Stereotactic and functional neurosurgery
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With the improved utilisation and widespread availability of opiates, the oral treatment of pain due to malignancy has changed radically, so that the expected need for intrathecal (IT) delivery systems for this pain has largely failed to materialise. Instead, the lack of equal progress in the design and production of non-opiates for treating non-malignant pain, in the long term, has resulted in a greater interest in the development of these IT systems in this non-malignant area.
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Stereotact Funct Neurosurg · Jan 2001
Comparative StudyMicrovascular decompression for hemifacial spasm: a long-term follow-up of 1,169 consecutive cases.
We analyzed the records of 1,169 patients with hemifacial spasm (HFS) who underwent microvascular decompression (MVD) and were followed up for more than 6 months from January 1987. The mean follow-up duration was 23.8 months (6-145 months). Excellent surgical outcome was obtained in 90.5% and good in 4.5%, giving an overall success rate of 95.0%. ⋯ Permanent facial weakness and hearing impairment were 1.4% and 2.3%, respectively. There were no anatomical differences at the root entry zone (REZ) and significant differences of surgical outcome in young HFS (34 patients). Factors such as type of offender, severity of compression on the facial nerve root, and the degree of decompression of the REZ on postoperative MRI did not correlate with surgical outcome.
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Stereotact Funct Neurosurg · Jan 2001
Stereotactic radiosurgery for primary trigeminal neuralgia using the Leksell Gamma unit.
Previous papers have reported Gamma Knife radiosurgery to be a safe, effective method for primary trigeminal neuralgia. Since November 1996, we have treated primary trigeminal neuralgia using the Leksell Gamma Knife at the Tianjin Medical University. The present study reports clinical results of Gamma Knife radiosurgery in the treatment of trigeminal neuralgia in 80 cases. ⋯ Gamma Knife radiosurgery is a safe and effective method in the treatment of trigeminal neuralgia once diagnosis is established.
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Stereotact Funct Neurosurg · Jan 2001
CT-guided percutaneous punctate midline myelotomy for the treatment of intractable visceral pain: a technical note.
Surgical treatment of intractable visceral pain has always been a challenge. The relatively recent discovery of a specific visceral pain pathway brought a new insight to this matter. The authors describe a new technique to interrupt this pathway, the CT-guided percutaneous punctate midline myelotomy, successfully applied in two patients with intractable pelvic visceral pain. Due to its simplicity, safety and high effectiveness, it may become the treatment of choice for intractable visceral pain.
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Stereotact Funct Neurosurg · Jan 2001
Microanatomy of medial temporal area and subtemporal amygdalohippocampectomy.
For seizure control in temporal lobe epilepsy, the head of the hippocampus to the choroidal point, parahippocampal gyrus, entorhinal area, uncus, and at least the basolateral nucleus of the amygdala should be completely removed. The subtemporal approach should be selected for removal of these structures, and it does not interrupt the temporal stem and optic radiation. Pre- and postoperative neuropsychological examinations revealed that there is no significant decline of scores of various examinations including WAIS, WMS, Randt memory, and verbal associates learning tests, even if the resection were performed on the language dominant side. Seizure control for the 20 non-lesional patients operated with this approach is 60% (Class I and II), without definite permanent complications.