The efficacy of deep brain stimulation of the anterior nucleus of the thalamus (ANT DBS) in patients with drug-resistant epilepsy (DRE) was demonstrated in the double-blind Stimulation of the ...Anterior Nucleus of the Thalamus for Epilepsy randomized controlled trial. The Medtronic Registry for Epilepsy (MORE) aims to understand the safety and longer-term effectiveness of ANT DBS therapy in routine clinical practice.
MORE is an observational registry collecting prospective and retrospective clinical data. Participants were at least 18 years old, with focal DRE recruited across 25 centers from 13 countries. They were followed for at least 2 years in terms of seizure frequency (SF), responder rate (RR), health-related quality of life (Quality of Life in Epilepsy Inventory 31), depression, and safety outcomes.
Of the 191 patients recruited, 170 (mean SD age of 35.6 10.7 years, 43% female) were implanted with DBS therapy and met all eligibility criteria. At baseline, 38% of patients reported cognitive impairment. The median monthly SF decreased by 33.1% from 15.8 at baseline to 8.8 at 2 years (
< 0.0001) with 32.3% RR. In the subgroup of 47 patients who completed 5 years of follow-up, the median monthly SF decreased by 55.1% from 16 at baseline to 7.9 at 5 years (
< 0.0001) with 53.2% RR. High-volume centers (>10 implantations) had 42.8% reduction in median monthly SF by 2 years in comparison with 25.8% in low-volume center. In patients with cognitive impairment, the reduction in median monthly SF was 26.0% by 2 years compared with 36.1% in patients without cognitive impairment. The most frequently reported adverse events were changes (e.g., increased frequency/severity) in seizure (16%), memory impairment (patient-reported complaint, 15%), depressive mood (patient-reported complaint, 13%), and epilepsy (12%). One definite sudden unexpected death in epilepsy case was reported.
The MORE registry supports the effectiveness and safety of ANT DBS therapy in a real-world setting in the 2 years following implantation.
This study provides Class IV evidence that ANT DBS reduces the frequency of seizures in patients with drug-resistant focal epilepsy.
MORE ClinicalTrials.gov Identifier: NCT01521754, first posted on January 31, 2012.
Summary We explored the efficacy and safety of bilateral SubThalamic Nucleus (STN) stimulation in two subjects suffering from drug-resistant epilepsy even after anterior callosotomy. Case 1 had about ...65% decrease of partial motor seizures and the complete disappearance of tonic–clonic generalized attacks. Case 2, with sudden drop (atonic) attacks, partial complex seizures, atypical absences and rare tonic–clonic seizures, showed no meaningful reduction of fits and a stimulation associated atypical absence rate increase.
Intraoperative neurophysiological monitoring (IONM) is a crucial advancement in neurosurgery, enhancing procedural safety and precision. This technique involves continuous real-time assessment of ...neurophysiological signals, aiding surgeons in timely interventions to protect neural structures. In addition to inherent limitations, IONM necessitates a detailed anesthetic plan for accurate signal recording. Given the growing importance of IONM in neurosurgery, we conducted a narrative review including the most relevant studies about the modalities and their application in different fields of neurosurgery. In particular, this review provides insights for all physicians and healthcare professionals unfamiliar with IONM, elucidating commonly used techniques in neurosurgery. In particular, it discusses the roles of IONM in various neurosurgical settings such as tumoral brain resection, neurovascular surgery, epilepsy surgery, spinal surgery, and peripheral nerve surgery. Furthermore, it offers an overview of the anesthesiologic strategies and limitations of techniques essential for the effective implementation of IONM.
Background:
Pituitary apoplexy is a life-threatening event with unspecific clinical background and no standardized treatment.
Materials and Methods:
The authors retrospectively analyzed seventeen ...patients affected by pituitary adenoma apoplexy and treated in a 10-year period. Thirteen patients underwent surgery through transsphenoidal route while four patients have been treated conservatively.
Results:
The endoscopic surgical procedure showed a better result in term of complete removal of the tumor while in the “conservative” group less frequent evidence of hormones' deficiency has been registered. Once a residual lesions was observed a strict radiological follow-up is mandatory.
Conclusions:
According to dedicated literature and pre- and post-operative evidence of personal series, the authors try to provide an algorithm that could help in the standardization of the diagnostic and therapeutic pathways in patients with pituitary adenoma apoplexy.
Outcome MRI was performed at 3, 12, 24 and 36 months after surgery and showed no evidence of residual tumour and no recurrence (figure 4). Since GTR was obtained and no atypical elements were found ...on histological examination, the patient did not undergo radiotherapy. Discussion Extraventricular neurocytoma (EVN) is a rare tumour with similar histopathological characteristics of CNC that occurs in lateral ventricles.2 Usually, these tumours are large lesions with significant overlap in imaging appearance with other brain neoplasms. ...it is difficult to make an accurate preoperative diagnosis. According to 2016 and 2021 WHO classification, EVN is generally considered as a grade-2 tumour, except for those with atypical histological features that include increased mitotic figures, focal necrosis, endothelial cell proliferation and/or a Ki-67 index of>2%. Diagnosis of low-grade tumour should not be made only by preoperative MRI findings, because radiological features of EVN overlap with those of more aggressive primary brain tumours. ...we planned an awake craniotomy with continuous language and cognitive function monitoring, aiming to GTR while prevent postoperative deficit.
Purpose
Biopsy of the spine can be performed by open surgery or percutaneous needle sampling. The first has the highest diagnostic yield while the second is a less invasive procedure with lower rate ...of complications and shorter hospitalization time. We described a modified technique of percutaneous biopsy using semi-rigid grasping forceps that may offer the advantages of both, open and minimally invasive surgery.
Methods
Thirty consecutive patients with spinal lesions requiring biopsy were admitted to Neurosurgical Unit of Belcolle Hospital (Viterbo, Italy) from January 2017 to September 2021. There was a suspicion of spondylodiscitis in 25 cases and of tumor in 5 cases. Percutanous trans-pedicular spine biopsy has been performed using this new semi-rigid grasping forceps. Combining the opening width, jaw length and full 360° rotation, the device allows a wide and precise sampling.
Results
Sampling was sufficient in all cases (100%); tumors was observed in 5 cases (16.7%%) with a percentage of definitive histopathologic diagnosis of 100% (
n
= 5); among the remaining patients histological examination yielded a diagnosis of spinal infection in 25 cases (100%), and microbiologic culture provided an aetiologic diagnosis in 23 cases (92%). All procedures were well tolerated, and no postoperative complications were observed. Levels involved included: thoracic (T5-T9) in 8 cases, thoracolumbar junction (T10-L2) in 12 cases and lumbar (L3-L5) in 10 cases.
Conclusions:
Percutaneous biopsy with the semi-rigid grasping forceps is a safe and effective procedure that can be used for diagnosis of both infectious and tumor lesions of the spine. It allows to obtain a larger specimen volume and to use a multidirectional trajectory for sampling, resulting in a minimally invasive technique with strong ability to yield etiologic diagnosis.
Abstract
Purpose: These two studies extended technology-aided programs to promote leisure and communication opportunities to a man with cervical spinal cord injury and a post-coma man with multiple ...disabilities. Method: The studies involved the use of ABAB designs, in which A and B represented baseline and intervention phases, respectively. The programs focused on enabling the participants to activate songs, videos, requests, text messages, and telephone calls. These options were presented on a computer screen and activated through a small pressure microswitch by the man with spinal cord injury and a special touch screen by the post-coma man. To help the latter participant, who had no verbal skills, with requests and telephone calls, series of words and phrases were made available that he could activate in those situations. Results: Data showed that both participants were successful in managing the programs arranged for them. The man with spinal cord injury activated mean frequencies of above five options per 10-min session. The post-coma man activated mean frequencies of about 12 options per 20-min session. Conclusions: Technology-aided programs for promoting leisure and communication opportunities might be successfully tailored to persons with spinal cord injury and persons with post-coma multiple disabilities.Implications for RehabilitationTechnology-aided programs may be critical to enable persons with pervasive motor impairment to engage in leisure activities and communication events independently.Persons with spinal cord injury, post-coma extended brain damage, and forms of neurodegenerative disease, such as amyotrophic lateral sclerosis, may benefit from those programs.The programs could be adapted to the participants' characteristics, both in terms of technology and contents, so as to improve their overall impact on the participants' functioning and general mood.
Background:
This work aims to review the current literature and our experience on vascular Eagle syndrome (ES) that can present misleading clinical presentations and better understand the possible ...therapeutic strategies.
Methods:
We reviewed the existing literature on PubMed from January 1, 2017, to December 31, 2022, including the sequential keywords “
vascular
AND
Eagle syndrome
,” “
vascular
AND
styloid syndrome
,” “
vascular
AND
elongated styloid process
,” “
vascular
AND
stylocarotid syndrome
,” and “
Eagle syndrome
AND
carotid artery dissection
.”
Results:
38 vascular ES cases, including our experience, were analyzed. The most frequent clinical onset was hemiparesis (
n
21, 57%), but other regular clinical presentations were aphasia, loss of consciousness, amaurosis, headache, or a combination of the latter. Massive oral bleeding was reported only once in the literature before our case. Twelve patients were treated with only antiplatelet therapy, either single or double. Nine patients were treated with anticoagulation therapy only. In 14 patients, a carotid artery stent was used, associated with anticoagulation or antiplatelet therapy. In 17 cases, a styloid process (SP) resection was performed.
Conclusion:
ES has many clinical presentations, and carotid artery dissection resulting in oral bleeding seems rare. Literature results and our experience make us believe that when dealing with vascular ES, the best treatment strategy is endovascular internal carotid artery stenting with antiplatelet therapy, followed by surgical removal of the elongated SP to prevent stent fracture.
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