Stereotactic and functional neurosurgery
-
Stereotact Funct Neurosurg · Jan 2009
Case ReportsWire tethering or 'bowstringing' as a long-term hardware-related complication of deep brain stimulation.
Widely reported long-term complications following implantation of deep brain stimulation (DBS) hardware include breakage of electrode leads, internal pulse generator (IPG) failure, skin erosions and infection. Here we report on a rarely described problem that arises from formation of scar tissue adhesions around the DBS extension wire(s). Over time, this scar tissue can become tight and pronounced, protruding noticeably beneath the skin ('bowstringing' in reference to its tight bow-like appearance) and leading to significant limitation of movement and discomfort. We term this 'wire tethering'. ⋯ Wire tethering, or 'bowstringing', is an underrecognized complication of DBS hardware implantation often necessitating surgical revision. The possible etiology of wire tethering is discussed as well as suggestions for its avoidance.
-
Stereotact Funct Neurosurg · Jan 2009
Avoiding abducens nerve palsy during the percutaneous balloon compression procedure.
The main purpose of this study is to underline the factors which are likely to increase the risk of a sixth nerve injury after percutaneous balloon compression of the gasserian ganglion. ⋯ The anatomic position and the shape of the inflated balloon represent key factors in determining the procedure's benefit or risk of complications.
-
Stereotact Funct Neurosurg · Jan 2008
Endocrine response after gamma knife-based stereotactic radiosurgery for secretory pituitary adenoma.
To examine treatment outcomes of Gamma Knife-based stereotactic radiosurgery (GK-based SRS) for secretory pituitary adenomas. ⋯ GK-based SRS provides a reasonable rate of endocrine normalization of secretory pituitary adenoma. The time to endocrine response is shorter than reported for fractionated external beam radiotherapy. There is a low risk of optic neuropathy.
-
Stereotact Funct Neurosurg · Jan 2008
Pain relief after cervical ganglionectomy (C2 and C3) for the treatment of medically intractable occipital neuralgia.
Occipital neuralgia (ON) presents a diagnostic challenge because of the wide variety of symptoms, surgical findings, and postsurgical outcomes. Surgical removal of the second (C2) or third (C3) cervical sensory dorsal root ganglion is an option to treat ON. The goal of this study was to evaluate the short-term and the long-term efficacy of these procedures for management of cervical and occipital neuropathic pain. ⋯ Cervical ganglionectomy offers relief to a majority of patients, immediately after procedure, but the effect is short lived. Nerve blocks are helpful in predicting short-term success, but a positive block result does not necessarily predict long-term benefit and therefore cannot justify surgery by itself. However, since 60% of patients report excellent-moderate results, cervical ganglionectomy continues to have a role in the treatment of intractable ON.
-
Stereotact Funct Neurosurg · Jan 2008
ReviewReview of the treatment of trigeminal neuralgia with gamma knife radiosurgery.
Trigeminal neuralgia is a debilitating condition caused by compression of the trigeminal nerve, ganglions, or divisions. Gamma knife radiosurgery has been increasingly used in the treatment of trigeminal neuralgia as a non-invasive alternative to microvascular decompression and rhizotomies. ⋯ The growing body of literature suggests that the low rates of complications of gamma knife radiosurgery, coupled with the high success rates and patient satisfaction, allow it to be increasingly used as primary intervention for trigeminal neuralgia for appropriate patients.