Stereotactic and Functional Neurosurgery最新文献

{"title":"Cingulotomy for Cancer Pain.","authors":"Valentina Lind, Harith Akram","doi":"10.1159/000548804","DOIUrl":"https://doi.org/10.1159/000548804","url":null,"abstract":"<p><p>Stereotactic anterior cingulotomy is a neurosurgical technique that can offer significant pain relief in patients with refractory cancer pain, particularly in the palliative setting. Despite being described in the 1960s, its use has recently resurged due to limitations of pharmacologic and neuromodulatory therapies in terminally ill patients. The anterior cingulate cortex plays a crucial role in the affective processing of pain, and its disruption through targeted lesioning may reduce suffering without eliminating nociception. This review summarises the historical background, patient selection criteria, surgical approaches, efficacy data, and safety outcomes associated with bilateral anterior cingulotomy for cancer-related pain. Additionally, the Queen Square approach, incorporating MRI-guided targeting and diffusion imaging, is described. Available data support the procedure's short-term efficacy in the majority of patients, with limited cognitive side effects and minimal morbidity. Future directions include network-based targeting, refinement of lesion techniques, and consideration of non-invasive alternatives such as focused ultrasound. Further research is warranted to optimise selection criteria and understand the neural mechanisms underlying pain relief.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-20"},"PeriodicalIF":2.4,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145245293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drezotomy and myelotomy for cancer pain.","authors":"Patrick Mertens, Andréi Brinzeu","doi":"10.1159/000548703","DOIUrl":"https://doi.org/10.1159/000548703","url":null,"abstract":"<p><p>Background When conservative treatment, including intrathecal infusion of pharmacological agents, or even multimodal therapies are not sufficiently effective, if their respective benefits-risks balances are favorable, Drezotomy and myelotomy, ablative surgeries targeting sensory circuits in the spinal cord, may still have a place today for well selected patients. Summary In this review article, the rationale and technical principles and their current potential indications, based on their results published, are described. Drezotomy have been reported effective for topographically limited cancer pain caused by well-localized lesion, in particular if nociceptive and neuropathic components are combined. Currently, the open punctate midline myelotomy is used for patients with intractable visceral cancer pain, abdominal or pelvic, even bilateral. For patients with limited survival, percutaneous myelotomy is recommended, given the less invasive nature of the procedure. However, the technique chosen for myelotomy will ultimately depend on the surgeon's experience and expertise. Key messages In spite of data coming only from case series, DREZotomy and myelotomy, that are technically demanding procedures, can be still useful interventions and discussed for well selected patients suffering from intractable cancer pain.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-19"},"PeriodicalIF":2.4,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145192889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asleep Deep Brain Stimulation for Essential Tremor.","authors":"Tessa A Harland, Shruti Gupta, Matthew Hefner, Jessica Wilden","doi":"10.1159/000548475","DOIUrl":"https://doi.org/10.1159/000548475","url":null,"abstract":"<p><strong>Introduction: </strong>Deep Brain Stimulation (DBS) was approved for Essential Tremor by the Food and Drug Administration (FDA) in 1997. Since that time, technological advancements in implanted hardware and operative technique have changed the landscape of functional neurosurgery. Interventional MRI-guided DBS lead placement is an emerging technique that can be used to treat ET patients, though the data is limited due to the perceived difficulty of direct targeting the ventral intermediate nucleus (VIM) relative to other structures. Here we review the experience of a single surgeon with interventional MRI guided DBS targeting of the VIM in ET patients under general anesthesia in a community setting.</p><p><strong>Method: </strong>We conducted a retrospective chart review of ET patients who underwent DBS under general anesthesia using an MRI-guided ClearPoint surgical technique at Willis-Knighton Health System between 2016 and 2021. Demographics, radial error, procedure details, complications, and clinical outcomes were collected. Clinical outcome measures included medication reduction postoperatively, the Quality of Life in Essential Tremor Questionnaire (QUEST), and the Fahn-Tolsa-Marin tremor rating scale (FTM).</p><p><strong>Results: </strong>A total of 113 ET patients underwent placement of 175 DBS leads. The 2D Radial Error on the was 0.43 ± 0.33 mm with only 2 leads requiring more than one pass. Following DBS placement, 69.2% stopped or reduced medication. There was an average reduction of 76.4% in total FTM score with a mean pre-operative FTM score of 34 and a post-operative FTM score of 8.9 (p <0.001). The QUEST Summary index improved from 47.1 preoperatively to 29.4 post-operatively with an average improvement of 77.8%.</p><p><strong>Conclusion: </strong>Interventional MRI-guided DBS lead placement under general anesthesia is a feasible and effective technique for ET patients that may expand the reach of DBS therapy to patients with advanced age, comorbidities, and/or anxiety regarding traditional, awake surgery.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-29"},"PeriodicalIF":2.4,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How neuromodulation changed the landscape of epilepsy surgery.","authors":"Tatiana von Hertwig Fernandes de Oliveira, Arthur Cukiert","doi":"10.1159/000548581","DOIUrl":"https://doi.org/10.1159/000548581","url":null,"abstract":"<p><strong>Background: </strong>Epilepsy is one of the most prevalent chronic neurological disorders, with approximately 30% of patients not responding to medical treatment. In selected cases, drug-resistant epilepsy can be safely managed with neuromodulation, leading to a significant reduction in disease burden.</p><p><strong>Summary: </strong>Experimental evidence has demonstrated that the primary neuromodulation modalities, vagus nerve stimulation (VNS), deep brain stimulation (DBS), and responsive neurostimulation (RNS), can modulate various brain circuits and reduce epileptic activity by decreasing neuronal hypersynchronization through multiple mechanisms at the molecular, cellular, and network levels. However, clear criteria for selecting among devices, determining optimal stimulation targets, and defining effective parameters to improve outcomes remain elusive.</p><p><strong>Key messages: </strong>Neuromodulation represents a promising treatment strategy for drug-resistant epilepsy. Nevertheless, further research is essential to refine clinical decision-making. In this review, we discuss the evolution of neuromodulation technologies, with a focus on the indications, advantages, disadvantages, and future directions of VNS, DBS, and RNS.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-45"},"PeriodicalIF":2.4,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to letter.","authors":"Matthias Tomschik, Christian Dorfer","doi":"10.1159/000548427","DOIUrl":"https://doi.org/10.1159/000548427","url":null,"abstract":"","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-4"},"PeriodicalIF":2.4,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145138864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary Ethical Considerations in Psychiatric Neurosurgery.","authors":"Justin M Campbell, Brent M Kious, Shervin Rahimpour, Ben Shofty","doi":"10.1159/000548528","DOIUrl":"https://doi.org/10.1159/000548528","url":null,"abstract":"<p><strong>Background: </strong>Psychiatric neurosurgery has been shaped by an ethically complex history and rapid evolution in neurotechnology. In the modern era, there is a growing need to match the accelerating pace of scientific innovation with rigorous, contemporary ethical frameworks that prioritize patient autonomy, safety, and maintaining public trust.</p><p><strong>Summary: </strong>In this article, we review 21st-century approaches to neurosurgery for psychiatric disorders that combine the precision of modern functional neurosurgery with advances in diagnostic and therapeutic neurotechnology. The ethical issues in contemporary psychiatric neurosurgery are multifaceted and evolving, reflecting the intersection of rapid scientific progress, changing societal values, and a controversial past.</p><p><strong>Key messages: </strong>The four core principles of medical ethics-beneficence, nonmaleficence, autonomy, and justice-and their application to psychiatric neurosurgery are discussed in the context of existing and anticipated ethical issues (e.g., post-trial responsibilities in research, informed consent, disparities in access to care). Finally, we explore how technological breakthroughs, coupled with growing market investment and consumer interest in the field, establish a compelling need to develop robust, forward-looking regulatory frameworks that are aligned with these bioethical principles.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-15"},"PeriodicalIF":2.4,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subcortical Structures and Epilepsy.","authors":"Aline Herlopian","doi":"10.1159/000548279","DOIUrl":"https://doi.org/10.1159/000548279","url":null,"abstract":"<p><p>Epilepsy is a network disorder characterized by dynamic interactions between cortical and subcortical circuits that collectively facilitate seizure initiation, propagation, maintenance, and termination. While cortical structures have traditionally dominated epilepsy research, diagnostic evaluation, and therapeutic targets, recent years have witnessed growth in exploring the role of subcortical structures beyond the well-studied limbic system for several decades. Structures such as the thalamus have emerged as critical nodes in epileptic networks, with growing evidence from neuromodulation studies underscoring its critical role in seizure dynamics. This shift reflects a paradigm change from localized cortical focus models to a more comprehensive understanding of distributed cortical-subcortical networks in epilepsy pathophysiology. In this review, we explore different subcortical structures and their involvement in both generalized and focal epilepsies, suggesting that there must be continued research into cortical-subcortical network dynamics. A more profound understanding of these networks holds promise for improving therapeutic strategies, enhancing patient outcomes, and reducing the risk of surgical failure.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-32"},"PeriodicalIF":2.4,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Ambulatory Intracranial EEG.","authors":"Imran H Quraishi, Lawrence J Hirsch","doi":"10.1159/000548278","DOIUrl":"https://doi.org/10.1159/000548278","url":null,"abstract":"<p><strong>Background: </strong>Long-term ambulatory intracranial EEG is beginning to transform epilepsy care by revealing new insights into seizure patterns and treatment responses over the course of months to years. The feasibility of such monitoring was initially demonstrated through a dedicated recording system. Subsequently brain-implanted neurostimulators became available with integrated recording functionality, revealing numerous clinically useful applications.</p><p><strong>Summary: </strong>Chronic intracranial EEG allows long-term characterization of patient events, which can clarify which are epileptic, and also help identify unrecognized or subclinical seizures, which can vastly outnumber reported ones. Longitudinal recordings allow monitoring of epilepsy burden over the course of months to years, including responses to treatments such as neuromodulation and antiseizure medications. Medication efficacy can be assessed in a matter of weeks rather than months. In patients with more than one potential localization, the predominant seizure focus can be identified, enabling further surgical options such as resection. Temporal patterns including circadian and multi-day cycles may be revealed with the potential to enable temporal-specific treatments, seizure forecasts, and seizure warnings. Beyond direct clinical applications, ambulatory intracranial EEG has also opened up a new field of neuroscience in naturalistic environments.</p><p><strong>Key messages: </strong>Long-term intracranial recordings have led to new discoveries about the individualized course of epilepsy and how it responds to treatment. They are clinically useful but are currently limited to patients with specific neurostimulators which are not available worldwide. Current systems allow long-term monitoring with intermittent EEG and/or hourly summary data but do not have continuous EEG availability. Expansion to patients without neurostimulators could provide broader clinical benefit. Scalp and implanted sub-scalp monitoring systems are now entering clinical care and may offer some of the same advantages as intracranial recording systems, although comparisons have not been made.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-20"},"PeriodicalIF":2.4,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SEEG-guided radiofrequency thermocoagulation of the epileptogenic networks: Its utility for both treatment and validation for localizing epileptogenic networks.","authors":"Poodipedi Sarat Chandra, Ramesh Sharanappa Doddamani, Raghavendra Honna, Aiswarya Suresh, Madhavi Tripathi, Ajay Garg, Jasmine Parihar, Manjari Tripathi","doi":"10.1159/000548196","DOIUrl":"https://doi.org/10.1159/000548196","url":null,"abstract":"<p><strong>Introduction: </strong>Stereoelectroencephalography-guided radio-frequency thermo coagulation (SEEG-RFTC) is a minimally invasive technique whereby radiofrequency-thermocoagulation is performed using SEEG electrodes, following recording and stimulation. It helps to disconnect/disrupt or ablate the epileptogenic networks, and provides both therapeutic and diagnostic abilities.</p><p><strong>Methods: </strong>Retrospective study (2016-2024). All underwent comprehensive epilepsy surgery workup (video EEG, MRI, ictal-SPECT, PET, and magnetoencephalography). SEEG was placed using robotic guidance. Recording of habitual seizure following stimulation (to produce seizures) was performed followed by SEEG-RFTC over the seizure onset zone(SOZ) was performed at the bedside, electrodes were then explanted. If seizures were still not, this was followed by surgery over SOZ.</p><p><strong>Results: </strong>61 patients underwent SEEG-RFTC, 41 males. Mean duration of seizures: 11 years; seizure frequency range 1-100/day. As per imaging, 5 had definite lesions, 12- dual substrates (either adjacent or distant), 5- doubtful lesions, 21- non-lesional on MRI, and 9-localization on SPECT/PET/MEG but MRI doubtful, 4-eloquent cortex and 5 had bilateral substrates. Seizure onset zone- frontal-18, temporal-35, insula-3, occipital-4, parietal-1. A total of 406 electrodes implanted, a mean 8.2+3.5/ patient. Mean follow up: 42 + 17.4 months.. About 72% (44/61) responded transiently (mean transient seizure free time- 95+19 days). Of these 29 underwent surgery; 48% had good outcomes (Class I & II). 22% (14/61) had good outcomes with SEEG-RFTC as stand-alone procedure (follow up 28+6.2 months, range 6-32 months). The Class I & I outcomes were 37% in MRI -ve and 53.8% in MRI +ve cases (p<0.01). The transient time in our study did not correlate with good outcomes, but presence or absence of a substrate did. Temporal substrates had better outcomes than extra-temporal (57% vs 47% Class I & II, p<0.01).</p><p><strong>Conclusion: </strong>SEEG-RFTC is a minimally invasive and effective adjuvant to SEEG recording and stimulation, may be done bedside under awake conditions and helps to disrupt/disconnect/ablate the abnormal networks. It may be therapeutic or can strengthen the hypothesis for a later surgical resection.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-21"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Centromedian Nucleus Stimulation on Interictal Scalp EEG Burden in Lennox-Gastaut Syndrome.","authors":"Adithya Sivaraju, James Poe, Hal Blumenfeld, Arthur Cukiert","doi":"10.1159/000548242","DOIUrl":"10.1159/000548242","url":null,"abstract":"<p><strong>Introduction: </strong>Deep brain stimulation (DBS) of the centromedian (CM) thalamic nucleus is a potential therapy for Lennox-Gastaut syndrome (LGS), a severe and drug-resistant epileptic encephalopathy. While long-term seizure outcomes with CM-DBS have been described, its acute electrophysiological effects and predictive value remain uncertain. We examined whether short-term changes in interictal epileptiform discharges (IEDs) following CM-DBS relate to seizure outcomes at 1 year.</p><p><strong>Methods: </strong>Ten patients with LGS underwent CM-DBS implantation. About 1 month post-surgery, each patient had a 1-h scalp EEG. After a 10-min baseline, stimulation began at 1 V for 5 min, increasing in 1 V increments to 5 V or until paresthesias occurred. IEDs were detected automatically (Persyst v14c) and verified by an expert reviewer. Patients were followed for 1 year, with clinical response defined as ≥50% seizure reduction, i.e., responder. Correlations between acute IED change and seizure outcomes were assessed using Spearman's rank correlation.</p><p><strong>Results: </strong>Nine of 10 patients showed reduced IED burden during acute stimulation (31%-100%). At 1 year, 8 were responders and 2 nonresponders. Overall, acute IED reduction did not correlate with seizure outcome (Spearman's ρ = 0.3, p = 0.35). A ≥50% reduction in IED burden was seen in 7 of 7 responders versus 1 of 3 nonresponders, suggesting a nonsignificant trend toward predictive value (p = 0.06).</p><p><strong>Conclusion: </strong>Acute CM-DBS reduced IED burden in most patients with LGS but did not significantly predict long-term seizure outcomes. A trend toward greater IED reduction in responders suggests possible biomarker potential, though findings are preliminary and hypothesis-generating. Limitations include small sample size, high responder rate, and short EEG duration. Larger studies with extended monitoring are needed to clarify the clinical utility of acute EEG changes as predictors of CM-DBS efficacy.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-6"},"PeriodicalIF":2.4,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144969777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}