Stereotactic and functional neurosurgery
-
Stereotact Funct Neurosurg · Jan 1996
Trigeminal neuralgia radiosurgery: the University of Pittsburgh experience.
The results of Gamma Knife stereotactic radiosurgery in the management of 51 patients who had typical trigeminal neuralgia were evaluated at the University of Pittsburgh. In all cases, a 4-mm isocenter was targeted at the proximal nerve at the root entry zone. The target dose varied from 60 to 90 Gy. ⋯ A maximum radiosurgery dose > or = 70 Gy was associated with a significantly greater chance for complete pain relief. Using magnetic resonance imaging stereotactic targeting, the proximal trigeminal nerve is an appropriate anatomic target for radiosurgery. Gamma Knife radiosurgery is a useful additional surgical approach in the management of medically or surgically refractory trigeminal neuralgia.
-
Stereotact Funct Neurosurg · Jan 1995
Clinical TrialAnalysis of breakthrough pain in 50 patients treated with intrathecal morphine infusion therapy. Development of tolerance or infusion system malfunction.
Fifty patients with intractable benign pain were treated with intrathecal morphine (IT-MS) infusion therapy. Median follow-up was 39 months (range 5-70). Breakthrough pain was reported in 45 (90%) patients in 75 outpatient clinic events. ⋯ Benefits were regained after all surgical catheter corrections. In total, partial tolerance was seen in 23 patients (46%) during 50 (67%) breakthrough events, 15 patients (30%) required 22 catheter revisions during 27% of breakthrough events and 2 patients had progressive disease. True tolerance was encountered in only 5 patients (10%) during 5 (7%) breakthrough pain events.
-
Stereotact Funct Neurosurg · Jan 1995
Clinical TrialSpinal cord stimulation in severe angina pectoris.
Since 1985, 225 patients suffering from severe pectoris due to New York Heart Association classes III-IV have been treated with spinal cord stimulation (SCS). All patients have been considered not suitable for open heart surgery by technical reasons. The long-term follow-up has shown a very good positive response to stimulation with pain relief, less intake of medication and increased quality of life. ⋯ Recordings with the so-called Holter technique have demonstrated that SCS does not create arrhythmias, and pacing studies that SCS does not mask ischemia at extreme workload. In conclusion, apart from the positive effect on the quality of life, SCS in angina pectoris has demonstrated antianginal and anti-ischemic effects. The clinical results and the physiological and hemodynamic measurements will be presented in detail.
-
Stereotact Funct Neurosurg · Jan 1995
Gamma Knife surgery for angiographically occult vascular malformations.
To evaluate the effect of radiosurgery on angiographically occult vascular malformations (AOVMs), 9 patients treated with Gamma Knife surgery were followed up for 21-37 months. Eight patients had bleeding episodes, 1 had uncontrollable epilepsy. Rebleeding occurred in 3 AOVMs 5 or 6 months after treatment. ⋯ Histological findings revealed an arteriovenous malformation (AVM) and a cavernous angioma. There was hypertrophy of the internal membrane of the AVM, but no effect on the cavernous malformation. Radiosurgery should only be considered in cases of inoperable AOVM, because there is no definite proof that radiosurgery prevents AOVMs from rebleeding.
-
Stereotact Funct Neurosurg · Jan 1995
A new approach to control central deafferentation pain: spinal intrathecal baclofen.
Baclofen, an agonist of the gamma-aminobutyric acid (GABA) receptor, has antinociceptive effects, and its intrathecal administration reduces allodynic responses in animal models of neurogenic central pain. Such experimental studies lead to the hypothesis that neurogenic pain may be induced in part by functional abnormalities in spinal GABAergic systems. However, whether a GABAergic system is actually involved in human central pain is unknown. ⋯ Pinprick and light touch sensations did not change in nonaffected regions. The results indicate that dysfunction of spinal GABAergic systems plays a role in the clinical expression of central pain. In clinical situations, continuous intrathecal infusion of baclofen seems feasible for relief of central pain.