Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2015
Long-term results of motor cortex stimulation in the treatment of chronic, intractable neuropathic pain.
Although motor cortex stimulation (MCS) has been used for more than 20 years in the treatment of chronic neuropathic pain, there is still a debate about the efficacy of MCS. ⋯ MCS was more effective in the treatment of chronic neuropathic pain of central poststroke pain and peripheral neuropathic pain types than in the treatment of SCI pain in the long-term follow-up.
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Stereotact Funct Neurosurg · Jan 2015
Factors Associated with Tremor Changes during Sedation with Dexmedetomidine in Parkinson's Disease Surgery.
Dexmedetomidine is an α2-agonist recently proposed as a potentially ideal drug for sedation during the surgical treatment of Parkinson's disease (PD). This report documents the incidence of changes in motor symptoms (especially tremor) in PD patients sedated with dexmedetomidine for deep brain stimulation or ablation procedures. ⋯ Dexmedetomidine provides adequate sedation during surgery for PD, but it might affect motor signs making intraoperative testing difficult or even impossible. Dosage appears not to be the determining factor in motor changes, whose cause remains unclear.
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Stereotact Funct Neurosurg · Jan 2015
Chronic Spinal Cord Stimulation in the Treatment of Cerebral and Spinal Spasticity.
The aim of this investigation is to assess the effectiveness of spinal cord stimulation (SCS) in different groups of patients with spasticity of different origin. ⋯ Chronic SCS may be a method of choice for patients with moderate spinal and cerebral spasticity with predominant spastic lower paraparesis. In patients with spastic tetraparesis SCS therapy did not prove to be effective. We encountered improvement of the spasticity and no need for further SCS therapy in a small group of patients (11%). This phenomenon requires further investigation. © 2015 S. Karger AG, Basel.
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Stereotact Funct Neurosurg · Jan 2015
A Prospective Study of the Intra- and Postoperative Efficacy of Intraoperative Neuromonitoring in Spinal Cord Stimulation.
Accurate lead placement is critical for spinal cord stimulation (SCS) efficacy. The traditional gold standard of awake placement is often technically difficult. While there is retrospective evidence supporting the use of intraoperative neurophysiological monitoring (IOM) as an alternative, a prospective assessment has not yet been performed. ⋯ We provide prospective evidence that IOM can be used to verify SCS placement. Additionally, EMG may help to streamline device programming and thereby improve outcomes by predicting the ideal stimulation contacts in many cases.
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Stereotact Funct Neurosurg · Jan 2015
ReviewResting-State Blood Oxygen Level-Dependent Functional MRI: A Paradigm Shift in Preoperative Brain Mapping.
Currently, functional magnetic resonance imaging (fMRI) facilitates a preoperative awareness of an association of an eloquent region with a tumor. This information gives the neurosurgeon helpful information that can aid in creating a surgical strategy. Typically, task-based fMRI has been employed to preoperatively localize speech and motor function. ⋯ Compared with task-related fMRI, rs-fMRI provides more comprehensive information on the functional architecture of the brain and is applicable in settings where task-related fMRI may provide inadequate information or could not be performed. Taken together, rs-fMRI substantially expands the preoperative mapping capability in efficiency, effectiveness, and scope. In this article, a brief introduction into rs-fMRI processing methods is followed by a detailed discussion on the role rs-fMRI plays in presurgical planning.