Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2011
Case ReportsSurgical treatment for late complications following gamma knife surgery for arteriovenous malformations.
To establish the surgical indications and strategy for late complications following gamma knife surgery (GKS) for arteriovenous malformations (AVMs). ⋯ Cyst formation is one of the late complications of GKS for AVM. Some cysts show spontaneous regression but others gradually increase in size and become symptomatic, although relatively large asymptomatic cysts are also known. Predicting the future course of a cyst is difficult. Surgery such as placement of an Ommaya reservoir should be considered for symptomatic cases. Expanding hematoma always increases in size and becomes symptomatic, so removal by craniotomy is necessary. Surrounding brain edema decreases rapidly after surgery and neurological symptoms quickly resolve.
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Stereotact Funct Neurosurg · Jan 2011
Case ReportsMotor cortex stimulation for trigeminal neuropathic or deafferentation pain: an institutional case series experience.
Trigeminal neuropathy is a rare, devastating condition that can be intractable and resistant to treatment. When medical treatment fails, invasive options are limited. Motor cortex stimulation (MCS) is a relatively recent technique introduced to treat central neuropathic pain. The use of MCS to treat trigeminal neuropathic or deafferentation pain is not widespread and clinical data in the medical literature that demonstrate efficacy are limited. ⋯ MCS is a safe and potentially effective therapy in certain patients with trigeminal neuropathy.
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Stereotact Funct Neurosurg · Jan 2011
Case ReportsBilateral subthalamic deep brain stimulation after bilateral pallidal deep brain stimulation for Parkinson's disease.
Globus pallidus internus (GPi) and subthalamic nucleus (STN) have successfully been targeted independently for deep brain stimulator (DBS) placement in medically intractable Parkinson's disease (PD). Bilateral implantation of STN DBS in a patient with preexisting, functioning GPi DBS to specifically treat motor fluctuations is, to our knowledge, yet unreported. ⋯ In this report we discuss the rationale, technical issues, programming nuances and outcome in a patient with preexisting bilateral GPi DBS who was implanted with bilateral STN DBS.
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Stereotact Funct Neurosurg · Jan 2011
Changes in motor function induced by chronic motor cortex stimulation in post-stroke pain patients.
In well-designed multicenter studies, the protocol of continuing motor cortex stimulation (MCS) temporarily for 3-6 weeks was employed with rehabilitation therapy, and these studies showed some recovery of motor weakness in post-stroke patients. ⋯ These findings indicate that MCS could be a new therapeutic approach to improving motor performance after stroke by attenuating rigidity and/or spasticity. However, it may be important to define the appropriate number of hours and conditions of daily MCS.
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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.