British journal of neurosurgery
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Deep Brain Stimulation (DBS) for neuromodulation is now commonplace. However little is known about the incidence of either procedural related seizures or epilepsy following chronic DBS. This study aims to provide estimates of these complications for movement disorders, pain and psychiatric conditions. ⋯ The quality of literature on seizures following DBS insertion for neuromodulation is highly variable. Analysis of the available data, after making corrections for publication of duplicate data, suggests strongly that the risk of seizures associated with DBS placement is probably lower than 2.4% (95% CI 1.7 to 3.3 %). The risk of postprocedural seizures associated with chronic deep brain stimulation is even lower with best estimates around 0.5% (95% CI .02 to 1.0%).
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Case Reports
Contralateral acute interdural haematoma occurring after burr hole drainage of chronic subdural haematoma.
We report the case of a 78-year-old man with chronic subdural haematoma (CSDH) who presented with impairment in recent memory and gait disturbance. He underwent burr-hole craniostomy with a closed-drainage system. ⋯ The haematoma was located between the outer and inner dura mater that each comprise a single layer. To our knowledge, this is the first reported case of an acute haematoma located between the separated dura mater that occurred following drainage of a contralateral CSDH, and it is the second reported case of interdural haematoma over the cerebral convexity.
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Case Reports
Pin-site epidural hematoma in an adult case of chronic hydrocephalus with associated thinning of the cranium.
We report a case of a 22-year-old man presenting with a fourth ventricular tumour and associated chronic obstructive hydrocephalus likely leading to thinning of the cranium. Intraoperatively, he developed an epidural hematoma secondary to a fracture of the temporal bone by application of the three-point skull fixator. This is the second reported adult case of an iatrogenic epidural hematoma secondary to pin-site complications. We advocate the careful placement of the pins and suggest the tightening force be catered individually especially in pediatric patients or patients with chronic hydrocephalus.
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Randomized Controlled Trial Comparative Study
Comparison of unilateral pallidotomy and subthalamotomy findings in advanced idiopathic Parkinson's disease.
A prospective, randomized, double-blind pilot study to compare the results of stereotactic unilateral pallidotomy and subthalamotomy in advanced idiopathic Parkinson's disease (PD) refractory to medical treatment was designed. Ten consecutive patients (mean age, 58.4 +/- 6.8 years; 7 men, 3 women) with similar characteristics at the duration of disease (mean disease time, 8.4 +/- 3.5 years), disabling motor fluctuations (Hoehn & Yahr stage 3-5 in off-drug phases) and levodopa-induced dyskinesias were selected. All patients had bilateral symptoms and their levodopa equivalent dosing were analysed. ⋯ Cognitive functions were unchanged in both groups. Complications were observed in two patients: one had a left homonymous hemianopsia after pallidotomy and another one developed left hemiballistic movements 3 days after subthalamotomy which partly improved within 1 month with Valproate 1000 mg/day. The findings of this study suggest that lesions of the unilateral STN and GPi are equally effective treatment for patients with advanced PD refractory to medical treatment.