Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 1997
Percutaneous radiofrequency lumbar facet rhizotomy in mechanical low back pain syndrome.
During the period from March 1992 to June 1996, we performed percutaneous radiofrequency (RF) facet rhizotomy in 324 patients with low back pain. Employing the lesion generator, we coagulated branches of the zygapophyseal nerve to treat low back pain. ⋯ Two-hundred and thirty-one patients (103 females and 128 males) had mechanical low back pain syndrome and showed marked improvement of pain after the procedure, including 29 cases with previous spinal surgery. We concluded that percutaneous RF facet rhizotomy is a safe and effective procedure for low back pain patients, especially for those with mechanical low back pain syndrome.
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From January 1, 1986, to June 30, 1996, 240 patients were operated on for trigeminal neuralgia: 182 patients were treated by thermocoagulation of the gasserian ganglion after Sweet and 58 patients by decompression of the trigeminal nerve after Janetta. In the thermocoagulation group, followed up for 6 months to 10 years 95.2% of the cases showed freedom from pain, in the Janetta operation group, followed up for 6 months to 6 years 98.5% showed freedom from pain. Thermocoagulation is the preferred therapy, especially in older patients in whom general anesthesia is risky, while the Janetta operation is the therapy of choice in younger patients.
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Stereotact Funct Neurosurg · Jan 1997
Can neuronavigation contribute to standardization of selective amygdalohippocampectomy?
Tailored selective amygdalohippocampal resections seem to be an interesting application for neuronavigation. The accuracy of freehand frameless neuronavigation was assessed in 28 patients for its ability to determine the hippocampal resection length, as compared to postoperative MRI. ⋯ The discrepancy is explained by an anterior-posterior component of brain collapse in a tilted head. Horizontal positioning of the head or navigational marking prior to the occurrence of brain collapse may overcome the problem.
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Stereotact Funct Neurosurg · Jan 1997
Microvascular decompression and percutaneous rhizotomy in trigeminal neuralgia.
We analyzed 417 patients with trigeminal neuralgia who underwent microvascular decompression (MVD; n = 146) or percutaneous procedures, i.e. radiofrequency rhizotomy (RFR; n = 235) and glycerol rhizotomy (GR; n = 36) between March 1973 and December 1996. MVD and RFR showed the highest rates of initial pain relief (MVD 96.5%; RFR 92.3%; GR 82.8%). ⋯ We concluded that MVD is the treatment of choice for tolerant younger patients and should be recommended for patients who desire no sensory deficit. We also determined that radiofrequency rhizotomy is the procedure of choice for patients in whom MVD failed.
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Stereotact Funct Neurosurg · Jan 1996
Trigeminal neuralgia radiosurgery: the University of Pittsburgh experience.
The results of Gamma Knife stereotactic radiosurgery in the management of 51 patients who had typical trigeminal neuralgia were evaluated at the University of Pittsburgh. In all cases, a 4-mm isocenter was targeted at the proximal nerve at the root entry zone. The target dose varied from 60 to 90 Gy. ⋯ A maximum radiosurgery dose > or = 70 Gy was associated with a significantly greater chance for complete pain relief. Using magnetic resonance imaging stereotactic targeting, the proximal trigeminal nerve is an appropriate anatomic target for radiosurgery. Gamma Knife radiosurgery is a useful additional surgical approach in the management of medically or surgically refractory trigeminal neuralgia.