Stereotactic and functional neurosurgery
-
Stereotact Funct Neurosurg · Jan 2015
Multimodal, Intraoperative Monitoring during Paddle Lead Placement for Cervicothoracic Spinal Cord Stimulation.
We investigated the efficacy of combined somatosensory evoked potentials (SSEP) and electromyography monitoring during paddle lead placement through cervicothoracic laminectomy under general anesthesia in a retrospective review of data from 25 patients. ⋯ Intraoperative neurophysiological guidance using SSEP and muscle MEP was useful for the safe and accurate placement of paddle leads for cervicothoracic SCS.
-
Stereotact Funct Neurosurg · Jan 2015
Successful use of high-frequency spinal cord stimulation following traditional treatment failure.
High-frequency spinal cord stimulation (HFSCS) offers an alternative treatment for chronic refractory pain syndromes nonresponsive to traditional spinal cord stimulation (SCS). Following the conflicting findings of preliminary HFSCS clinical studies performed at 5-10 kHz, this study is the first to report successful clinical usage of 1-kHz frequency SCS with a standard generator. ⋯ HFSCS at the frequency of 1 kHz offers a new tool for treatment of chronic pain in patients with traditional stimulation settings. Furthermore, most standard SCS batteries are capable of delivering stimulation in this frequency range.
-
Stereotact Funct Neurosurg · Jan 2015
Factors Associated with Tremor Changes during Sedation with Dexmedetomidine in Parkinson's Disease Surgery.
Dexmedetomidine is an α2-agonist recently proposed as a potentially ideal drug for sedation during the surgical treatment of Parkinson's disease (PD). This report documents the incidence of changes in motor symptoms (especially tremor) in PD patients sedated with dexmedetomidine for deep brain stimulation or ablation procedures. ⋯ Dexmedetomidine provides adequate sedation during surgery for PD, but it might affect motor signs making intraoperative testing difficult or even impossible. Dosage appears not to be the determining factor in motor changes, whose cause remains unclear.
-
Stereotact Funct Neurosurg · Jan 2015
Constant Current versus Constant Voltage Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease.
Background: Subthalamic nucleus (STN) deep brain stimulation (DBS) is an established therapy for advanced Parkinson's disease (PD). Motor efficacy and safety have been established for constant voltage (CV) devices and more recently for constant current (CC) devices. CC devices adjust output voltage to provide CC stimulation irrespective of impedance fluctuation, while the current applied by CV stimulation depends on the impedance that may change over time. ⋯ Conclusion: CC STN DBS is safe. For equivalent motor efficacy, no significant difference could be identified between CC and CV stimulation for nonmotor evaluations in PD patients 2 years after surgery. © 2015 S. Karger AG, Basel.
-
Stereotact Funct Neurosurg · Jan 2015
Chronic Spinal Cord Stimulation in the Treatment of Cerebral and Spinal Spasticity.
The aim of this investigation is to assess the effectiveness of spinal cord stimulation (SCS) in different groups of patients with spasticity of different origin. ⋯ Chronic SCS may be a method of choice for patients with moderate spinal and cerebral spasticity with predominant spastic lower paraparesis. In patients with spastic tetraparesis SCS therapy did not prove to be effective. We encountered improvement of the spasticity and no need for further SCS therapy in a small group of patients (11%). This phenomenon requires further investigation. © 2015 S. Karger AG, Basel.