Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2004
Comparative StudyBilateral stimulation of the subthalamic nucleus in Parkinson's disease: surgical efficacy and prediction of outcome.
Over the last decade neurosurgery has reemerged as a valid therapy for patients with advanced Parkinson's disease. Previously, we have addressed safety and efficacy of subthalamic nucleus (STN) deep brain stimulation (DBS). In this study, we extended these observations and analyzed factors that affect surgical outcome and its predictive value. ⋯ Bilateral STN DBS produces robust improvements in parkinsonian motor symptoms. Surgical outcome can reliably be predicted.
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Stereotact Funct Neurosurg · Jan 2004
Comparative StudyRecovery of pain control by intensive reprogramming after loss of benefit from motor cortex stimulation for neuropathic pain.
Motor cortex stimulation (MCS) may serve as an adjunct in managing neuropathic pain after other conservative and interventional methods have failed. However, the magnitude and duration of the benefit are highly variable, with a significant percentage of patients losing pain relief over time. We investigated whether intensive reprogramming could recapture the beneficial effects of MCS. ⋯ Intensive reprogramming can recapture the benefit of MCS in patients who have lost pain control. The use of broad dipoles using two contacts rather than one contact of the 1 x 4 electrode array improved the ability to recapture beneficial stimulation. There is a significant risk of seizures during aggressive reprogramming.
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Stereotact Funct Neurosurg · Jan 2003
Clinical TrialClinical study for alleviating opiate drug psychological dependence by a method of ablating the nucleus accumbens with stereotactic surgery.
The aim of this study was to explore a new way of treating drug addiction by ablating the nucleus accumbens (NAC), which has a close relationship with drug-induced psychological dependence, using stereotactic surgery, blocking the mesocorticolimbic dopamine circuit, alleviating craving for drugs and lowering the relapse rate after detoxification. On the basis of animal experiments, stereotactic surgery was performed in 28 patients by making a lesion in the NAC bilaterally to treat opiate drug dependence. Indications, the criterion of therapeutic effect, treatment process and the therapeutic and safety evaluation index of the surgery were formulated particularly. ⋯ The mean follow-up time in this study was 15 months. The effectiveness was satisfactory. The relapse rate of drug addicts after detoxification was clearly reduced.
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Stereotact Funct Neurosurg · Jan 2003
Long-term outcome of spinal cord stimulation and hardware complications.
Spinal cord stimulation (SCS) is a treatment modality for medically intractable chronic pain. This study reports an 11-year experience with SCS assessing long-term pain relief and specifically evaluating complications and revisions. It took the form of a retrospective review of medical/surgical records with a postal questionnaire. ⋯ Clinician-reported pain relief was substantial in 69 (68%) patients. This study adds to the weight of evidence that patients undergoing SCS derive significant benefits in terms of pain relief. However, revision rates remain high due to technical and biological factors.
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Stereotact Funct Neurosurg · Jan 2003
Microvascular decompression for trigeminal neuralgia in patients with multiple sclerosis.
To assess whether microvascular decompression (MVD) is a safe and efficacious treatment for patients with trigeminal neuralgia (TGN) and multiple sclerosis (MS). ⋯ Although MVD provides good initial pain relief, the recurrence rate is much higher than that obtained in 'idiopathic' TGN. Although all procedures for the treatment of TGN are worse than those for idiopathic TGN, it is concluded that because of the high recurrence rate together with the morbidity associated with the procedure MVD should not be offered to patients with TGN and MS.