Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2007
Clinical TrialDeep brain stimulation for treatment of the epilepsies: the centromedian thalamic target.
Electrical stimulation (ES) of the thalamic centromedian nucleus (CMN) has been proposed as a minimally invasive alternative for the treatment of difficult-to-control seizures of multifocal origin and seizures that are generalized from the onset. ES intends to interfere with seizure propagation in a non-specific manner through the thalamic system. By adopting a frontal parasagittal approach and based on anterior-posterior (AC-PC) commissure intersection, deep brain stimulation (DBS) electrodes are stereotactically inserted. ⋯ ES of CMN significantly decreases generalized seizures of cortical origin and focal motor seizures. Best results are obtained in non-focal generalized tonic clonic seizures and atypical absences of the Lennox-Gastaut syndrome. Experience has indicated that the most effective target for seizure control is the thalamic parvocellular centromedian subnucleus.
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Acta Neurochir. Suppl. · Jan 2007
Did the partial contralateral C7-transfer fulfil our expectations? Results after 5 year experience.
Within the last decade contralateral C7-transfer has become a new source of axon donor in complete brachial plexus lesions. ⋯ The C7-transfer proved to be a safe transfer if at the time of operation no fascicles innervating wrist and finger extension are taken. Provided adequate biceps muscle organ function, active elbow flexion can be reconstructed in most of the patients. However, for median nerve reinnervation motor results are moderate up to now.
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Acta Neurochir. Suppl. · Jan 2007
Clinical TrialMinimally invasive placement of epidural plate electrodes under local anaesthesia in spinal cord stimulation.
In the treatment of pain syndromes of different aetiologies a change has occurred from destructive interventions to stimulation procedures. Spinal cord stimulation is the best known example of this treatment strategy. It is used often in patients with persistent neuropathic pain syndromes in an extremity, for instance following low back surgery. ⋯ Besides this, the laminectomy procedure can subsequently result in new pain complaints due to the invasiveness of the procedure. To solve both problems we have modified the implantation technique. By using a tubular retractor system (METRx system, Medtronic Sofamor Danek, Memphis, TN), originally developed for minimally invasive degenerative disc surgery, it is possible to reach the epidural spinal space and introduce the plate electrode with a small approach under local anaesthesia both allowing trial stimulation and avoiding severe postoperative backache related to the approach in these patients.
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Acta Neurochir. Suppl. · Jan 2007
In peripheral nerve regeneration environment enriched with activity stimulating factors improves functional recovery.
Enriched environment stimulates brain plasticity processes after brain lesion. Less is known about the influence of enriched environment with activity stimulating factors as determinants of functional outcome after peripheral nerve repair. ⋯ Our study aimed to elucidate if enriched environment influences functional results after peripheral nerve repair. The results in this rat sciatic nerve transection and repair model showed that environment enriched with activity stimulating factors can improve functional results.
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Acta Neurochir. Suppl. · Jan 2007
Intrathecal baclofen therapy: indications, pharmacology, surgical implant, and efficacy.
Intrathecal baclofen (ITB) therapy is an option for those in whom predominantly lower extremity spasticity is severe, problematic, and intractable to oral doses of medications and/or focal treatment. When delivered to the lumbar area, ITB avoids high concentrations from reaching the brain (4:1 ratio lumbar to brain cisterns). A screening test dose is done prior to implanting the pump via a lumbar puncture with 50 microg baclofen, working up to 100 microg if necessary. ⋯ Catheter complications are reduced by using a shallow-angle paramedian oblique insertion to the spine, and meticulous anchoring of the catheter. Threading the catheter to T6/7 rather than the traditional T10/11 can allow upper limb relief also. Long term efficacy is excellent, although catheter complications are frequent. and if not recognized and treated, can lead to significant effects of withdrawal of baclofen.