Stereotactic and functional neurosurgery
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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
Comparative StudyCerebrospinal fluid pressure measurement in the ovine intrathecal space: a preliminary study towards the diagnosis of intrathecal drug administration catheter dislodgement or occlusion.
Intrathecal drug delivery catheter malfunctions are a principal cause of therapy interruption. We determined that normal baseline intrathecal cerebrospinal fluid (CSF) pressure recordings could be obtained in an ovine model and in a catheter dislodgement scenario. ⋯ These findings support the notion that pressure sensors can play a role in determining the status of intraspinal drug delivery catheters.
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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
Review Case ReportsShould we consider Vim thalamic deep brain stimulation for select cases of severe refractory dystonic tremor.
Dystonic tremor, which may present with many different clinical presentations (rhythmic oscillations, abnormal posture, pain, and/or a null point) has proven to be a challenge for the clinician to effectively treat. Although recent studies have demonstrated excellent outcomes in select cases following deep brain stimulation (DBS) of the internal globus pallidus, the optimal target for dystonia and particularly for dystonic tremor remains unknown. ⋯ We also review the literature concerning the efficacy of Vim DBS for addressing dystonia. This case series illustrates the potential use of Vim DBS for select cases of dystonic tremor.
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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.