Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2000
Combined treatment with stereotactic intracavitary irradiation and gamma knife surgery for craniopharyngiomas.
To evaluate the effectiveness of the combined treatment of stereotactic intracavitary irradiation and Gamma Knife surgery on craniopharyngiomas. ⋯ Gamma Knife surgery plays an important role in the treatment of the solid component of craniopharyngiomas and the combination of treatment is a simple, safe and effective method for treatment of craniopharyngiomas, especially for the recurrent mixed solid and cystic tumors.
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We treated 126 patients with different neurosurgical diseases by performing endoscopic neurosurgery, endoscopy-controlled microneurosurgery and endoscopy-assisted microneurosurgery. The indications were intracranial cysts in 51 patients, brain cysticercosis in 10 patients, hydrocephalus in 31 patients, and epidermoid cysts in 34 patients. ⋯ After operation, 115 of 126 patients had improvement in their initial symptoms, 7 had no change and 4 developed complications, including subarachnoid hemorrhage (SAH), intraventricular hemorrhage, and transient cardiopulmonary dysfunction. It is concluded that (1) neuroendoscopic techniques show a distinct value in the treatment of deep-seated, intracranial diseases, or ventricle and cistern lesions; (2) neuroendoscopic techniques play an important role in microneurosurgery and consequently improve surgical quality; (3) the benefits of neuroendoscopic techniques include less surgical manipulation and trauma, milder postoperative reaction, decreased expenses and shortened hospitalizations.
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Stereotact Funct Neurosurg · Jan 2000
Clinical TrialThe significance of intrathecal opioid therapy for the treatment of neuropathic cancer pain conditions.
The effectiveness of intrathecal opioid therapy when applied to different pain mechanisms, in particular neuropathic and nociceptive pain conditions, was studied retrospectively in 43 patients suffering from cancer pain. On the basis of clinical and radiological data, the pain mechanisms were categorized as nociceptive (n = 23) and neuropathic (n = 20). The average duration of treatment of nociceptive pain was 5 months, of neuropathic pain only 2.5 months. ⋯ Patients suffering from neuropathic pain showed poor long-term results (11.1% median pain reduction). Neuropathic pain in the extremities reacted least to the application of intrathecal opioids. Optimal results were obtained for nociceptive pain in the trunk area of the body.
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Stereotact Funct Neurosurg · Jan 1999
Randomized Controlled Trial Multicenter Study Clinical Trial Controlled Clinical TrialLong-term multicenter experience with vagus nerve stimulation for intractable partial seizures: results of the XE5 trial.
Intermittent stimulation of the left cervical vagus nerve trunk (VNS) with the NeuroCybernetic Prosthesis (NCP) is emerging as a novel adjunct in the management of medically refractory epilepsy. We review the safety and efficacy of VNS 1 year after completion of the E05 study, the largest controlled clinical trial of VNS to date. ⋯ The long-term multicenter safety, efficacy, feasibility and tolerability of VNS, as well as the durability of the NCP device have been confirmed. Unlike chronic therapy with antiepileptic medication, the efficacy of VNS is maintained during prolonged stimulation, and overall seizure control continues to improve with time.
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Stereotact Funct Neurosurg · Jan 1999
The role of Gamma Knife radiosurgery in arteriovenous malformation with aneurysms.
A review of 217 patients treated with Gamma knife radiosurgery (GKRS), at Hospital Na Homolce, Prague, between October 1992 and January 1998 for arteriovenous malformation (AVM) is presented. Forty-one patients (18.9%) with an AVM and associated aneurysm are the subjects of special interest for this study. ⋯ Ten patients out of 14, who had an aneurysm close to or within the nidus, showed a complete obliteration of their AVM and aneurysm, although the latter was not always included within the irradiated volume. Thus, this study indicates that radiosurgery alone could be the method of choice for the treatment of a combination of AVM and aneurysm, if the aneurysm is close to or within the nidus.