Neurosurgery clinics of North America
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Advances in deep brain stimulation (DBS) surgery have been achieved through the use of stereotactic targeting of key tracks in patients undergoing awake surgery. Intraoperative detection of track location has been useful in interpreting physiologic results, has limited the number of brain penetrations, and has decreased the incidence of reoperations. Alternatively, some centers are gaining experience with placement of the lead under general anesthesia using a purely anatomic approach, for which both computed tomography and magnetic resonance imaging have proved useful. In this article, the use of image guidance with both the anatomic and physiologic approaches is described.
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Neurosurg. Clin. N. Am. · Jan 2014
ReviewPeripheral neuromodulation for treatment of chronic migraine headache.
Chronic migraines (CM) affect approximately 2% of the population, resulting in significant disability, economic burden, and impairments in quality of life. Historical neurosurgical procedures, such as lesioning of the trigeminal dorsal root entry zone or neurolysis of the occipital nerve, have not gained favor because of procedural morbidity and poor durability, respectively. Occipital nerve stimulation is emerging as a potentially promising modality for the treatment of CM, with greater than 50% pain reduction in approximately 80% of patients in open-label trials and ∼40% of patients in randomized controlled trials. Mechanisms of neuromodulation remain unclear.
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This article describes the basis for neuromodulation procedures for obsessive-compulsive disorder (OCD) and summarizes the literature on the efficacy of these interventions. Discussion includes neural circuitry underlying OCD pathology, the history and types of ablative procedures, the targets and modalities used for neuromodulation, and future therapeutic directions.
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Neurosurg. Clin. N. Am. · Jan 2014
ReviewSpinal cord stimulation for the treatment of vascular pathology.
Multiple studies have shown proved efficacy of spinal cord stimulation (SCS) in peripheral vascular disease (PVD). The exact mechanism by which SCS acts in the treatment of PVD is not completely understood, and may include stimulating the release of nitric oxide, modulation of the sympathetic nervous system, or modulation of prostaglandin production. Patient selection criteria have been well defined and SCS should be reserved for patients with end-stage lower limb PVD unresponsive to medical therapy and not amenable to surgical reconstruction but in whom disease has not caused inevitable limb loss. This article reviews the outcomes, techniques, patient selection criteria, and putative mechanisms of SCS for PVD.
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Neurosurg. Clin. N. Am. · Jan 2014
ReviewSacral neuromodulation for refractory overactive bladder, interstitial cystitis, and painful bladder syndrome.
Various pelvic floor conditions, including overactive bladder syndrome and chronic pelvic pain, have been successfully managed with the neuromodulation of sacral nerves. Sacral neuromodulation is a minimally invasive procedure involving the implantation of a programmable pulse generator that delivers low-amplitude electrical current via quadripolar tined leads through the S3 foramen. Durable efficacy has been demonstrated in retrospective studies, but questions regarding ideal patient candidacy and optimal technical considerations remain unanswered.