The advances of Deep Brain Stimulation (DBS) for treatment of Parkinson's Disease (PD)

Advanced Parkinson's disease (PD) is characterized by the presence of motor fluctuations, various degrees of dyskinesia, and disability with functional impact on daily living and independence. Therapeutic management aims to extend levodopa (L-DOPA) benefit while minimizing motor complications and includes, in selected cases, the implementation of drug infusion and surgical techniques. The concept of deep brain stimulation (DBS) for PD was introduced over 20 years ago, but our understanding of the nuances of this procedure continues to improve. This review aims to demonstrate the advances of DBS in the treatment of PD patients. Keywords: Deep brain stimuation; previous pallidotomy; microrecording; Parkinson diseas

The advances of Deep Brain Stimulation (DBS) for treatment of Parkinson's Disease (PD)

Advanced Parkinson's disease (PD) is characterized by the presence of motor fluctuations, various degrees of dyskinesia, and disability with functional impact on daily living and independence. Therapeutic management aims to extend levodopa (L-DOPA) benefit while minimizing motor complications and includes, in selected cases, the implementation of drug infusion and surgical techniques. The concept of deep brain stimulation (DBS) for PD was introduced over 20 years ago, but our understanding of the nuances of this procedure continues to improve. This review aims to demonstrate the advances of DBS in the treatment of PD patients.  Keywords: Deep brain stimuation; previous pallidotomy; microrecording; Parkinson diseas

Predictive factors for beneficial application of high-frequency electromagnetics for tumour vaporization and coagulation in neurosurgery

<p>Abstract</p> <p>Objective</p> <p>To identify preoperative and intraoperative factors and conditions that predicts the beneficial application of a high-frequency electromagnetic field (EMF) system for tumor vaporization and coagulation.</p> <p>Methods</p> <p>One hundred three subsequent patients with brain tumors were microsurgically treated using the EMF system in addition to the standard neurosurgical instrumentarium. A multivariate analysis was performed regarding the usefulness (ineffective/useful/very helpful/essential) of the new technology for tumor vaporization and coagulation, with respect to tumor histology and location, tissue consistency and texture, patients' age and sex.</p> <p>Results</p> <p>The EMF system could be used effectively during tumor surgery in 83 cases with an essential contribution to the overall success in 14 cases. In the advanced category of effectiveness (very helpful/essential), there was a significant difference between hard and soft tissue consistency (50 of 66 cases vs. 3 of 37 cases). The coagulation function worked well (very helpful/essential) for surface (73 of 103 cases) and spot (46 of 103 cases) coagulation when vessels with a diameter of less than one millimeter were involved. The light-weight bayonet hand piece and long malleable electrodes made the system especially suited for the resection of deep-seated lesions (34 of 52 cases) compared to superficial tumors (19 of 50 cases).</p> <p>The EMF system was less effective than traditional electrosurgical devices in reducing soft glial tumors. Standard methods where also required for coagulation of larger vessels.</p> <p>Conclusion</p> <p>It is possible to identify factors and conditions that predict a beneficial application of high-frequency electromagnetics for tumor vaporization and coagulation. This allows focusing the use of this technology on selective indications.</p

Der Einfluss von trigeminokardialem Reflex auf das Hörvermögen in Akustikus Neurinom Chirurgie

Objective. To study the impact of the trigeminocardiac reflex (TCR) on postoperative auditory function in vestibular schwannoma surgery. Surgery for vestibular schwannomas (acoustic neuromas) and other procedures close to the fifth cranial nerve at its intra- or extracranial course may lead to patient’s bradycardia or even asystolia along with arterial hypotension. This phenomenon is described as the TCR. Clinical Material and Methods. One hundred subsequent patients scheduled for vestibular schwannoma surgery were studied prospectively for parameters that might influence the postoperative auditory function. The evaluation included gender, age, pre- and postoperative auditory function, preoperative mean arterial blood pressure, preoperative medical diseases or medication (e.g. antiarrhythmic drugs), tumor size and localization, and the intraoperative occurrence of the TCR. Results. The overall hearing preservation was 47% among all tumor sizes. TCR occurred in 11% of the patients. In the TCR group the rate of hearing preservation was 11%, while in the non-TCR group the hearing preservation rate was 51.4%, considering all tumor sizes (p=0.005). In larger tumors (T3 and T4), patients with intraoperative TCR had a significantly worse postoperative hearing function than those without a TCR (p<0.005). Conclusion. The hypotension following TCR is a negative prognostic factor for hearing preservation in vestibular schwannoma surgery. Referring to this knowledge patients’ information can be increased pre- and postoperatively. Further study of this phenomenon will advance the understanding of the underlying mechanisms and may help to improve hearing preservation by controlling the occurrence of the TCR.In der vorliegenden prospektiven Studie wurde der Einfluss des intraoperativen trigemino-kardialen Reflexes auf die postoperative Hörfunktion bei Vestibularis-Schwannom-Operationen untersucht. Dieser Reflex kann bei Operationen auftreten, bei denen der fünfte Hirnnerv (Nervus trigeminus) tangiert wird, und ist gekennzeichnet durch eine vorübergehende Hypotension und Bradykardie. An einem Kollektiv von 100 Patienten mit Vestibularisschwannomen konnte gezeigt werden, dass das Auftreten des trigemino-kardialen Reflexes ein negativer prognostischer Faktor für das postoperative Hörvermögen ist