Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2012
Case ReportsGlobus pallidus interna deep brain stimulation improves chorea and functional status in a patient with chorea-acanthocytosis.
We report a 39-year-old woman with chorea-acanthocytosis (ChAc) who was referred with refractory hyperkinetic movement and truncal bending spasm. She was diagnosed with ChAc with clinical features and laboratory findings of acanthocytosis in peripheral blood smear, and genetic studies revealed novel mutations in the VPS13 gene. Because her symptoms did not respond well to medical treatment, she was in a totally dependent state. ⋯ After the operation her hyperkinetic movement, bradykinesia, and truncal bending motion were improved, the preoperative total score of the motor section on the Unified Huntington's Disease Rating Scale (UHDRS) was 44, the independence scale was 50, and functional capacity was 1. However, a year after GPi-DBS, the postoperative score on the motor section was 12, the independence scale was 80, functional capacity was 9, and she had become capable of independent daily life. Although there is currently no curative treatment for ChAc, GPi-DBS represents a promising option for symptomatic control.
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Stereotact Funct Neurosurg · Jan 2012
Case ReportsGamma knife radiosurgery for recurrent glossopharyngeal neuralgia after microvascular decompression.
We report the first application of Gamma Knife radiosurgery (GKR) for recurrent glossopharyngeal neuralgia (GN) after microvascular decompression (MVD). The patient is a 51-year-old male with left-sided GN. He underwent MVD and did well for almost 4 years. Later on, the patient started to experience recurrent intolerable throat pain, frequently 10/10 in intensity. Based on the application of radiosurgery for trigeminal neuralgia, GKR was offered to the patient. ⋯ GKR, which is now widely used for refractory trigeminal neuralgia, can be considered for refractory or recurrent GN. With a multidisciplinary approach and advanced neuroimaging, GKR is feasible for GN after MVD, despite the shortness of the intracranial cisternal nerve portion. Further studies are necessary to establish the role of GKR for refractory GN after MVD; however, given its rarity and the lack of experience with GKR for this condition, retrospective studies with dozens of patients are almost impossible at this time.
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Stereotact Funct Neurosurg · Jan 2012
Case ReportsShielded battery syndrome: a new hardware complication of deep brain stimulation.
Deep brain stimulation hardware is constantly advancing. The last few years have seen the introduction of rechargeable cell technology into the implanted pulse generator design, allowing for longer battery life and fewer replacement operations. The Medtronic® system requires an additional pocket adaptor when revising a non-rechargeable battery such as their Kinetra® to their rechargeable Activa® RC. This additional hardware item can, if it migrates superficially, become an impediment to the recharging of the battery and negate the intended technological advance. ⋯ We describe strategies to minimise the occurrence of the shielded battery syndrome and advise vigilance in all patients who experience difficulty with recharging after replacement surgery of this type for the implanted pulse generator.
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Stereotact Funct Neurosurg · Jan 2012
Stereotactic placement of ventricular catheters: does it affect proximal malfunction rates?
The majority of ventriculoperitoneal (VP) shunt malfunctions are due to proximal catheter failure. Ideal placement of Ommaya reservoirs is desired to avoid toxicity from intraparenchymal chemotherapy infusion. ⋯ In terms of results corroborating decreased proximal malfunction rates, we present the largest series of stereotactic-guided ventricular catheter placements to date. Though time in the operating room is increased due to navigation registration, actual operative time is comparable to procedures without navigation. A longer-term follow-up is needed to assess the longevity of our positive short-term results.
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Stereotact Funct Neurosurg · Jan 2012
Effects of relative low-frequency bilateral globus pallidus internus stimulation for treatment of cervical dystonia.
To assess the effect of relative lower amplitude and frequency for globus pallidus internus (GPi) deep brain stimulation (DBS) of cervical dystonia (CD). ⋯ According to our results, the initial settings of low amplitude and especially relatively low frequency are safe and effective for treatment of CD.