World Neurosurg
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Surgery in psychiatric disorders has a long history and has regained momentum in the past few decades with deep brain stimulation (DBS). DBS is an adjustable and reversible neurosurgical intervention using implanted electrodes to deliver controlled electrical pulses to targeted areas of the brain. It holds great promise for therapy-refractory obsessive-compulsive disorder. ⋯ Another promising indication is Tourette syndrome, where potential efficacy of DBS is shown by several case series and a few controlled trials. Further research should focus on optimizing DBS with respect to target location and increasing the number of controlled double-blinded trials. In addition, new indications for DBS and new target options should be explored in preclinical research.
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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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Review Historical Article
Deep brain stimulation for treatment-resistant depression.
Major depressive disorder is a common and disabling illness and is the leading cause of disability worldwide. Despite aggressive medical, behavioral, and electroconvulsive therapies, a significant number of patients remain refractory to treatment. Deep brain stimulation (DBS) has proven efficacy in neurobehavioral disorders and, in a general sense, works by modulation of corticostriatopallidothalamocortical circuits implicated in these disorders. ⋯ Early work suggests DBS may become a therapeutic option in treatment-resistant depression. Further study is justified given the immense burden of disease.
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To describe epidemiology in relation to gender differences and treatment modalities 10 years after intracranial aneurysm rupture in the Stockholm cohort 1996-1999. ⋯ Ten years after rupture, most treated patients were still alive. The mortality was highest in the first month after rupture, due to the initial hemorrhage. Gender differences were apparent in incidence, but 10 years after the rupture mortality rates and survival times were equal between men and women. Survival time was equal between patients within active treatment modalities.
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The nature of the pituitary adenomas itself exposes the possibility of a recurrence of the tumor. The aim of this study was to evaluate the effectiveness of the endoscopic endonasal transsphenoidal approach for the removal of recurrent and residual pituitary adenomas, already treated by a microscopic or endoscopic transsphenoidal approach or by a transcranial route. ⋯ The endoscopic endonasal approach is a safe and effective procedure for the management of recurrent and/or regrowing pituitary tumors previously treated by either a microsurgical or an endoscopic approach.