Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2009
Subthalamic nucleus stimulation does not cause deterioration of preexisting hallucinations in Parkinson's disease patients.
Among the neuropsychiatric symptoms in Parkinson's disease (PD) patients, hallucination can result from the disease itself or medical treatment. Hallucination associated with subthalamic nucleus stimulation (STN-DBS) has been reported; however, it is still unclear whether PD patients with a history of hallucination are appropriate candidates for STN-DBS or not. ⋯ Our findings indicate that STN-DBS surgery does not always lead to deterioration of preexisting hallucination in PD. In advanced PD, hallucination involves a multifactorial pathogenesis and a history of hallucination is not a contraindication to STN-DBS surgery.
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Stereotact Funct Neurosurg · Jan 2009
ReviewHistoric evolution of open cingulectomy and stereotactic cingulotomy in the management of medically intractable psychiatric disorders, pain and drug addiction.
Stereotactic cingulotomy constitutes a psychosurgical procedure nowadays advocated in the treatment of medically intractable obsessive-compulsive disorder, chronic pain and drug addiction. From its theoretical conception to the first cingulectomies performed and modern stereotactic-guided cingulotomies, various target localization methods, different surgical techniques, and numerous lesioning devices have been utilized. In the current article, the authors performed a literature review related to cingular lesion placement in an effort to identify misconceptions of the past, recapitulate existing knowledge and recognize targets for further research. ⋯ The anatomic target localization methodologies, surgical technique, and the outcome of the initial stereotactic cingulotomy procedures were reviewed, and the evolution of the imaging techniques, stereotactic devices, and lesioning strategies were followed. The modern advanced surgical techniques, clinical outcome and the procedure-associated complications were analyzed with particular emphasis on the emotional, behavioral, and cognitive procedure-induced changes. Large-scale prospective studies with strict inclusion and well-defined, objective outcome criteria are necessary for defining the role of stereotactic cingulotomy in the current psychosurgical armamentarium.
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Stereotact Funct Neurosurg · Jan 2009
Case ReportsSimultaneous use of functional tractography, neuronavigation-integrated subcortical white matter stimulation and intraoperative magnetic resonance imaging in glioma surgery: technical note.
The importance of preserving function during glioma surgery cannot be overemphasized. There are a number of techniques utilized including functional MRI, direct electrophysiological monitoring and functional neuronavigation to maximize and safely resect gliomas. ⋯ Combining these technologies will enhance the safety and efficacy of glioma surgery. This is the first report in the literature where we successfully combine both functional neuronavigation and subcortical stimulation, using a single probe to safely resect a recurrent glioblastoma.
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Stereotact Funct Neurosurg · Jan 2009
Comparative Study Clinical TrialEpidural anesthesia for placement of spinal cord stimulators with paddle-type electrodes.
Placement of paddle electrodes for spinal cord stimulation is usually performed under local anesthesia as the patient must be alert and cooperative during the procedure. This is often difficult, and involves significant discomfort for the patient. We explore the placement of spinal cord stimulators (SCS) under epidural anesthesia. ⋯ Epidural anesthesia provides a safe and effective means of placing SCS with paddle-type electrodes. There is no patient discomfort, and paresthesias are consistently elicited in appropriate areas in all patients.
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Stereotact Funct Neurosurg · Jan 2009
Dorsal root entry zone lesions for phantom limb pain with brachial plexus avulsion: a study of pain and phantom limb sensation.
Lesions in the dorsal root entry zone (DREZ) have been shown to be significantly effective in relieving the pain of brachial plexus avulsion (BPA), but they have a limited effect on phantom limb pain (PLP). There is still the question remaining of whether DREZ lesions are effective in treating PLP in cases of BPA. ⋯ DREZ lesions are effective in the treatment of PLP with BPA. Alteration in PLS after the surgery may be a predictive factor for good pain relief. The good response of PLP patients with BPA to DREZ lesions suggests that an evaluation of the cervical dorsal roots should be conducted in patients with post-traumatic PLP.