Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 1996
Use of magnetic resonance imaging in stereotactic surgery. A survey of members of the American Society of Stereotactic and Functional Neurosurgery.
Members of the American Society of Stereotactic Functional Neurosurgery were surveyed to determine the current use of magnetic resonance imaging (MRI) for stereotactic coordinate determination. Of 137 respondents, 48% used MRI as the sole technique for some biopsy procedures. ⋯ Significant factors related to the use of MRI amongst individual surgeons included the performance of > or = 2 stereotactic surgeries per week, the performance of radiosurgery, and being in an academic practice (p < 0.0004). The increasing use of MRI in stereotactic surgery must be coupled with quality assurance testing from frame manufacturers, imaging manufacturers, and surgeons.
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Stereotact Funct Neurosurg · Jan 1995
Effect of spinal cord stimulation on cerebral blood flow in cats.
Effects of electric spinal cord stimulation (SCS) on cerebral blood flow (CBF) were investigated in anesthetized adult cats. SCS was performed under various stimulus conditions for 1 h via a wire electrode inserted into the dorsal epidural space at various levels in the spinal cord. CBF was measured in the subcortex of the parietal lobe by hydrogen clearance method before, during, and after SCS. ⋯ Nor did SCS of the high cervical cord with frequencies of 200 and 2,000 Hz increase CBF. No CBF increase was observed after SCS of the high cervical cord with 20 Hz when the dorsal column was sectioned at the medullo-cervical junction. These results suggest that the ability of SCS to increase CBF is peculiar to high cervical cord stimulation with moderately low frequencies.
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Stereotact Funct Neurosurg · Jan 1995
Clinical TrialSpinal cord stimulation in severe angina pectoris.
Since 1985, 225 patients suffering from severe pectoris due to New York Heart Association classes III-IV have been treated with spinal cord stimulation (SCS). All patients have been considered not suitable for open heart surgery by technical reasons. The long-term follow-up has shown a very good positive response to stimulation with pain relief, less intake of medication and increased quality of life. ⋯ Recordings with the so-called Holter technique have demonstrated that SCS does not create arrhythmias, and pacing studies that SCS does not mask ischemia at extreme workload. In conclusion, apart from the positive effect on the quality of life, SCS in angina pectoris has demonstrated antianginal and anti-ischemic effects. The clinical results and the physiological and hemodynamic measurements will be presented in detail.
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Stereotact Funct Neurosurg · Jan 1995
Complications associated with infusion pumps implanted for spasticity.
Implanted infusion pumps are an effective method for delivering medications into the intrathecal space to reduce spasticity. Complications can occur with the surgical aspect of implantation, as well as with the hardware. ⋯ The overall incidence of total complications was 62%; 24% in the Infusaid pumps, and 167% in the Medtronic pumps. The incidence and types of complications are important in informed consent as well as in the selection of pumps and connectors.
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Stereotact Funct Neurosurg · Jan 1995
Clinical TrialAnalysis of breakthrough pain in 50 patients treated with intrathecal morphine infusion therapy. Development of tolerance or infusion system malfunction.
Fifty patients with intractable benign pain were treated with intrathecal morphine (IT-MS) infusion therapy. Median follow-up was 39 months (range 5-70). Breakthrough pain was reported in 45 (90%) patients in 75 outpatient clinic events. ⋯ Benefits were regained after all surgical catheter corrections. In total, partial tolerance was seen in 23 patients (46%) during 50 (67%) breakthrough events, 15 patients (30%) required 22 catheter revisions during 27% of breakthrough events and 2 patients had progressive disease. True tolerance was encountered in only 5 patients (10%) during 5 (7%) breakthrough pain events.