Acta neurochirurgica
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Acta neurochirurgica · Aug 2011
ReviewSurgical management of glioneuronal tumors with drug-resistant epilepsy.
In this review, we discuss the options for the surgical management of glioneuronal tumors (GNTs) associated with drug-resistant epilepsy, with an emphasis on the surgical issues involved in addressing the epileptogenic nature of these lesions. We briefly summarize the pathological hallmarks of these lesions in order to outline how these tumors contribute to seizure activity. Understanding the pathophysiology of these lesions is important in discussing the advantages and disadvantages of different surgical strategies. There have been a number of studies that have investigated the utility of different surgical approaches in improving seizure outcome, and we highlight some of these studies in order to shed light on surgical issues related to these tumors.
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Acta neurochirurgica · Jul 2011
Review"Minimally invasive" lumbar spine surgery: a critical review.
Minimal-access technology has evolved rapidly with "tubular" or "percutaneous" approaches for decompression and stabilization in the lumbar spine. Potential benefits (smaller scars, diminished local pain, reduced blood loss, reduced postoperative wound pain, shorter hospital stays) have to be weighed against possible drawbacks (reduced orientation, steep learning curve, increased radiation exposure, dependency on technology, cost). While non-comparative case series are often rather enthusiastic, comparative studies and particularly RCTs are scarce and might convey a more realistic appreciation. ⋯ This review, based solely on the very limited number of available comparative studies, shows no relevant benefit from minimally invasive techniques, and a tendency for more safety in open procedures in lumbar disc herniation, TLIF and PLIF.
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Acta neurochirurgica · Apr 2011
ReviewPulsed radiofrequency treatment in interventional pain management: mechanisms and potential indications-a review.
The objective of this review is to evaluate the efficacy of Pulsed Radiofrequency (PRF) treatment in chronic pain management in randomized clinical trials (RCTs) and well-designed observational studies. The physics, mechanisms of action, and biological effects are discussed to provide the scientific basis for this promising modality. ⋯ From the available evidence, the use of PRF to the dorsal root ganglion in cervical radicular pain is compelling. With regards to its lumbosacral counterpart, the use of PRF cannot be similarly advocated in view of the methodological quality of the included study. PRF application to the supracapular nerve was found to be as efficacious as intra-articular corticosteroid in patients with chronic shoulder pain. The use of PRF in lumbar facet arthropathy and trigeminal neuralgia was found to be less effective than conventional RF thermocoagulation techniques.
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Acta neurochirurgica · Mar 2011
ReviewDeep brain stimulation therapy for treatment-refractory Tourette's syndrome: A review.
Tourette's syndrome is a chronic neurobehavioral disorder that can demonstrate refractoriness to conservative treatments, or to invasive nonsurgical treatments such as botulinum toxin infiltration, or to psychobehavioral treatments. In these cases, the surgical option is often proposed, either with lesional interventions, or more recently with deep brain stimulation (DBS). This latter modality is currently preferred because of its reversibility and modularity. Some relevant issues, however, still persist in terms of appropriate indication to treatment, selection of target, and follow-up evaluation.
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Acta neurochirurgica · Feb 2011
Review Case ReportsThe place for surgical treatment for AVM involving the temporal lobe.
The objective of this study was to analyze preoperative symptoms and late clinical outcomes in patients who underwent surgical treatment of arterio-venous malformations (AVMs) of the temporal lobe, including those involving the Sylvian fissure (SF) and the lateral wall of the inferior ventricular horns-with special respect to postoperative hemiparesis and visual field defects (VFD). ⋯ Treatment of temporal lobe AVMs is demanding due to their close spatio-anatomical relationship with important neurovascular structures and the optic radiation. In this surgically treated series, morbidity for a new permanent hemiparesis was 7% and preservation of the visual field could be achieved in almost 90% of all cases. This is a calculable risk for most patients that renders microsurgical resection a justifiable option, even in light of other treatment modalities. The risk for new permanent motor deficits is elevated in temporo-mesial AVMs, and these patients have to be advised accordingly for surgical treatment.