Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2015
Comparative StudyAwake Neurophysiologically Guided versus Asleep MRI-Guided STN DBS for Parkinson Disease: A Comparison of Outcomes Using Levodopa Equivalents.
Deep brain stimulation (DBS) for Parkinson's disease (PD) has traditionally been performed in awake patients. Some patients are unable to tolerate awake surgery or extensive time off their medication to allow for neurophysiological testing during traditional DBS implantation, which has previously limited surgical options for these patients. Recently, asleep image-guided lead placement using intraoperative MRI or CT for verification has been proposed as an alternative for patients unable or unwilling to undergo awake DBS surgery. ⋯ Asleep MRI-guided DBS is a viable option for PD patients unable or unwilling to undergo awake placement, with similar results in terms of LEDD reduction and complications.
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Stereotact Funct Neurosurg · Jan 2015
Treatment of postherpetic neuralgia using DREZotomy guided by spinal cord stimulation.
Postherpetic neuralgia (PHN) is the most common complication following an episode of acute herpes zoster. The curative effect of current treatments is limited. ⋯ Microsurgical DREZotomy assisted with SCS for target localization is an effective remedy for PHN.
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Stereotact Funct Neurosurg · Jan 2015
Multimodal, Intraoperative Monitoring during Paddle Lead Placement for Cervicothoracic Spinal Cord Stimulation.
We investigated the efficacy of combined somatosensory evoked potentials (SSEP) and electromyography monitoring during paddle lead placement through cervicothoracic laminectomy under general anesthesia in a retrospective review of data from 25 patients. ⋯ Intraoperative neurophysiological guidance using SSEP and muscle MEP was useful for the safe and accurate placement of paddle leads for cervicothoracic SCS.
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Stereotact Funct Neurosurg · Jan 2015
The Influence of Positioning and Muscle Activity on Motor Threshold during Motor Cortex Stimulation Programming.
Background: Stimulation parameters are crucial for the efficacy and safety of motor cortex stimulation (MCS). Motor threshold (MT) can be defined as the lowest voltage that produces motor contraction. The final stimulation parameters are always a smaller percentage of MT in order to avoid seizures. ⋯ Conclusion: When selecting final stimulation parameters for MCS, clinicians should be aware that the lowest MT is elicited while patients are seated upright and actively contracting the target muscle. Using this method of determining the MT when calculating the final stimulation parameters could reduce the chance of MCS-induced seizures. © 2015 S. Karger AG, Basel.
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Stereotact Funct Neurosurg · Jan 2015
Constant Current versus Constant Voltage Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease.
Background: Subthalamic nucleus (STN) deep brain stimulation (DBS) is an established therapy for advanced Parkinson's disease (PD). Motor efficacy and safety have been established for constant voltage (CV) devices and more recently for constant current (CC) devices. CC devices adjust output voltage to provide CC stimulation irrespective of impedance fluctuation, while the current applied by CV stimulation depends on the impedance that may change over time. ⋯ Conclusion: CC STN DBS is safe. For equivalent motor efficacy, no significant difference could be identified between CC and CV stimulation for nonmotor evaluations in PD patients 2 years after surgery. © 2015 S. Karger AG, Basel.