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11. |
Subthalamic Nucleus Stimulation for Gait Disturbance in Parkinson’s Disease |
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Neurosurgery,
Volume 45,
Issue 1,
1999,
Page 41-41
Tetsuo Yokoyama,
Kenji Sugiyama,
Shigeru Nishizawa,
Noki Yokota,
Seiji Ohta,
Kenichi Uemura,
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摘要:
OBJECTIVE:A preliminary study of subthalamic nucleus (STN) stimulation was performed to determine its applicability for the treatment of gait and postural disturbances in Parkinson’s disease.METHODS:Five Parkinson’s disease patients with freezing gait and postural instability were selected for this study. Their ages ranged from 60 to 73 years (mean ± standard deviation, 65.6 ± 4.8 years). Semi-microelectrode recording was used to identify the STN and to place a chronic electrical stimulation electrode within the right STN in all patients. The Unified Parkinson’s Disease Rating Scale and the modified Hoehn and Yahr Staging Scale were used to assess patients in on- and off-drug conditions before surgery and 3 months after surgery.RESULTS:The scores on the Hoehn and Yahr Staging Scale and the total Unified Parkinson’s Disease Rating Scale for akinesia (P< 0.05), gait (P< 0.05), and gait and posture (P< 0.01) in off-drug on-stimulation conditions significantly improved over the preoperative and postoperative off-drug off-stimulation conditions (analysis of variance [ANOVA],P< 0.01). Improvement over the preoperative scores was 24% on the Hoehn and Yahr Staging Scale, 43.6% on the total Unified Parkinson’s Disease Rating Scale, 33.4% for akinesia, 36.6% for gait, and 38.7% for gait and posture. However, stimulation in the on-drug phase did not show a significant difference compared with pre- and postoperative conditions (ANOVA,P> 0.05). Comparisons between preoperative on-drug and postoperative off-drug on-stimulation conditions revealed that there were no significant differences in the scores, except for gait (ANOVA,P< 0.05). The scores on subscales for falling, freezing, walking, and gait in off-drug on-stimulation conditions were significantly improved over the scores for preoperative and postoperative off-stimulation (ANOVA,P< 0.05), but the score for postural stability remained unchanged.CONCLUSION:Our findings showed that STN stimulation effectively alleviates freezing gait and improves walking to its status during the preoperative on-drug phase and can be applied for treatment of Parkinson’s disease patients with these symptoms.
ISSN:0148-396X
出版商:OVID
年代:1999
数据来源: OVID
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12. |
Foundation for International Education in Neurological Surgery, Inc.: Report of Activities |
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Neurosurgery,
Volume 45,
Issue 1,
1999,
Page 49-49
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ISSN:0148-396X
出版商:OVID
年代:1999
数据来源: OVID
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13. |
Direct and Combined Revascularization in Pediatric Moyamoya Disease |
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Neurosurgery,
Volume 45,
Issue 1,
1999,
Page 50-50
Alexandra,
Golby Michael,
Marks Reid,
Thompson Gary,
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摘要:
OBJECTIVE:Surgical revascularization of moyamoya disease can improve neurological outcomes, compared with the natural history of the disease or the results of medical treatment. Controversy exists regarding whether direct or indirect revascularization yields better outcomes. This study involves a single-center experience with direct anastomosis and is the first North American series using direct revascularization for pediatric patients with moyamoya disease.METHODS:Twelve patients (age range, 5–17 yr; mean age, 10.2 yr) underwent direct revascularization of 21 hemispheres. Two patients had experienced failure of previous indirect revascularization procedures, with continued clinical deterioration. Superficial temporal artery-middle cerebral artery anastomosis was performed in 19 hemispheres (with concurrent encephaloduroarteriosynangiosis in 6). Middle meningeal artery-middle cerebral artery anastomosis and omental transposition were each performed in one hemisphere. Follow-up periods ranged from 12 to 65 months (mean, 35 mo), and monitoring included neurological examinations, angiography, magnetic resonance imaging, and cerebral blood flow studies.RESULTS:The neurological conditions of all patients were stable or improved after surgery. None of the patients developed new strokes, and no new ischemic lesions were seen in magnetic resonance imaging scans. All grafts evaluated by follow-up angiography were patent. Postoperative cerebral blood flow studies showed significantly improved blood flow (54.4 versus 42.5 ml/100 g/min;P= 0.017, n = 4) and hemodynamic reserve (70.3 versus 43.9 ml/100 g/min;P= 0.009, n = 4), compared with preoperative studies.CONCLUSION:Surgical revascularization by direct anastomosis in pediatric patients is technically feasible, is well tolerated, and can improve the progressive natural history, the angiographic appearance, and the cerebral blood flow abnormalities associated with the disease. Direct revascularization has the advantage of providing immediate and high-flow revascularization and is particularly useful for patients who have experienced failure of previous indirect revascularization procedures.
ISSN:0148-396X
出版商:OVID
年代:1999
数据来源: OVID
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14. |
2000 Van Wagenen Fellowship Applications |
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Neurosurgery,
Volume 45,
Issue 1,
1999,
Page 60-60
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ISSN:0148-396X
出版商:OVID
年代:1999
数据来源: OVID
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15. |
Long-term Follow-up of Patients Treated with Cervical Radiofrequency Neurotomy for Chronic Neck Pain |
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Neurosurgery,
Volume 45,
Issue 1,
1999,
Page 61-61
Greg McDonald,
Susan Lord,
Nikolai Bogduk,
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摘要:
OBJECTIVE:To determine the long-term efficacy of percutaneous radiofrequency medial branch neurotomy in the treatment of chronic neck pain.METHODS:Between 1991 and 1996, radiofrequency neurotomy was performed in 28 patients diagnosed as having cervical zygapophysial joint pain on the basis of controlled diagnostic blocks. The procedure was repeated in patients whose pain recurred. Outcome measures were the proportion of patients who responded to the initial procedure and the duration of relief subsequently obtained. Outcome was correlated with the operator performing the procedure, the type of electrode used, litigation status, and the type of diagnostic blocks used to establish the diagnosis.RESULTS:Complete relief of pain was obtained in 71% of patients after an initial procedure. No patient who failed to respond to a first procedure responded to a repeat procedure, but if pain returned after a successful initial procedure, relief could be reinstated by a repeat procedure. The median duration of relief after a first procedure was 219 days when failures are included but 422 days when only successful cases are considered. The median duration of relief after repeat procedures was at least 219 days; several patients had ongoing relief at the time of follow-up. Outcome did not differ according to the operator, the type of electrode used, litigation status, or the type of diagnostic block used.CONCLUSION:Radiofrequency neurotomy provides clinically significant and satisfying periods of freedom from pain, and its effects can be reinstated if pain recurs.
ISSN:0148-396X
出版商:OVID
年代:1999
数据来源: OVID
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16. |
Congress of Neurological Surgeons/American Association of Neurological Surgeons Joint Section Chairmen |
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Neurosurgery,
Volume 45,
Issue 1,
1999,
Page 68-68
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ISSN:0148-396X
出版商:OVID
年代:1999
数据来源: OVID
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17. |
Comparative Study of Propofol and Midazolam Effects on Somatosensory Evoked Potentials during Surgical Treatment of Scoliosis |
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Neurosurgery,
Volume 45,
Issue 1,
1999,
Page 69-69
Emmanuèle,
Laureau Bruno,
Marciniak Anne,
Hébrard Bernard,
Herbaux Jean,
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摘要:
OBJECTIVE:Studies of the effects on lower-limb cortical somatosensory evoked potentials (CSEP) during total intravenous anesthesia are sparse for propofol and are lacking for midazolam. This study was designed to compare the effects of propofol and midazolam on CSEP under total intravenous anesthesia during intraoperative monitoring for surgical treatment of scoliosis.METHODS:CSEPs were recorded in two groups of 15 patients during posterior instrumentation for treatment of idiopathic scoliosis. The anesthesia used the combination of atracurium, alfentanil, and an hypnotic agent (propofol for Group I or midazolam for Group II). The main characteristics of the CSEPs (P40 latency and N34–P40 and P40–N50 amplitudes) were recorded using ankle posterior tibial nerve stimulation. The CSEPs were recorded before induction, 10, 70, 100, 130, and 160 minutes after induction, and before the wake-up test. The statistical analysis involved analysis of variance for repeated measures. Both groups were homogeneous before induction.RESULTS:Neither CSEP deterioration during risk-associated surgical procedures nor postoperative clinical abnormalities were observed. Both propofol and midazolam induced increases in P40 latencies, with the increases being greater and more regular for the propofol-treated group. The amplitude values changed with time for both groups, decreasing mainly after induction; in the midazolam-treated group, the amplitudes were smaller but more stable. Propofol modified the morphological characteristics of the response by decreasing the late P60 component amplitude; the W-shaped CSEP morphological pattern was maintained with midazolam.CONCLUSION:This study demonstrates the appropriate use of either propofol or midazolam in scoliosis monitoring. Preoperative small-amplitude CSEPs might favor the use of propofol anesthesia.
ISSN:0148-396X
出版商:OVID
年代:1999
数据来源: OVID
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18. |
WANTED Your Help to Preserve Neurosurgical History |
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Neurosurgery,
Volume 45,
Issue 1,
1999,
Page 75-75
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ISSN:0148-396X
出版商:OVID
年代:1999
数据来源: OVID
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19. |
Transcranial Doppler Ultrasonography-guided Management of Internal Carotid Artery Closure |
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Neurosurgery,
Volume 45,
Issue 1,
1999,
Page 76-76
Wilhelm Sorteberg,
Angelika Sorteberg,
Karl-Fredrik Lindegaard,
Morten Boysen,
Helge Nornes,
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摘要:
OBJECTIVE:To emphasize the integrated use of transcranial Doppler ultrasonography (TCD) in the management of internal carotid artery (ICA) closure.METHODS:Thirty-three patients being considered for ICA closure underwent TCD assessment, vasomotor reserve testing/estimation, and carotid artery test occlusion with concomitant middle cerebral artery (MCA) blood velocity (VMCA) monitoring, including calculation of the MCA pulsatility index. Twelve of these patients proceeded to undergo ICA sacrifice. Sequential TCD sonograms guided their postoperative treatment.RESULTS:ICA aneurysms and neck neoplasms affected the TCD results and vasomotor reserve insignificantly, whereas carotid-cavernous fistulae induced characteristic circulatory alterations. The 10 subjects who tolerated ICA sacrifice hemodynamically all showed an initial decrease in the ipsilateral VMCAto ≥60% of the preocclusion value and a progressively decreasing MCA pulsatility index during carotid artery test occlusion. The two patients who developed hemodynamic cerebral infarctions exhibited a decrease in VMCAto <60% and a MCA pulsatility index that remained stable after a vast initial reduction. Postoperative hypervolemic and hypertensive support was safely titrated in all patients who received postoperative TCD surveillance, providing an ipsilateral VMCAof ≥80% of the preocclusion value. ICA closure permanently altered the cerebral circulatory pattern.CONCLUSION:The hemodynamic outcome of ICA sacrifice can be correctly predicted by using the TCD occlusion test. TCD provides the means to titrate the extent of postoperative hypervolemic/hypertensive support.
ISSN:0148-396X
出版商:OVID
年代:1999
数据来源: OVID
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20. |
Neurosurgeons’ Library |
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Neurosurgery,
Volume 45,
Issue 1,
1999,
Page 88-88
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ISSN:0148-396X
出版商:OVID
年代:1999
数据来源: OVID
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