Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2008
Comparative StudyEffects of bilateral deep brain stimulation of the subthalamic nucleus on olfactory function in Parkinson's disease patients.
The goal of the present study was to evaluate the effects of bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) on olfaction in patients with Parkinson's disease (PD). ⋯ STN DBS can significantly improve olfactory cognitive function in PD patients. The possible mechanisms include an improvement in striatal metabolism and neuronal activity in the orbitofrontal cortex mediated by STN DBS, as well as increased glucose metabolism in the striatum, midbrain, cingulate gyrus, and motor and higher-order somatosensory association cortices.
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Stereotact Funct Neurosurg · Jan 2008
Comparative StudyModeling parkinsonian circuitry and the DBS electrode. II. Evaluation of a computer simulation model of the basal ganglia with and without subthalamic nucleus stimulation.
Treatment with deep brain stimulation (DBS) for Parkinson's disease (PD) has become routine over the past decade, particularly using the subthalamic nucleus (STN) as a target and utilizing microelectrode recordings to ensure accurate placement of the stimulating electrodes. The clinical changes seen with DBS in the STN for PD are consistently beneficial, but there continues to be only marginal understanding of the mechanisms by which DBS achieves these results. Using an analytical model of the typical DBS 4-contact electrode and software developed to simulate individual neurons and neural circuitry of the basal ganglia we compare the results of the model to those of data obtained during DBS surgery of the STN. Firing rate, interspike intervals and regularity analyses were performed on the simulated data and compared to results in the literature.
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Stereotact Funct Neurosurg · Jan 2008
ReviewReview of the treatment of trigeminal neuralgia with gamma knife radiosurgery.
Trigeminal neuralgia is a debilitating condition caused by compression of the trigeminal nerve, ganglions, or divisions. Gamma knife radiosurgery has been increasingly used in the treatment of trigeminal neuralgia as a non-invasive alternative to microvascular decompression and rhizotomies. ⋯ The growing body of literature suggests that the low rates of complications of gamma knife radiosurgery, coupled with the high success rates and patient satisfaction, allow it to be increasingly used as primary intervention for trigeminal neuralgia for appropriate patients.
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Stereotact Funct Neurosurg · Jan 2008
Case ReportsLow-frequency bilateral hypothalamic stimulation for treatment of drug-resistant aggressiveness in a young man with mental retardation.
Stereotactic bilateral electrode implantation in the medial portion of the posterior hypothalamus was performed on a 22-year-old male with drug-resistant aggressiveness. To localize the targets during implantation, microrecording was performed, and the clinical and electroencephalographic responses to intraoperative stimulation were monitored. The patient had an improved response to low-frequency stimulation that was sustained 18 months later at a follow-up examination.
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Twiddler's syndrome describes the intentional external manipulation or spontaneous rotation of implanted devices such as cardiac pacemakers. Here we report the same phenomenon occurring in a patient with an implanted deep brain stimulator generator. The clinical syndrome is described and potential technical nuances to prevent its occurrence are suggested.