Neurosurgery
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The author has designed a simple and inexpensive cylindrical stereotactic retractor that is compatible with the Leksell stereotactic system. The device allows the stereotactic localization and open resection of appropriate intracranial lesions through a 3-cm craniotomy, using standard microsurgical techniques and a completely sterile field. The device and its use are described.
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The actual site of excitation of the facial nerve by transcranial magnetic stimulation was investigated in five patients with hemifacial spasm who underwent microvascular decompression. The facial nerve was stimulated preoperatively and intraoperatively by transcranial magnetic stimulation and intraoperatively by electrical stimulation at its root exit zone with a minimum of surgical invasion of the facial nerves. ⋯ Therefore, transcranial magnetic stimulation was basically the same as electrical stimulation in onset latency. From this study, it appears that the root exit zone of the facial nerves is stimulated by transcranial magnetic stimulation.
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Over the past two decades, spinal cord stimulation devices and techniques have evolved from single-channel systems, with electrodes requiring laminectomy, into programmable "multichannel" systems with electrodes that may be placed percutaneously. We have reviewed our experience in 320 consecutive patients treated with these devices at our institution between 1972 and 1990. Technical details of treatment as well as patient characteristics have been assessed as predictors of clinical outcome and of hardware reliability by univariate and multivariate statistical methods. ⋯ A majority had maintained improvements in activities of daily living and analgesic use. Analysis of hardware reliability for 298 permanent implants revealed significantly fewer clinical failures (P < 0.001) and technical failures (in particular, electrode migration and malposition, P = 0.025) as single-channel implants have evolved into programmable, multichannel devices. Our analysis of technical and clinical prognostic factors may be useful to the clinician in selecting patients for this procedure.
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Comparative Study
Targeted brain biopsy: a comparison of freehand computed tomography-guided and stereotactic techniques.
With computed tomography (CT) and magnetic resonance imaging stereotactic systems, biopsies of intracranial lesions can be made with safety and ease. Before the development of this technique, neurosurgeons often performed freehand brain biopsies under CT guidance. While stereotactic biopsy is the procedure of choice for small, deep lesions, few studies have compared the morbidity, mortality, and efficacy in obtaining a diagnosis associated with these two techniques for superficial lesions. ⋯ Freehand CT-guided biopsy was associated with 5% morbidity, compared with 6% morbidity for stereotactic biopsy. Seven CT-guided needle biopsies (9%) and 12 stereotactic biopsies (18%) were nondiagnostic. Statistical analysis showed no significant difference between morbidity and mortality in the two groups, but the rate of diagnostic failure was significant (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Comparative Study
Analgesia and sedation during percutaneous radiofrequency electrocoagulation for trigeminal neuralgia.
Patient comfort during percutaneous radiofrequency electrocoagulation for trigeminal neuralgia provides better working conditions for the surgeon and makes the patient more willing to return if a second procedure is necessary. This study evaluates five different regimens for analgesia and sedation including the standard of fentanyl and droperidol (Group A) and four other regimens, each containing midazolam. In a sixth group, droperidol was assessed for its antiemetic effects. ⋯ In another group of 96 patients, 1.25 mg of droperidol was given in addition to the medications described for Groups D and E. There was a statistically significant improvement in comfort in Groups C, D, and E and added amnesia in Groups D and E. Vomiting occurred in none of the patients medicated with droperidol and in 5 of 143 patients who did not receive droperidol.(ABSTRACT TRUNCATED AT 250 WORDS)