Stereotactic and Functional Neurosurgery最新文献

{"title":"Long-Term Ambulatory Intracranial EEG.","authors":"Imran H Quraishi, Lawrence J Hirsch","doi":"10.1159/000548278","DOIUrl":"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 anti-seizure 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 multiday 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 subscalp 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":"1-12"},"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}

{"title":"Contemporary disconnection and neuromodulation treatments for generalized drug-resistant epilepsy: A narrative review and clinical decision-making framework.","authors":"Karim Mithani, Pranjan Gandhi, Yousof Alrumayyan, Puneet Jain, George M Ibrahim","doi":"10.1159/000547924","DOIUrl":"10.1159/000547924","url":null,"abstract":"<p><p>Surgical treatment of generalized drug-resistant epilepsy (DRE), lacking a clearly resectable epileptogenic focus, presents a formidable clinical challenge. Inadequately treated generalized DRE is associated with neurological deficits, impaired neurodevelopment, poor quality of life, and lifelong educational and occupational difficulties. Over the last half-century, various neurosurgical interventions have been introduced for the management of generalized DRE. These include longstanding and well-established disconnection procedures, which have evolved over time to reduce surgical morbidity, as well as more recent options such as neuromodulation through surgically implanted devices. As technological advances and evidence for their use continues to grow, clinical decision-making has become increasingly nuanced. In this article, we review contemporary neurosurgical approaches for managing generalized DRE, including the most common disconnection and neuromodulation-based interventions, and provide a framework to guide patient selection and presurgical counselling at specialized epilepsy centers. We conclude with an overview of current and emerging technological advances in this rapidly evolving field, providing an up-to-date resource for clinicians to inform practice.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-28"},"PeriodicalIF":2.4,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12503669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144875344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pituitary Targeting for Intractable Cancer Pain: A Systematic Review and Current Recommendations.","authors":"Anne Balossier, Ghassen Soussi, Jean Régis","doi":"10.1159/000547889","DOIUrl":"10.1159/000547889","url":null,"abstract":"<p><strong>Background: </strong>Most patients suffering from cancer will face pain during the course of their disease. Pain is a source of major discomfort and alteration of quality of life. Pituitary targeting, initially reported as hypophysectomy, was first proposed to control endocrine cancer. Although this technique did not improve the overall tumoral control, it rapidly showed an interesting effect on cancer pain related to bone metastases. Due to the complications, this technique gradually decreased and finally fell into disuse. Recently, some authors have shown a regained interest in pituitary targeting using a radiosurgical procedure, in order to limit surgical complications, with interesting results. We performed a systematic review of the literature and meta-analysis with the aim of evaluating the outcome and complications of pituitary targeting and determining its current place in the management of cancer pain.</p><p><strong>Summary: </strong>Twenty-four studies were included in this systematic review (700 patients). Nineteen studies reported the results of surgical and 5 studies of stereotactic radiosurgical pituitary targeting. Pain relief was reported in 82.2% and 93.5% for surgery and radiosurgery, respectively. On the long-term, pain relief was maintained in 80.2% and 88.6% for surgery and radiosurgery, respectively. Complications varied among treatment modalities, with diabetes insipidus being the most common complication.</p><p><strong>Key messages: </strong>Pituitary targeting remains an attractive option for refractory cancer-related pain after failure of traditional therapies. Radiosurgery is a promising treatment modality due to its high success rate and reduced risk of complications and should be recommended over surgery whenever possible. Pain relief is presumably related to a neuromodulation mechanism.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":2.4,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144800371","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":"Hippocampal Radiation Exposure and Cognitive Outcomes after Single-Fraction Gamma Knife Radiosurgery for Benign Sellar and Parasellar Lesions: A Prospective Study.","authors":"Cafer Ikbal Gulsever, Altay Sencer, Duygu Dolen Burak, Fatih Koksoy, Dogukan Ozler, Duran Sahin, Deniz Buyukgok, Ilyas Dolas, Pulat Akin Sabanci, Aydin Aydoseli, Yavuz Aras, Levent Demirkol, Rasim Meral, Tugrul Cem Unal","doi":"10.1159/000547709","DOIUrl":"10.1159/000547709","url":null,"abstract":"<p><strong>Introduction: </strong>This study evaluates hippocampal dosimetry and neurocognitive outcomes in patients undergoing Gamma Knife radiosurgery (GKRS) for benign sellar, parasellar, and suprasellar lesions. While hippocampal protection has been well studied in whole-brain radiotherapy, its relevance in stereotactic radiosurgery (SRS) remains underexplored. This study systematically investigates hippocampal radiation dose thresholds and associated neurocognitive outcomes in patients undergoing single-fraction GKRS specifically for benign sellar and parasellar lesions. Although cognitive outcomes after SRS have been previously studied in various contexts, specific hippocampal radiation thresholds and their cognitive impacts in this particular patient population have not been clearly defined.</p><p><strong>Methods: </strong>A prospective analysis was conducted on 41 patients who underwent GKRS, with hippocampal dosimetry assessed using dose-volume parameters (D_min, D_max, D_mean, D40, and D100) following RTOG 0933 contouring protocols. Neurocognitive function was evaluated at baseline and 6 months post-treatment using standardized neuropsychological tests, including assessments of memory, executive function, and emotional well-being. The relationships between hippocampal radiation exposure and cognitive changes were analyzed through correlation and regression models.</p><p><strong>Results: </strong>The mean prescription dose was 12 Gy (range: 10-16 Gy), with a steep dose gradient facilitating hippocampal sparing. Receiver operating characteristic curve analysis identified hippocampal D40 ≥2.5 Gy and D100 ≥2.4 Gy as critical thresholds for neurocognitive decline, and these cutoff values were used in multivariable logistic regression analysis. Significant associations were found between higher hippocampal dose exposure and cognitive decline, particularly in verbal and memory retention domains. A 20% decline in verbal learning (Oktem Verbal Learning Test) was significantly associated with D40 ≥2.5 Gy (OR = 3.04, p = 0.006) and D100 ≥2.4 Gy (OR = 4.3, p = 0.031). Similarly, a 20% decline in memory retention (WMS Immediate Recall) was significantly linked to D40 ≥2.5 Gy (OR = 3.10, p = 0.041) and D100 ≥2.4 Gy (OR = 5.3, p = 0.045). Other factors, including age, gender, education level, and hippocampal volume, were not significantly associated with cognitive decline.</p><p><strong>Conclusion: </strong>This preliminary study suggests that even relatively low-dose hippocampal radiation exposure in GKRS may potentially contribute to memory impairment. These initial findings provide insights into possible hippocampal dose thresholds specifically for single-fraction GKRS in benign lesions. However, larger prospective studies with longer follow-up periods are essential to validate these observations before recommending routine incorporation of hippocampal-sparing strategies into GKRS planning.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-17"},"PeriodicalIF":2.4,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144790120","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":"The Present and Future of Laser Interstitial Thermal Therapy in Epilepsy Surgery.","authors":"Robert E Gross, Hai Sun, Ashley L B Raghu, Arevik Abramyan","doi":"10.1159/000547794","DOIUrl":"10.1159/000547794","url":null,"abstract":"<p><strong>Background: </strong>In the 15 years since the first patient with drug-resistant epilepsy was treated by MR-guided laser interstitial thermal therapy (LITT), it has revolutionized the surgical treatment of epilepsy. Therapeutic targets have ranged from every form of epileptogenic lesion, including mesial temporal sclerosis (MTS), hypothalamic hamartomas (HHs), malformations of cortical development, low-grade epilepsy-associated tumors, and cerebral cavernous malformations (CCM), to MRI-normal epileptogenic zones characterized by stereoelectroencephalography (SEEG), to disconnection surgeries such as corpus callosotomy and even functional hemispherotomy (FH). Many series now support the general effectiveness and safety of LITT for epilepsy, although we are still in the period where increasing experience and technical advances are driving refinement in the therapy. Here, we provide a broad survey of the landscape of LITT for epilepsy and a perspective on future developments.</p><p><strong>Summary: </strong>The largest experience is with stereotactic laser amygdalohippocampotomy for mesial temporal lobe epilepsy (MTLE), leading to seizure freedom (Engel I) in 57% of patients (N = 554), less effective than anterior temporal lobectomy but with significantly improved cognitive outcomes. Seizure-free rates are about 10% higher for MTS, with lower rates in MRI-normal MTLE. The largest experience in epileptogenic lesions is with HH where a pooled analysis found 77% of patients became seizure-free (N = 374), with up to 93% of patients becoming free of gelastic seizures. Experience with other lesions is more limited, with seizure freedom in 59% of patients with focal cortical dysplasias (N = 37), 80% of patients with periventricular nodular heterotopias (N = 39), and 88% of patients with CCMs (N = 39); 54% of patients with cortical tubers achieved Engel I or II outcomes. Outcomes in patients undergoing stereotactic laser corpus callosotomy (N = 82) or FH (N = 6) are similar to the results of open surgery.</p><p><strong>Key messages: </strong>MR-guided LITT is becoming well established as a minimally invasive option for the treatment of drug-resistant epilepsy. While seizure freedom may in some circumstances be less than open resection, it offers improved therapeutic windows and, in some circumstances, provides surgical options where none existed previously. Moreover, it marries well with SEEG to offer a completely minimally invasive option. This combined with the increased therapeutic window and the lower level of surgical complications, pain, and even cost lowers the barrier to a potentially definitive surgical option for patients that have heretofore been reluctant. The future will see increased experience and technical advances in both laser technology and stereotactic delivery driving rapid global spread of LITT as a surgical tool in epilepsy.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-19"},"PeriodicalIF":2.4,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144785359","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":"Stereotactic Spinothalamic Mesencephalic Tractotomy for the Treatment of Cancer Pain in the Neuromodulation Era: Advocacy for the Renaissance of a Forgotten Surgery.","authors":"Jean Régis, Ghassen Souissi, Anne Balossier","doi":"10.1159/000547640","DOIUrl":"10.1159/000547640","url":null,"abstract":"<p><strong>Background: </strong>The radiofrequency unilateral interruption of the spinothalamic tract (STT) at the level of the superior colliculi in the mesencephalon is one of the more ancient functional neurosurgery operations. Based on the literature review, our aim was to consider the potential role of this old intervention in the modern neurosurgical armamentarium against cancer pain taking into account the evolution of the operative technique and the emergence of alternative approaches.</p><p><strong>Summary: </strong>We reviewed the literature in order to analyze the anatomical targeting of the STT, the technical strategies, the efficacy on pain, the morbi-mortality, the comparison of the safety efficacy ratio with other surgical techniques depending on the indications. Among 19 published series, only 4 are reporting only cancer pain patients. Two of these 4 series are reporting an anterior approach. At the level of the superior colliculi, the STT location is quite stable. With the anterior approach, a trajectory parallel to the quadrigeminal plate and a target at 7-8 mm from the midline, the rate of permanent oculomotor palsy is very low. In patients operated under local anesthesia with electrical stimulation of the target area, painful paresthesia due to injury of the medial lemniscus is very rare (min 0, max 6%). The rate of patient with analgesia of the painful area, pain relief, and stop of pain drugs in these conditions is around 80% (min 75%-max 86%) in cancer patients. Early pain recurrences appearing within a month are due to insufficient coagulation. When a morphine pump is not an option, this intervention can transform the comfort of the last days of patients with unilateral drug-resistant pain of the upper part of the body.</p><p><strong>Key messages: </strong>Although very ancient, the stereotactic spinothalamic mesencephalic tractotomy by radiofrequency is turning out to offer a very good safety efficacy for lateralized cancer pain at the upper part of the body in drug-resistant patients with a modest life expectancy. We recommend the young generation of neurosurgeon involved in pain surgery to learn this remarkably effective intervention.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":2.4,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144761397","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":"Stereotactic Focused Ultrasound Mesencephalotomy for the Treatment of Head and Neck Cancer Pain.","authors":"W Jeffrey Elias, Chang-Chia Liu, Divine Nwafor, Patrick H Finan, Mark Quigg, Shayan Moosa","doi":"10.1159/000547639","DOIUrl":"10.1159/000547639","url":null,"abstract":"<p><strong>Introduction: </strong>Historically, stereotactic mesencephalotomy was developed as a \"supraspinal\" cordotomy for cancer and neuropathic pain. Early experiences relieved pain, but the procedure was never widely adopted because of the associated morbidity with midbrain lesioning. Contemporary image-guided lesioning could make this a feasible procedure for cancer patients suffering with pain.</p><p><strong>Methods: </strong>A single-center, nonrandomized, early phase trial was designed to treat patients with severe, refractory pain from head and neck cancer with unilateral MRI-guided focused ultrasound mesencephalotomy. Safety was the primary outcome, but measures of efficacy were assessed with pain intensity and more functional components of pain.</p><p><strong>Results: </strong>A discrete midbrain lesion was created for the 5 patients. All patients with advanced cancer had limited survival of less than 3 months, but they tolerated the procedure and experienced pain relief to different degrees. Two had profound pain relief, one was partial, and two others were very brief. One patient was transiently obtunded and other procedural morbidities were mild: numbness (3), oculomotor disturbance (1), and agitation (1). Electroencephalography, somatosensory evoked potentials, and quantitative sensory testing were obtained when possible.</p><p><strong>Conclusion: </strong>Stereotactic focused ultrasound mesencephalotomy is a modern, image-guided, lesioning technique that may be effective for cancer pain.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":2.4,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12406951/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144733346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrode Tract Oedema in Stereo-Electroencephalography.","authors":"Ming-Sheng Lim, Rayyan AlBaram, Aoife Leonard, Donncha O'Brien, Peter Widdess-Walsh, Ronan Kilbride, Kieron Sweeney","doi":"10.1159/000547449","DOIUrl":"10.1159/000547449","url":null,"abstract":"<p><strong>Introduction: </strong>Stereo-electroencephalography (SEEG) is a safe and effective procedure for the identification of the epileptogenic zone to guide epilepsy surgery. Electrode tract oedema in SEEG is poorly understood. This study reports on its incidence and its clinical and biochemical correlations.</p><p><strong>Methods: </strong>The presence of oedema along the electrode tract on patients after removal of SEEG electrodes was recorded and described. The number of electrodes, duration of implantation, and trend of serum inflammatory markers of patients with and without oedema, and with different extents of oedema were compared.</p><p><strong>Results: </strong>A total of 79.2% of patients and 34.3% of electrodes were associated with oedema. Two radiographic distributions of oedema are described. No differences were found between the number of electrodes, duration of implantation, and the trends of serum inflammatory markers of patients with and without oedema. The trend of the WCC differed between patients who had diffuse compared to localised oedema, but this difference is unlikely to be clinically significant.</p><p><strong>Conclusions: </strong>Radiographic electrode tract oedema is common in SEEG and runs a benign clinical course in our series.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":2.4,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144660244","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}