Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 2000
ReviewCerebral protection before, during and after neurosurgical procedures.
Not only the pathology but also the neurosurgical procedure itself can lead to an impairment of cerebral structures. This may cause neurological symptoms like confusion, disorientation or cognitive deficits which have hardly been noticed until now. ⋯ As an example of the effectiveness, based on our own experiences and international trials, two different medical drugs, Nimodipine and Cerebrolysin, are presented. In conclusion one has to realize that nowadays neurosurgeons have to focus their interest more and more to neuroprotective adjuvant treatment possibilities.
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Stereotact Funct Neurosurg · Jan 2000
ReviewThe idea of stereotaxy toward minimally invasive neurosurgery.
The idea of stereotaxy in modern neurosurgery is reviewed. Stereotactic surgery has been one of the particular neurosurgical techniques mainly used for functional disorders. ⋯ Functional neurosurgery itself is also changing in the sense that many alternative surgical procedures are now available due to the progress in neuroscience. The original premise of stereotaxy is exactly the same as that of minimally invasive neurosurgery today.
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Cancer pain can be successfully managed with oral or parenteral narcotics in 80% of patients, if those factors that magnify pain perception are also controlled. Pain from any source can be made worse and pain tolerance impaired by depression, regression, intolerance to stress, and/or recurrent withdrawal, all of which require attention and management. Those patients whose cancer pain is still intractable may benefit from a procedure to interrupt pain pathways. ⋯ The subarachnoid route is preferable to the epidural route because it is less likely to result in catheter failure and because much smaller doses can be used, with less systemic effect. In addition, tolerance can be managed more readily by readjustment of dose with the subarachnoid route, and there is no greater incidence of complications. Intraventricular narcotics can be considered in patients whose spinal canal does not allow catheter placement, at approximately 1/10th the spinal dose requirement.