Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2014
Case Reports Comparative StudyDeep brain stimulation for obsessive-compulsive disorder: is the side relevant?
Deep brain stimulation for obsessive-compulsive disorder (OCD) has targeted several subcortical nuclei, including the subthalamic nucleus (STN) and the nucleus accumbens. While the most appropriate target is still being looked for, little attention has been given to the side of the stimulated hemisphere in relationship to outcome. ⋯ Some reports suggest that lesion stimulation or stimulation of only the right side relieves OCD symptoms. However, anatomical and functional studies are not conclusive as to which side is most affected in OCD. Possibly, each OCD patient has an individualized optimal side to stimulate.
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Stereotact Funct Neurosurg · Jan 2014
Case ReportsHuman striatum remodelling after neurotransplantation in Huntington's disease.
Restoration of functions in Huntington's disease (HD) by neurotransplantation stems from the formation of a striatum-like structure capable of establishing host connections as a result of grafted striatal neuroblast maturation. For the first time, we demonstrated some developmental steps accomplished by progenitor cells in the brain of an HD patient and analysed the molecular asset of the human primordium. ⋯ The striatal primordium grew into the host brain and this process was associated with metabolic change and some clinical benefit. The study suggests the plasticity and reparative potential of un-manipulated primordium in an era where promising cell-based therapies are still in their infancy.
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Stereotact Funct Neurosurg · Jan 2014
Integration of magnetoencephalography-generated functional brain maps into dose planning during arteriovenous malformation radiosurgery.
Magnetoencephalography (MEG) can delineate critical regions of the cortex and facilitate conformal stereotactic radiosurgery (SRS) dose planning. Despite the substantial role of Gamma Knife® SRS in arteriovenous malformation (AVM) management, MEG-generated maps of critical regions have never been utilized to improve dose planning. ⋯ Coregistration of MEG data improves the accuracy and dose sparing needed for optimal planning during Gamma Knife SRS.
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Stereotact Funct Neurosurg · Jan 2014
Treatment of chronic pain: diffusion tensor imaging identification of the ventroposterolateral nucleus confirmed with successful deep brain stimulation.
A variety of pain syndromes have been treated successfully with deep brain stimulation (DBS) by targeting the thalamic ventroposterolateral (VPL) nucleus. The purpose of this study was to preoperatively identify the thalamic VPL nucleus by diffusion tensor imaging (DTI) fiber tractography (FT) and confirm it intraoperatively. ⋯ DTI has the potential to identify the thalamic nuclei in individuals, which would be more accurate than anatomical localization and likely identical to intraoperative physiological testing. Postoperative DBS electrode placement and the affected cortical areas can be confirmed with coregistration of CT and FT using the electrode as a seed ROI.
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Stereotact Funct Neurosurg · Jan 2014
Variation in deep brain stimulation electrode impedance over years following electrode implantation.
Deep brain stimulation (DBS) electrode impedance is a major determinant of current delivery to target tissues, but long-term variation in impedance has received little attention. ⋯ Impedance decreases gradually in a stimulation-dependent manner. These trends have implications for long-term programming, the development of a closed-loop DBS device and current understanding of the electrode-tissue interface.