Radiosurgical Pallidotomy for Parkinson's Disease.
Authors: Cahan LD, Young RF, Li F
Abstract
Deep brain stimulation (DBS) has been widely accepted as a tool for treating many symptoms of Parkinson's disease (PD); pallidotomy has been nearly abandoned. Concerns about both the safety and efficacy of pallidotomy are based on small series, isolated case reports, and techniques that would now be considered obsolete. The senior author recently reviewed long-term follow-up of a series of patients who had gamma knife pallidotomy (GKP) for advanced PD. GKP leads to durable, clinically significant benefit. Bilateral GKP adds incremental improvement. The complicatio...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Radiosurgical Subthalamic Nucleotomy.
Authors: Régis J, Carron R, Witjas T
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is the reference technique in Parkinson's disease (PD) at different stages of complications. Some patients cannot afford DBS due to anticoagulation or comorbidities or due to pecuniary reasons. Radiosurgery is a minimally invasive stereotactic technique, with no craniotomy and subsequently no risk of bleeding or infection. Its good safety efficacy profile has been established in the treatment of tremor, and the postoperative care issues are simple with a much shorter hospital stay (mean 48 h). The a...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Frameless Functional Stereotactic Approaches.
Authors: Palys V, Holloway KL
Abstract
The stereotactic frame has served as the gold standard apparatus for accurate and precise targeting of deep brain structures since 1947. Despite passing the test of time, the stereotactic frame has several limitations from the perspective of both neurosurgeons and patients. Therefore, there was a need to develop a frameless system that had equivalent accuracy and reliability to the frame. This need was met with 3 commercially available frameless stereotactic systems designed specifically for deep brain stimulation surgery: Nexframe, STarFix, and ClearPoint. Over the p...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Deep Brain Stimulation: Interventional and Intraoperative MRI Approaches.
Authors: Larson PS, Starr PA, Martin AJ
Abstract
Interventional and intraoperative MRI approaches to deep brain stimulator implantation are relatively new, and in their purest form represent a distinct departure from traditional stereotactic techniques. They employ a novel means of stereotaxis based on regions of interest in the MR space and simple geometric principles, which eliminate the need for a stereotactic frame. This approach is appropriate for targets that are MR visible, and for whom the local anatomy and function are well characterized. It may also be appropriate for targets that do not have a w...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Thalamic Deep Brain Stimulation.
Authors: Whiting BB, Whiting AC, Whiting DM
Abstract
The use of deep brain stimulation (DBS) of the thalamus has been proven to be a safe and efficacious treatment for the management of many diseases. The most common indication for thalamic DBS remains essential tremor (ET), one of the most common movement disorders in the world. ET patients should be considered for surgical intervention when their tremor has demonstrated to be refractory to medication, a characteristic estimated to be present in roughly 50% of ET cases. Advantages of DBS over thalamotomy include its reversibility, the ability to adjust st...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Deep Brain Stimulation of the Subthalamic Nucleus and Globus Pallidus for Parkinson's Disease.
Authors: Lee PS, Crammond DJ, Richardson RM
Abstract
The concept of deep brain stimulation (DBS) for Parkinson's disease (PD) was introduced over 20 years ago, but our understanding of the nuances of this procedure continues to improve. The average motor outcomes of internal segment of the globus pallidus (GPi) and subthalamic nucleus (STN) DBS appear to be similar, although GPi DBS may allow greater recovery of verbal fluency and may provide greater relief of depression symptoms and improvement in the quality of life, and STN DBS appears more likely to result in decrease in levodopa equivalent doses. Desp...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Current and Expected Advances in Deep Brain Stimulation for Movement Disorders.
Authors: Bari AA, Thum J, Babayan D, Lozano AM
Abstract
Deep brain stimulation (DBS) has become an established treatment for medically refractory movement disorders including Parkinson's disease, essential tremor, and dystonia. The field of DBS continues to evolve with advances in patient selection, target identification, electrode and pulse generator technology, and the development of more effective stimulation paradigms such as closed-loop stimulation. Furthermore, as the safety and efficacy of DBS improves through better hardware design and deeper understanding of its mechanisms of action, the indicatio...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Adaptive Brain Stimulation for Movement Disorders.
Authors: Beudel M, Cagnan H, Little S
Abstract
Deep brain stimulation (DBS) has markedly changed how we treat movement disorders including Parkinson's disease (PD), dystonia, and essential tremor (ET). However, despite its demonstrable clinical benefit, DBS is often limited by side effects and partial efficacy. These limitations may be due in part to the fact that DBS interferes with both pathological and physiological neural activities. DBS could, therefore, be potentially improved were it applied selectively and only at times of enhanced pathological activity. This form of stimulation is known as closed-...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Drug Delivery for Movement Disorders.
Authors: Barua N, Gill S
Abstract
There has been substantial research interest in delivering therapeutic neurotrophic factors directly to the brain for the treatment of Parkinson's Disease (PD) and other movement disorders. Direct infusion of glial cell-line derived neurotrophic factor has been investigated in both pre-clinical models and clinical trials. In this chapter we discuss past and present research investigating the potential of direct drug delivery to the brain for the treatment of PD and other movement disorders.
PMID: 29332088 [PubMed - in process] (Source: Progress in Neurological Surgery)
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Gene Therapy for Parkinson's Disease.
Authors: Sudhakar V, Richardson RM
Abstract
Gene therapy is a clinical tool that may eventually provide therapeutic benefit to patients suffering from movement disorders through a few potential mechanisms: direct correction of the pathogenic mechanism, neuroprotection, neurorestoration or symptom control. The therapeutic mechanism is therefore dependent on knowledge of disease pathogenesis and the required temporal and spatial specificities of gene expression. An additional critical challenge is achieving the most complete transduction of the target structure while avoiding leakage into neighboring regions...
Source: Progress in Neurological Surgery - January 15, 2018 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Epidemiology of Intracranial Gliomas.
Authors: Ostrom QT, Gittleman H, Stetson L, Virk S, Barnholtz-Sloan JS
Abstract
Gliomas are the most common primary intracranial neoplasms, which cause significant mortality and morbidity that is disproportionate to their relatively rare incidence. Many potential risk factors for glioma have been studied to date, but only few provide explanation for the number of brain tumor cases identified. The most significant findings include increased risk due to exposure to ionizing radiation and decreased risk with the history of allergy or atopic diseases. The potential effect of the cellular phone usage has been e...
Source: Progress in Neurological Surgery - December 16, 2017 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Imaging of Intracranial Gliomas.
Authors: Ono Y, Chernov MF, Muragaki Y, Maruyama T, Abe K, Iseki H
Abstract
Combined use of contemporary radiological modalities, particularly integration of structural, metabolic, and functional imaging, provides optimal multifaceted information for detailed characterization of intracranial gliomas. It allows differentiation of the tumor from non-neoplastic pathology, its non-invasive histopathological typing and grading, prediction of patient prognosis and clinical course of the disease, detailed planning of surgical resection or biopsy, critical postoperative assessment of the residual lesion, effective...
Source: Progress in Neurological Surgery - December 16, 2017 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Rationale for Aggressive Resection and General Surgical Principles for Intracranial Gliomas.
Authors: McCutcheon IE, Chernov MF
Abstract
Given the infiltrative nature of gliomas, controversy has long persisted over the value of their aggressive surgical removal. Nevertheless, in recent decades, the balance of opinion in neurosurgical oncology has shifted from a more nihilistic view that led to many patients' receiving stereotactic biopsy or very limited debulking of lesions for tissue diagnosis only, to more extensive tumor resections which relieve mass effect, lower intracranial pressure, reduce accompanying brain edema, and attenuate dependence on steroids. Achieving a clinically significant cyt...
Source: Progress in Neurological Surgery - December 16, 2017 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Virtual Reality Surgical Simulation: Implications for Resection of Intracranial Gliomas.
Authors: Dakson A, Hong M, Clarke DB
Abstract
Surgical simulation has the potential to play important roles in surgical training and preoperative planning. The advent of virtual reality (VR) with tactile haptic feedback has revolutionized surgical simulation, creating a novel environment for residents to learn manual skills without compromising patient safety. This concept is particularly relevant in neurosurgical training where the acquired skill set demands performance of technically challenging tasks under pressure and where the consequences of error are significant. The evolution of VR simulation is di...
Source: Progress in Neurological Surgery - December 16, 2017 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
Neurophysiological Monitoring and Awake Craniotomy for Resection of Intracranial Gliomas.
Authors: Saito T, Tamura M, Chernov MF, Ikuta S, Muragaki Y, Maruyama T
Abstract
Aggressive resection of intracranial gliomas has a positive impact on patients' prognosis, but is associated with a risk of neurological complications. For preservation of brain functions and avoidance of major postoperative morbidity various methods of intraoperative neurophysiological monitoring have been introduced into clinical practice. At present, somatosensory evoked potentials (SSEP), motor evoked potentials (MEP), visual evoked potentials (VEP), brainstem auditory evoked potentials (BAEP), and electrocorticography (EC...
Source: Progress in Neurological Surgery - December 16, 2017 Category: Neurosurgery Tags: Prog Neurol Surg Source Type: research
