Journal of neurosurgery
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Journal of neurosurgery · Apr 2006
Case ReportsHolocord intramedullary abscess due to dermal sinus in a 2-month-old child successfully treated with limited myelotomy and aspiration. Case report.
This 2-month-old child presented with paraplegia. The authors observed a dermal sinus with purulent discharge in the lumbosacral area. Magnetic resonance (MR) imaging of the spine revealed an intramedullary enhancing cavity spanning C-1 to the conus medullaris. ⋯ Follow-up MR imaging revealed complete resolution of abscess. When the patient was 26 months of age, examination showed complete neurological recovery. The authors describe what, to their knowledge, is the first case of a holocord IASC treated successfully by the aforementioned technique, and review of the related literature.
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Journal of neurosurgery · Apr 2006
Best-practice surgical techniques for intrathecal baclofen therapy.
In March 2004, a multidisciplinary conference, "ITB Therapy Best Practice Forum," was held in Minneapolis, Minnesota. The goal of the conference was to develop recommendations for techniques to implant intrathecal baclofen (ITB) pump and catheter systems more effectively and with fewer complications. The authors present the techniques for optimal pump and catheter implantation, including subfascial pump placement; insertion of the Tuohy needle in an oblique, paramedian trajectory; and positioning of the catheter tip at levels commensurate with the therapeutic indication: approximately T10-12 for spastic diplegia, C5-T2 for spastic tetraparesis, and C1-4 for generalized secondary dystonia. ⋯ Techniques to minimize surgery-related infection are also detailed; most involve the use of iodine solutions multiple times intraoperatively. Techniques to insert intrathecal catheters during spinal fusion are addressed, particularly the technique of inserting the catheter cephalad to the fusion site. Panel members advocate the aforementioned techniques to improve the efficacy of and decrease the morbidity associated with ITB therapy.
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Journal of neurosurgery · Apr 2006
Review Case ReportsIntrinsic brainstem epidermoid cyst. Case report and review of the literature.
Brainstem epidermoid cysts are rare lesions, with only 18 reported cases in the literature and only five purely intrinsic epidermoid cysts within this group. The authors present the case of a 3-year-old girl with a history of chronic headaches, progressive diplopia, and relapsing and remitting mild right hemiparesis who was found to harbor an intrinsic brainstem epidermoid cyst at the pontomedullary junction. Initial working diagnoses included intrinsic brainstem astrocytoma and cavernoma. ⋯ Three years after the operation, the patient is neurologically intact and no evidence of tumor recurrence has been found. The rarity of brainstem epidermoid cysts can make their diagnosis difficult; thus a DW MR imaging sequence of the brain is a useful diagnostic modality. Intrinsic brainstem epidermoid cysts can be removed safely, in a manner similar to that used for the surgical treatment of focal tumors.
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Journal of neurosurgery · Apr 2006
Multicenter StudyLong-term evaluation of deep brain stimulation of the thalamus.
The effects of thalamic deep brain stimulation (DBS) on essential tremor (ET) and Parkinson disease (PD) have been well documented, but there is a paucity of long-term data. The aim of this study was to evaluate the long-term safety and efficacy of DBS of the ventralis intermedius nucleus (VIM) of the thalamus for PD and ET. ⋯ Thalamic stimulation is safe and effective for the long-term management of essential and Parkinsonian tremors. Bilateral stimulation can cause dysarthria and incoordination and should be used cautiously.
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Journal of neurosurgery · Apr 2006
Multicenter StudyA functional neuroimaging investigation of deep brain stimulation in patients with obsessive-compulsive disorder.
Deep brain stimulation (DBS) of the ventral [anterior internal] capsule/ventral striatum (VC/VS) is under investigation as an alternative to anterior capsulotomy for severe obsessive-compulsive disorder (OCD). In neuroimaging studies of patients with OCD, dysfunction in the orbitofrontal and anterior cingulate cortex, striatum, and thalamus has been identified; and modulation of activity in this circuit has been observed following successful nonsurgical treatment. The purpose of the current study was to test hypotheses regarding changes in regional cerebral blood flow (rCBF) during acute DBS at the VC/VS target in patients with OCD who were participating in a clinical DBS trial. ⋯ Acute DBS at the VC/VS target is associated with activation of the circuitry implicated in OCD. Further studies will be necessary to replicate these findings and to determine the neural effects associated with chronic VC/VS DBS. Moreover, additional data are needed to investigate whether pretreatment imaging profiles can be used to predict a patient's subsequent clinical response to chronic DBS.