Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2009
Comparative StudyIntraoperative X-ray detection and MRI-based quantification of brain shift effects subsequent to implantation of the first electrode in bilateral implantation of deep brain stimulation electrodes.
After implantation of the first electrode in bilateral deep brain stimulation (DBS) lead implantation, brain shift effects in the target region and along the implantation trajectory of the second electrode are quantified with intraoperative magnetic resonance imaging (MRI). We investigated intraoperative X-ray imaging for its feasibility in indirect detection of brain shift. ⋯ In bilateral DBS implantation, brain shift effects can cause misallocation of the second electrode with the risk of adverse or no stimulation effects as well as unnecessary cortical damage. A lack of X-ray signal changes caused by intracranial air invasion during DBS lead implantation indicates a lack of clinically relevant brain shift.
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Stereotact Funct Neurosurg · Jan 2009
Subthalamic nucleus stimulation does not cause deterioration of preexisting hallucinations in Parkinson's disease patients.
Among the neuropsychiatric symptoms in Parkinson's disease (PD) patients, hallucination can result from the disease itself or medical treatment. Hallucination associated with subthalamic nucleus stimulation (STN-DBS) has been reported; however, it is still unclear whether PD patients with a history of hallucination are appropriate candidates for STN-DBS or not. ⋯ Our findings indicate that STN-DBS surgery does not always lead to deterioration of preexisting hallucination in PD. In advanced PD, hallucination involves a multifactorial pathogenesis and a history of hallucination is not a contraindication to STN-DBS surgery.
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Stereotact Funct Neurosurg · Jan 2009
Linear accelerator radiosurgery for cavernous sinus meningiomas.
In this paper, the authors review the results of a single-center experience using linear accelerator (LINAC) radiosurgery for the treatment of cavernous sinus meningiomas. ⋯ This is the largest LINAC radiosurgery experience for cavernous sinus meningiomas reported to date. Radiosurgery appears to offer greatly superior tumor control and much lower morbidity than surgical resection of cavernous sinus meningiomas.
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Stereotact Funct Neurosurg · Jan 2009
Gamma knife radiosurgery for recurrent and residual meningeal hemangiopericytomas.
The aim of this study was to assess the clinical effects of Gamma Knife radiosurgery (GKS) for recurrent and residual meningeal hemangiopericytomas (M-HPC). ⋯ GKS provides an effective and safe adjunct management for postoperative small-to-moderate sized M-HPC and plays an important role in controlling recurrent and residual M-HPC to avoid a repeat surgical resection.
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Stereotact Funct Neurosurg · Jan 2009
Parasagittal transinsular electrodes for stereo-EEG in temporal and insular lobe epilepsies.
Direct invasive EEG recordings of the insula - due to its particular anatomical position, deeply seated between both opercula - can only be performed with intracerebral electrodes. To date, the technique most commonly used for insular stereoelectroencephalography (SEEG) is the orthogonal-transopercular electrode approach with the Talairach methodology. We propose another technique utilizing MRI with transinsular parasagittal electrodes and a posterior entry point. This avoids passing through the opercula and sylvian vessels running over the insular surface. ⋯ We report a novel technique for insular SEEG with parasagittal electrodes, parallel to the insular cortex, with an entry point at the parieto-occipital junction. This technique is based entirely on use of MRI, and avoids passing through the opercula and sylvian vessels.