Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 1999
Gamma knife radiosurgery for trigeminal neuralgia: experience at the Barrow Neurological Institute.
Forty-three patients with trigeminal neuralgia (TN) unresponsive to pharmacologic treatment and/or prior invasive procedures underwent stereotactic radiosurgery with the Gamma Knife (GK). Outcome was evaluated by a standardized questionnaire mailed to each patient. The mean follow-up was 9 months. ⋯ Three patients (7%) described new facial numbness, but in none was this bothersome. GK radiosurgery for TN appears to have minimal morbidity, although the success rate may be slightly lower than that of other operative procedures. More patients and longer follow-up are needed before drawing final conclusions regarding efficacy and complications.
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Stereotact Funct Neurosurg · Jan 1999
Randomized Controlled Trial Multicenter Study Clinical Trial Controlled Clinical TrialLong-term multicenter experience with vagus nerve stimulation for intractable partial seizures: results of the XE5 trial.
Intermittent stimulation of the left cervical vagus nerve trunk (VNS) with the NeuroCybernetic Prosthesis (NCP) is emerging as a novel adjunct in the management of medically refractory epilepsy. We review the safety and efficacy of VNS 1 year after completion of the E05 study, the largest controlled clinical trial of VNS to date. ⋯ The long-term multicenter safety, efficacy, feasibility and tolerability of VNS, as well as the durability of the NCP device have been confirmed. Unlike chronic therapy with antiepileptic medication, the efficacy of VNS is maintained during prolonged stimulation, and overall seizure control continues to improve with time.
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Stereotact Funct Neurosurg · Jan 1999
Placement of deep brain stimulators into the subthalamic nucleus.
We present our technique for deep brain stimulation (DBS) of the subthalamic nucleus (STN) and include information which may be helpful in general DBS. With the patient in a stereotactic head frame, the anterior and posterior commissures are identified on SPGR-sequence magnetic resonance imaging (MRI). ⋯ Electromyography is used to quantitatively measure tremor responses to macrostimulation. Permanent lead placement is confirmed with intraoperative fluoroscopy and postoperative MRI.
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Stereotact Funct Neurosurg · Jan 1999
Comparative StudyA comparison of single fraction radiosurgery tumor control and toxicity in the treatment of basal and nonbasal meningiomas.
Between July 1993 and October 1997, 107 patients with 118 meningiomas were treated with Gamma Knife radiosurgery (GKRS). The most frequent site of tumor origin was the skull base (54%). The mean tumor diameter and volume were 2.5 cm and 9.4 cm3, respectively. ⋯ Deteriorating peritumoral edema associated with symptoms was observed in 1 of 49 (2%) skull-base tumors and in 4 of 39 (10%) non-basal tumors, without associated tumor growth. (p=0.l5 and 0.234 respectively, z-test). Stereotactic radiosurgery can achieve acceptable tumor control with low morbidity in the treatment of most meningiomas. However, when the tumor is nonbasal, the potential morbidity from peritumoral edema should be recognized and other treatment options considered, such as adjuvant surgery, partial fractionated irradiation or stereotactic radiotherapy.
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Stereotact Funct Neurosurg · Jan 1999
Clinical TrialEfficacy of transverse tripolar stimulation for relief of chronic low back pain: results of a single center.
The goal of this study was to evaluate the efficacy of the transverse tripolar spinal cord stimulation system (TTS) in providing relief of low back pain in patients with chronic non-malignant pain. Transverse tripolar electrodes were implanted in the lower thoracic region (T(8-9) to T(12)-L(1)) in 10 patients with chronic neuropathic pain, all of whom reported a significant component of low back pain in combination with unilateral or bilateral leg pain. ⋯ Similarly, functional disability evaluated using Oswestry Low Back Pain Questionnaire was not improved (p = 0. 46; paired t test). We conclude that chronic low back pain is not particularly responsive to the transverse stimulation provided by the TTS system.