Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 1999
Stereotactic radiosurgery of cerebral arteriovenous malformations: appearance of perinidal T(2) hyperintensity signal as a predictor of favorable treatment response.
The purpose of this study was to analyze the significance of perinidal T(2) hyperintensity appearance after radiosurgery of arteriovenous malformations (AVMs), as a predictor of treatment response. Our initial experience with linear accelerator (LINAC) radiosurgery at University of California, Los Angeles, between 1990 and 1997 involved treatment of 129 patients affected by cerebral AVMs. Based upon availability of neuroimaging follow-up, 48 patients with 50 AVMs were selected for review. ⋯ Ten (20%) of 50 AVMs (average volume 23.1 cm(3), ranging 7.5-46.5) were unchanged. Furthermore, only 3 AVMs in this group showed reversible T(2) signal changes. In patients with complete nidal obliteration, appearance of T(2) hyperintensity signal achieves 72% sensitivity in predicting successful treatment response.
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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.
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Stereotact Funct Neurosurg · Jan 1999
Placement of deep brain stimulators into the subthalamic nucleus.
We present our technique for deep brain stimulation (DBS) of the subthalamic nucleus (STN) and include information which may be helpful in general DBS. With the patient in a stereotactic head frame, the anterior and posterior commissures are identified on SPGR-sequence magnetic resonance imaging (MRI). ⋯ Electromyography is used to quantitatively measure tremor responses to macrostimulation. Permanent lead placement is confirmed with intraoperative fluoroscopy and postoperative MRI.
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Stereotact Funct Neurosurg · Jan 1999
Historical ArticleHistory of the American Society for Stereotactic and Functional Neurosurgery.
The field of human stereotactic neurosurgery has just passed the half-century mark. Soon after its inception, the pioneers in the field began to meet to exchange information and ideas, which led to an international forum for stereotactic surgery. ⋯ The first independent meeting of the American Society for Stereotactic and Functional Neurosurgery took place in Houston in 1980, at which there were 27 papers, 40% of which were on the newly emerging field of image-guided neurosurgery and the rest on classical functional neurosurgery. The five meetings since, occurring at approximately 4-year intervals, have documented the progress in epilepsy surgery, the reemergence of stereotactic surgery for movement disorders, the growth of stereotactic radiosurgery, and the genesis of frameless stereotactic techniques which have now become widespread.
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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.