Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2010
Case ReportsElectrocorticographic frequency alteration mapping of speech cortex during an awake craniotomy: case report.
Traditional electrocortical stimulation (ECS) mapping is limited by the lengthy serial investigation (one location at a time) and the risk of afterdischarges in localizing eloquent cortex. Electrocorticographic frequency alteration mapping (EFAM) allows the parallel investigation of many cortical sites in much less time and with no risk of afterdischarges because of its passive nature. We examined its use with ECS in the context of language mapping during an awake craniotomy for a tumor resection. ⋯ EFAM was technically achieved in an awake craniotomy patient and had good concordance with ECS mapping. Because it poses no risk of afterdischarges and offers substantial time savings, EFAM holds promise for future development as an adjunct intraoperative mapping tool. Additionally, the cortical signals obtained by this modality can be utilized for localization in the presence of a tumor adjacent to the eloquent regions.
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Stereotact Funct Neurosurg · Jan 2010
Stimulation-induced dyskinesia in the early stage after subthalamic deep brain stimulation.
Deep brain stimulation of the subthalamic nucleus (STN-DBS) is a very effective surgical procedure for Parkinson's disease. It significantly improves cardinal parkinsonian symptoms as well as levodopa-induced dyskinesia. Interestingly, STN-DBS can also provoke or exacerbate dyskinesia. In the present study, stimulation-induced dyskinesia (SID) was found in the early stage (less than 1 month) after STN-DBS in some patients. The aim was to discuss this interesting phenomenon. ⋯ In the early stage after STN-DBS, dyskinesia is easily induced by high-frequency stimulation of the upper portion of the STN, which may predict the best site for chronic stimulation.
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Stereotact Funct Neurosurg · Jan 2010
Nexframe frameless stereotaxy with multitract microrecording: accuracy evaluated by frame-based stereotactic X-ray.
The development of image-guided systems rendered it possible to perform frameless stereotactic surgery for deep brain stimulation (DBS). As well as stereotactic targeting, neurophysiological identification of the target is important. Multitract microrecording is an effective technique to identify the best placement of an electrode. This is a report of our experience of using the Nexframe frameless stereotaxy with Ben's Gun multitract microrecording drive and our study of the accuracy, usefulness and disadvantages of the system. ⋯ The Nexframe with multitract microrecording for STN DBS still has some problems that need to be resolved. Thus far, we do not consider that this technology in its present state can replace conventional frame-based stereotactic surgery. The accuracy of the system is similar to that of frame-based stereotaxy. However, the narrow surgical field is a disadvantage for multiple electrode insertion. Improvement on this point will enhance the usefulness of the system.
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Stereotact Funct Neurosurg · Jan 2010
Occipital nerve stimulator placement via a retromastoid to infraclavicular approach: a technical report.
Occipital nerve stimulation is a form of peripheral nerve stimulation used to treat refractory headache disorders. Various techniques have been described for occipital nerve stimulator implantation; these include midline cervical or retromastoid lead insertion with internal pulse generator placement in the infraclavicular, gluteal or low abdominal regions. ⋯ Implantation approaches that include remote battery sites may contribute to mechanical stress on the components, as the leads or extensions may traverse highly mobile body regions. In this technical report, we describe an occipital stimulator implantation technique that may be advantageous in terms of patient positioning, ease of surgical approach and minimization of mechanical stress on components.
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Stereotact Funct Neurosurg · Jan 2010
Comparative StudyIntraoperative use of the Medtronic O-arm for deep brain stimulation procedures.
The purpose of this study was to analyze the feasibility and utility of 3D imaging to help lead positioning during a deep brain stimulation (DBS) procedure. A bilateral subthalamic DBS procedure was conducted in 2 patients for idiopathic Parkinson's disease. ⋯ We used the Medtronic O-arm to perform 2D-imaging control (frontal and lateral) as well as quick (<30 s) 3D acquisition. This allowed us to check the positioning of micro-macro electrodes and definite electrodes. 3D images were fused with postoperative CT to assess their accuracy, and with preoperative MRI to visualize the anatomical location of the electrodes. 3D imaging is a quick and safe method to ensure perioperative control of lead placement during DBS procedures.