Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2011
Case ReportsSubcutaneous peripheral neurostimulation for the treatment of severe chronic poststernotomy neuralgia.
Poststernotomy pain frequently develops after sternotomy in thoracic and cardiovascular surgery, and may affect patients' quality of life. In some cases of severe poststernotomy neuralgia, pharmacologic therapy does not provide adequate relief. ⋯ SPNS may be a viable treatment option in patients with severe chronic poststernotomy neuralgia.
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Stereotact Funct Neurosurg · Jan 2011
Intraoperative image fusion to ascertain adequate lead placement.
In order to view the position of the deep brain stimulator (DBS) lead in relation to the stereotactic target on 3-tesla magnetic resonance (3T-MR) images prior to the conclusion of the procedure, intraoperative postimplantation computed tomography (CT) images were fused with preoperative 3T-MR images. The method to do this is described and discussed in this paper. ⋯ This is a simple method to intraoperatively visualize DBS lead position on high-quality 3T-MR images. It gives the surgeon the capability to detect errors and correct them prior to the conclusion of the procedure.
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Stereotact Funct Neurosurg · Jan 2011
ReviewSpinal cord stimulation and cerebral hemodynamics: updated mechanism and therapeutic implications.
The effects of spinal cord stimulation (SCS) on cerebral blood flow (CBF) are well known based on experimental investigations, and its vasodilator effect on peripheral arteries is widely used in clinical settings in the treatment of peripheral vascular disease. Since Hosobuchi's [Appl Neurophysiol 1985;48:372-376] first observations on the effects of SCS on CBF were published 22 years ago, many advances have been made in understanding SCS-mediated effects on CBF. ⋯ The authors revised the published experiences in humans with hypoperfusion syndromes and 'adjuvant' locoregional CBF increase in chemotherapy of brain tumors. SCS represents a new perspective in challenging neurosurgical clinical fields such as cerebral ischemia and vasospasm, and seems promising as a new trend of functional neurosurgery in cerebrovascular diseases.
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Stereotact Funct Neurosurg · Jan 2011
Comparative StudySubthalamic deep brain stimulation in Parkinson's disease under different anesthetic modalities: a comparative cohort study.
The efficacy and feasibility of bilateral subthalamic deep brain stimulation (STN-DBS) for Parkinson's disease (PD) under general anesthesia (GA) has not been evaluated. ⋯ Desflurane GA was shown to be a good alternative anesthetic method for PD patients undergoing DBS. Although the motor outcomes were comparable, a significant cognitive decline may be seen in the GA group with a higher occurrence of stimulation side effects.
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Stereotact Funct Neurosurg · Jan 2011
Comparative StudyMRI-guided subthalamic nucleus deep brain stimulation without microelectrode recording: can we dispense with surgery under local anaesthesia?
Subthalamic nucleus (STN) deep brain stimulation (DBS) for Parkinson's disease (PD) is traditionally performed under local anaesthetic (LA). STN visualization and routine validation of electrode location on stereotactic MRI may allow surgery under general anaesthesia (GA). This study compares the clinical outcome of MRI-guided STN DBS performed under LA or GA in a consecutive patient series. ⋯ MRI-guided STN DBS under GA with routine stereotactic verification of lead location did not have a negative effect on efficacy or safety. Surgery under GA is a viable option in patients who would find it hard to tolerate awake surgery due to disease severity, comorbidities or anxiety.