Case report on ear numbness following deep brain stimulation implantation

Abstract Introduction and importance Deep brain stimulation (DBS) implantation is a neurosurgical procedure in which electrodes are implanted in the brain. Complications that may occur include wound infection, issues with the DBS hardware, and others. This case report presents a patient who suffered ear numbness following DBS implantation. Case presentation A 50-year-old man presented with resting tremors in both hands. He reported that his handwriting had worsened and his movements had slowed. Physical examination revealed rigidity and postural instability. The patient was diagnosed with Parkinson's disease and a bilateral subthalamic nucleus DBS implantation was scheduled combined with the patient's medication all this time. Patient's symptoms showed improvement after the procedure. However, the patient complained of ear numbness and occasional pain in the area around his ear. We observed the patient over the next 3 months and the symptoms eventually resolved without any medication and intervention. Clinical discussion Ear numbness is a rare complication that occasionally occurs after DBS implantation. This complication occurs because the tunneling track's proximity to the great auricular nerve and the lesser occipital nerve can result in accidental damage to either one or both of these nerves during subcutaneous tunneling. Conclusion We suggest a simple procedure to avoid neural injury while maintaining the course of the tunneling in which the tunnel is created below the periosteum rather than at the subcutaneous level

VIM Line Technique for Determining the Ventral Intermediate Location‎

Abstract Aim: To prove that VIM line technique created by using a mathematical model, can be used to identify the location of the ventral intermediate nucleus of the thalamus (VIM) MATERIAL and METHODS: Eleven patients with Parkinson?s disease (PD) were assessed. To determine the VIM location, 3-T magnetic resonance imaging and stereotactic protocol 128-slice computed tomography were used. The VIM line technique was performed by drawing a line from the end-point of the right external globus pallidus to that of the left external globus pallidus in the intercommissural plane. PD severity was measured using the Unified Parkinson?s Disease Rating Scale (UPDRS). Results: A mathematical model was constructed to describe the VIM line technique for determining the VIM location. UPDRS scores before and after thalamotomy showed a significant decreasing trend (p=0.003). Conclusion: The VIM line technique using the mathematical model can be considered a referential method to determine the VIM location. Its effectiveness was demonstrated by decreased UPDRS scores in patients after VIM thalamotomy

Vim line technique thalamotomy for Parkinson tremor: Case series

Introduction The ventral intermediate (Vim) nucleus of the thalamus is difficult to identify even with 3 T magnetic resonance imaging. Stereotactic Vim thalamotomy is a usual procedure to control Parkinson tremor. Successful relieving of the tremor depends on the accuracy of defining the Vim location. Presentation of cases Three patients with Parkinson tremor were subjected to stereotactic thalamotomy using the Vim line technique (VLT) so as to precisely determine the Vim location. All patients showed good results, with improved tremors, as indicated by the UPDRS score, without any complications. Discussion The precise targeting of the Vim nucleus is crucial importance for the successful Vim thalamotomy. Various method has been developed to determine Vim location. Atlas based and Guiot’s technique routinely used by neurosurgeon. VLT is a new technique that has been developed to determine the Vim location on MRI. Conclusion VLT is useful for the determination of the Vim location. However, further research is warranted to prove its effectiveness

Rescue pallidotomy for dystonia through implanted deep brain stimulation electrode

BACKGROUND: Some patients with deep brain stimulation (DBS), where removal of implants is indicated due to hardware related infections, are not candidates for later re-implantation. In these patients a rescue lesion through the DBS electrode has been suggested as an option. In this case report we present a patient where a pallidotomy was performed using the DBS electrode. CASE DESCRIPTION: An elderly woman with bilateral Gpi DBS suffered an infection around the left burr hole involving the DBS electrode. A unilateral lesion was performed through the DBS electrode before it was removed. No side effects were encountered. Burke-Fahn-Marsden (BFM) dystonia movement scale score was 39 before DBS. With DBS before lesioning BFM score was 2.5 points. The replacement of the left sided stimulation with a pallidotomy resulted in only a minor deterioration of the score to 5 points. CONCLUSIONS: In the case presented here a small pallidotomy performed with the DBS electrode provided a satisfactory effect on the patient's dystonic symptoms. Thus, rescue lesions through the DBS electrodes, although off-label, might be considered in patients with Gpi DBS for dystonia when indicated.Ingår i SNI: Stereotactic, a supplement to Surgical Neurology International </p

Safety and efficacy of unilateral and bilateral pallidotomy for primary dystonia

Abstract Objective Ablation of the globus pallidus internus (pallidotomy) is an effective surgical intervention for dystonia. However, the current literature on the efficacy and safety of pallidotomy for dystonia is derived only from single‐case reports and small cohort studies. Methods We retrospectively analyzed patients with primary dystonia who underwent pallidotomy at our institution between 2014 and 2019. Neurological conditions were evaluated using the Burke‐Fahn‐Marsden Dystonia Rating Scale (BFMDRS, range: 0–120). We evaluated the total BFMDRS score and each subitem score (nine body regions) in the patients who underwent unilateral and bilateral pallidotomy before surgery and at last available follow‐up. Moreover, postoperative complications were analyzed. Results We found that 69 and 20 patients underwent unilateral and bilateral pallidotomy respectively. The mean age at dystonia onset was 40.4 ± 15.2 years. The mean clinical follow‐up period was 17.2 ± 11.6 months. Unilateral pallidotomy significantly improved the total BFMDRS score from 11.2 ± 14.7 preoperatively to 5.4 ± 7.6 at last available follow‐up (51.8% improvement, p < 0.001). Furthermore, there was a significant and independent improvement in all midline BFMDRS subitems, including eyes, mouth, speech/swallow, and neck, after unilateral pallidotomy. Bilateral pallidotomy significantly improved the total BFMDRS score from 14.6 ± 10.2 preoperatively to 3.8 ± 8.2 at last available follow‐up (74.0% improvement, p < 0.001). However, bilateral pallidotomy induced medically refractory parkinsonism (postural instability and gait disturbance) in five patients, dysarthria in three patients, and dysphagia in one patient. Interpretation Unilateral radiofrequency pallidotomy remains a viable treatment option for patients with some forms of dystonia. Bilateral pallidotomy cannot be recommended due to unacceptably high complication rates

脳動脈瘤を伴ったラトケ嚢胞5症例の経験

ラトケ嚢胞は,画像診断技術の発達に伴い近年報告例が増加している腫瘍である.しかしラトケ嚢胞と脳動脈瘤の合併の報告例は少なく,我々の渉猟し得た範囲では過去2例の文献報告をみるのみである.1980年より1997年7月までに我々の施設および関連病院においてラトケ嚢胞と診断されたものは38症例である.これらのうち動脈瘤を合併した症例を5例経験したので報告する.2例は下垂体部腫瘍症例に術前検査として脳血管撮影を施行したところ動脈瘤が偶然に発見された症例である.3例はくも膜下出血で発症し,そのクリッピング手術の際に,嚢胞性腫瘍が鞍上部に偶然発見されたものである.全症例について切除標本に対し病理学的検査を施行し,ラトケ嚢胞と診断した.ラトケ嚢胞に対する脳動脈瘤の合併頻度は不明であるが,我々はラトケ嚢胞38症例中5例(13%)と高率に動脈瘤の合併を経験した.下垂体腺腫においては約7%に脳動脈瘤の合併を認めるとの報告がなされているが,ラトケ嚢胞についても脳動脈瘤の合併は稀なものではないと考えられた.我々の経験した症例数は,いまだ十分ではなく今後の症例の積重ねが必要と考えられるが,下垂体部の腫瘍を認めた際には脳動脈瘤の存在を考慮し,脳血管撮影を施行すべきと考えられた.また,近年のMRAや3次元CTの進歩により,より非侵襲的に動脈瘤の合併を検索することが可能となってきセいると考えられる.ラトケ嚢胞は良性腫瘍であるが,視神経障害や下垂体機能低下といつた症候を伴うものは積極的な外科治療の必要性を有するものと考えられる.しかし,正常下垂体と腫瘍の位置関係や合併する動脈瘤の位置などにつき,十分に術前検討を加えることが必要と考える.くも膜下出血で発症し偶然ラトケ嚢胞が発見された場合には,術者の疲労度や時間的余裕を考慮して,可能ならば嚢胞切除を行うことが望ましいと考える.Over the past few decades a considerable numbers of studies have been made on Rathke\u27s cleft cyst. Cerebral aneurysm occurs in approximately 7% of patients with pituitary adenoma, but the factual incidence of Rathke\u27s cleft cyst with cerebral aneurysm remains an open question. To the authors knowledge, only a few reports have been reported in the literature concerning such a combined lesion. From 1980 to July 1997, we have experienced 38 cases of Rathke\u27s cleft cyst. These included 16 males and 22 females with a mean age of 42.5 years (range 11-73 years). They were obtained from the Tokyo Women\u27s Medical College Hospital and its affiliated hospitals to treat Rathke\u27s cleft cyst by surgical procedure and histological verification. We have experienced with five cases (13%) in 38 patients. Our data show that, as compared with pituitary adenoma, incidence of Rathke\u27s cleft cyst associated with cerebral aneurysm was not rare than we have considered previously. Our study documents the necessity and importance of cerebral angiography in patient with tumor of the sellar region prior to the surgical procedure

脳動脈瘤を伴ったラトケ嚢胞5症例の経験

ラトケ嚢胞は,画像診断技術の発達に伴い近年報告例が増加している腫瘍である.しかしラトケ嚢胞と脳動脈瘤の合併の報告例は少なく,我々の渉猟し得た範囲では過去2例の文献報告をみるのみである.1980年より1997年7月までに我々の施設および関連病院においてラトケ嚢胞と診断されたものは38症例である.これらのうち動脈瘤を合併した症例を5例経験したので報告する.2例は下垂体部腫瘍症例に術前検査として脳血管撮影を施行したところ動脈瘤が偶然に発見された症例である.3例はくも膜下出血で発症し,そのクリッピング手術の際に,嚢胞性腫瘍が鞍上部に偶然発見されたものである.全症例について切除標本に対し病理学的検査を施行し,ラトケ嚢胞と診断した.ラトケ嚢胞に対する脳動脈瘤の合併頻度は不明であるが,我々はラトケ嚢胞38症例中5例(13%)と高率に動脈瘤の合併を経験した.下垂体腺腫においては約7%に脳動脈瘤の合併を認めるとの報告がなされているが,ラトケ嚢胞についても脳動脈瘤の合併は稀なものではないと考えられた.我々の経験した症例数は,いまだ十分ではなく今後の症例の積重ねが必要と考えられるが,下垂体部の腫瘍を認めた際には脳動脈瘤の存在を考慮し,脳血管撮影を施行すべきと考えられた.また,近年のMRAや3次元CTの進歩により,より非侵襲的に動脈瘤の合併を検索することが可能となってきセいると考えられる.ラトケ嚢胞は良性腫瘍であるが,視神経障害や下垂体機能低下といつた症候を伴うものは積極的な外科治療の必要性を有するものと考えられる.しかし,正常下垂体と腫瘍の位置関係や合併する動脈瘤の位置などにつき,十分に術前検討を加えることが必要と考える.くも膜下出血で発症し偶然ラトケ嚢胞が発見された場合には,術者の疲労度や時間的余裕を考慮して,可能ならば嚢胞切除を行うことが望ましいと考える.Over the past few decades a considerable numbers of studies have been made on Rathke's cleft cyst. Cerebral aneurysm occurs in approximately 7% of patients with pituitary adenoma, but the factual incidence of Rathke's cleft cyst with cerebral aneurysm remains an open question. To the authors knowledge, only a few reports have been reported in the literature concerning such a combined lesion. From 1980 to July 1997, we have experienced 38 cases of Rathke's cleft cyst. These included 16 males and 22 females with a mean age of 42.5 years (range 11-73 years). They were obtained from the Tokyo Women's Medical College Hospital and its affiliated hospitals to treat Rathke's cleft cyst by surgical procedure and histological verification. We have experienced with five cases (13%) in 38 patients. Our data show that, as compared with pituitary adenoma, incidence of Rathke's cleft cyst associated with cerebral aneurysm was not rare than we have considered previously. Our study documents the necessity and importance of cerebral angiography in patient with tumor of the sellar region prior to the surgical procedure