Neurosurgery clinics of North America
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Neurosurg. Clin. N. Am. · Oct 2011
Historical ArticleResponsive neurostimulation for the treatment of epilepsy.
Neurostimulation in epilepsy has witnessed a century-long evolution that has resulted in the use of neurostimulation to both modulate and suppress abnormal neuronal firing. The recent development of advanced responsive stimulation via a closed-loop device (the RNS System) has provided evidence that surgical epilepsy treatment continues to move toward the possibility of reducing or eliminating seizures in medically refractory patients.
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Neurosurg. Clin. N. Am. · Oct 2011
Multicenter Study Clinical TrialResponsive neurostimulation suppresses synchronized cortical rhythms in patients with epilepsy.
Deep brain stimulation (DBS) is an established treatment for Parkinson's disease, and is increasingly used for other neuropsychiatric conditions including epilepsy. Nevertheless, neural mechanisms for DBS and other forms of neurostimulation remain elusive. ⋯ Neurostimulation acutely suppressed gamma frequency (35-100 Hz) phase-locking. This may represent a therapeutic mechanism by which responsive neurostimulation can suppress epileptiform activity and disconnect stimulated regions from downstream targets in epilepsy and other neuropsychiatric conditions.
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The pineal region can harbor highly diverse histologic tumor subtypes. Because optimal therapeutic strategies vary with tumor type, an accurate diagnosis is the foundation of enlightened management decisions. ⋯ Biopsy has the advantage of ease and minimal invasiveness but is associated with more sampling errors than open surgery. The emergence of endoscopic techniques and stereotactic radiosurgery provide complementary options to improve pineal tumor management, and will assume greater importance in the neurosurgeon's armamentarium.
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The present review assesses how to make pineal surgery, refined over decades, better, ie, less invasive, while still respecting this delicate region, and achieving anatomic and oncologic goals. An explication of anatomic principles of this region, and some basic surgical principles of keyhole surgery are provided to further assist those interested in minimizing surgical impact during pineal surgery. Although this review, for the sake of brevity, focuses on the infratentorial-supracerebellar approach, many of these principles can be adapted to other approaches, such as the occipital transtentorial, without excessive imagination.
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Neurosurg. Clin. N. Am. · Apr 2011
ReviewDiffusion tractography: methods, validation and applications in patients with neurosurgical lesions.
Diffusion tensor imaging (DTI) tractography is increasingly used in presurgical mapping in tumors located in eloquent areas since it is the only non invasive technique that permits in vivo dissection of white matter tracts. Concordance between the DTI tracts and subcortical electrical intraoperative mapping is high, and DTI tractography has proven useful to guide surgery. However, it presents limitations due to the technique and the tumor, which must be known before using the images in the operative room. This review focuses on the possibilities and limits of DTI imaging in intraoperative tumoral mapping and presents an overview of current knowledge.