Acta neurochirurgica
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Acta neurochirurgica · May 2011
Bilateral subthalamic deep brain stimulation using single track microelectrode recording.
Microelectrode recording (MER) is widely used during deep brain stimulation (DBS) procedures because MER can identify structural borders and eloquent structures, localize somatotopic arrangements, and provide an outline of the three-dimensional shapes of target nuclei. However, MER may cause intracranial hemorrhage. We preformed single track MER during DBS procedures, analyzed the accuracy of electrode positioning with MRI, and compared the amount of air and the potential risk of intracranial hemorrhage. ⋯ Although MER can facilitate accurate positioning of electrodes, multi-track MER may increase the risk of intracranial hemorrhage. The accuracy of electrode positioning appears to be acceptable under single track MER during STN DBS with careful electrophysiological and neurological monitoring. The risk of intracranial hemorrhage appears to be minimal, especially in elderly patients with atrophic brains.
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Acta neurochirurgica · May 2011
Cryoneurolysis for zygapophyseal joint pain: a retrospective analysis of 117 interventions.
Lumbar facet joint syndrome (LFJS) is the cause of pain in 15-54% of the patients with low-back pain. There are few studies of cryotherapy for LFJS, focusing mainly on pain scores rather than further outcome measures. The aim of the study was to determine the long-term outcome after cryoneurolysis of lumbar facet joints, looking at pain scores, pain-related impairment patient satisfaction, and pain-related anxiety/depression. ⋯ Cryoneurolysis for LFJS can lead to favourable results with sustained pain relief, amelioration of pain-related disability and reduction of depression scores.
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Acta neurochirurgica · May 2011
Intraoperative continuous monitoring of evoked facial nerve electromyograms in acoustic neuroma surgery.
Preservation of facial nerve function is one of the most important goals in acoustic neuroma surgery. We have been using intraoperative continuous monitoring of evoked facial nerve electromyograms (EMGs) since 1997 in acoustic neuroma surgery. We therefore investigated surgically treated patients to clarify the usefulness of this monitoring, and to determine safety criteria for preserving facial nerve function. ⋯ Postoperative course of facial nerve function appears predictable using intraoperative continuous monitoring of evoked facial nerve EMGs. This monitoring is useful to increase the tumor excision rate while avoiding severe postoperative facial nerve palsy in acoustic neuroma surgery.
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Acta neurochirurgica · May 2011
Case Reports Comparative StudySurgical intervention for severe head injury: ethical considerations when performing life-saving but non-restorative surgery.
The aim of this study was to compare the predicted outcome with observed outcome in those patients who have had a unilateral decompressive craniectomy following evacuation of an intracranial mass lesion and to consider some of the ethical issues that need to be addressed when performing life-saving but non-restorative surgery. ⋯ As the index of injury severity (as adjudged by the CRASH outcome prediction model) increases, clinical decision making and discussion with surrogates must reflect the evidence provided by observed outcome, prior to life-saving but potentially non-restorative decompressive surgery.
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Acta neurochirurgica · May 2011
Biography Historical ArticleHarvey Cushing's case series of trigeminal neuralgia at the Johns Hopkins Hospital: a surgeon's quest to advance the treatment of the 'suicide disease'.
A review of Dr. Harvey Cushing's surgical cases at the Johns Hopkins Hospital provided insight into his early work on trigeminal neuralgia (TN). There was perhaps no other affliction that captured his attention in the way that TN did, and he built a remarkable legacy of successful treatment. At the time, surgical interventions carried an operative mortality of 20%. ⋯ Modern day interventions of TN are reflective of the legacy left to us by Harvey Cushing, a pioneering forefather in neurosurgery. He pioneered the infra-arterial approach to excision of the Gasserion ganglion in face of problematic bleeding and later the use of sensory root avulsion to spare motor function. Through the evolution of his legacy and the refinement of original approaches, the quest to advance the treatment of TN took him along the trigeminal nerve from the periphery into the brain.