Journal of neurosurgery
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Journal of neurosurgery · Feb 2009
Prognostic factors in the persistence of posttraumatic epilepsy after penetrating head injuries sustained in war.
The goal of this paper was to investigate the long-term outcome and the possible prognostic factors that might have influenced the persistence of posttraumatic epilepsy after penetrating head injuries sustained during the Iraq-Iran war (1980-1988). ⋯ Early seizures, prophylactic antiepileptics drugs, and surgical intervention did not significantly affect long-term outcome in regard to persistence of seizures.
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Journal of neurosurgery · Feb 2009
ReviewEfficacy and safety of motor cortex stimulation for chronic neuropathic pain: critical review of the literature.
The authors systematically reviewed the published literature to evaluate the efficacy of and adverse effects after motor cortex stimulation (MCS) for chronic neuropathic pain. ⋯ A search of the PubMed database (1991-2006) using the key words "motor cortex," "stimulation," and "pain" yielded 244 articles. Only original nonduplicated articles were selected for further analysis; 14 studies were identified for critical review. All were series of cases and none was controlled. The outcomes in 210 patients were assessed and expressed as the percentage of patients that improved with the procedure. Results A good response to MCS (pain relief > or = 40-50%) was observed in approximately 55% of patients who underwent surgery and in 45% of the 152 patients with a postoperative follow-up > or = 1 year. Visual analog scale scores were provided in 76 patients, revealing an average 57% improvement in the 41 responders. A good response was achieved in 54% of the 117 patients with central pain and 68% of the 44 patients with trigeminal neuropathic pain. Adverse effects were reported in 10 studies, including 157 patients. Infections (5.7%) and hardware-related problems (5.1%) were relatively common complications. Seizures occurred in 19 patients (12%) in the early postoperative period, but no chronic epilepsy was reported. Conclusions The results of the authors' review of the literature suggest that MCS is safe and effective in the treatment of chronic neuropathic pain. Results must be considered with caution, however, as none of the trials were blinded or controlled. Studies with a better design are mandatory to confirm the efficacy of MCS for chronic neuropathic pain.
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Journal of neurosurgery · Feb 2009
Significant reduction in stereotactic and functional neurosurgical hardware infection after local neomycin/polymyxin application.
Hardware infection is a common occurrence after the implantation of neurostimulation and intrathecal drug delivery devices. The authors investigated whether the application of a neomycin/polymyxin solution directly into the surgical wound decreases the incidence of perioperative infection. ⋯ The combination of local neomycin/polymyxin with systemic antibiotic therapy can lead to a significantly lower rate of postoperative infection than when systemic antibiotics are used alone.
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The authors analyzed deep brain stimulation electrode trajectories on MR images to identify risks of cerebrovascular complications associated with the number of electrode insertions, traversal of a sulcus, and penetration of the ventricle. ⋯ Symptomatic cortical complications occur when electrodes traverse close to a sulcus. Asymptomatic IVH occurs infrequently with ventricular penetration. Despite intraoperative efforts to avoid cortical sulci, a higher than expected incidence of electrode proximity to the sulci was identified on careful postoperative trajectory analysis. This finding emphasizes the importance of assiduously planning trajectories and reviewing cases with thorough MR analysis.
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Journal of neurosurgery · Feb 2009
Editorial Comment Biography Historical ArticleWilliam S. Halsted and Harvey W. Cushing: reflections on their complex association.