Acta neurochirurgica
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Acta neurochirurgica · Dec 2011
Case ReportsA case of tremor reduction and almost complete ageusia under bilateral thalamic (VIM) deep brain stimulation in essential tremor--a therapeutic dilemma.
Essential tremor (ET) is a neurological disorder that can be treated effectively by means of bilateral thalamic ventral intermediate nucleus (VIM) deep brain stimulation (DBS). We present a rare case of stimulation-dependent reversible ageusia that poses a therapeutic dilemma on the one hand and serves as an instructive example to elucidate the as yet incompletely defined gustatory pathways on the other. A 69-year-old patient with successful reduction of his disabling upper extremity ET experienced an almost complete but during stimulation cessation reversible ageusia under bilateral VIM DBS. ⋯ This case report stresses the importance of fiber tracts for DBS surgery. Reconciled with previous findings in lesion cases, we assume the coexistence of decussating and non-decussating fibers in the gustatory tract combined with hemispheric dominance in the processing of gustatory information. A therapeutic option for this dilemma may be a patient-selectable stimulation program or bipolar stimulation establishing a smaller ovoid VTA.
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Acta neurochirurgica · Dec 2011
ReviewInfundibulo-tuberal or not strictly intraventricular craniopharyngioma: evidence for a major topographical category.
This study investigates retrospectively the clinical, neuroradiological, pathological and surgical evidence verifying the infundibulo-tuberal topography for craniopharyngiomas (CPs). Infundibulo-tuberal CPs represent a surgical challenge due to their close anatomical relationships with the hypothalamus. An accurate definition of this topographical category is essential in order to prevent any undue injury to vital diencephalic centres. ⋯ Infundibulo-tuberal CPs represent a major topographical category of lesions with a primary subpial development at the floor of the third ventricle. These lesions expand within the hypothalamus itself and subsequently occupy the third ventricle; consequently, they can be classified as not strictly intraventricular CPs. A tight attachment to the hypothalamus and remnants of the third ventricle floor is the pathological landmark of infundibulo-tuberal CPs.
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Acta neurochirurgica · Dec 2011
ReviewExpanding applications of deep brain stimulation: a potential therapeutic role in obesity and addiction management.
The indications for deep brain stimulation (DBS) are expanding, and the feasibility and efficacy of this surgical procedure in various neurologic and neuropsychiatric disorders continue to be tested. This review attempts to provide background and rationale for applying this therapeutic option to obesity and addiction. We review neural targets currently under clinical investigation for DBS—the hypothalamus and nucleus accumbens—in conditions such as cluster headache and obsessive-compulsive disorder. These brain regions have also been strongly implicated in obesity and addiction. These disorders are frequently refractory, with very high rates of weight regain or relapse, respectively, despite the best available treatments. ⋯ Well-designed pilot studies and clinical trials enrolling carefully selected patients with obesity or addiction should be initiated.
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Acta neurochirurgica · Dec 2011
Comparative StudyStudy of dural suture watertightness: an in vitro comparison of different sealants.
CSF leakages constitute a major complication of intradural procedures, especially for posterior fossa and skull base surgery. Dural suture watertightness is a decisive issue, and neurosurgeons routinely use different products to reinforce their dural closure. We have designed an experimental system capable of testing CSF leak pressure levels in order to compare two types of sutures in vitro and particularly four different sealants. ⋯ We have developed an experimental device capable of testing dural closure watertightness. Interrupted stitch suturing seemed no different from running simple closure. On the contrary, the sealants tested show different watertightness capacities.
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Acta neurochirurgica · Dec 2011
Case ReportsResection of an inferior pontine cavernous malformation using a far-lateral transcondylar approach.
When considering an approach to remove a symptomatic brainstem cavernous malformation, exposure and adequate visualization of the lesion with minimal morbidity should be the primary goals. ⋯ We recommend adding this technique to the repertoire of approaches used to resect these technically challenging lesions in selected cases.