Stereotactic and functional neurosurgery
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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.
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Stereotact Funct Neurosurg · Jan 2007
Clinical TrialHypofractionated stereotactic radiotherapy using intensity-modulated radiotherapy in patients with one or two brain metastases.
A small fraction of patients with 1-2 brain metastases will not be suitable candidates to either surgical resection or stereotactic radiosurgery (SRS) due to either their location or their size. The objective of this study was to determine the local control, survival, patterns of relapse and the incidence of brain injury following a course of hypofractionated stereotactic radiotherapy while avoiding upfront whole brain radiation therapy (WBRT) in this subgroup of patients. ⋯ The preliminary results of hypofractionated SRS are comparable to both surgery and SRS data for solitary brain metastases in terms of local control and overall survival with acceptable morbidity in this cohort of unfavorable patients.
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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
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 TrialIntracerebral microvascular measurements during deep brain stimulation implantation using laser Doppler perfusion monitoring.
The aim of the study was to investigate if laser Doppler perfusion monitoring (LDPM) can be used in order to differentiate between gray and white matter and to what extent microvascular perfusion can be recorded in the deep brain structures during stereotactic neurosurgery. An optical probe constructed to fit in the Leksell Stereotactic System was used for measurements along the trajectory and in the targets (globus pallidus internus, subthalamic nucleus, zona incerta, thalamus) during the implantation of deep brain stimulation leads (n = 22). The total backscattered light intensity (TLI) reflecting the grayness of the tissue, and the microvascular perfusion were captured at 128 sites. ⋯ In 6 sites the perfusion was more than 6 times higher than the closest neighbor indicating a possible small vessel structure. TLI was significantly higher (p < 0.005) and the perfusion significantly lower (p < 0.005) in positions identified as white matter in the respective MRI batch. The measurements imply that LDPM has the potential to be used as an intracerebral guidance tool.