Acta neurochirurgica. Supplement
-
Acta Neurochir. Suppl. · Jan 2007
Clinical TrialFactors affecting spinal cord stimulation outcome in chronic benign pain with suggestions to improve success rate.
For patient selection, psychological factors like fear avoidance, depression, secondary gain or refusal to be weaned off narcotics should be avoided. Trial Stimulation is an important tool to reduce the rate of failed permanent implants, and to improve cost-effectiveness. The etiology of pain has a strong influence on the success rate. ⋯ The electrode fracture rate can be reduced by using the paramedian approach, the use of three wing silicone anchor placed immediately at the point of exit of the lead from the deep fascia and avoiding a hard plastic twist lock anchor. The displacements can be reduced by fixing the anchor to the deep fascia firmly, supplemented by the use of silicone glue, and by placing the implantable pulse generator (IPG) in the abdominal wall, instead of the gluteal region. The use of prophylactic antibiotics tends to reduce the infection rate.
-
Acta Neurochir. Suppl. · Jan 2007
Case ReportsNeuromodulation of the inferior thalamic peduncle for major depression and obsessive compulsive disorder.
Neuromodulation of the inferior thalamic peduncle is a new surgical treatment for major depression and obsessive-compulsive disorder. The inferior thalamic peduncle is a bundle of fibers connecting the orbito-frontal cortex with the non-specific thalamic system in a small area behind the fornix and anterior to the polar reticular thalamic nucleus. Electrical stimulation elicits characteristic frontal cortical responses (recruiting responses and direct current (DC)-shift) that confirm correct localization of this anatomical structure. ⋯ GAF improved significantly in both cases. The neuropsychological tests battery showed no significant changes except from a reduction in the perseverative response of the obsessive-compulsive patient and better performance in manual praxias of the female depressive patient. Moderate increase in weight (5 kg on average) was observed in both cases.
-
Acta Neurochir. Suppl. · Jan 2007
Clinical TrialMinimally invasive placement of epidural plate electrodes under local anaesthesia in spinal cord stimulation.
In the treatment of pain syndromes of different aetiologies a change has occurred from destructive interventions to stimulation procedures. Spinal cord stimulation is the best known example of this treatment strategy. It is used often in patients with persistent neuropathic pain syndromes in an extremity, for instance following low back surgery. ⋯ Besides this, the laminectomy procedure can subsequently result in new pain complaints due to the invasiveness of the procedure. To solve both problems we have modified the implantation technique. By using a tubular retractor system (METRx system, Medtronic Sofamor Danek, Memphis, TN), originally developed for minimally invasive degenerative disc surgery, it is possible to reach the epidural spinal space and introduce the plate electrode with a small approach under local anaesthesia both allowing trial stimulation and avoiding severe postoperative backache related to the approach in these patients.
-
Acta Neurochir. Suppl. · Jan 2007
Did the partial contralateral C7-transfer fulfil our expectations? Results after 5 year experience.
Within the last decade contralateral C7-transfer has become a new source of axon donor in complete brachial plexus lesions. ⋯ The C7-transfer proved to be a safe transfer if at the time of operation no fascicles innervating wrist and finger extension are taken. Provided adequate biceps muscle organ function, active elbow flexion can be reconstructed in most of the patients. However, for median nerve reinnervation motor results are moderate up to now.
-
Acta Neurochir. Suppl. · Jan 2007
In peripheral nerve regeneration environment enriched with activity stimulating factors improves functional recovery.
Enriched environment stimulates brain plasticity processes after brain lesion. Less is known about the influence of enriched environment with activity stimulating factors as determinants of functional outcome after peripheral nerve repair. ⋯ Our study aimed to elucidate if enriched environment influences functional results after peripheral nerve repair. The results in this rat sciatic nerve transection and repair model showed that environment enriched with activity stimulating factors can improve functional results.