. 21 In contrast, large and/or irregularly shaped lesions may be more difficult to destroy entirely, but may be amenable to disconnection, whereby pathways that conduct ictal activity from the HH to the rest of the brain are disrupted. 4 , 21 In this case series, we describe lesion morphologies and seizure outcomes in 5 cases involving pediatric patients who underwent laser ablative therapy of HHs at the University of California, San Francisco (UCSF). In all cases, target selection and laser probe placement were performed using an interventional MRI (iMRI) system
Derek G. Southwell, Harjus S. Birk, Paul S. Larson, Philip A. Starr, Leo P. Sugrue and Kurtis I. Auguste
Ashwin Viswanathan, Viraat Harsh, Erlick A. C. Pereira and Tipu Z. Aziz
Cingulotomy has been reported in the literature as a potential treatment option for refractory cancer-related pain. However, the optimal candidates for this intervention and the outcomes are not well characterized. The goal of this study was to review the available literature on cingulotomy, specifically for cancer-related pain.
A search of PubMed, PubMed Central, the Cochrane Library, and MEDLINE was performed to identify all articles discussing cingulotomy for cancer pain. The text strings “cingul*” and “pain” were separated by the Boolean AND operator, and used to perform the query on PubMed. Only studies in which a stereotactic technique was used, as opposed to an open technique, and specifically detailing outcomes for cancer pain were included. For centers with multiple publications, care was taken not to double-count individual patients.
The literature review revealed only 8 unique studies describing outcomes of stereotactic cingulotomy for cancer pain. Between 32% and 83% of patients had meaningful pain relief. The location of the lesion was variable, ranging between 1 cm and 4 cm posterior to the tip of the anterior horn. Although serious adverse events are rare, a decline in focused attention can been seen in the early postoperative period, along with apathy and decreased activity.
For patients with cancer pain with diffuse pain syndromes, head and neck malignancies, and significant emotional distress, cingulotomy may be a safe treatment option with minimal cognitive changes.
Peter C. Gerszten and William C. Welch
✓Percutaneous balloon kyphoplasty has become a widely adopted treatment option for patients with pain due to pathological compression fractures. One potential risk of the procedure is the displacement of tumor into the spinal canal and resulting spinal cord or cauda equina injury during inflation of the balloon prior to polymethylmethacrylate (PMMA) placement. In addition, the presence of any remaining tumor between the PMMA and the fractured cortical bone can lead to suboptimal improvement in stabilization and subsequent pain relief. The authors describe a technique to remove tumor from within the vertebral body (VB) through a percutaneous working channel prior to kyphoplasty balloon inflation and augmentation.
The technique was successfully used in all three patients who had presented with pain, and the pain improved in all three cases. There was no extravasation of PMMA into the spinal canal in any case.
A combined VB tumor debulking and kyphoplasty technique offers the ability to improve the placement of PMMA within the diseased vertebral body, potentially leading to increased safety as well as clinical effectiveness for stabilization of these fractures.
Philip C. Su, Ham-Min Tseng, Hon-Man Liu, Ruoh-Fang Yen and Horng-Huei Liou
Object. The aim of this study was to determine if subthalamotomy is effective in treating advanced Parkinson disease (PD).
Methods. The authors performed microelectrode mapping—guided stereotactic surgery on the subthalamic nucleus in eight patients with PD. Lesioning was performed using radiofrequency heat coagulation and confirmed with magnetic resonance imaging. Three patients who underwent unilateral and four with bilateral subthalamotomy were evaluated for up to 18 months according to the Unified PD Rating Scale (UPDRS). One patient who underwent unilateral subthalamotomy died 6 months postsurgery.
At 3 months into the “off” period after surgery, there were significant improvements in contralateral bradykinesia (p < 0.0002), rigidity (p < 0.0001), tremor (p < 0.01), axial motor features (p < 0.02), gait (p < 0.03), postural stability (p < 0.03), total UPDRS scores (p < 0.03), and Schwab and England scores (p < 0.04). The benefits were sustained at 6, 12, and 18 months, except for the improvement in tremor. At 12 months into the “on” period, significant benefits were present for motor fluctuation (p < 0.04), on dyskinesia (p < 0.006), off duration (p < 0.05), total UPDRS score (p < 0.02), and contralateral tremor (p < 0.05). Benefits for motor fluctuation, off duration, and off-period tremor were lost after the 18-month follow-up period. The levodopa requirement was reduced by 66% for the unilateral and 38% for the bilaterally treated group. Bilateral subthalamotomy offered more benefits than did unilateral surgery for various parkinsonian features in both the on and off periods. Three patients suffered hemiballismus, two recovered spontaneously, and one died of aspiration pneumonia after discontinuation of levodopa.
Conclusions. These findings indicate that subthalamotomy can ameliorate the cardinal symptoms of PD, reduce the dosage of levodopa, diminish complications of the drug therapy, and improve the quality of life.
Kim J. Burchiel
originally described, the procedure has an appropriate and established role in the treatment of TN. Exactly the same can be said for stereotactic radiosurgery for TN. According to the report of Tawk and associates, within 24 months of treatment, half of all their patients with TN treated with GKS experienced pain recurrence. As has been known for some time, there is also a lag in the time interval from GKS treatment to pain relief. This lag and the high rate of pain recurrence after GKS “represent major limiting factors” of the therapy. Ablative therapies for TN, which
) that neurosurgery still represents a potentially useful strategy to augment the management of chronic depression and OCD in a small number of patients.” All of the above supports the use of deep brain stimulators for the treatment of intractable OCD as an alternative to traditional ablative therapies. The presence of “psychic side effects” following psychosurgery needs to be carefully analyzed in the context of complex intractable psychiatric diagnoses. The presence of such side effects following permanent stereotactic anterior capsular lesions creates further
Report of two cases
Caglar Berk and Christopher R. Honey
European study of thalamic stimulation in parkinsonian and essential tremor. J Neurol Neurosurg Psychiatry 66 : 289 – 296 , 1999 Limousin P, Speelman JD, Gielen F, et al: Multicentre European study of thalamic stimulation in parkinsonian and essential tremor. J Neurol Neurosurg Psychiatry 66: 289–296, 1999 17. Louw DF , Burchiel KJ : Ablative therapy for movement disorders. Complications in the treatment of movement disorders. Neurosurg Clin N Am 9 : 367 – 373 , 1998 Louw DF, Burchiel KJ: Ablative therapy for
Jamal M. Taha, Michele A. Janszen and Jacques Favre
in advanced Parkinson's disease. Neurology 51: 850–855, 1998 20. Louw D , Burchiel K : Ablative therapy for movement disorders. Complications in the treatment of movement disorders. Neurosurg Clin North Am 9 : 367 – 373 , 1998 Louw D, Burchiel K: Ablative therapy for movement disorders. Complications in the treatment of movement disorders. Neurosurg Clin North Am 9: 367–373, 1998 21. Lundy DS , Casiano RR , Lu FL , et al : Abnormal soft palate posturing in patients with laryngeal movement disorders. J Voice 10 : 348 – 353 , 1996 Lundy DS
Andrew L. Ko, Alp Ozpinar, Albert Lee, Ahmed M. Raslan, Shirley McCartney and Kim J. Burchiel
T rigeminal neuralgia (TN) is a pain syndrome characterized by severe, paroxysmal, lancinating facial pain. While many patients experience relief with carbamazepine or other drugs, many patients require surgery when their symptoms become refractory to medical therapy, or when they can no longer tolerate the medications. 1 Surgical treatments such as neurectomy have targeted peripheral branches of the nerve external to the skull, and percutaneous ablative therapies have been directed at the gasserian ganglion using techniques such as radiofrequency
Ronald F. Young, Skip Jacques, Rufus Mark, Oleg Kopyov, Brian Copcutt, Allen Posewitz and Francisco Li
91: 68–72, 1999 42. Tasker RR : Ablative therapy for movement disorders. Does thalamotomy alter the course of Parkinson's disease. Neurosurg Clin North Am 9 (2) : 375 – 380 , 1998 Tasker RR: Ablative therapy for movement disorders. Does thalamotomy alter the course of Parkinson's disease. Neurosurg Clin North Am 9(2): 375–380, 1998 43. Tasker RR : Deep brain stimulation is preferable to thalamotomy for tremor suppression. Surg Neurol 49 : 145 – 154 , 1998 Tasker RR: Deep brain