Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2010
Comparative StudyCerebrospinal fluid pressure measurement in the ovine intrathecal space: a preliminary study towards the diagnosis of intrathecal drug administration catheter dislodgement or occlusion.
Intrathecal drug delivery catheter malfunctions are a principal cause of therapy interruption. We determined that normal baseline intrathecal cerebrospinal fluid (CSF) pressure recordings could be obtained in an ovine model and in a catheter dislodgement scenario. ⋯ These findings support the notion that pressure sensors can play a role in determining the status of intraspinal drug delivery catheters.
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Stereotact Funct Neurosurg · Jan 2010
Case ReportsResponse to sham and active gamma ventral capsulotomy in otherwise intractable obsessive-compulsive disorder.
This case regards a 34-year-old woman with severe and refractory obsessive-compulsive disorder, who was enrolled in a double-blind, randomized controlled trial of radiosurgery. She was at first submitted to a sham radiosurgical procedure, and 1 year later to an active intervention. ⋯ During the sham surgery follow-up, no improvements were observed, but a remarkable amelioration was seen a few months after the active procedure. Detailed descriptions of psychopathological changes and neuroimaging findings as well as a discussion regarding the surgical technique are provided.
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Stereotact Funct Neurosurg · Jan 2010
Stimulation-induced dyskinesia in the early stage after subthalamic deep brain stimulation.
Deep brain stimulation of the subthalamic nucleus (STN-DBS) is a very effective surgical procedure for Parkinson's disease. It significantly improves cardinal parkinsonian symptoms as well as levodopa-induced dyskinesia. Interestingly, STN-DBS can also provoke or exacerbate dyskinesia. In the present study, stimulation-induced dyskinesia (SID) was found in the early stage (less than 1 month) after STN-DBS in some patients. The aim was to discuss this interesting phenomenon. ⋯ In the early stage after STN-DBS, dyskinesia is easily induced by high-frequency stimulation of the upper portion of the STN, which may predict the best site for chronic stimulation.
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Stereotact Funct Neurosurg · Jan 2010
Occipital nerve stimulator placement via a retromastoid to infraclavicular approach: a technical report.
Occipital nerve stimulation is a form of peripheral nerve stimulation used to treat refractory headache disorders. Various techniques have been described for occipital nerve stimulator implantation; these include midline cervical or retromastoid lead insertion with internal pulse generator placement in the infraclavicular, gluteal or low abdominal regions. ⋯ Implantation approaches that include remote battery sites may contribute to mechanical stress on the components, as the leads or extensions may traverse highly mobile body regions. In this technical report, we describe an occipital stimulator implantation technique that may be advantageous in terms of patient positioning, ease of surgical approach and minimization of mechanical stress on components.
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Stereotact Funct Neurosurg · Jan 2010
Nexframe frameless stereotaxy with multitract microrecording: accuracy evaluated by frame-based stereotactic X-ray.
The development of image-guided systems rendered it possible to perform frameless stereotactic surgery for deep brain stimulation (DBS). As well as stereotactic targeting, neurophysiological identification of the target is important. Multitract microrecording is an effective technique to identify the best placement of an electrode. This is a report of our experience of using the Nexframe frameless stereotaxy with Ben's Gun multitract microrecording drive and our study of the accuracy, usefulness and disadvantages of the system. ⋯ The Nexframe with multitract microrecording for STN DBS still has some problems that need to be resolved. Thus far, we do not consider that this technology in its present state can replace conventional frame-based stereotactic surgery. The accuracy of the system is similar to that of frame-based stereotaxy. However, the narrow surgical field is a disadvantage for multiple electrode insertion. Improvement on this point will enhance the usefulness of the system.