Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2010
Comparative StudyAsymptomatic deep venous thrombosis after deep brain stimulation for Parkinson disease.
Patients with advanced Parkinson disease (PD) are at increased risk for asymptomatic leg deep venous thrombosis (DVT) because of severe motor fluctuations. Protracted immobility in the absence of antiparkinsonian therapy during stereotactic surgery may further increase the risk for venous thrombosis. Our aim was to determine the incidence of asymptomatic DVT of leg veins in PD patients undergoing subthalamic nucleus deep brain stimulation (STN-DBS). ⋯ Our data show that advanced PD patients are at risk for developing asymptomatic leg DVT following stereotactic surgery performed for STN-DBS. A strict clinical monitoring in the perioperative period is advisable in order to ensure early detection of DVT and prevent further thrombo-embolic complications.
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Stereotact Funct Neurosurg · Jan 2010
Comparative StudySurgical outcome and improvement in quality of life after microvascular decompression for hemifacial spasms: a case series assessment using a validated disease-specific scale.
Hemifacial spasm (HFS) is a movement disorder characterized by intermittent, involuntary clonic or tonic-clonic contractions of muscles innervated by the ipsilateral facial nerve. Recent studies have documented change in quality of life after HFS management with botulinum toxin injection. However, we failed to locate any study that documented change in quality of life after surgical management with retrosigmoid microvascular decompression (MVD). ⋯ MVD offers significant and prolonged improvement in quality of life for the HFS patients we studied, as measured using a disease-specific, validated quality of life assessment scale. Postoperative quality of life, however, was strongly influenced by both the success of surgery in resolving the symptoms and the absence of any permanent complications of surgery.
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Stereotact Funct Neurosurg · Jan 2010
Comparative StudyCT-based, fiducial-free frameless stereotaxy for difficult ventriculoperitoneal shunt insertion: experience in 26 consecutive patients.
Patients with small or dysmorphic ventricles requiring ventriculoperitoneal shunt (VPS) insertion for hydrocephalus can be challenging. The 'freehand' technique does not always provide for accurate catheter insertion, particularly in patients with slit ventricles, complex hydrocephalus or displaced ventricles. Consequently, many surgeons use stereotaxy for assistance. We have employed a frameless stereotactic technique, obviating the need for fiducials or preoperative MRI, for difficult ventricular catheter placement over the past 1.5 years with excellent results. We describe our experience with frameless stereotactic VPS insertion. ⋯ Our results confirm that frameless stereotactic VPS without fiducial marker placement is a feasible technique for catheter insertion in patients who have small/dysmorphic ventricles. In experienced hands, there is negligible added operative time and a low complication rate.
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Stereotact Funct Neurosurg · Jan 2010
Comparative StudyCommissural myelotomy in the treatment of intractable visceral pain: technique and outcomes.
Commissural myelotomy can be valuable for patients with intractable pain associated with malignancy in the abdominal or pelvic region. ⋯ We found that for the properly selected patient, open midline commissural myelotomy can provide effective pain relief with acceptable postoperative morbidity.
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Stereotact Funct Neurosurg · Jan 2010
Comparative StudyIntraoperative use of the Medtronic O-arm for deep brain stimulation procedures.
The purpose of this study was to analyze the feasibility and utility of 3D imaging to help lead positioning during a deep brain stimulation (DBS) procedure. A bilateral subthalamic DBS procedure was conducted in 2 patients for idiopathic Parkinson's disease. ⋯ We used the Medtronic O-arm to perform 2D-imaging control (frontal and lateral) as well as quick (<30 s) 3D acquisition. This allowed us to check the positioning of micro-macro electrodes and definite electrodes. 3D images were fused with postoperative CT to assess their accuracy, and with preoperative MRI to visualize the anatomical location of the electrodes. 3D imaging is a quick and safe method to ensure perioperative control of lead placement during DBS procedures.