Resection and permanent intracranial brachytherapy using modular, biocompatible cesium-131 implants: results in 20 recurrent, previously irradiated meningiomas.

Objective: Effective treatments for recurrent, previously irradiated intracranial meningiomas are limited, and resection alone is not usually curative. Thus, the authors studied the combination of maximum safe resection and adjuvant radiation using permanent intracranial brachytherapy (R+BT) in patients with recurrent, previously irradiated aggressive meningiomas.

Methods: Patients with recurrent, previously irradiated meningiomas were treated between June 2013 and October 2016 in a prospective single-arm trial of R+BT.

Radiosurgery for multiple sclerosis-related trigeminal neuralgia: retrospective review of long-term outcomes.

Objective: The objective of this study was to assess long-term outcomes of facial pain and numbness after radiosurgery for multiple sclerosis (MS)-related trigeminal neuralgia (MS-TN).

Methods: The authors conducted a retrospective review of their Gamma Knife radiosurgeries (GKRSs) to identify all patients treated for MS-TN (1998-2014) with at least 3 years of follow-up. Treatment and clinical data were obtained via chart review and mailed or telephone surveys.

Open-loop deep brain stimulation for the treatment of epilepsy: a systematic review of clinical outcomes over the past decade (2008-present).

OBJECTIVE The field of deep brain stimulation (DBS) for epilepsy has grown tremendously since its inception in the 1970s and 1980s. The goal of this review is to identify and evaluate all studies published on the topic of open-loop DBS for epilepsy over the past decade (2008 to present). METHODS A PubMed search was conducted to identify all articles reporting clinical outcomes of open-loop DBS for the treatment of epilepsy published since January 1, 2008.

Cost of Deep Brain Stimulation Infection Resulting in Explantation.

Background: Deep brain stimulation (DBS) hardware infection is a serious complication, often resulting in multiple hardware salvage attempts, hospitalizations, and long-term antibiotic therapy.

Objectives: We aimed to quantify the costs of DBS hardware-related infections in patients undergoing eventual device explantation.

Methods: Of 362 patients who underwent 530 electrode placements (1 January 2010 to 30 December 2014), 16 (4.

Radiation Necrosis Secondary to Trigeminal Nerve TomoTherapy: A Cautionary Case Study.

New radiation delivery modalities have recently challenged Gamma Knife surgery as the historic gold standard in the treatment of trigeminal neuralgia (TN). TomoTherapy, a relative newcomer, has been approved by the U.S.

Hypothalamic hamartomas: neuropathological features with and without prior gamma knife radiosurgery.

Background: The neuropathological consequences of Gamma Knife radiosurgery (GK) on hypothalamic hamartoma (HH) are unknown.

Objective: In a cohort of patients undergoing surgery for treatment-resistant epilepsy, we compared surgically resected HH tissue from patients without (group I; n = 19) and with (group II; n = 10) a history of GK (median dose 16 Gy to the 50% isodose margin).

Methods: Techniques included thick-section stereology for total nucleated and total neuron cell counts, and thin-section immunohistochemistry.

Long-term radiosurgical control of subtotally resected adult pineocytomas.

Object: The optimal management of pineocytomas remains controversial. Although the value of complete microsurgical removal is well accepted, gross-total resection is not always feasible. Data regarding the role of postoperative adjuvant stereotactic radiosurgery (SRS) for residual disease is limited and conflicting.

Seizure outcome and complications following hypothalamic hamartoma treatment in adults: endoscopic, open, and Gamma Knife procedures.

Object: This study aimed at identifying outcomes with respect to seizures, morbidity, and mortality in adult patients undergoing resective or Gamma Knife surgery (GKS) to treat intractable epilepsy associated with hypothalamic hamartoma (HH).

Methods: Adult patients undergoing surgical treatment for HH-related epilepsy were prospectively monitored at a single center for complications and seizure outcome by using a proprietary database. Preintervention and postintervention data for patients 18 years of age and older, and with at least 1 year of follow-up, were analyzed, with specific attention to seizure control, complications, hormonal status, and death.

Gamma Knife surgery for hypothalamic hamartomas and epilepsy: patient selection and outcomes.

Object: The authors present outcomes obtained in patients who underwent Gamma Knife surgery (GKS) at 1 institution as part of a multimodal treatment of refractory epilepsy caused by hypothalamic hamartomas (HHs).

Methods: Between 2003 and 2010, 19 patients with HH underwent GKS. Eight patients had follow-up for less than 1 year, and 1 patient was lost to follow-up.

Gamma Knife surgery combined with resection for treatment of a single brain metastasis: preliminary results.

Object: Resection and whole-brain radiation therapy (WBRT) have classically been the standard treatment for a single metastasis to the brain. The objective of this study was to evaluate the use of Gamma Knife surgery (GKS) as an alternative to WBRT in patients who had undergone resection and to evaluate patient survival and local tumor control.

Methods: The authors retrospectively reviewed the charts of 150 patients treated with a combination of stereotactic radiosurgery and resection of a cranial metastasis at their institution between April 1997 and September 2009.

Electrical stimulation of the anterior nucleus of thalamus for treatment of refractory epilepsy.

Purpose: We report a multicenter, double-blind, randomized trial of bilateral stimulation of the anterior nuclei of the thalamus for localization-related epilepsy.

Methods: Participants were adults with medically refractory partial seizures, including secondarily generalized seizures. Half received stimulation and half no stimulation during a 3-month blinded phase; then all received unblinded stimulation.

Cranial migration of a baclofen pump catheter associated with subarachnoid hemorrhage: case report.

Objective: Cephalad migration of an indwelling intrathecal catheter within the spinal canal has rarely been described. Cranial subarachnoid hemorrhage (SAH) related to movement of this type of catheter has not been described. We report a case of SAH coincident with the migration of a free fragment of a baclofen pump catheter into the prepontine cistern.

Salvage gamma knife stereotactic radiosurgery for surgically refractory trigeminal neuralgia.

Purpose: To evaluate the clinical outcome of patients with surgically refractory trigeminal neuralgia (TN) treated with rescue gamma knife radiosurgery (GKRS).

Methods And Materials: Seventy-nine patients with typical TN received salvage GKRS between 1997 and 2002 at the Barrow Neurological Institute (BNI). All patients had recurrent pain following at least one prior surgical intervention.

Long-term pain response and quality of life in patients with typical trigeminal neuralgia treated with gamma knife stereotactic radiosurgery.

Objective: The long-term outcome of patients treated with gamma knife radiosurgery (GKRS) for typical trigeminal neuralgia has not been fully studied. We evaluated 185 patients who underwent their first GKRS treatment between 1997 and 2003 at the Barrow Neurological Institute.

Methods: Follow-up was obtained by surveys and review of medical records.

Role of Gamma Knife surgery in the management of pineal region tumors.

Object: Increasingly, radiosurgery is used to treat pineal region tumors, either as a primary treatment or as an adjunct to conventional radiation therapy. The authors report their experience with Gamma Knife surgery (GKS) for the treatment of pineal region tumors.

Methods: The authors retrospectively reviewed the charts of all patients undergoing GKS at their institution between 1997 and 2005.

Microvascular decompression after gamma knife surgery for trigeminal neuralgia: intraoperative findings and treatment outcomes.

Object: The authors sought to determine whether the results of trigeminal microvascular decompression (MVD) are influenced by prior gamma knife surgery (GKS).

Methods: Gamma knife surgery is an established procedure for treating medically intractable trigeminal neuralgia but failures do occur. The authors assessed six patients (two men and four women; mean age 52 years) who experienced pain recurrence after GKS and elected to undergo trigeminal MVD via retrosigmoid craniotomy.

Electrical stimulation of the anterior nucleus of the thalamus for the treatment of intractable epilepsy.

Purpose: Animal studies and sporadic case reports in human subjects have suggested that intermittent electrical stimulation of the anterior nucleus of the thalamus reduces seizure activity. We embarked on an open-label pilot study to determine initial safety and tolerability of bilateral stimulation of the anterior nucleus of the thalamus (ANT), to determine a range of appropriate stimulation parameters, and to begin to gather pilot efficacy data.

Methods: We report an open-label pilot study of intermittent electrical stimulation of the anterior nucleus of the thalamus in five patients (three men, two women; age range, 24-47 years), with follow-up between 6 and 36 months.

Intramedullary histoplasmosis spinal cord abscess in a nonendemic region: case report and review of the literature.

An immunocompetent patient from a nonendemic region developed a rare intramedullary thoracic histoplasmoma. A native Arizonan, with no history of travel to endemic regions, received 3 months of itraconazole for confirmed gastrointestinal histoplasmosis at an outside institution. Two years later she experienced the rapid onset of paraplegia and lost bowel and bladder function.

Gamma knife radiosurgery for recurrent trigeminal neuralgia.

Object: Pain may fail to respond or may recur after initial gamma knife radiosurgery (GKS) for trigeminal neuralgia (TN). The authors examined their experience with performing a second GKS procedure in these patients.

Methods: Twenty-nine patients underwent repeated GKS for TN at our institution between March 1997 and March 2002.

Gamma knife radiosurgery for trigeminal neuralgia associated with multiple sclerosis.

Object: The authors assessed the efficacy and complications from gamma knife radiosurgery (GKS) for multiple sclerosis (MS)-associated trigeminal neuralgia (TN).

Methods: There were 15 patients with MS-associated TN (MS-TN). Treatment involved three sequential protocols, 70 to 90-Gy maximum dose, using a single 4-mm isocenter targeting the ipsilateral trigeminal nerve at its junction with the pons with the 50% isodose.

Physiology and pathophysiology of cortico-basal ganglia-thalamocortical loops: theoretical and practical aspects.

A new theoretical framework is used to analyze functions and pathophysiological processes of cortico-basal ganglia-thalamocortical loops and to demonstrate the hierarchical relationships between various loops. All hierarchical levels are built according to the same functional principle: Each loop is a neural optimal control system (NOCS) and includes a model of object behavior and an error distribution system. The latter includes dopaminergic neurons and is necessary to tune the model to a controlled object (CO).