World Neurosurg
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Case Reports
Successful Management of Hemorrhage-associated Hemiballism after STN DBS with Pallidal Stimulation: A Case Report.
Deep brain stimulation has been widely used for treating several movement disorders including idiopathic Parkinson disease (IPD). The development of hemiballism after an iatrogenic injury to the subthalamic nucleus (STN) such as postoperative hemorrhage or stroke is rare. Employing pallidal DBS to manage hemiballism arising as a result of STN injury is a unique application of this therapeutic modality, which has only been reported twice in the literature. ⋯ In our case pallidal DBS was effective in treating hemiballism that arose as a result of traumatic displacement of STN DBS electrodes. Medical management and changes in stimulation parameters failed to produce any significant change in the hemiballism. This report is only the third of its kind in the literature wherein hemiballism arising as a result of STN damage after DBS was successfully treated with pallidal stimulation.
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Deep brain stimulation (DBS) is a cost-effective strategy for the treatment of different neurologic disorders. However, DBS procedures are associated with high costs of implantation and replacement of the internal pulse generator (IPG). Different manufacturers propose the use of rechargeable IPGs. The objective of this study is to compare the implantation costs of nonrechargeable IPGs versus the estimated costs of rechargeable IPGs in different categories of patients to evaluate if an economic advantage for the health care system could be derived. ⋯ Implantation of rechargeable IPGs presents clinical advantages compared with nonrechargeable devices. A huge economic savings can be realized with the implantation of rechargeable IPGs in categories of patients implanted with IPGs for DBS.
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The endoscopic endonasal approach for pituitary neoplasms has shown similar efficacy compared with the microscopic approach. However, outcomes and complication rates with larger macroadenomas is not as well documented. This study addresses the efficacy and outcome of the fully endoscopic endonasal approach for large and giant pituitary adenomas. ⋯ Endoscopic endonasal resection of large and giant pituitary macroadenomas is safe and efficient. Postoperative complications, including cerebrospinal fluid leak, are low. Surgical efficacy of the fully endoscopic endonasal approach for large and giant macroadenomas makes the technique a preferable option in this subset of patients.
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This study was performed to analyze the outcome of multisession gamma knife radiosurgery (GKS) in benign tumors located at the orbital apex. ⋯ Multisession GKS proved to be an effective and safe management strategy for benign orbital apex tumors. Response to treatment was different according to the pathology, and multisession GKS may be considered as the initial treatment of choice for specific pathology such as cavernous hemangioma.
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Quality of care measurement was a late addition to managed care. As a small specialty, neurosurgery quality of care metrics have a low priority for Medicare and other health care payers. Frequency of complications of glioma surgery derived from a large administrative database can be used as a quality measure, but the results may be inaccurate and inadequate. Prospective voluntary outcome registries offer a better alternative.