Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2003
Effect of motor improvement on quality of life following subthalamic stimulation is mediated by changes in depressive symptomatology.
Subthalamic deep brain stimulation (STN-DBS) for Parkinson's disease (PD) improves motor symptoms and quality of life (QOL). Because depression is a potent correlate of QOL, and STN-DBS may be associated with changes in mood, this study sought to determine whether QOL improvement is a direct or indirect consequence of motor improvement. ⋯ Significant QOL improvements after STN-DBS are associated with improved motor 'on' state and depressive symptoms. The influence of motor improvement on QOL may be largely indirect by reducing depression.
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Stereotact Funct Neurosurg · Jan 2003
Permanent iodine-125 interstitial radiation therapy in the treatment of non-glioblastoma multiforme high-grade gliomas.
This study evaluates prognostic factors influencing survival outcomes for 60 patients with permanent iodine-125 implants in the primary treatment of non-glioblastoma multiforme (GBM) high-grade gliomas. ⋯ Brachytherapy with permanent implant of 125I appears promising in the treatment of primary non-GBM malignant gliomas. It improved survival time and reduced the incidence of complications and provided good quality of life. In order to further confirm these results, multicenter randomized prospective studies are needed. RPA analysis is a valid tool to define prognostically distinct survival groups. In this study, 2-year survival and median survival time were improved in all prognostic classes. This would suggest that selection bias alone does not account for the survival benefit seen with 125I implants. Further randomized studies with effective stratification are needed.
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Stereotact Funct Neurosurg · Jan 2003
Longevity of batteries in internal pulse generators used for deep brain stimulation.
The longevity of batteries in internal pulse generators (IPGs) used clinically for deep brain stimulation is not known. We conducted a study to assess the life span of these batteries. From 1993 to 2000, 163 single-channel batteries were surgically implanted in our institution. ⋯ Batteries with high energy consumption as assessed by TEED had a reduced life span (r = -0.82, p < or = 0.001). Patients with essential tremor who required battery replacement needed higher settings to control their symptoms and therefore presented a shorter battery life when compared to patients with Parkinson's disease. In our series of patients who needed battery replacement, battery longevity varied with stimulation parameters but was longer than expected from the manufacturer's specifications.
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Stereotact Funct Neurosurg · Jan 2003
Spinal cord stimulation for the treatment of refractory unilateral limb pain syndromes.
Spinal cord stimulation (SCS) is an established therapy for chronic pain. Its success depends on vigorous patient selection and good follow-up. ⋯ We feel that SCS is an effective treatment in RULPS and its results depend upon vigorous patient selection and an adequate follow-up and maintenance program.
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Stereotact Funct Neurosurg · Jan 2002
MRI-directed subthalamic nucleus surgery for Parkinson's disease.
The subthalamic nucleus (STN) is now regarded as the optimal surgical target for the treatment of medically refractory idiopathic Parkinson's disease. In our center, a predominantly MRI-directed method has been developed for targeting the STN. The STN is localized on T2-weighted images from a 1.5-T MRI scanner. ⋯ Cumulative frequencies predict that the majority of DBS electrodes placed in this manner will be within 0.5 mm of the planned target. Because physiological methods are not required, the whole procedure can be performed under general anesthesia. We feel that planning with reference to a standard atlas is unreliable and not significantly helped by the addition of microelectrode recording, the accuracy of which in the axial plane is dependent upon the distance between the recording trajectories, which is typically 2 mm.