Stereotactic and Functional Neurosurgery最新文献

{"title":"Long-Term Effects of Spinal Cord Stimulation on Pain in Postherpetic Neuralgia.","authors":"Egor D Anisimov, Oleg M Andrushkevich, Vidzhai M Dzhafarov, Evgenia V Amelina, Jamil A Rzaev, Konstantin V Slavin","doi":"10.1159/000542138","DOIUrl":"10.1159/000542138","url":null,"abstract":"<p><strong>Introduction: </strong>Postherpetic neuralgia (PHN) is a pain syndrome that develops within few months after the acute herpetic outbreak. The pain may be accompanied by specific cutaneous signs in the distribution of affected dermatomes and feel unbearable reaching up to 9-10/10 on visual analog scale (VAS). Despite the introduction of new medications, drug resistance develops in at least 50% of cases. Neuromodulation techniques such as spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS) are considered as ones of the last resorts for PHN treatment, especially in pharmacoresistant patients. Recently, several studies with limited number of cases have shown high efficiency of neuromodulation (regression of pain syndrome in more than 82% of cases) after SCS in PHN patients, but these findings require further confirmation and have not been supported by large RCTs.</p><p><strong>Methods: </strong>Initially, 32 patients diagnosed with chronic drug-resistant PHN underwent a trial of SCS. Based on the trial results, a decision was made whether to implant a permanent SCS system. The condition of all patients implanted with SCS system was assessed using the VAS, SF-36, Patient Global Impression of Change (PGIC), and Medicine Quantification Scale, version III (MQS) questionnaires before the surgery and in the long-term follow-up. We also conducted systematic follow-up of patients who did not pass the test stimulation stage, using them as a control group to track the levels of pain. The hypothesis of normal distribution for quantitative values was tested using Shapiro-Wilk tests.</p><p><strong>Results: </strong>During the trial period, tonic spinal stimulation was effective in 16 out of 32 (50%) patients with drug-resistant PHN. Among 14 patients with implanted stimulators, a significant pain reduction (more than 50% from the baseline) was observed in 10 patients (71.4%). The pain level in patients with a tonic SCS was statistically lower than in patients receiving conservative therapy. For the entire group of patients with implanted SCS, a significant improvement was also observed in results of SF-36, PGIC, and MQS.</p><p><strong>Conclusion: </strong>Our clinical series demonstrates that tonic SCS was effective in 50% of patients with refractory PHN undergoing SCS trial. Significant improvement in pain control obtained during the long-term follow-up in patients treated with tonic SCS improves the quality of life and reduces the need for analgesic medications.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"35-41"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142688468","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":"Detailed Images of Deep Brain Stimulation Leads Using Micro-CT.","authors":"Thomas Billoud, Peter Christoph Reinacher, Moritz Weigt, Dominik von Elverfeldt, Theo Demerath, Martin Pichotka","doi":"10.1159/000542015","DOIUrl":"10.1159/000542015","url":null,"abstract":"<p><strong>Introduction: </strong>One of the challenges in directional deep brain stimulation (DBS) is to determine the orientation of implanted electrodes relative to targeted regions. Post-operative images must be aligned with a model of the implanted lead, usually a computer-based model provided by the manufacturer. This paper shows that models can alternatively be obtained by capturing images of individual leads using micro-CT, a high-resolution CT technique. Contrary to computer-aided design models, lead models generated this way provide realistic X-ray contrast and finer details.</p><p><strong>Methods: </strong>We scanned DBS leads from various vendors using a Bruker SkyScan 1276 micro-CT system. To reduce beam-hardening artefacts, samples were scanned at maximum X-ray tube voltage (100 kV) and with copper filtering. Images were made publicly available for download and 3D visualisation.</p><p><strong>Conclusion: </strong>Detailed images of single DBS leads can be generated using standard micro-CT systems. Their use as reference models could improve lead orientation algorithms, in particular those dedicated to X-ray modalities. Furthermore, the possibility to share models online could broaden access for clinical research.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"69-74"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142628582","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":"Subthalamic Deep Brain Stimulation under General Anaesthesia for Parkinson's Disease: Institutional Experience and Outcomes.","authors":"Pedro Roldán, Alejandra Mosteiro, Jordi Rumià Arboix, Daniel Asín, Almudena Sánchez-Gómez, Francesc Valldeoriola, Marta García-Orellana, Nicolás de Riva, Ricard Valero","doi":"10.1159/000542791","DOIUrl":"10.1159/000542791","url":null,"abstract":"<p><strong>Introduction: </strong>Direct targeting in deep brain stimulation (DBS) has remarkably impacted the patient's experience throughout the surgery and the overall logistics of the procedure. When the individualised plan is co-registered with a 3D image acquired intraoperatively, the electrodes can be safely placed under general anaesthesia. How this applies to a general practice scenery (outside clinical trials and in a moderate caseload centre) has been scarcely reported.</p><p><strong>Methods: </strong>Prospective single-centre study of patients treated with asleep subthalamic DBS for Parkinson's disease between January 2021 and December 2022. Clinical, motor, medication-dependence, and quality-of-life outcomes were evaluated after optimal programming (6 months). Wilcoxon test was used to compare pre- versus post-repeated measures. Surgical-related parameters were also analysed.</p><p><strong>Results: </strong>Eighty-nine patients primarily operated for DBS were included in the study. Intraoperative electrode replacement was not necessary. Mean surgical duration was 217 (SD 44) minutes, including the implantation of the generator; and mean length of stay was 3 (SD 1) days. There was one surgical-related complication (delayed infection). Significant and clinically relevant improvement was seen in UPRS III (mean decrease 62%) (p < 0.001) and PDQ-8 (50% increase) (p < 0.001) after 6 months. Daily doses of medication were decreased by a mean of 68%, p < 0.001).</p><p><strong>Conclusion: </strong>DBS can be safely performed under general anaesthesia in a pragmatic clinical environment, provided a multidisciplinary committee for patient selection and a dedicated surgical and anaesthetic team are available. The effectiveness in ameliorating motor symptoms, the ability to reduce the drug load, and the improvement in quality of life demonstrated in clinical trials could be reproduced under more generalised conditions as in our centre. The need for a team learning curve and the progressive evolution in, and adaptation to, trajectory planning software, anaesthetic management, intraoperative imaging, DBS device upgrades, and programming schemes should be contemplated in the transition process to direct targeting.</p><p><strong>Introduction: </strong>Direct targeting in deep brain stimulation (DBS) has remarkably impacted the patient's experience throughout the surgery and the overall logistics of the procedure. When the individualised plan is co-registered with a 3D image acquired intraoperatively, the electrodes can be safely placed under general anaesthesia. How this applies to a general practice scenery (outside clinical trials and in a moderate caseload centre) has been scarcely reported.</p><p><strong>Methods: </strong>Prospective single-centre study of patients treated with asleep subthalamic DBS for Parkinson's disease between January 2021 and December 2022. Clinical, motor, medication-dependence, and quality-of-life outcomes were evaluated ","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"102-110"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11965811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740517","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":"Single Surgeon DBS Surgeries Can Also Be Optimised to Two a Day.","authors":"Erlick A C Pereira, Teresa Scott, Audrey Tan","doi":"10.1159/000543393","DOIUrl":"10.1159/000543393","url":null,"abstract":"","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"124-125"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923165","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":"Reply to Pereira et al.: Delivering High-Volume, High-Quality and Cost-Effective DBS Surgery.","authors":"Ludvic Zrinzo, Harith Akram, Marie T Krüger","doi":"10.1159/000543553","DOIUrl":"10.1159/000543553","url":null,"abstract":"","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"145-146"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024876","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":"Phantom Safety Assessment of 3 Tesla Magnetic Resonance Imaging in Directional and Sensing Deep Brain Stimulation Devices.","authors":"Riccardo Ludovichetti, Clement T Chow, Sriranga Kashyap, Ian Connell, Benson Yang, Simon J Graham, Gavin Elias, Brendan Santyr, Asma Naheed, Diego Martinez, Michael Colditz, Jürgen Germann, Artur Vetkas, Kâmil Uludağ, Andres M Lozano, Alexandre Boutet","doi":"10.1159/000542725","DOIUrl":"10.1159/000542725","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Magnetic resonance imaging (MRI) is both a crucial clinical and research tool for patients with deep brain stimulation (DBS) devices. However, safety concerns predominantly related to device heating have limited such imaging. Rigorous safety testing has demonstrated that scanning outside of vendor guidelines may be both safe and feasible, unlocking unique opportunities for advanced imaging in this patient population. Currently, however, 3T MRI safety data including advanced MRI sequences in novel directional and sensing DBS devices is lacking.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;An anthropomorphic phantom replicating bilateral DBS system was used to assess the temperature rise at the electrode tips, implantable pulse generator, and cranial loop during acquisition of routine clinical sequences (three dimensional [3D] T1, GRE T2*, T2 FSE) and advanced imaging sequences including functional MRI (fMRI), arterial spin labelling (ASL), and diffusion weighted imaging (DWI). Measures of radiofrequency exposure (specific absorption rate [SAR] and root-mean square value of the MRI effective component of the radiofrequency transmission field [B1+rms]) were also recorded as an indirect measure of heating. Testing involved both a new directional and sensing DBS device (Medtronic: B30015 leads and Percept PC neurostimulator) and a previous-generation DBS device (Medtronic: 3,387 leads and Percept PC neurostimulator) in combination with a state-of-the-art (Siemens MAGNETOM Prisma) and a previous-generation (GE Signa HDxt) 3T MRI scanner.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;On the state-of-the-art 3T MRI scanner, the new DBS device produced safe temperature rises with clinically used sequences and fMRI but not with other advanced sequences such as DWI and ASL, which also exceeded B1+rms vendor guidelines (i.e., ≤2 μT). When scanned on the previous MRI scanner, the recent DBS device produced overall lower and slower temperature rises compared to the previous DBS model. Among the sequences performed on this scanner, several (3D T1, DWI, T2 FSE, and ASL) exceeded the approved SAR vendor limit (&lt;1 W/kg), but only ASL resulted in an unacceptable temperature rise during scanning of the previous DBS model.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;These phantom safety data show that both clinically used MRI sequences and research sequences such as fMRI can be successfully acquired on 3T MRI scanners with a novel directional and sensing DBS model. As several of these sequences were obtained outside regulatory-approved vendor guidelines, preemptive safety testing should be done. As directional leads become increasingly common, improving MRI safety knowledge is crucial to expand clinical and research possibilities.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Magnetic resonance imaging (MRI) is both a crucial clinical and research tool for patients with deep brain stimulation (DBS) devices. However, safety concerns predominantly related to device heating have l","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"42-54"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11797914/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740514","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":"Reoperation Rates and Risk Factors after Spinal Cord Stimulation Revision Surgery.","authors":"Samuel H Kim, Christian G Lopez Ramos, Mihir J Palan, Elise Kronquist, Hao Tan, Mohamed Amgad Elsayed Elkholy, Ahmed Raslan","doi":"10.1159/000541445","DOIUrl":"10.1159/000541445","url":null,"abstract":"<p><strong>Introduction: </strong>Spinal cord stimulation (SCS) is an effective treatment for patients with refractory chronic pain. Despite its efficacy, rates of reoperation after initial implantation of SCS remain high. While revision rates after index SCS surgeries are well reported, less is known about rates and risk factors associated with repeat reoperations. We sought to evaluate patient, clinical, and surgical characteristics associated with repeat reoperation among patients who underwent an initial SCS revision procedure.</p><p><strong>Methods: </strong>We performed a retrospective review of patients who underwent SCS revision surgery performed at a single institution between 2008 and 2022. Patients were stratified by whether they underwent a single revision (SR) or multiple revision (MR) surgeries. Multivariate logistic regression was performed to determine risk factors associated with repeat SCS revision. Kaplan-Meier survival analysis was used to compare rates of devices requiring revision across groups.</p><p><strong>Results: </strong>A total of 54 patients underwent an initial SCS revision. Of these, 15 (28%) underwent a second revision. The most common indication for revision surgery was lead migration (65%). No significant differences were observed in age, body mass index, comorbidities, lead type, and revision indication among the SR and MR groups. On multivariate adjusted analysis, only cervical lead position was significantly associated with repeat reoperation (OR 7.10, 95% CI [1.14, 44.3], p = 0.036). Time to reoperation after a single and MR SCS surgeries did not differ.</p><p><strong>Conclusions: </strong>Among patients who undergo SCS reoperation, a substantial portion requires additional revisions. Cervical lead placement may be associated with a higher risk of repeat revision surgery compared to thoracic lead positioning. Consideration of lead positioning in the decision to perform and undergo reoperation may therefore result in lower revision rates and improved clinical outcomes among SCS patients with MRs.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"24-34"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11794026/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547580","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":"2024 Biennial Meeting of the American Society for Stereotactic and Functional Neurosurgery. Nashville, TN, June 1-4, 2024.","authors":"Kim Santos","doi":"10.1159/000541197","DOIUrl":"https://doi.org/10.1159/000541197","url":null,"abstract":"None.","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":"18 1","pages":"3-287"},"PeriodicalIF":1.7,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142263059","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":"2024 ASSFN Biennial Meeting, Nashville, TN, USA, June 1-4, 2024.","authors":"Kim Santos","doi":"10.1159/000541198","DOIUrl":"https://doi.org/10.1159/000541198","url":null,"abstract":"None.","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":"27 1","pages":"1-2"},"PeriodicalIF":1.7,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142263060","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":"Factors Influencing Long-Term Outcomes of Single-Session Gamma Knife Radiosurgery in Large-Volume Meningiomas &gt;10 cc.","authors":"Abhijit Goyal-Honavar, Vibhor Pateriya, Sonal Chauhan, Nishanth Sadashiva, Vikas Vazhayil, Subhas Konar, Manish Beniwal, Prabhuraj Ar, Arivazhagan Arimappamagan, Jeeva B, Ponnusamy Natesan","doi":"10.1159/000536409","DOIUrl":"10.1159/000536409","url":null,"abstract":"<p><strong>Introduction: </strong>Meningiomas are the most common primary intracranial tumour. Gamma knife radiosurgery (GKRS) is a frequently employed non-invasive method of treatment, with good remission rates and low morbidity in literature. However, the role of GKRS in the management of \"large\" meningiomas is unclear, with reported outcomes that vary by centre. We aimed to assess the factors that influence long-term outcomes following GKRS in meningiomas &gt;10 cc in volume.</p><p><strong>Methods: </strong>A retrospectively analysed all patients with meningiomas exceeding 10 cc in volume who underwent GKRS between January 2006 and December 2021 at the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru. Demographic, clinical, radiological, and follow-up data were acquired, and factors associated with progression following GKRS were assessed.</p><p><strong>Results: </strong>The cohort comprised 76 patients 29 males (38.2%) and 47 females (61.8%) with a mean age of 46.3 ± 11.02 years. Thirty-nine patients had been previously operated (51.3%). Meningiomas were most frequently located in the parasagittal region (26 tumours, 34.2%) and sphenopetroclival region (23 tumours, 30.3%), with mean lesion volume of 12.55 ± 5.22 cc, ranging 10.3 cc-25 cc. The mean dose administered to the tumour margin was 12.5 Gy ± 1.2 Gy (range 6-15 Gy). The median duration of clinical follow-up was 48 months, over which period radiological progression occurred in 14 cases (20%), with unchanged tumour volume in 20 cases (28.6%) and reduction in size of the tumour in 36 cases (51.4%). Progression-free survival after GKRS was 72% at 5 years, was significantly poorer among meningiomas with tumour volume &gt;14 cc (log-rank test p = 0.045), tumours presenting with limb motor deficits (log-rank test p = 0.012), and tumours that underwent prior Simpson grade 3 or 4 excision (log-rank test p = 0.032).</p><p><strong>Conclusions: </strong>Meningiomas &gt;10 cc in volume appear to display a high rate of progression and subsequent need for surgery following GKRS. Primary surgical resection, when not contraindicated, may be considered with GKRS serving an adjuvant role, especially in tumours exceeding 14 cc in volume, and presenting with limb motor deficits. Long-term clinical and radiological follow-up is essential following GKRS as the response of large meningiomas may be unpredictable.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"109-119"},"PeriodicalIF":1.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140022646","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}