Neurosurgery
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Treatment in trigeminal neuralgia (TN) must be adapted in each patient. Surgeons must be conscious of medical, surgical, and radiation treatment modalities to suggest ideal management. Gamma knife radiosurgery (GKRS) could be used multiple times compared with percutaneous retrogasserian balloon compression for pain control. The objective of this study is evaluate the efficacy of Gamma Knife Radiosurgery and retrogasserian balloon compression in TN refractory for prior GKRS. ⋯ Balloon compression decreased acute primary trigeminal neuralgia, but did not provide a clinically substantial advantage compared with GKRS in terms of decreasing pharmacological dosage and pain relief in a 24-month period.
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Sports-related concussion (SRC) represents an important cause of morbidity in young athletes. Baseline and postconcussive neurocognitive testing is useful in managing concussed athletes. The Concussion in Sport Group has postulated that the use of psychotropic medications is a modifying factor in the management of SRC. About 7% of US adolescents are prescribed psychotropics in a given year. Our aim was to investigate whether psychotropic medication use or history of depression and/or anxiety affects baseline neurocognitive test scores. ⋯ This pilot study suggests that the effect of psychotropic medications on baseline ImPACT test scores may be dependent on medication subclass. Our preliminary results support the inclusion of psychotropic medications, specifically psychostimulants and antidepressants, as well as history of depression/anxiety as potential concussion modifiers.
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Dose reduction during fluoroscopy is of paramount importance. Our center has developed a novel patient-dose-savings technique for image-guided neurovascular interventions, involving a combination of a material x-ray region-of-interest (ROI) attenuator and spatially different temporal filtering. Our technique gives real-time full field-of-view as against some previous techniques of restricted view (spot fluoroscopy). We present our comparative clinical experience with standard flat panel angiography (FPA) and our technique (ROI-FPA). ⋯ Our study has shown that a significant dose reduction could be achieved without compromising the image quality during neuroendovascular interventions.
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Prominent beta band oscillations have been observed in Parkinson disease (PD) in the subthalamic nucleus (STN) and globus pallidus interna (GPi), and proposed as closed-loop signal controls for deep brain stimulation therapy. The GPi is a less studied target than the STN, and human basal ganglia physiology has rarely been compared across different disease states. We test the hypothesis that resting-state local field potential (LFP) characteristics distinguish the parkinsonian state from segmental and generalized dystonia. ⋯ Direct comparison of GPi LFPs in PD, craniocervical, and generalized dystonia shows that all patients have peak spectral power in the beta band, casting doubt on the view that excessive beta-band power is a specific biomarker of the parkinsonian state. Cross-frequency interactions are also found in GPi and are not specific for disease state. The study reveals potential similarities between abnormal neural network activity and synchronization in PD and dystonia.
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To examine the microsurgical anatomy of the nucleus accumbens and related structures using fiber dissection technique. ⋯ The nucleus accumbens and its related cortical and subcortical gray matter and fiber pathways play a major role in the etiopathogenesis of psychiatric disorders. Therefore, a better understanding of the neuroanatomical features of the nucleus accumbens and its related structures will enable more accurate surgical treatment of neuropsychiatric disorders.