Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2011
Comparative StudyMRI-guided subthalamic nucleus deep brain stimulation without microelectrode recording: can we dispense with surgery under local anaesthesia?
Subthalamic nucleus (STN) deep brain stimulation (DBS) for Parkinson's disease (PD) is traditionally performed under local anaesthetic (LA). STN visualization and routine validation of electrode location on stereotactic MRI may allow surgery under general anaesthesia (GA). This study compares the clinical outcome of MRI-guided STN DBS performed under LA or GA in a consecutive patient series. ⋯ MRI-guided STN DBS under GA with routine stereotactic verification of lead location did not have a negative effect on efficacy or safety. Surgery under GA is a viable option in patients who would find it hard to tolerate awake surgery due to disease severity, comorbidities or anxiety.
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Stereotact Funct Neurosurg · Jan 2011
Comparative StudyLongevity analysis of currently available deep brain stimulation devices.
There continues to be debate about the surgical technique, electrophysiology, and hardware used in deep brain stimulation (DBS), despite its widespread use in medically intractable Parkinson's disease and essential tremor. This article is the first, to our knowledge, to compare the longevity of the available internal pulse generators (IPGs) of DBS (Kinetra and Soletra, Medtronics). ⋯ Our findings support superior battery life and a greater capacity for titration to symptom control with bilateral Soletra IPGs.
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Stereotact Funct Neurosurg · Jan 2011
Case ReportsA technique of distal to proximal revision of peripheral neurostimulator leads: technical note.
Peripheral nerve stimulation for chronic pain states is a safe and efficacious technique, being used with increasing frequency. The incidence of hardware-related complications requiring revision remains high. ⋯ The distal to proximal neurostimulator lead revision technique quickly and safely adjusts lead position, including both lead depth and lead tip location, without a need for replacement of components or revision of the entire system.
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Stereotact Funct Neurosurg · Jan 2011
Case ReportsSurgical treatment for late complications following gamma knife surgery for arteriovenous malformations.
To establish the surgical indications and strategy for late complications following gamma knife surgery (GKS) for arteriovenous malformations (AVMs). ⋯ Cyst formation is one of the late complications of GKS for AVM. Some cysts show spontaneous regression but others gradually increase in size and become symptomatic, although relatively large asymptomatic cysts are also known. Predicting the future course of a cyst is difficult. Surgery such as placement of an Ommaya reservoir should be considered for symptomatic cases. Expanding hematoma always increases in size and becomes symptomatic, so removal by craniotomy is necessary. Surrounding brain edema decreases rapidly after surgery and neurological symptoms quickly resolve.
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Stereotact Funct Neurosurg · Jan 2011
Effective subthalamic nucleus deep brain stimulation sites may differ for tremor, bradykinesia and gait disturbances in Parkinson's disease.
Subthalamic nucleus (STN) deep brain stimulation (DBS) is an effective therapy for Parkinson's disease (PD). This study investigates whether improvement for particular PD symptoms varies differentially with respect to stimulation location in the STN. ⋯ The iterative volumetric analysis is a valuable tool in identifying anatomic regions responsive to DBS across a subject population treated for PD. In the subjects tested, overlapping efficacy for all symptoms was observed in the region of the STN, but anatomic variances in the responsiveness for tremor, bradykinesia, and gait were found.