Journal of neurosurgery
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Journal of neurosurgery · Nov 2007
Randomized Controlled TrialProspective randomized double-blind trial of bilateral thalamic deep brain stimulation in adults with Tourette syndrome.
The severity of Tourette syndrome (TS) typically peaks just before adolescence and diminishes afterward. In some patients, however, TS progresses into adulthood, and proves to be medically refractory. The authors conducted a prospective double-blind crossover trial of bilateral thalamic deep brain stimulation (DBS) in five adults with TS. ⋯ Bilateral thalamic DBS appears to reduce tic frequency and severity in some patients with TS who have exhausted other available means of treatment.
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Journal of neurosurgery · Nov 2007
Review Case ReportsIdiopathic distal lenticulostriate artery aneurysm in a child.
The authors describe a rare case of idiopathic distal lenticulostriate artery (LSA) aneurysm in a 5-year-old boy who presented in the emergency department with a sudden onset of headache. Admission computed tomography scans revealed an intracerebral hemorrhage in the left caudate nucleus with intraventricular extension. Angiographic studies demonstrated a left medial LSA aneurysm. ⋯ The child left the hospital after 5 days; at that time he was asymptomatic and without motor impairment. The optimum treatment of aneurysms involving small perforating arteries is controversial and depends mainly on the causative factors. The pathogenesis and treatment of these unusual aneurysms are discussed.
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Journal of neurosurgery · Nov 2007
Case Reports Comparative StudyThalamic deep brain stimulation for writer's cramp.
Writer's cramp is a type of idiopathic focal hand dystonia characterized by muscle cramps that accompany execution of the writing task specifically. In this report, the authors describe the clinical outcome after thalamic deep brain stimulation (DBS) therapy in patients with writer's cramp and present an illustrative case with which they compare the effects of pallidal and thalamic stimulation. In addition to these results for the clinical effectiveness, they also examine the best point and pattern for therapeutic stimulation of the motor thalamus, including the nucleus ventrooralis (VO) and the ventralis intermedius nucleus (VIM), for writer's cramp. ⋯ The authors successfully treated patients with writer's cramp by thalamic DBS. Insofar as they are aware, this is the first series in which writer's cramp has been treated with DBS. Thalamic stimulation appears to be a safe and valuable therapeutic option for writer's cramp.
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Journal of neurosurgery · Nov 2007
Hearing preservation following fractionated stereotactic radiotherapy for vestibular schwannomas: prognostic implications of cochlear dose.
The goal in this study was to evaluate hearing preservation rates and to determine prognostic factors for this outcome following fractionated stereotactic radiotherapy (FSRT) of vestibular schwannoma. ⋯ The radiation dose to the cochlea is strongly predictive for subsequent hearing deterioration. It is essential for the cochlea to be outlined as an organ at risk, and for radiation techniques to be optimized, to improve long-term hearing preservation.
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Journal of neurosurgery · Nov 2007
Case ReportsEndoscopic endonasal clipping of an unsecured superior hypophyseal artery aneurysm. Technical note.
Paraclinoidal aneurysms, especially superior hypophyseal artery (SHA) aneurysms (with medial projection), can be challenging to access via a pterional craniotomy and damage to the optic nerve can occur during surgery. The authors have previously reported on endonasal clipping and aneurysmorrhaphy of a vertebral artery aneurysm following proximal and distal protection of the aneurysm using partial coil embolization. To the best of the authors' knowledge no unprotected aneurysm has been clipped using an endonasal approach. ⋯ The ACoA aneurysm was clipped via a pterional craniotomy during the same anesthetic session. This report shows that it is possible to successfully clip a medially projecting, paraclinoidal aneurysm using an endonasal approach. Such cases must be chosen with extreme caution and only performed by surgeons with significant experience with both endoscopic endonasal approaches and neurovascular surgery.