Neurosurgery
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Randomized Controlled Trial Clinical Trial
Long-term electrical capsular stimulation in patients with obsessive-compulsive disorder.
Because of the irreversibility of lesioning procedures and their possible side effects, we studied the efficacy of replacing bilateral anterior capsulotomy with chronic electrical capsular stimulation in patients with severe, long-standing, treatment-resistant obsessive-compulsive disorder. ⋯ These observations indicate that capsular stimulation reduces core symptoms 21 months after surgery in patients with severe, long-standing, treatment-refractory obsessive-compulsive disorder. The stimulation elicited changes in regional brain activity as measured by functional magnetic resonance imaging and positron emission tomography.
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Review Case Reports
Midaortic syndrome and subarachnoid hemorrhage associated with ruptured middle cerebral artery aneurysm: case report and review of the literature.
We describe the presentation, screening, management, and clinical outcome of a 21-year-old man who sought care for a ruptured middle cerebral artery (MCA) aneurysm and midaortic syndrome (MAS). Only three cases of MAS and intracranial aneurysm rupture have previously been described in the literature. ⋯ Our patient is the first reported case of ruptured MCA aneurysm with MAS in an adult. The most important problem in the management of MAS associated with ruptured intracranial aneurysm is medically intractable hypertension, which may markedly increase the incidence of rebleeding. It is hard to achieve normotension unless the narrowed aorta and its branches are dilated. For these reasons, MAS should be considered in patients with medically intractable hypertension associated with ruptured intracranial aneurysm.
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Comparative Study
Clinical evaluation of intraparenchymal Spiegelberg pressure sensor.
The Spiegelberg 3-PN intraparenchymal pressure sensor was clinically evaluated. ⋯ The Spiegelberg 3-PN sensor was reliable and simple to use. It can be recommended for routine intraparenchymal and subdural pressure measurement at a considerably lower price compared with other tip transducers and has the unique advantage of automated zeroing in vivo.
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Spinal cord stimulation (SCS) has been used for more than 30 years in patients with intractable neuropathic pain, and global success rates have varied from 40 to 70%, according to reported series. Patient selection is currently based on a preliminary percutaneous test, which is useful but invasive, increases the risk of infection, and has yielded false-positive and false-negative results. In this study, we evaluated an alternative method of predicting the effectiveness of SCS before deciding whether to implant laminotomy electrodes-specifically, assessment of neural conduction in the dorsal columns with the use of somatosensory evoked potentials (SSEPs). Thus, we examined the value of preoperative central conduction time (CCT) of SSEPs to stimulation at the level of the painful area as a possible predictor of patient outcome after SCS. ⋯ Preoperative SSEPs provide an objective prediction of patient outcome after SCS. We suggest that if a patient's CCT is abolished or significantly altered, the patient should not undergo SCS.
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The aim of this study was to analyze the usefulness of preoperative language functional magnetic resonance imaging (fMRI), by correlating fMRI data with intraoperative cortical stimulation results for patients with brain tumors. ⋯ With the paradigms and analysis thresholds used in this study, language fMRI data obtained with naming or verb generation tasks, before and after surgery, were imperfectly correlated with intraoperative brain mapping results. A better correlation could be obtained by combining the fMRI tasks. The overall results of this study demonstrated that language fMRI could not be used to make critical surgical decisions in the absence of direct brain mapping. Other acquisition protocols are required for evaluation of the potential role of language fMRI in the accurate detection of essential cortical language areas.