Thalamotomy as a treatment option for tremor after ineffective deep brain stimulation.

Background: As the number of deep brain stimulation (DBS) surgeries increases, complications from malpositioned electrodes, tolerance to stimulation and loss of efficacy have also increased. Our objective was to assess thalamotomy as a salvage treatment option after ineffective DBS.

Methods: A retrospective chart analysis of patients who underwent ipsilateral stereotactic thalamotomy after an ineffective ventrointermediate nucleus DBS procedure was undertaken.

A randomized comparison of thalamic stimulation and lesion on self-paced finger movement in essential tremor.

Deep brain stimulation (DBS) and ablation (thalamotomy) of the motor thalamus reduce tremor and improve function of the contralateral hand in patients with essential tremor (ET). Neuroimaging and electrophysiological evidence suggest that unlike a focal lesion, high frequency stimulation affects widespread neural networks that include those involved in motor timing. The purpose of this pilot study was to compare the effects of thalamic stimulation and lesion on the timing of simple, self-paced finger movements in patients with ET.

Precision and accuracy of stereotactic targeting in patients undergoing repeat stereotactic surgery.

Background/aims: Accurate and precise stereotactic targeting is crucial in obtaining the best outcome for patients undergoing functional neurosurgical procedures.

Methods: We calculated the precision and accuracy of stereotactic targeting in 20 consecutive patients who underwent repeat stereotactic surgery from January 2001 to December 2007 at one institution. Two sets of target coordinates were calculated for each patient undergoing repeat surgery from their magnetic resonance images and using Stealth Station and Framelink software.

Sensitivity of high-resolution three-dimensional magnetic resonance angiography and three-dimensional spoiled-gradient recalled imaging in the prediction of neurovascular compression in patients with hemifacial spasm.

Object: Hemifacial spasm is a clinical syndrome caused by vascular compression of the facial nerve in the cerebellopontine angle, which can be relieved by surgical intervention. Advances in medical imaging technology allow for direct visualization of the offending blood vessels in hemifacial spasm and similar conditions (such as trigeminal neuralgia). The utility of high resolution 3D MR angiography and 3D spoiled-gradient recalled (SPGR) imaging sequences for surgical decision-making in hemifacial spasm, as measured by sensitivity, specificity, and positive and negative predictive values, has not been previously determined.

Reducing hardware-related complications of deep brain stimulation.

Background: Deep brain stimulation (DBS) is used increasingly worldwide for the treatment of Parkinson's disease, dystonia, tremor and pain. As with any implanted system, however, DBS introduces a new series of problems related to its hardware. Infection, malfunction and lead migration or fracture may increase patient morbidity and should be considered when evaluating the risk/benefit ratio of this therapy.

Surgical management of intracranial cavernous malformations: the Louisiana State University Health Sciences Center, Shreveport experience.

Intracranial cavernous malformations are vascular anomalies consisting of endothelium-lined caverns filled with blood at various stages of thrombosis and organized and separated by a collagenous stroma devoid of mature vessel wall elements. They represent a clinical challenge both in diagnosis and management due to the variety of presenting symptoms and neuroradiological features. This study analyzes the clinical manifestations and surgical outcomes in 16 patients with cavernous malformations who were treated surgically at the Louisiana State University Health Sciences Center in Shreveport.

Assessment of pain control, quality of life, and predictors of success after gamma knife surgery for the treatment of trigeminal neuralgia.

Object: There are various surgical treatment alternatives for trigeminal neuralgia (TN), but there is no single scale that can be used uniformly to assess and compare one type of intervention with the others. In this study the objectives were to determine factors associated with pain control, pain-free survival, residual pain, and recurrence after gamma knife surgery (GKS) treatment for TN, and to correlate the patients' self-reported quality of life (QOL) and satisfaction with the aforementioned factors.

Methods: Between the years 2000 and 2004, the authors treated 81 patients with medically refractory TN by using GKS.

Factors influencing outcome in intracerebral hematoma: a simple, reliable, and accurate method to grade intracerebral hemorrhage.

Background: Intracerebral hemorrhage (ICH) is a major public health problem. This subset of stroke often coexists with other serious medical problems such as hypertension, diabetes, and obesity. Management of hemorrhagic stroke is controversial and there is no standardized system for assessing presentation and predicting outcome of this disease.

Bilateral reversible deafness after surgery for unilateral epidermoid tumor: an unusual complication: case report.

Objective And Importance: We present an unusual complication of bilateral hearing loss after surgery for unilateral epidermoid tumor situated at the right pontocerebellar junction. The neurosurgeon must know the possible causes of this catastrophic complication and should take every possible measure to avoid it.

Clinical Presentation: A 43-year-old male patient presented with progressive hearing loss in the right ear.

Delineation of lateral tentorial sinus with contrast-enhanced MR imaging and its surgical implications.

Background And Purpose: The lateral tentorial sinus (LTS) has not been well described in the imaging literature. The aim of this study was to investigate the value of MR imaging in assessing the LTS, which may provide guidance for preoperative planning.

Methods: Fifty-five adult patients underwent MR imaging of the brain.

Neuroepithelial cysts presenting with movement disorders: two cases.

Background: The authors present two cases of movement disorders caused by neuroepithelial cysts and highlight their management. Neuroepithelial cysts are ependymal or epithelial lined fluid collections of unknown etiology within the central nervous system parenchyma with no obvious ventricular or subarachnoid connection. Most cysts are asymptomatic, however, some present with seizures, mass effect, or rarely with movement disorders.

The treatment of trigeminal neuralgia in patients with multiple sclerosis using percutaneous radiofrequency rhizotomy.

Background: Trigeminal neuralgia (TN) has a higher incidence among patients with multiple sclerosis (MS) than in the general population. This cohort of MS patients with TN presents a series of management challenges including poor tolerance of antineuralgic medications and occasional bilateral presentation. We analyzed our surgical series of MS patients presenting with TN who were treated with percutaneous radiofrequency rhizotomy to estimate the success, failure and recurrence rate of this procedure for those patients.

Regulation of aquaporin-4 in a traumatic brain injury model in rats.

Object: Aquaporin-4 (AQP4) plays a significant role in the regulation of brain water homeostasis. In this study the authors investigated the regulation of AQP4 following a focal cortical contusion injury in rats.

Methods: Thirty-three adult male Wistar rats received a focal cortical contusion of the parietal cortex.

Thalamic deep brain stimulation for the treatment of tremor due to multiple sclerosis: a prospective study of tremor and quality of life.

Object: In several studies a significant reduction in tremor after thalamic deep brain stimulation (DBS) has been reported among patients with multiple sclerosis (MS). It has not been determined if this results in an improved quality of life. In this study the authors prospectively evaluated the effects of thalamic DBS on tremor and quality of life.

Percutaneous biopsy through the foramen ovale: a case report.

A 59-year-old man presented with an intracranial mass that involved the cavernous sinus. It was biopsied percutaneously through the foramen ovale and the diagnosis of meningioma was established. The literature was reviewed for the employment of similar procedures and the potential benefits of this technique explored.

Resolution of cerebral vasospasm with trapidil; an animal model.

Cerebral vasospasm and rebleeding are important clinical phenomena associated with a high mortality rate. Therefore, any promising finding in the laboratory deserves assessment in clinical practice. The present study was designed to examine the possible effects of trapidil on the basilar artery of the rabbit through a cerebral vasospasm model.

A metaanalysis comparing the results of pallidotomy performed using microelectrode recording or macroelectrode stimulation.

Object: There is an active debate regarding whether pallidotomy should be performed using macroelectrode stimulation or the more sophisticated and expensive method of microelectrode recording. No prospective, randomized trial results have answered this question, although personnel at many centers claim one method is superior. In their metaanalysis the authors reviewed published reports of both methods to determine if there is a significant difference in clinical outcomes or complication rates associated with these methods.

Bilateral thalamic deep brain stimulation for the treatment of head tremor. Report of two cases.

Isolated head tremor is rare, but can be disabling. The authors' experience with the treatment of limb tremor due to essential tremor led them to consider using bilateral thalamic deep brain stimulation (DBS) in two patients presenting only with disabling head tremor. One patient exhibited no peripheral tremor and the other displayed only a slight upper-limb tremor.