in the X, Y, and Z axes, respectively. Therefore, it is possible to effectively target the STN for stereotactic treatment of Parkinson's disease, for instance in a situation where expensive advanced technology is unavailable.