Robot-assisted stereotactic laser ablation in medically intractable epilepsy: operative technique.

Background: Stereotactic laser ablation offers an advantage over open surgical procedures for treatment of epileptic foci, tumors, and other brain pathology. Robot-assisted stereotactic laser ablation could offer an accurate, efficient, minimally invasive, and safe method for placement of an ablation catheter into the target.

Objective: To determine the feasibility of placement of a stereotactic laser ablation catheter into a brain lesion with the use of robotic assistance, via a safe, accurate, efficient, and minimally invasive manner.

Complications of posterior cranial fossa surgery--an institutional experience of 500 patients.

Background: The complication of the posterior fossa surgery is seldom described in the literature. The purposes of this retrospective study are to draw attention to the potential complications associated with posterior fossa surgery and to critically review the predisposing factors that might influence the complication rate.

Methods: We undertook a 10-year (1992-2002) retrospective study of all posterior fossa surgery performed at LSUHSC.

Trigeminal neuralgia: a modern-day review.

Objective: To review the disorder of trigeminal neuralgia (TN) in the context of previously known data and recent advancements.

Methods: A PubMed search (November 25, 2006) was conducted, with review of existing literature related to this search. Review articles were accessed along with new advancements in diagnosis, pathophysiology, treatment, and prognosis.

Left vagus nerve stimulation for depression: first implantation case post-fDA approval and review of the literature.

Objective: To describe the first case of left vagus nerve stimulation (VNS) following FDA approval and to review this in the context of existing literature.

Methods: A case report of the first patient undergoing VNS post-FDA approval is described. Indications, challenges, post-operative outcomes, and long-term implications are discussed.

The voice-controlled robotic assist scope holder AESOP for the endoscopic approach to the sella.

Objective: To evaluate the feasibility of using a voice-controlled robot Automated Endoscopic System for Optimal Positioning (AESOP) for holding and maneuvering the endoscope in the trans-sphenoidal approach to the pituitary.

Design: To compare the manual approach to the voice-activated robotic scope holder in maneuvering the endoscope and resecting pituitary lesions using a two-handed technique.

Setting: Robotic laboratory at Louisiana State University Health Sciences Center, Shreveport.

Neurosurgical treatment of multiple sclerosis.

Objectives: To describe the role of neurosurgical techniques in treatment of symptoms of multiple sclerosis (MS).

Methods: A review of the existing world literature searching (using PubMed, August 22, 2005) for key words 'multiple sclerosis' and multiple symptoms associated with MS including trigeminal neuralgia, pain (pump and rhizotomy), spasticity, intrathecal pump, hydrocephalus and stimulation (brain and spinal).

Results: In total, 1,404 articles met selection criteria.

Cyclooxygenase-2 expression in brain metastases.

Background: Elevated Cyclooxygenase-2 (COX-2) expression is thought to increase metastatic potential of many tumors. Furthermore, elevated COX-2 expression correlates with radiation resistance in many tumor types. We evaluated whether: (i) the degree of COX-2 expression correlated with either metastatic tumor type or with the presence of necrosis and whether (ii) radiation-resistant tumors (renal cell and melanoma) had higher expression of COX-2 than did relatively radiation-sensitive tumors (breast and lung).

Control of refractory status epilepticus precipitated by anticonvulsant withdrawal using left vagal nerve stimulation: a case report.

Objective: To describe a case of left vagal nerve stimulation (VNS) resulting in immediate cessation of status epilepticus (SE) with good neurological outcome.

Case Description: A 30-year-old man with medically intractable seizures including episodes of SE was successfully treated using left VNS. After requiring discontinuation of phenytoin, valproic acid, carbamazepine, and topiramate because of severe allergic reactions resembling Stevens-Johnson syndrome, the patient required pentobarbital coma along with phenobarbital, tiagabine, and levetiracetam for seizure frequency reduction.

Electroconvulsive therapy for seizure control: preliminary data in a new seizure generation and control model.

Electroconvulsive therapy (ECT) effect upon seizure cessation was studied in five male Wistar rats using a penicillin intracisternal injection model (which did not damage the cranial vault). Animals were observed both clinically and electrographically for seizure development. ECT was applied at varying times following onset of seizure, at varying parameters (frequency, pulsewidth, and duration).

Technical note: preliminary results in development of a novel intracisternal penicillin seizure model in the rat.

In order to develop an intracisternal penicillin rat model of epilepsy, eleven anesthetized male Wistar rats were studied. 5 underwent intracisternal injection of penicillin (doses 150,000-300,000 units) in the prone position, and another 5 underwent intraperitoneal penicillin injection; one died following intracisternal injection, prior to further study. Time between penicillin injection and seizure induction (determined by electroencephalography) was recorded.

Concomitant choroid plexus papillomas involving the third and fourth ventricles: A case report and review of the literature.

Choroid plexus papillomas (CPP) are histopathologically benign and rare central nervous system (CNS) neoplasms arising from the epithelium of the choroid plexus. The most common site of presentation of these lesions is in the fourth ventricle in adults and lateral ventricles in children. Third ventricular CPP are uncommon.

Intracranial fungal granuloma: analysis of 40 patients and review of the literature.

Objective: To describe the characteristics of patients diagnosed with intracranial fungal granuloma (IFG) in the largest reported series to date (to our knowledge).

Methods: A 22-year retrospective, multi-institutional review of 40 patients, aged 16 to 62 years (mean, 40.2 years), was performed in patients with histopathologically confirmed IFG.

Implanted ventricular shunts in the United States: the billion-dollar-a-year cost of hydrocephalus treatment.

Objective: To characterize admissions related to ventricular shunts in the year 2000 in terms of diagnoses, procedures, socioeconomic status, and other related data.

Methods: The Nationwide Inpatient Sample database (year 2000) was analyzed retrospectively. We reviewed 7.

Metastatic lesions involving the sella: report of three cases and review of the literature.

Metastatic cancer must be considered as a possibility for intrasellar masses. Newer treatment modalities, such as gamma knife radiosurgery needs to be explored for these lesions. Three cases of intrasellar metastatic lesions were retrospectively reviewed.

Survival trends in elderly patients with glioblastoma multiforme: resective surgery, radiation, and chemotherapy.

Background: It is appropriate to investigate and to determine survival trends following glioblastoma multiforme treatment using resective surgery, radiation therapy, and/or chemotherapy in patients aged 59 years and higher.

Methods: We retrospectively reviewed 30 elderly patients (> or =59 years old) who were treated for histopathologically confirmed glioblastoma multiforme at our tertiary care institution from 1990 through 2002. All patients were treated with steroids.

Cortical representation of Hering's nerve: a possible anatomical pathway for seizure cessation following electrical stimulation.

Objective: We recently found that Hering's nerve stimulation (HNS) effectively blunts seizure activity. This study characterizes the cortical areas that are activated by HNS.

Methods: Hering's nerve (HN) was stimulated in 3 dogs and 6 pigs, and then the brains of the animals were removed.

The effectiveness of Hering's nerve stimulation in controlling penicillin-induced seizures in the rat is dependent on the amygdala.

Objective: This study tests the hypothesis that the ability of Hering's nerve stimulation (HNS) to blunt seizure activity is dependent on the availability of dopamine in the amygdala.

Methods: In 10 rats, Hering's nerve (HN) on the right side was isolated and placed on an electrode and penicillin was locally placed on each rat's left frontoparietal region to induce seizures. After the initiation of seizures, HN was stimulated.

Discernment of adipose versus nervous tissue: a novel adjunct solution in lipomyelomeningocele surgery.

Objective: To determine a solution capable of discerning adipose versus nervous tissue, to aid in surgical separation of the adipose tissue which appears to be visually indistinguishable from nervous tissue in lipomyelomeningoceles (LMMs).

Methods: The following solutes (in normal saline) were investigated, both at 25 and 37 degrees C: beta-carotene, vitamin D, vitamin E, lecithin, hydrogen peroxide, lipase, protease, hyaluronidase, partially purified collagenase, purified collagenase, trypsin, trypsin plus purified collagenase and non-solute-containing saline (control). Each solution was applied to a pediatric lipoma to determine gross effects over a period of approximately 30 min.

Ninth cranial nerve stimulation for epilepsy control. Part 2: surgical feasibility in humans.

Objective: To determine the anatomical and surgical feasibility of placement of a stimulator around the nerve of Hering (HN; a branch of cranial nerve nine). We previously determined the success of HN stimulation in controlling epileptiform activity in a canine model study. The present study assessed the ability to extrapolate the ease of surgical dissection and surrounding anatomy to humans.

Ninth cranial nerve stimulation for epilepsy control. Part 1: efficacy in an animal model.

Objective: To characterize the effects of stimulation of the nerve of Hering (HN; cranial nerve nine) in controlling seizure activity using a canine model.

Methods: Using penicillin applied topically to a region of the cerebral cortex, 16 seizure-type continuous epileptiform discharges were generated. Ten specimens of HN (five left-sided and five right-sided) were dissected from the cervical region in five dogs and stimulated at varying parameters to determine the effects in controlling epileptiform activity.