Neurosurgery
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Controlled Clinical Trial
Neuropsychological effects after chronic subthalamic stimulation and the topography of the nucleus in Parkinson's disease.
The neuropsychological effects of chronic subthalamic nucleus (STN)-deep brain stimulation (DBS) as a treatment for Parkinson's disease are variable. Whether these side effects result from the target per se or current diffusion into neighboring structures is uncertain. In this study, the relationship between clinical outcomes and coordinates of active contact are analyzed and compared between patients with and without neuropsychological sequelae. ⋯ When taking spatial influence into consideration, the neuropsychological effects of chronic STN-DBS were related to a significant anteriorly located active contact within the ventral STN in this preliminary study. This might suggest the existence of topography of STN in patients with Parkinson's disease concerning limbic and associative circuits.
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Case Reports
Freehand dynamic endoscopic resection of an epidermoid tumor of the cerebellopontine angle: technical case report.
In the last 10 years, experience with endoscopic transsphenoidal surgery for the treatment of sellar and perisellar lesions has highlighted advantages brought about by the endoscope for less-invasive procedures. Focusing on these advantages, there is increasing interest in endoscope use for treatment of lesions located in other regions such as the cerebellopontine angle (CPA). Epidermoid tumors, especially those located on the CPA, resulting from their avascular and noninfiltrative nature, appear particularly suited to being treated using an endoscopic approach. ⋯ The patient's postoperative course was uneventful. The trigeminal neuralgia completely resolved, and postoperative control magnetic resonance imaging scans demonstrated no residual lesion. The benefits of endoscopic treatment for CPA lesions, with special emphasis on the dynamic aspect of this new technique, are discussed.
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The aims of this study are to assess the surgical outcome of elderly patients aged 80 years or more, to analyze the factors influencing postoperative course, and to propose a grading system to standardize the surgical indication of intracranial meningioma in the elderly. ⋯ Surgery of intracranial meningioma in elderly patients is feasible when the SKALE score is 8 or greater. Prospective studies are required to validate this grading system.
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Clinical Trial
Single electrode and multiple electrode guided electrical stimulation of the subthalamic nucleus in advanced Parkinson's disease.
It is still debated to what extent intraoperative electrophysiological techniques contribute to the outcome of subthalamic nucleus (STN) deep brain stimulation (DBS). Intraoperative electrophysiological recordings for identification of the STN can be made with one electrode or with multiple, simultaneously implanted electrodes. The latter provide more detailed information about the electrophysiological boundaries of the STN; however, implantation of several electrodes at one time might increase the risk of bleeding. Here we report the results of a study of patients with advanced Parkinson's disease, in which one group of patients underwent bilateral STN DBS with electrophysiological recordings from a single electrode, and the other group received STN DBS with multiple (five or fewer) simultaneously implanted electrodes. ⋯ STN DBS performed with multiple electrophysiological recording electrodes resulted in better motor outcome but induced specific mild declines in neuropsychological functions.