Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2008
Comparative StudyEffects of bilateral deep brain stimulation of the subthalamic nucleus on olfactory function in Parkinson's disease patients.
The goal of the present study was to evaluate the effects of bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) on olfaction in patients with Parkinson's disease (PD). ⋯ STN DBS can significantly improve olfactory cognitive function in PD patients. The possible mechanisms include an improvement in striatal metabolism and neuronal activity in the orbitofrontal cortex mediated by STN DBS, as well as increased glucose metabolism in the striatum, midbrain, cingulate gyrus, and motor and higher-order somatosensory association cortices.
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Stereotact Funct Neurosurg · Jan 2008
ReviewA comprehensive review of radiosurgery for cerebral arteriovenous malformations: outcomes, predictive factors, and grading scales.
The management of cerebral arteriovenous malformations (AVMs) continues to present a challenge to neurosurgeons. The natural history of this condition, as well as the morbidity and mortality of therapeutic interventions, remains incompletely elucidated. Predictive factors and grading scales in AVM management allow risk-benefit analysis of treatment options and comparison of outcomes. ⋯ Lesion characteristics and postsurgical complications differ markedly in patientstreated by radiosurgery versus microsurgery. Radiosurgery-based grading systems account for factors that have been associated with various aspects of radiosurgical outcomes including obliteration, hemorrhage, and postoperative complications, particularly those induced by radiation. The purpose of this paper is to describe the most current predictive factors and grading systems for radiosurgical treatment of cerebral AVMs.
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Stereotact Funct Neurosurg · Jan 2008
Comparative StudySubthalamic stimulation for essential tremor. Short- and long-term results and critical target area.
In order to explore the usefulness and long-term result of subthalamic nucleus (STN) stimulation for the treatment of essential tremor (ET), we evaluated 3 groups of patients undergoing deep brain stimulation (DBS) for ET. ⋯ Provided that intra-operative test stimulation produces satisfactory tremor control, STN is a good target for long-term treatment of ET. For patients above the age of 70 years, however, the Vim is a preferable target.
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Stereotact Funct Neurosurg · Jan 2008
Comparative StudyModeling parkinsonian circuitry and the DBS electrode. II. Evaluation of a computer simulation model of the basal ganglia with and without subthalamic nucleus stimulation.
Treatment with deep brain stimulation (DBS) for Parkinson's disease (PD) has become routine over the past decade, particularly using the subthalamic nucleus (STN) as a target and utilizing microelectrode recordings to ensure accurate placement of the stimulating electrodes. The clinical changes seen with DBS in the STN for PD are consistently beneficial, but there continues to be only marginal understanding of the mechanisms by which DBS achieves these results. Using an analytical model of the typical DBS 4-contact electrode and software developed to simulate individual neurons and neural circuitry of the basal ganglia we compare the results of the model to those of data obtained during DBS surgery of the STN. Firing rate, interspike intervals and regularity analyses were performed on the simulated data and compared to results in the literature.
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Stereotact Funct Neurosurg · Jan 2008
Case ReportsSuccessful bilateral subthalamic nucleus stimulation for segmental dystonia after unilateral pallidotomy.
Several subcortical structures have been targeted for surgical treatment of dystonia, including motor thalamus, internal segment of globus pallidus (GPi), and more recently, the subthalamic nucleus (STN). Deep brain stimulation of GPi is currently the preferred surgical treatment, but it is unclear if targeting other structures would yield better results. Patients who have already had a pallidotomy yet continue to experience dystonic symptoms may be limited in further treatment options. ⋯ This result supports the efficacy of STN deep brain stimulation in dystonia patients, even those with prior pallidotomy.