Lessons Learned from Open-label Deep Brain Stimulation for Tourette Syndrome: Eight Cases over 7 Years.

Background: Deep brain stimulation (DBS) remains an experimental but promising treatment for patients with severe refractory Gilles de la Tourette syndrome (TS). Controversial issues include the selection of patients (age and clinical presentation), the choice of brain targets to obtain optimal patient-specific outcomes, and the risk of surgery- and stimulation-related serious adverse events.

Methods: This report describes our open-label experience with eight patients with severe refractory malignant TS treated with DBS.

Deep brain stimulation in Tourette's syndrome.

A 48-year-old man with severe, lifelong Tourette's syndrome (TS) characterized by forceful self-injurious motor tics and obsessive-compulsive disorder was treated with bilateral deep brain stimulation (DBS). The decision to treat was based on his progressive neurological impairment (left sided weakness secondary to spinal cord injury) because of his relentless, violent head jerks. Electrodes were implanted at the level of the medial part of the thalamus (centromedian nucleus, the substantia periventricularis, and the nucleus ventro-oralis internus).

Carbamylated erythropoietin reduces radiosurgically-induced brain injury.

Gamma knife radiosurgery is an attractive noninvasive treatment of brain tumors and vascular malformations that minimizes collateral tissue damage. However, exposure of normal tissue to even low-dose radiation triggers a cascade of acute and chronic injury and potentially significant morbidity and mortality. Because many irradiated patients now survive for years, identifying methods to prevent radiotherapy-induced collateral tissue damage is a major focus of current research.

Malignant rhabdoid tumor in a pregnant adult female: literature review of central nervous system rhabdoid tumors.

Rhabdoid tumors of the central nervous system are uncommon, aggressive childhood malignancies. The 13 described adult cases comprise both primary CNS tumors and malignant transformation of previously existing gliomas, meningiomas, and astrocytomas. Central nervous system rhabdoid lesions of adults have been diagnosed as primary malignant rhabdoid tumors, atypical teratoid/rhabdoid tumors, and more recently, rhabdoid glioblastomas.

Patterns of functional magnetic resonance imaging activation in association with structural lesions in the rolandic region: a classification system.

Object: Functional magnetic resonance (fMR) imaging of the motor cortex is a potentially powerful tool in the preoperative planning of surgical procedures in and around the rolandic region. Little is known about the patterns of fMR imaging activation associated with various pathological lesions in that region or their relation to motor skills before surgical intervention.

Methods: Twenty-two control volunteers and 44 patients whose pathologies included arteriovenous malformations (AVMs; 16 patients), congenital cortical abnormalities (11 patients), and tumors (17 patients) were studied using fMR imaging and a hand motor task paradigm.

Image registration and calculation of a biologically effective dose for multisession radiosurgical treatments. Technical note.

The purpose of this study was to develop techniques for registering image sets associated with staged or multifraction radiosurgical treatments of large targets with the Leksell gamma knife to transform shot coordinates between treatment sessions and produce cumulative dose distributions and to investigate the theoretical biological effects of such protracted treatments by means of such concepts as the linear-quadratic model and biologically effective dose. An image registration technique based on normalized mutual information was adapted to produce one fused-image study from an imaging series acquired during distinct treatment sessions. A spreadsheet computer program was developed to determine coordinate transformations between the associated stereotactic coordinate systems based on digitized coordinates of fiducial markers appearing on the fused images.

The neuron doctrine, the mind, and the arctic.

The late 19th century and early 20th century represent an era of significant progress and important discoveries. Explorers of unknown continents interacted with pioneers of neuroscience, including the founders of the neuron doctrine, which asserted that nerve tissue was composed of individual cells that were genetic, anatomic, functional, and trophic units. Fridtiof Nansen (1861-1930), an arctic explorer and a cofounder of the neuron doctrine, knew Sigmund Freud (1856-1939), a neuroscientist and the founder of psychoanalysis, as well as Harvey Cushing (1869-1939), the father of modern neurosurgery.

Neurosarcoidosis presenting as hypopituitarism and a cystic pituitary mass.

We report a young woman with clinical hypopituitarism and systemic sarcoidosis involving the lung, gastrointestinal tract, and peripheral lymph nodes. Laboratory evaluation confirmed that cortisol, thyroid indices, insulin-like growth factor 1, follicle-stimulating hormone, luteinizing hormone, and estradiol levels were low, with a normal prolactin. Magnetic resonance imaging revealed a large cystic pituitary lesion compressing the optic chiasm and exhibiting rim but not hypothalamic enhancement.

Detection of nerve rootlet avulsion on CT myelography in patients with birth palsy and brachial plexus injury after trauma.

Objective: Recent advances in neurosurgical treatment of traumatic and birth-related brachial plexus injuries require differentiation of preganglionic nerve rootlet avulsion from postganglionic lesions. The purpose of this study was to evaluate the efficacy of thin-section high-resolution CT myelography for revealing cervicothoracic nerve rootlet avulsion in patients with brachial plexus injuries before surgery.

Materials And Methods: We evaluated eight patients with posttraumatic or birth-related brachial plexus injury on cervical plain film myelography and high-resolution CT myelography before surgical exploration and repair.

Severe disturbances in speech, swallowing, and gait following stereotactic infrathalamic lesions in Gilles de la Tourette's syndrome.

A 40-year-old man with severe Gilles de la Tourette's syndrome characterized by forceful self-injurious motor tics, coprolalia, and obsessive-compulsive disorder had bilateral anterior cingulotomies and bilateral infrathalamic lesions placed stereotactically during two neurosurgical procedures. During the second procedure, the patient acutely developed a marked dysarthria. Postoperatively, he manifested a severe gait disturbance with postural instability, bradykinesia, axial rigidity, micrographia, and a profound swallowing disorder.

False lateralization by surface EEG of seizure onset in patients with temporal lobe epilepsy and gross focal cerebral lesions.

Medically intractable temporal lobe seizures developed in 3 patients with radiological and clinical evidence of a gross focal cerebral lesion acquired early in life. All had bilateral independent epileptogenic discharges from the lateral and inferomesial regions of both hemispheres. Scalp and sphenoidal electroencephalographic (EEG) recordings suggested that the seizures originated from the side contralateral to the known cerebral lesion.

[Integration of digital angiography, magnetic resonance, x-ray computed tomography and positron emission tomography in stereotaxy].

Consecutively to drastic changes which occurred in cerebral imagery techniques, we have developed a stereotactic apparatus and system based on the integration of several new techniques allowing visualisation of the brain: tomodensitometry (TDM), digital subtraction angiography (DSA), magnetic resonance (MR) and positron emission tomography (PET). TDM, DSA and MR can be performed in stereotactic conditions with the apparatus in situ. They give the computer the anatomic references necessary for all calculations.

Combined use of digital subtraction angiography and MRI for radiosurgery and stereoencephalography.

The authors report their experience with the combined use of digital subtraction angiography (DSA) and magnetic resonance imaging (MRI) for the stereotactic placement of intracerebral electrodes in epilepsy and for the radiosurgical treatment of otherwise inoperable arteriovenous malformations of the brain. Both imaging techniques, when used in conjunction, have been found most useful and complementary. For deep electrode placement, they permit optimal visualization of the cerebral structures to be reached by the electrode array while allowing the avoidance of vessels in the vicinity.

Stereotactic external beam calculations for radiosurgical treatment of brain lesions.

Radiosurgical techniques are becoming increasingly popular for the selective destruction of brain lesions. To ensure precision in the procedure, set-up and treatment of lesions in this manner, we have adopted standard stereotactic methods to allow one to calculate accurately the absorbed dose and also to preserve accuracy in locating the target site in three dimensions. At McGill University, radiosurgery is performed using the dynamic technique, which utilizes the concurrent rotation of both the 10-MV photon beam linear accelerator (from 30 to 330 degrees) and the patient couch (from 75 to -75 degrees) about a common point centered on the target within the lesion.

Physical aspects of dynamic stereotactic radiosurgery.

Dynamic stereotactic radiosurgery is a radiosurgical technique based on a medium-energy isocentric linear accelerator and a stereotactic frame. The technique uses concurrent and continuous rotations of both the gantry (300 degrees, from 30 to 330 degrees) and the couch (150 degrees, from 75 to -75 degrees). It gives a uniform dose (+/- 5%) within the target volume and dose fall-offs outside the target volume comparable to those obtained from presently known radiosurgical techniques.