Stereotactic and Functional Neurosurgery最新文献

{"title":"Contemporary Ethical Considerations in Psychiatric Neurosurgery.","authors":"Justin M Campbell, Brent M Kious, Shervin Rahimpour, Ben Shofty","doi":"10.1159/000548528","DOIUrl":"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":"91-100"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13046383/pdf/","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":"OA","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":"36-41"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","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":"Local Field Potentials in Movement Disorders: A Narrative Review.","authors":"Renato P Munhoz, Gustavo da Cunha Ribas, Nathalia C B Tortato, Marina Farah","doi":"10.1159/000550545","DOIUrl":"10.1159/000550545","url":null,"abstract":"<p><p><p>Background: Local field potentials (LFPs) represent the summed electrical activity of neuronal populations and provide a critical window into synaptic and oscillatory dynamics across brain networks. In recent decades, advances in deep brain stimulation (DBS) and chronic sensing technology have established LFPs as essential biomarkers for understanding movement disorders and optimizing neuromodulation therapies. Summary: This review synthesizes evidence on LFPs in movement disorders, focusing on methodological aspects, functional characterization, disease-specific findings, and clinical applications. In Parkinson's disease (PD), exaggerated beta-band activity in the subthalamic nucleus and globus pallidus internus (GPi) correlates with bradykinesia and rigidity, while dyskinesias are linked to broadband gamma activity and disrupted cross-frequency coupling. Essential tremor (ET) shows tremor-frequency synchronization in the thalamus and related networks. In dystonia, theta and alpha oscillations in the GPi correlate with symptom severity and guide DBS targeting. Tics in Tourette syndrome involve thalamic low-frequency oscillations, while chorea in Huntington's disease is associated with elevated beta-gamma power. Clinically, LFPs are increasingly used for intraoperative targeting, postoperative programming, outpatient monitoring, and as biomarkers for adaptive DBS (aDBS). Key Messages: LFPs provide fundamental insights into disease-specific neural oscillations across PD, ET, dystonia, tics, and chorea. Pathological patterns serve as reliable biomarkers of symptom states. By leveraging these signals, DBS can be more accurately targeted, programming can be streamlined, and long-term outpatient monitoring can be enhanced. aDBS based on LFP biomarkers is already in clinical use for PD, offering superior motor control and fewer side effects than conventional stimulation. </p>.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"297-314"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12952862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012375","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":"Anterior versus Posterior: Evolving Evidence in Callosotomy for Drug-Resistant Epilepsy.","authors":"Karim Mithani, George M Ibrahim","doi":"10.1159/000548513","DOIUrl":"10.1159/000548513","url":null,"abstract":"","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"150-151"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145820257","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":"Magnetic Resonance Imaging-Guided Focused Ultrasound Lesioning under General Anesthesia: A Case Series.","authors":"Franziska A Schmidt, Rafael E Buongermini, Jürgen Germann, Mohammad Mehdi Hajiabadi, Oliver Bichsel, Can Sarica, Ghazaleh Darmani, Alfonso Fasano, Alexandre Boutet, Andres M Lozano","doi":"10.1159/000549057","DOIUrl":"10.1159/000549057","url":null,"abstract":"<p><strong>Introduction: </strong>Real-time monitoring during MR-guided focused ultrasound (MRgFUS) procedures has been considered essential to monitor tremor improvement and side effects in the alignment and/or verify phase before the actual MRgFUS treatment and following the ablative sonications. However, a subgroup of patients does not tolerate being awake during the entire procedure for a variety of reasons.</p><p><strong>Case presentations: </strong>We performed MRgFUS treatments in three Parkinson's disease/Parkinsonism patients under general anesthesia. These patients had previously failed an attempt to undergo the procedure awake. All 3 patients who had the procedure under general anesthesia experienced significant improvement of their symptoms and experienced only transient adverse effects (e.g., balance problems, left facial droop) that were no longer evident at their first postoperative visit.</p><p><strong>Conclusion: </strong>Our findings suggest that MRgFUS treatment under general anesthesia could possibly be done safely and may represent a valid therapeutic option for patients unable to tolerate the procedure awake.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"225-229"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145393319","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":"10.1159/000551020","DOIUrl":"10.1159/000551020","url":null,"abstract":"<p><p>The article \"Anatomical Group-Level Studies of the Volume of Tissue Activated by Deep Brain Stimulation in Parkinson's Disease: A Model for Targeting?\" [Stereotact Funct Neurosurg. 2025; https://doi.org/10.1159/000549455] by Wiggerts et al. was published with the wrong open access license. The correct license of the article is CC-BY.The original article has been corrected.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"230"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147481610","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":"A Systematic Review of the Current Trends and Future Directions of High-Intensity Focused Ultrasound in Neurosurgery.","authors":"Leonardo Di Cosmo, Giorgio Costa, Francesca Romana Centini, Jordan Hammond, Carlotta Mariola, Francesca Pellicanò, Francesca Totis, Joseph Tam, Andres M Lozano","doi":"10.1159/000549834","DOIUrl":"10.1159/000549834","url":null,"abstract":"<p><strong>Introduction: </strong>High-intensity focused ultrasound (HIFU) has evolved significantly since its introduction to neurosurgery over 15 years ago. In the past decade, its clinical use has expanded to treat a broader range of surgical domains and indications. However, the pace and pattern of this evolution remain poorly characterized within the literature. This systematic review aimed to synthesize global research on HIFU in neurosurgery over the past 10 years, identifying trends across indications and regions.</p><p><strong>Methods: </strong>Following PRISMA guidelines, we identified clinical studies involving HIFU in neurosurgical practice from January 1, 2014, to November 1, 2024. Studies were categorized by application and country of origin, and a quantitative analysis was performed to assess distribution and trends in these factors.</p><p><strong>Results: </strong>A total of 498 studies were included. Research output increased over the period, from 13 studies in 2014 to 92 in 2024. While the scope of clinical applications expanded from 6 to 13 domains over this period, a disparity in research volume persisted, with movement disorders - particularly essential tremor (62.0%) and Parkinson's disease (29.9%) - accounting for the majority of publications. Nonetheless, growth was observed in previously underrepresented domains such as neurooncology, psychiatry, epilepsy, chronic pain, and neurovascular disorders. Geographically, the USA accounted for the largest share of publications (38.4%), followed by Switzerland (11.6%) and the UK (8.2%). Over this period, study quality improved with a shift from case reports and pilot studies toward an increasing number of cohort studies and randomized controlled trials.</p><p><strong>Conclusion: </strong>This review outlines the accelerating, yet uneven, exploration of HIFU in neurosurgical practice over the past decade. While movement disorders remain the central focus of this technology, expanding interest in underexplored indications indicates a shifting landscape. At the same time, the maturation of study designs reflects a strengthening evidence base. As the field advances, increased global collaboration and greater attention to budding applications are necessary.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"283-296"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145744563","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":"Absence of STN Neuronal Activity during MER in DBS Surgery: Diagnostic and Clinical Implications.","authors":"Atsushi Umemura, Genko Oyama, Yasushi Shimo, Hirokazu Iwamuro, Asuka Nakajima, Mai Shimizu, Taku Hatano, Akihide Kondo, Nobutaka Hattori","doi":"10.1159/000549010","DOIUrl":"10.1159/000549010","url":null,"abstract":"<p><p><p>Introduction: Intraoperative microelectrode recording (MER) is a widely employed technique for the physiological identification of the subthalamic nucleus (STN) during deep brain stimulation (DBS) surgery targeting the STN. However, failure to detect typical STN activity may raise concerns about diagnostic accuracy and treatment efficacy. Objective of this study were to retrospectively evaluate the clinical characteristics and long-term outcomes of patients with advanced Parkinson's disease (PD) in whom STN neuronal activity was not detected during intraoperative MER and to explore the implications of this finding for differential diagnosis and DBS candidacy.</p><p><strong>Methods: </strong>Among 624 STN-DBS procedures performed at Juntendo University Hospital between 2012 and 2024, we identified 3 patients (0.5%) in whom intraoperative MER failed to detect typical STN neuronal activity. Clinical records were reviewed retrospectively, including demographic data, levodopa responsiveness, preoperative images, intraoperative MER findings, surgical decision-making processes, and postoperative clinical courses.</p><p><strong>Results: </strong>All 3 patients were male, in their 60s at the time of surgery, with disease durations ranging from 5 to 7 years. Cognitive function was preserved in all cases. Gait disturbance was a prominent early symptom, and all patients experienced relatively early wearing-off phenomena. None exhibited dyskinesia, yet all showed good responsiveness to levodopa, confirmed by preoperative levodopa challenge tests. Despite multiple MER trajectories, no characteristic STN neuronal firing patterns were observed. DBS electrodes were implanted according to the initial surgical plan in 2 cases; in the other case, implantation was aborted. Following surgery, all patients demonstrated progressive axial motor deterioration. Based on their clinical course and imaging findings, all were ultimately diagnosed with or strongly suspected to have progressive supranuclear palsy-parkinsonism (PSP-P).</p><p><strong>Conclusions: </strong>The absence of detectable STN activity during intraoperative MER may reflect underlying neurodegenerative pathology distinct from idiopathic PD, such as PSP-P. These findings suggest that MER, beyond its role in anatomical targeting, may serve as a valuable intraoperative biological indicator for diagnostic refinement. Even within a multidisciplinary setting led by movement disorder specialists, distinguishing PD from PSP-P prior to surgery remains a significant challenge. Improved diagnostic accuracy is critical to optimize patient selection for DBS and to prevent ineffective or potentially deleterious interventions. </p>.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"81-90"},"PeriodicalIF":2.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12707879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145356182","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":"Frailty Indices in Patients Undergoing Functional Neurosurgical Procedures: A Systematic Review.","authors":"Carmelo Venero, Joanna M Roy, Nirbha Ghurye, Akshay Warrier, Muhammad Usman Khalid, Niels Pacheco-Barrios, Farhan A Mirza, Christian A Bowers","doi":"10.1159/000547128","DOIUrl":"10.1159/000547128","url":null,"abstract":"<p><strong>Introduction: </strong>Functional neurosurgery covers a wide array of neurological disorders with an equally vast array of treatment modalities, including neuromodulation, decompressive, and ablative therapies for disparate pathologies such as pain, neuromodulation, disconnection, and refractory epilepsy. One of the most common functional treatments is deep brain stimulation for movement disorders and select psychiatric diseases. Functional neurosurgery treats patients with reduced quality of life from pathological neuronal pathways. Optimal patient selection by preoperatively identifying high-risk patients is critical for avoiding as many operative complications as possible, in addition to managing complications better once they occur. Frailty indices have demonstrated superior discrimination in predicting adverse postoperative outcomes across the spectrum of neurosurgical subspecialties when compared to increasing patient age. This systematic review describes multiple different frailty indices utilized by patients undergoing functional neurosurgery procedures.</p><p><strong>Methods: </strong>A systematic review of literature was performed using PubMed. The Newcastle Ottawa Scale (NOS) was used to assess for risk of bias and studies with NOS >6 were considered high-quality. An initial search identified 541 articles through our search strategy and, after screening and review, five met criteria for inclusion The 5-factor modified frailty index (mFI-5) and Risk Analysis Index (RAI) were most frequently utilized (n = 5). One study utilized single-hospital databases in contrast to the nationwide databases utilized by the other four studies.</p><p><strong>Results: </strong>RAI was found to have superior predictive ability as frailty metric when compared to the mFI-5. All five studies were considered high-quality based on the NOS. Frailty indices have demonstrated the ability to predict adverse outcomes in patients undergoing procedures from across the spectrum of neurosurgical subspecialties.</p><p><strong>Conclusion: </strong>Our review identified articles that utilized frailty indices in predicting outcomes among patients undergoing functional neurosurgery procedures.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"55-64"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144554917","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":"Are Some Robotic Devices for SEEG Electrode Implantation More Beneficial than Others?","authors":"Anukoon Kaewborisutsakul, Mikhail Chernov, Yuichi Kubota","doi":"10.1159/000548685","DOIUrl":"10.1159/000548685","url":null,"abstract":"","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"66-70"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145356167","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}