Stereotactic and Functional Neurosurgery最新文献

{"title":"Neurophysiologic Characteristics of the Anterior Nucleus of the Thalamus during Deep Brain Stimulation Surgery for Epilepsy.","authors":"Megan V Ryan, David Satzer, Steven G Ojemann, Daniel R Kramer, John A Thompson","doi":"10.1159/000539398","DOIUrl":"10.1159/000539398","url":null,"abstract":"<p><strong>Introduction: </strong>Anterior nucleus of the thalamus (ANT) deep brain stimulation (DBS) is an increasingly promising treatment option for refractory epilepsy. Optimal therapeutic benefit has been associated with stimulation at the junction of ANT and the mammillothalamic tract (mtt), but electrophysiologic markers of this target are lacking. The present study examined microelectrode recordings (MER) during DBS to identify unique electrophysiologic characteristics of ANT and the ANT-mtt junction.</p><p><strong>Methods: </strong>Ten patients with medically refractory epilepsy underwent MER during ANT-DBS implantation under general anesthesia. MER locations were determined based on coregistration of preoperative MRI, postoperative CT, and a stereotactic atlas of the thalamus (Morel atlas). Several neurophysiological parameters including single unit spiking rate, bursting properties, theta and alpha power and cerebrospinal fluid (CSF)-normalized root mean square (NRMS) of multiunit activity were characterized at recording depths and compared to anatomic boundaries.</p><p><strong>Results: </strong>From sixteen hemispheres, 485 recordings locations were collected from a mean of 30.3 (15.64 ± 5.0 mm) recording spans. Three-hundred and ninety-four of these recording locations were utilized further for analysis of spiking and bursting rates, after excluding recordings that were more than 8 mm above the putative ventral ANT border. The ANT region exhibited discernible features including: (1) mean spiking rate (7.52 Hz ± 6.9 Hz; one-way analysis of variance test, p = 0.014 when compared to mediodorsal nucleus of the thalamus [MD], mtt, and CSF), (2) the presence of bursting activity with 40% of ANT locations (N = 59) exhibited bursting versus 24% the mtt (χ2; p &lt; 0.001), and 32% in the MD (p = 0.38), (3) CSF-NRMS, a proxy for neuronal density, exhibited well demarcated changes near the entry and exit of ANT (linear regression, R = -0.33, p &lt; 0.001). Finally, in the ANT, both theta (4-8 Hz) and alpha band power (9-12 Hz) were negatively correlated with distance to the ventral ANT border (linear regression, p &lt; 0.001 for both). The proportion of recordings with spiking and bursting activity was consistently highest 0-2 mm above the ventral ANT border with the mtt.</p><p><strong>Conclusion: </strong>We observed several electrophysiological markers demarcating the ANT superior and inferior borders including multiple single cell and local field potential features. A local maximum in neural activity just above the ANT-mtt junction was consistent with the previously described optimal target for seizure reduction. These features may be useful for successful targeting of ANT-DBS for epilepsy.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"293-307"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141620963","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":"Gamma Knife Radiosurgery for Third Ventricular Colloid Cysts: A Retrospective Study.","authors":"Amr M N El-Shehaby, Wael A Reda, Khaled M Abdel Karim, Ahmed M Nabeel, Reem M Emad Eldin, Sameh R Tawadros","doi":"10.1159/000535423","DOIUrl":"10.1159/000535423","url":null,"abstract":"<p><strong>Introduction: </strong>Colloid cysts often occur in the third ventricle, and they are considered benign, slowly growing lesions. They commonly present with symptoms of intracranial hypertension and rarely sudden death due to acute hydrocephalus. The management options include cerebrospinal fluid diversion procedure by shunt, endoscopic or transcranial surgical excision, and stereotactic aspiration. Complications associated with excisional procedures make them undesirable to some patients. Stereotactic radiosurgery has emerged as a noninvasive less risky treatment option. To date, there is no clinical series in the literature reporting on this treatment modality. The aim of the study was to determine the efficacy and safety of gamma knife (GK) radiosurgery in the treatment of third ventricular colloid cysts.</p><p><strong>Methods: </strong>This is a retrospective study involving 13 patients with third ventricular colloid cysts who underwent GK radiosurgery. GK radiosurgery was used as a primary treatment in all the patients. The median prescription dose was 12 Gy (11-12 Gy). The cyst volumes ranged from 0.2 to 10 cc (median 1.6 cc).</p><p><strong>Results: </strong>The median follow-up was 50 months (18-108 months). Cyst control was achieved in 100% of the patients. Complete or partial response was observed in 12 patients (92%). Eight patients (62%) had hydrocephalus on imaging at the initial diagnosis. Seven of these patients had VP shunt insertion before GK. One patient required shunt insertion after GK.</p><p><strong>Conclusion: </strong>GK for third ventricular colloid cysts is a promising treatment, regarding its efficacy and safety, to be added to other treatment options. A longer follow-up is required to confirm long-term control.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"33-39"},"PeriodicalIF":1.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139378293","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 Ascension of Ronald Tasker to the Constellation of Stereotactic and Functional Neurosurgery Icons: December 18, 1927-April 19, 2023.","authors":"Osvaldo Vilela-Filho, Alison M Tasker, Andres M Lozano","doi":"10.1159/000534664","DOIUrl":"10.1159/000534664","url":null,"abstract":"","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"58-62"},"PeriodicalIF":1.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138462748","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":"General Algorithm Applicability in Determining DBS Lead Orientation: Adapting 2D and 3D X-Ray Techniques for SenSightTM Leads.","authors":"Stefan Hunsche, Dieter Fedders, Alexandra Hellerbach, Markus Eichner, Jochen Wirths, Till A Dembek, Veerle Visser-Vandewalle, Harald Treuer","doi":"10.1159/000535716","DOIUrl":"10.1159/000535716","url":null,"abstract":"<p><strong>Introduction: </strong>With recent advancements in deep brain stimulation (DBS), directional leads featuring segmented contacts have been introduced, allowing for targeted stimulation of specific brain regions. Given that manufacturers employ diverse markers for lead orientation, our investigation focuses on the adaptability of the 2017 techniques proposed by the Cologne research group for lead orientation determination.</p><p><strong>Methods: </strong>We tailored the two separate 2D and 3D X-ray-based techniques published in 2017 and originally developed for C-shaped markers, to the dual-marker of the Medtronic SenSight™ lead. In a retrospective patient study, we evaluated their feasibility and consistency by comparing the degree of agreement between the two methods.</p><p><strong>Results: </strong>The Bland-Altman plot showed favorable concordance without any noticeable systematic errors. The mean difference was 0.79°, with limits of agreement spanning from 21.4° to -19.8°. The algorithms demonstrated high reliability, evidenced by an intraclass correlation coefficient of 0.99 (p &lt; 0.001).</p><p><strong>Conclusion: </strong>The 2D and 3D algorithms, initially formulated for discerning the circular orientation of a C-shaped marker, were adapted to the marker of the Medtronic SenSight™ lead. Statistical analyses revealed a significant level of agreement between the two methods. Our findings highlight the adaptability of these algorithms to different markers, achievable through both low-dose intraoperative 2D X-ray imaging and standard CT imaging.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"120-126"},"PeriodicalIF":1.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10997254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139466379","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":"Non-Motor Effects of Low-Frequency Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson's Disease: A Systematic Review.","authors":"Kenneth Ong, Franziska Schmidt, Kira Tosefsky, Muhammad Faran, Can Sarica, Christopher R Honey, Fidel Vila-Rodriguez, Stefan Lang","doi":"10.1159/000540210","DOIUrl":"10.1159/000540210","url":null,"abstract":"<p><strong>Introduction: </strong>Deep brain stimulation of the subthalamic nucleus is an effective therapy for the motor symptoms of Parkinson's disease (PD). Typically, stimulation is applied at a high frequency (≥100 Hz) to alleviate motor symptoms. However, the effects on non-motor symptoms can be variable. Low-frequency oscillations are increasingly recognized as playing an important role in the non-motor functions of the subthalamic nucleus. Therefore, it has been hypothesized that low-frequency stimulation of the subthalamic nucleus (<100 Hz) may have a direct effect on these non-motor functions, thereby preferentially impacting non-motor symptoms of PD. Despite important therapeutic implications, the literature on this topic has not been summarized.</p><p><strong>Method: </strong>To understand the current state of the field, we performed a comprehensive systematic review of the literature assessing the non-motor effects of low-frequency stimulation of the subthalamic nucleus in PD. We performed a supplementary meta-analysis to assess the effects of low- versus high-frequency stimulation on verbal fluency outcomes.</p><p><strong>Results: </strong>Our search returned 7,009 results, of which we screened 4,199 results. A total of 145 studies were further assessed for eligibility, and a total of 21 studies met our inclusion criteria, representing 297 patients. These studies were a mix of case reports and control trials. The four clinical outcomes measured were sleep, sensory perception, cognition, and mood. A supplementary meta-analysis of six studies investigating the impact of low-frequency stimulation on verbal fluency did not find any significant results when pooling across subgroups.</p><p><strong>Conclusion: </strong>LFS of the STN may have benefits on a range of cognitive and affective symptoms in PD. However, current studies in this space are heterogeneous, and the effect sizes are small. Factors that impact outcomes can be divided into stimulation and patient factors. Future work should consider the interactions between stimulation location and stimulation frequency as well as how these interact depending on the specific non-motor phenotype.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"401-413"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875957","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 on Gait and Balance of VIM Gamma Knife Radiosurgery in Essential Tremor.","authors":"Valentin Mira, Babette Zwaard, Emmanuelle Boutin, Etienne Guillaud, Axelle Cretol, Jean Régis, Jean-Philippe Azulay, Tatiana Witjas, Marianne Vaugoyeau","doi":"10.1159/000539812","DOIUrl":"10.1159/000539812","url":null,"abstract":"<p><strong>Introduction: </strong>Essential tremor (ET) is the most common movement disorder, characterized by an action tremor in the upper limbs. Neurosurgical techniques targeting the thalamic ventrointermediate nucleus (VIM) including thermocoagulation demonstrated a potential risk for gait and posture worsening. This study evaluates the potential effect of VIM Gamma Knife radiosurgery (GKR) in ET on gait and posture performances.</p><p><strong>Methods: </strong>We conducted a prospective study to quantitatively assess gait and balance in severe ET patients before and 1 year after unilateral GKR. Seventy-three patients were included in this series.</p><p><strong>Results: </strong>First, we confirmed the unilateral GKR efficacy in severe ET patients: global tremor score and impairments in activities of daily living improved, respectively, by 67% and 71.7%. The global gait and posture analysis found no significant differences before and 1 year after GKR. Three patients (4.1%) developed mild to moderate gait and posture impairment with proprioceptive ataxia. All of these AEs were induced by a hyper-response to radiosurgery.</p><p><strong>Conclusions: </strong>Gait and posture performances were not statistically significant at the population. Nevertheless, gait and posture worsened in 4% of patients after GKR, all in the setting of hyper-response. This study shows that GKR may be a safe neurosurgical alternative to improve ADL in a population of patients with TE.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"284-292"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142018662","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":"Erratum.","authors":"","doi":"10.1159/000541606","DOIUrl":"10.1159/000541606","url":null,"abstract":"","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"422"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354212","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":"Combination of or Transition between Deep Brain Stimulation and Responsive Neurostimulation for the Treatment of Drug-Resistant Epilepsy.","authors":"Jimmy C Yang, Henry Skelton, Faical Isbaine, Katie L Bullinger, Abdulrahman Alwaki, Brian T Cabaniss, Jon T Willie, Robert E Gross","doi":"10.1159/000540431","DOIUrl":"10.1159/000540431","url":null,"abstract":"<p><strong>Introduction: </strong>Neuromodulation is an important treatment modality for patients with drug-resistant epilepsy who are not candidates for resective or ablative procedures. However, randomized controlled trials and real-world studies reveal that a subset of patients will experience minimal reduction or even an increase in seizure frequency after neuromodulation. We describe our experience with patients who undergo a second intracranial neuromodulation procedure after unsatisfactory initial response to intracranial neuromodulation.</p><p><strong>Methods: </strong>We performed a retrospective chart review to identify all patients who had undergone deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) or responsive neurostimulation (RNS), followed by additional intracranial neuromodulatory procedures, with at least 12 months of follow-up. Demographic and clinical data, including seizure frequencies, were collected.</p><p><strong>Results: </strong>All patients had temporal lobe epilepsy. Six patients were treated with concurrent ANT DBS and temporal lobe RNS, and 3 patients transitioned between neuromodulation systems. Of the patients treated concurrently with ANT DBS and temporal lobe RNS, 5 of the 6 patients experienced additional reduction in seizure frequency after adding a second neuromodulation system. Of the patients who switched between neuromodulation modalities, all patients experienced further reduction in seizure frequency.</p><p><strong>Conclusions: </strong>For patients who do not experience adequate benefit from initial therapy with ANT DBS or temporal lobe RNS, the addition of a neuromodulation system or switching to a different form of neuromodulation may allow for additional reduction in seizure frequency. Larger studies will need to be performed to understand whether the use of multiple systems concurrently leads to improved clinical results in patients who are initially treatment resistant to neuromodulation.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"345-355"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142475229","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":"Radiofrequency Ablation in the MRI Era: Back to Our Roots - Commentary on Kostiuk: \"Stereotactic Staged Asymmetric Bilateral Radiofrequency Lesioning for Parkinson's Disease\".","authors":"Ludvic Zrinzo","doi":"10.1159/000534796","DOIUrl":"10.1159/000534796","url":null,"abstract":"","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"55-57"},"PeriodicalIF":1.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10866174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138478615","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":"A Systematic Review Comparing Radiofrequency versus Focused Ultrasound Pallidotomy in the Treatment of Parkinson's Disease.","authors":"Jennifer A Guidera, Sravani Kondapavulur, Doris D Wang","doi":"10.1159/000539911","DOIUrl":"10.1159/000539911","url":null,"abstract":"<p><strong>Introduction: </strong>Focused ultrasound (FUS) pallidotomy is a promising new therapy for Parkinson's disease (PD). The efficacy, motor outcomes, and side effects of FUS pallidotomy compared to radiofrequency (RF) pallidotomy are unknown.</p><p><strong>Methods: </strong>We performed a systematic review of the outcomes and side effect profiles of FUS versus RF pallidotomy in patients with PD.</p><p><strong>Results: </strong>Across four RF reports and one FUS report, putative contralateral UPDRS III scores were not significantly different following RF versus FUS pallidotomy. Across 18 RF and 2 FUS reports, the mean failure rate was 14% following RF pallidotomy versus 24% following FUS pallidotomy. Across 25 RF and 3 FUS reports, cognitive deficit was significantly more prevalent following RF pallidotomy (p = 0.004).</p><p><strong>Conclusion: </strong>At present, limited data and heterogeneity in outcome reporting challenges comparisons of FUS and RF pallidotomy efficacy and safety. Available evidence suggests FUS pallidotomy may have broadly similar efficacy and a lower risk of cognitive impairment relative to RF pallidotomy. Standardized reporting of post-lesion outcomes in future studies would improve power and rule out potential confounders of these results.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"325-342"},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037016","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}