World Neurosurg
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Review Historical Article
History of psychosurgery: a psychiatrist's perspective.
Interest in using neuromodulation to treat psychiatric disorders is rapidly increasing. The development of novel tools and techniques, such as deep brain stimulation (DBS), increases precision and minimizes risk. This article reviews the history of psychosurgical interventions and recent developments of DBS to provide a framework for understanding current options and future goals. ⋯ We focus the discussion on two psychiatric disorders that have been targets of neurosurgical interventions: obsessive-compulsive disorder and mood disorders such as major depressive disorder. Evidence from studies of DBS in psychiatric disorders, including efficacy and tolerability, is reviewed. Finally, we look to the future, exploring the possibilities for these approaches to increase understanding, transform societal views of mental illness, and improve treatment.
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Review Historical Article
Anatomic hemispherectomy: historical perspective.
The history of surgical treatment for hemispheric epilepsy is rich with colorful twists and turns. The authors trace the evolution of the surgical treatment of hemispheric epilepsy from radical anatomic resections to current less invasive disconnection procedures. Anatomic hemispherectomy (AH) was first described by Dandy in 1928 as a treatment for gliomas. ⋯ Thus, surgery for hemispheric epilepsy has undergone dramatic transformation since the technique was first introduced. Less invasive techniques have been developed to reduce surgical morbidity. Although optimal seizure control is best achieved with radical AH, the newer less invasive disconnection techniques appear to achieve near-comparable postoperative seizure control with a significantly lower rate of complications.
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Meta Analysis
Computed tomography for clearance of cervical spine injury in the unevaluable patient.
To review computed tomography (CT) as a stand-alone test for the clearance of cervical spine injury in the unevaluable patient population. ⋯ The evidence supporting CT for the stand-alone evaluation of the cervical spine in the unevaluable patient is insufficient. We contend that a CT of the cervical spine must be supplemented by an additional examination addressing ligamentous instability in this patient population.
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With increasing popularity of percutaneous spinal access for minimally invasive spinal neurosurgery, the treatment paradigm has shifted from open approaches to vertebroplasty or kyphoplasty for degenerative spinal disease and vertebral compression fractures. Addressing the challenges of this shift, we integrate the fluoroscopic studies of these percutaneous approaches with the three-dimensional surgical anatomy. Step-by-step techniques are illustrated in video demonstrations that highlight the nuances of effective percutaneous access during spinal surgeries for vertebral compression fractures and pedicle screw fixation. ⋯ With an appreciation for the standard anatomical landmarks, fluoroscopic views, and avenues of approach, percutaneous access techniques can be safely and effectively applied to many spinal procedures.
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In preparation for a multicenter study, a protocol was written on how to perform surgical targeting of the bed nucleus of the stria terminalis, based on the lead implantation experience in patients with treatment-refractory obsessive-compulsive disorder (OCD) at the Universitaire Ziekenhuizen Leuven (UZ Leuven). When analyzing the postoperative images, we were struck by the fact that the difference between the postoperative position of the leads and the planned position seemed larger than expected. ⋯ The cause of the posterior deviation could not be determined with certainty. The most likely cause was an increased mechanical resistance of the brain tissue along the trajectory when following the targeting protocol compared with the trajectories classically used for subthalamic nucleus or ventral intermediate nucleus of the thalamus stimulation.