Neurosurgery clinics of North America
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Neurosurg. Clin. N. Am. · Oct 2011
ReviewImplanted subdural electrodes: safety issues and complication avoidance.
Invasive electroencephalography via subdural implanted electrodes is essential for the identification and localization of the epileptogenic focus in a large percentage of cases of medically refractory epilepsy. The implantation of subdural electrodes constitutes a widely used method for the preoperative investigation of these patients. ⋯ This article systematically reviews the literature regarding safety issues, potential complications, and complication avoidance strategies associated with the implantation of subdural electrodes. Knowledge of all the reported complications may help in their early detection and their prompt management.
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Neurosurg. Clin. N. Am. · Oct 2011
Historical ArticleResponsive neurostimulation for the treatment of epilepsy.
Neurostimulation in epilepsy has witnessed a century-long evolution that has resulted in the use of neurostimulation to both modulate and suppress abnormal neuronal firing. The recent development of advanced responsive stimulation via a closed-loop device (the RNS System) has provided evidence that surgical epilepsy treatment continues to move toward the possibility of reducing or eliminating seizures in medically refractory patients.
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The pineal region can harbor highly diverse histologic tumor subtypes. Because optimal therapeutic strategies vary with tumor type, an accurate diagnosis is the foundation of enlightened management decisions. ⋯ Biopsy has the advantage of ease and minimal invasiveness but is associated with more sampling errors than open surgery. The emergence of endoscopic techniques and stereotactic radiosurgery provide complementary options to improve pineal tumor management, and will assume greater importance in the neurosurgeon's armamentarium.
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The present review assesses how to make pineal surgery, refined over decades, better, ie, less invasive, while still respecting this delicate region, and achieving anatomic and oncologic goals. An explication of anatomic principles of this region, and some basic surgical principles of keyhole surgery are provided to further assist those interested in minimizing surgical impact during pineal surgery. Although this review, for the sake of brevity, focuses on the infratentorial-supracerebellar approach, many of these principles can be adapted to other approaches, such as the occipital transtentorial, without excessive imagination.
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Neurosurg. Clin. N. Am. · Apr 2011
ReviewDiffusion tractography: methods, validation and applications in patients with neurosurgical lesions.
Diffusion tensor imaging (DTI) tractography is increasingly used in presurgical mapping in tumors located in eloquent areas since it is the only non invasive technique that permits in vivo dissection of white matter tracts. Concordance between the DTI tracts and subcortical electrical intraoperative mapping is high, and DTI tractography has proven useful to guide surgery. However, it presents limitations due to the technique and the tumor, which must be known before using the images in the operative room. This review focuses on the possibilities and limits of DTI imaging in intraoperative tumoral mapping and presents an overview of current knowledge.