Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2013
Long-term efficacy of stereotactic bilateral anterior cingulotomy and bilateral anterior capsulotomy as a treatment for refractory obsessive-compulsive disorder.
To investigate the long-term efficacy and adverse effects of stereotactic bilateral anterior cingulotomy (BACI) and bilateral anterior capsulotomy (BACA) as a treatment for refractory obsessive-compulsive disorder (OCD) patients. ⋯ The BACI and BACA were effective for the treatment of refractory OCD, and no significant adverse effects on long-term follow-up were found.
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The use of functional neuroimaging holds the promise of improving neurosurgical outcomes by providing preoperative localization of critical brain functions. The brain representation of somatosensory function can be effectively localized using magnetoencephalography (MEG) in both normal subjects and in patients with tumors, vascular malformation, and epilepsy. This study investigates the pattern of somatosensory localization in 45 patients. ⋯ Results showed that this peak localized either to the central or postcentral sulcus of the somatosensory cortex. We found that neither age nor the presence of brain pathologies had significant effect on the recognition of the somatosensory cortex. Patients who underwent surgery after presurgical planning using MEG suffered no new somatosensory deficits, indicating the valuable role of pre-surgical mapping using MEG in the surgical planning.
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Stereotact Funct Neurosurg · Jan 2013
Accuracy of frame-based stereotactic depth electrode implantation during craniotomy for subdural grid placement.
Frame-based stereotaxy and open craniotomy may seem mutually exclusive, but invasive electrophysiological monitoring can require broad sampling of the cortex and precise targeting of deeper structures. ⋯ The described technique for craniotomy through a stereotactic frame allows placement of subdural grids and depth electrodes without sacrificing the accuracy of a frame or requiring staged procedures.
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Stereotact Funct Neurosurg · Jan 2012
Microelectrode recording duration and spatial density constraints for automatic targeting of the subthalamic nucleus.
Accurate detection of the boundaries of the subthalamic nucleus (STN) in deep brain stimulation (DBS) surgery using microelectrode recording (MER) is considered to refine localization and may therefore improve clinical outcome. However, MER tends to extend operation time and its cost-utility balance has been debated. ⋯ STN entry detection error was about half of the step size. Sampling duration of STN activity can be minimized to 1 s/record without compromising accuracy. We conclude that bilateral DBS surgery time utilizing MER may be significantly shortened without compromising targeting accuracy.
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Stereotact Funct Neurosurg · Jan 2012
Comparative StudyThe effect of intraventricular trajectory on brain shift in deep brain stimulation.
Brain shift during deep brain stimulation (DBS) surgery may compromise target localization. Loss of cerebrospinal fluid is believed to be the underlying mechanism, thus an intraventricular trajectory during DBS surgery may be associated with increased shift, in addition to other complications, such as intraventricular hemorrhage. ⋯ Intraventricular trajectories during DBS surgery do not appear to compromise safety or targeting accuracy.