Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2010
Occipital nerve stimulator placement via a retromastoid to infraclavicular approach: a technical report.
Occipital nerve stimulation is a form of peripheral nerve stimulation used to treat refractory headache disorders. Various techniques have been described for occipital nerve stimulator implantation; these include midline cervical or retromastoid lead insertion with internal pulse generator placement in the infraclavicular, gluteal or low abdominal regions. ⋯ Implantation approaches that include remote battery sites may contribute to mechanical stress on the components, as the leads or extensions may traverse highly mobile body regions. In this technical report, we describe an occipital stimulator implantation technique that may be advantageous in terms of patient positioning, ease of surgical approach and minimization of mechanical stress on components.
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Stereotact Funct Neurosurg · Jan 2010
Case ReportsA case of mania following deep brain stimulation for obsessive compulsive disorder.
Deep brain stimulation (DBS) of the basal ganglia is an effective treatment for select movement disorders, including Parkinson's disease, essential tremor and dystonia. Based on these successes, DBS has been explored as an experimental treatment for medication-resistant neuropsychiatric disease. ⋯ We present a case of a young woman treated for OCD with DBS of the anterior limb of the internal capsule and nucleus accumbens region, who subsequently manifested a manic episode. We aim to discuss the case details, treatment and potential neuroanatomical underpinnings of this response.
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Stereotact Funct Neurosurg · Jan 2010
Case ReportsThalamic deep brain stimulation for the treatment of action myoclonus caused by perinatal anoxia.
Perinatal anoxia rarely causes myoclonus as the main neurologic abnormality. The exact neuronal mechanism underlying myoclonus induced by perinatal anoxia remains unknown. Some studies have indicated that the development of involuntary movements may be related to the maturation of the thalamus after birth. ⋯ The effectiveness of chronic thalamic DBS in this patient supports the concept of involvement of the thalamus in post-perinatal anoxic myoclonus.
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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.
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Stereotact Funct Neurosurg · Jan 2010
Case ReportsResponse to sham and active gamma ventral capsulotomy in otherwise intractable obsessive-compulsive disorder.
This case regards a 34-year-old woman with severe and refractory obsessive-compulsive disorder, who was enrolled in a double-blind, randomized controlled trial of radiosurgery. She was at first submitted to a sham radiosurgical procedure, and 1 year later to an active intervention. ⋯ During the sham surgery follow-up, no improvements were observed, but a remarkable amelioration was seen a few months after the active procedure. Detailed descriptions of psychopathological changes and neuroimaging findings as well as a discussion regarding the surgical technique are provided.