Stereotactic and functional neurosurgery
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Stereotact Funct Neurosurg · Jan 1997
Angiographic follow-up in 37 patients after radiosurgery for cerebral arteriovenous malformations as part of a multimodality treatment approach.
Modified Linac radiosurgery was utilized at our institution between 1990 and 1995 in 54 patients with cerebral arteriovenous malformations (AVMs) as part of a multimodality therapeutic approach. Most patients also underwent surgery and embolization of the AVMs prior to radiosurgery. The goal of the adjunctive radiosurgical treatment was the complete angiographic obliteration of the deep residual AVM after subtotal embolization and resection. ⋯ These data support the use of radiosurgery for treatment of cerebral AVMs as part of a multimodality approach if the surgical risk of any residual AVM after embolization and microsurgical resection is deemed excessive. The adjunctive use of radiosurgery in this series resulted in the safe complete obliteration of many very difficult grade 4 and 5 AVMs. These data do not support the use of radiosurgery as the primary treatment of surgically resectable AVMs since there is a risk of interval hemorrhage and the obliteration rate is far inferior to that of microsurgical resection.
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Stereotact Funct Neurosurg · Jan 1997
Image-guided neurosurgery with intraoperative MRI: update of frameless stereotaxy and radicality control.
Intraoperative shifts and resulting inaccuracies have been a concern in frame based and frameless stereotactically guided interventions, particularly in open microsurgical procedures. Trying to solve this problem, we developed a method to perform intraoperative MRI (0.2 tesla, Magnetom Open) and use intraoperatively acquired data sets to update neuronavigation. ⋯ The operation was continued in 10 cases to resect detected tumor remnants using navigation, leaving 4 patients (19%) with residual tumor postoperatively. We showed that update of frameless stereotaxy to compensate for brain shift is feasible and might increase the number of cases where radiologically complete resection can be achieved.
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Stereotact Funct Neurosurg · Jan 1997
Volumegraph (overlaid three-dimensional image-guided navigation). Clinical application of augmented reality in neurosurgery.
We have developed an overlaid three-dimensional image (Volumegraph)-guided navigation system that allows navigation during operative procedures. The three-dimensional image is superimposed on the patient's head and body via a semi-transparent mirror. The Volumegraph can display three-dimensional images in the air by a light beam which is based on CT/MRI. ⋯ This preliminary study of overlaid three-dimensional-image-guided navigation demonstrated its clinical usefulness. The application of augmented reality in the surgical field makes it possible to do a neurosurgical intervention easily and accurately.
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Stereotact Funct Neurosurg · Jan 1997
Percutaneous radiofrequency lumbar facet rhizotomy in mechanical low back pain syndrome.
During the period from March 1992 to June 1996, we performed percutaneous radiofrequency (RF) facet rhizotomy in 324 patients with low back pain. Employing the lesion generator, we coagulated branches of the zygapophyseal nerve to treat low back pain. ⋯ Two-hundred and thirty-one patients (103 females and 128 males) had mechanical low back pain syndrome and showed marked improvement of pain after the procedure, including 29 cases with previous spinal surgery. We concluded that percutaneous RF facet rhizotomy is a safe and effective procedure for low back pain patients, especially for those with mechanical low back pain syndrome.
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From January 1, 1986, to June 30, 1996, 240 patients were operated on for trigeminal neuralgia: 182 patients were treated by thermocoagulation of the gasserian ganglion after Sweet and 58 patients by decompression of the trigeminal nerve after Janetta. In the thermocoagulation group, followed up for 6 months to 10 years 95.2% of the cases showed freedom from pain, in the Janetta operation group, followed up for 6 months to 6 years 98.5% showed freedom from pain. Thermocoagulation is the preferred therapy, especially in older patients in whom general anesthesia is risky, while the Janetta operation is the therapy of choice in younger patients.