Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2001
Neurophysiological monitoring for epilepsy surgery: the Talairach SEEG method. StereoElectroEncephaloGraphy. Indications, results, complications and therapeutic applications in a series of 100 consecutive cases.
In some candidates for epilepsy surgery in whom the decision to operate is difficult to make, invasive presurgical investigations, namely depth electrode recordings, may be needed. The SEEG (StereoElectroEncephaloGraphy) method consists of stereotactic orthogonal implantation of depth electrodes (5 to 15, 11 on average). The object of this study is to clarify the indications for SEEG, to expose its complications, and to display its usefulness in terms of surgical strategy and results. ⋯ SEEG proved to be a relatively safe and a very useful method in 'difficult' candidates for epilepsy surgery. In addition, in some cases the implanted electrodes can be used to perform therapeutic RF thermocoagulation of epileptic foci or networks.
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Stereotact Funct Neurosurg · Jan 2001
Radiosurgery and stereotactic radiation therapy of skull base meningiomas: proposal of a grading system.
The development of a grading system to guide treatment selection, and predict treatment difficulty and outcome of skull base meningiomas infiltrating the cavernous sinus which are managed by stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRT), based on an 8-year experience with stereotactic radiation of skull base meningiomas. ⋯ This grading system correlated with outcome and difficulty in planning radiosurgery. Failure of treatment was more likely to occur in patients with higher Grade tumors.
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Stereotact Funct Neurosurg · Jan 2001
CT-guided percutaneous punctate midline myelotomy for the treatment of intractable visceral pain: a technical note.
Surgical treatment of intractable visceral pain has always been a challenge. The relatively recent discovery of a specific visceral pain pathway brought a new insight to this matter. The authors describe a new technique to interrupt this pathway, the CT-guided percutaneous punctate midline myelotomy, successfully applied in two patients with intractable pelvic visceral pain. Due to its simplicity, safety and high effectiveness, it may become the treatment of choice for intractable visceral pain.
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Stereotact Funct Neurosurg · Jan 2001
Microanatomy of medial temporal area and subtemporal amygdalohippocampectomy.
For seizure control in temporal lobe epilepsy, the head of the hippocampus to the choroidal point, parahippocampal gyrus, entorhinal area, uncus, and at least the basolateral nucleus of the amygdala should be completely removed. The subtemporal approach should be selected for removal of these structures, and it does not interrupt the temporal stem and optic radiation. Pre- and postoperative neuropsychological examinations revealed that there is no significant decline of scores of various examinations including WAIS, WMS, Randt memory, and verbal associates learning tests, even if the resection were performed on the language dominant side. Seizure control for the 20 non-lesional patients operated with this approach is 60% (Class I and II), without definite permanent complications.
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The history of open and subsequently stereotactic brain lesions for the relief of pain is traced. Important steps included recognition of the importance of the non-specific pain pathways and the differential effects of lesioning on nociceptive pain and on different elements of neuropathic pain. Although the advent of morphine infusion and deep brain stimulation has greatly eroded the number of destructive lesions made, new technical and conceptual advances must be carefully evaluated.