Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2014
Treatment of chronic pain: diffusion tensor imaging identification of the ventroposterolateral nucleus confirmed with successful deep brain stimulation.
A variety of pain syndromes have been treated successfully with deep brain stimulation (DBS) by targeting the thalamic ventroposterolateral (VPL) nucleus. The purpose of this study was to preoperatively identify the thalamic VPL nucleus by diffusion tensor imaging (DTI) fiber tractography (FT) and confirm it intraoperatively. ⋯ DTI has the potential to identify the thalamic nuclei in individuals, which would be more accurate than anatomical localization and likely identical to intraoperative physiological testing. Postoperative DBS electrode placement and the affected cortical areas can be confirmed with coregistration of CT and FT using the electrode as a seed ROI.
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Stereotact Funct Neurosurg · Jan 2013
Comparative StudyThe contemporary practice of psychiatric surgery: results from a global survey of functional neurosurgeons.
Interest in neurosurgery for psychiatric diseases (NPD) has grown globally. We previously reported the results of a survey of North American functional neurosurgeons that evaluated general attitudes towards NPD and the future directions of the field. ⋯ Surgery for psychiatric conditions is an expanding field within functional neurosurgery. The opinions of international functional neurosurgeons were largely in line with those of their North American colleagues. Optimism regarding the future of NPD predominates, and future editions of this survey can be used to track the evolution of neurosurgeons' attitudes towards NPD and neuroenhancement.
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Stereotact Funct Neurosurg · Jan 2013
Case ReportsPallidal deep brain stimulation for a case of hemidystonia secondary to a striatal stroke.
The efficacy of bilateral globus pallidus internus (GPi) deep brain stimulation (DBS) for medically refractory idiopathic generalized dystonia has been demonstrated repeatedly. More variable outcomes have been reported in the treatment of secondary dystonia with GPi DBS. ⋯ The patient had marked benefit from bilateral GPi DBS, which suggests that the therapeutic effects of DBS were mediated by the intact pathways in this case of hemidystonia.
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Stereotact Funct Neurosurg · Jan 2013
The risk of hardware infection in deep brain stimulation surgery is greater at impulse generator replacement than at the primary procedure.
Infection of implanted hardware after deep brain stimulation (DBS) has a significant impact on patient morbidity. We examined all patients who underwent DBS procedures over the last 9 years in our centre to assess the infection rate and possible factors related to surgery that may predispose to infection. ⋯ It is unclear why infection rates should be more than three times higher after IPG replacement surgery than after the de novo procedure. The former is a shorter and simpler procedure to conduct. Perhaps the use of better antimicrobial protection and rechargeable batteries may be useful strategies to reduce infections following IPG revision surgery.
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Stereotact Funct Neurosurg · Jan 2013
Spinal cord stimulation and intrathecal baclofen therapy: combined neuromodulation for treatment of advanced complex regional pain syndrome.
Spinal cord stimulation (SCS) is one of the widely used procedures for the treatment of complex regional pain syndrome (CRPS). However, complete pain relief is rarely achieved, and the SCS effect diminishes over time. Recently intrathecal baclofen (ITB) therapy is reported to be a modality for treating fixed dystonia related to CRPS. Other reports have suggested that ITB therapy can enhance the effect of SCS in patients with neuropathic pain. We report the effectiveness of combined SCS and ITB therapy, focusing on the role of ITB therapy as an adjunctive therapy for controlling symptoms of advanced CRPS. ⋯ Combined SCS and ITB neuromodulation decreases pain intensity in refractory CRPS cases or improves associated abnormal dystonic posture and movement disorders and reduces pain fluctuations.