Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2010
Comparative StudyCT-based, fiducial-free frameless stereotaxy for difficult ventriculoperitoneal shunt insertion: experience in 26 consecutive patients.
Patients with small or dysmorphic ventricles requiring ventriculoperitoneal shunt (VPS) insertion for hydrocephalus can be challenging. The 'freehand' technique does not always provide for accurate catheter insertion, particularly in patients with slit ventricles, complex hydrocephalus or displaced ventricles. Consequently, many surgeons use stereotaxy for assistance. We have employed a frameless stereotactic technique, obviating the need for fiducials or preoperative MRI, for difficult ventricular catheter placement over the past 1.5 years with excellent results. We describe our experience with frameless stereotactic VPS insertion. ⋯ Our results confirm that frameless stereotactic VPS without fiducial marker placement is a feasible technique for catheter insertion in patients who have small/dysmorphic ventricles. In experienced hands, there is negligible added operative time and a low complication rate.
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Stereotact Funct Neurosurg · Jan 2010
Comparative StudyCommissural myelotomy in the treatment of intractable visceral pain: technique and outcomes.
Commissural myelotomy can be valuable for patients with intractable pain associated with malignancy in the abdominal or pelvic region. ⋯ We found that for the properly selected patient, open midline commissural myelotomy can provide effective pain relief with acceptable postoperative morbidity.
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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.
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Stereotact Funct Neurosurg · Jan 2010
Case ReportsResponse to sham and active gamma ventral capsulotomy in otherwise intractable obsessive-compulsive disorder.
This case regards a 34-year-old woman with severe and refractory obsessive-compulsive disorder, who was enrolled in a double-blind, randomized controlled trial of radiosurgery. She was at first submitted to a sham radiosurgical procedure, and 1 year later to an active intervention. ⋯ During the sham surgery follow-up, no improvements were observed, but a remarkable amelioration was seen a few months after the active procedure. Detailed descriptions of psychopathological changes and neuroimaging findings as well as a discussion regarding the surgical technique are provided.
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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.