World Neurosurg
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The consequences of chronic alcohol dependence cause important health and economic burdens worldwide. Relapse rates after standard treatment (medication and psychotherapy) are high. There is evidence from in vivo investigations and from studies in patients that the brain's reward system is critically involved in the development and maintenance of addictive behavior, suggesting that modification of this system could significantly improve the prognosis of addictive patients. Motivated by an accidental observation, we used the nucleus accumbens (NAc), which has a central position in the dopaminergic reward system for deep brain stimulation (DBS) of alcohol addiction. ⋯ To our knowledge, the data presented here reflect the first attempt to treat alcohol-addicted patients with NAc DBS. Electrical NAc stimulation probably counterbalances the effect of drug-related stimuli triggering involuntarily drug-seeking behavior. Meanwhile, two prospective clinical studies using randomized, double-blind, and crossover stimulation protocols for DBS are underway to corroborate these preliminary results.
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To describe our institutional experience with deep-brain stimulation (DBS) used in the treatment of aggressive and disruptive behavior refractory to conservative treatment. ⋯ DBS of the posterior hypothalamic region could be an effective treatment for patients affected by mental retardation in whom disruptive and drug-refractory aggressive behavior coexists. Although several experimental data are available on this target, further studies are necessary to confirm the long-term efficacy and safety of this procedure.
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Case Reports
Tibial artery autografts: alternative conduits for high flow cerebral revascularizations.
Extracranial-to-intracranial (EC-IC) bypass is a valuable tool in treating intracranial diseases requiring flow replacement or parent vessel sacrifice. Radial artery grafts (RAGs) and saphenous vein grafts (SVGs) have been used as conduits to provide adequate high flow revascularizations. It is a therapeutic challenge when these grafts are unavailable. ⋯ Tibial arteries are safe, contingent alternatives to conventional conduits for performing high flow cerebral revascularizations and conduit reconstructions.
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Certain clinical situations, such as a surgical embolectomy for an acute embolic occlusion of the internal carotid artery (ICA) or the surgical repair of a blood blister-like aneurysm (BBA), can require the superior wall of the ICA to be repaired using a microsuture technique. This can be complicated and challenging, as it not only involves delicate work in a deep surgical field but is also a time-limited procedure performed during temporary occlusion of the ICA. Thus, to facilitate a less complicated repair of the ICA and maintenance of the cerebral blood flow during the procedure, a microsuture technique using compartmentalizing clips is proposed. ⋯ The proposed microsuture technique using compartmentalizing clips facilitates the repair of the ICA in cases of a surgical embolectomy or BBA without temporary occlusion of the ICA.
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Case Reports
Onyx embolization of a ruptured lenticulostriate artery aneurysm in a patient with moyamoya disease.
Lenticulostriate artery (LSA) aneurysms are uncommon. Most reported cases have been surgically treated. There are only three reports of LSA aneurysms treated with endovascular techniques. ⋯ Treatment of these lesions with either surgery or endovascular therapy is challenging and requires specialized expertise. Given the risks of surgery, we believe that LSA aneurysms are best treated by endovascular means, especially in the setting of moyamoya disease.