Stereotactic and functional neurosurgery
-
Stereotact Funct Neurosurg · Jan 2012
Case ReportsFour-decade maintenance of analgesia with percutaneous cordotomy.
The management of severe, medically intractable pain is a significant challenge for neurosurgeons and pain management physicians. An existing technique that can effectively alleviate contralateral chronic pain is cordotomy, interruption of the lateral spinothalamic tract of the spinal cord. ⋯ Here we describe a case with a 41-year follow-up of percutaneous cordotomy for noncancer pain that resulted in over 35 years of complete analgesia, the longest recorded in the literature to date. This case demonstrates that percutaneous cordotomy can provide long-lasting, complete analgesia in some patients and merits continuation as a part of the neurosurgical arsenal of pain therapies.
-
Stereotact Funct Neurosurg · Jan 2012
Comparative StudyChanging practice patterns of deep brain stimulation in Parkinson's disease and essential tremor in the USA.
Randomized controlled studies have shown deep brain stimulation (DBS) to be an effective treatment for Parkinson's disease (PD). Outside of large-center studies, little is known about trends in DBS use in the USA. ⋯ Patients who underwent DBS in the 2007 sample were older and had more comorbidities than those in the 2000 sample; in-hospital complications remained low. Understanding trends in DBS is helpful in assessing how the technology is adopted and what relationships should be further explored.
-
Stereotact Funct Neurosurg · Jan 2012
Capability of identifying red nuclei in different pulse sequences of regular 1.5-tesla magnetic resonance images.
To investigate the optimal pulse sequences of commonly used 1.5-tesla MRI for identifying the red nucleus (RN) to aid targeting of the subthalamic nucleus (STN). ⋯ T2FLAIR is an alternative to FSE-T2WI that can readily demarcate the RN to help target the STN.
-
Stereotact Funct Neurosurg · Jan 2012
An evaluation of hardware and surgical complications with deep brain stimulation based on diagnosis and lead location.
Deep brain stimulation is the most frequently performed neurosurgical procedure for movement disorders. This procedure is well tolerated, but not free of complications. Analysis of hardware complications based on patient diagnosis and lead location could prove valuable in recognizing potential pitfalls and patients at higher risk. ⋯ This large series of patients and long-term follow-up demonstrate that risks of complications are not universal among movement disorder patients. Diagnosis and lead location are important risk stratification factors in determining complications.
-
Stereotact Funct Neurosurg · Jan 2012
Comparative StudyThe effect of intraventricular trajectory on brain shift in deep brain stimulation.
Brain shift during deep brain stimulation (DBS) surgery may compromise target localization. Loss of cerebrospinal fluid is believed to be the underlying mechanism, thus an intraventricular trajectory during DBS surgery may be associated with increased shift, in addition to other complications, such as intraventricular hemorrhage. ⋯ Intraventricular trajectories during DBS surgery do not appear to compromise safety or targeting accuracy.