Stereotactic and functional neurosurgery
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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
Comparative StudyPrognostic factors of subthalamic stimulation in Parkinson's disease: a comparative study between short- and long-term effects.
Bilateral subthalamic nucleus deep brain stimulation (STN-DBS) has been shown to have long-term benefits in Parkinson's disease (PD). Through analyzing different variables, this study identified prognostic factors for the short- and long-term effects of STN-DBS. ⋯ The prognostic factors for STN-DBS benefit were different for short- and long-term follow-ups. Good prognostic factors for long-term STN-DBS for PD patients were good cognitive function and tremor dominance. Poor prognostic factors were related to older age and non-dopaminergic-responsive axial disability.
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Stereotact Funct Neurosurg · Jan 2009
Clinical TrialSpectral analysis of field potential recordings by deep brain stimulation electrode for localization of subthalamic nucleus in patients with Parkinson's disease.
Spectral analysis of local field potential (LFP) recorded by deep brain stimulation (DBS) electrode around the subthalamic nucleus (STN) in patients with Parkinson's disease was performed. ⋯ A spectral power analysis of LFP recording by DBS electrode helps with the final confirmation of the dorsal and ventral borders of the STN of Parkinson's disease in DBS implantation surgery.
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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
Comparative StudyIntraoperative X-ray detection and MRI-based quantification of brain shift effects subsequent to implantation of the first electrode in bilateral implantation of deep brain stimulation electrodes.
After implantation of the first electrode in bilateral deep brain stimulation (DBS) lead implantation, brain shift effects in the target region and along the implantation trajectory of the second electrode are quantified with intraoperative magnetic resonance imaging (MRI). We investigated intraoperative X-ray imaging for its feasibility in indirect detection of brain shift. ⋯ In bilateral DBS implantation, brain shift effects can cause misallocation of the second electrode with the risk of adverse or no stimulation effects as well as unnecessary cortical damage. A lack of X-ray signal changes caused by intracranial air invasion during DBS lead implantation indicates a lack of clinically relevant brain shift.