Surgical treatment of movement disorders:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia [u.a.]
Saunders
1998
|
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XIV S., S. 203 - 419 Ill., graph. Darst. |
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| 245 | 1 | 0 | |a Surgical treatment of movement disorders |c Roy A. e. Bakay, guest ed. |
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Datensatz im Suchindex
| _version_ | 1804126531580067840 |
|---|---|
| adam_text | CURRENT MANAGEMENT OF CEREBRAL ANEURYSMS, PART I:
EVALUATION AND PERIOPERATIVE CARE
CONTENTS
Preface xv
Peter D. Le Roux and H. Richard Winn
Management of Cerebral Aneurysms: How Can Current Management
Be Improved? 421
Peter D. Le Roux and H. Richard Winn
Future clinical or scientific innovations may bring about improvements in
the management of intracranial aneurysms and subarachnoid hemorrhage.
However, there are several potential avenues for improvement in the care
of, and present management of, patients with cerebral aneurysms. These
opportunities for improvement exist in areas of prevention, systems ap¬
proach and organization of cerebrovascular centers, physician and patient
education, screening and treatment of unruptured aneurysms, and advances
in surgical and endovascular therapy. All such advances, however, will
depend on rigorous academic evaluation.
Epidemiology and Clinical Presentation of Aneurysmal Subarachnoid
Hemorrhage 435
Kyra J. Becker
This article provides an overview of the epidemiology and acquired risk
factors associated with intracranial aneurysms and aneurysmal subarach¬
noid hemorrhage. The clinical presentation of subarachnoid hemorrhage is
reviewed and compared to important conditions that can mimic aneurysm
rupture, such as thunderclap headache and perimesencephalic nonaneurys
mal subarachnoid hemorrhage.
Imaging of Intracranial Aneurysms and Subarachnoid Hemorrhage 445
Alexander B. Baxter, Wendy A. Cohen, and Kenneth R. Maravilla
Diagnostic evaluation of the patient with an intracranial aneurysm is guided
by the clinical presentation and surgical plan. This article reviews the state
of the art technologies for imaging of subarachnoid hemorrhage and aneu
NEUROSURGERY CLINICS OF NORTH AMERICA
VOLUME 9 • NUMBER 3 • JULY 1998 jx
tive movement disorders caused by dysfunction of the basal ganglia and
related neuronal loops. The following topics are discussed: Among the
akinetic rigid Lewy body disorders is idiopathic Parkinson s disease, which
reveals specific lesion patterns of pathophysiologic and therapeutic rele¬
vance. Dementia with Lewy bodies characterized by cortical Lewy bodies
appears intermediate between Parkinson s and Alzheimer s diseases. Tau
pathologic disorders may show some clinical and morphologic overlap.
Multiple system atrophy has ubiquitous oligodendroglial inclusions as a
cytopathologic hallmark. Secondary parkinsonism includes drug related,
toxic, and other symptomatic disorders. Hyperkinetic disorders include
CAG related inherited diseases, showing specific genetic defects and mor¬
phologic lesions. Dystonia syndromes show inconsistent pathologic find¬
ings, and myoclonus may be related to a variety of disorders. Consensus data
on clinical and neuropathologic criteria already existing for some disorders,
together with molecular genetic and biochemical data will provide further
insight into the complex pathophysiology and pathogenesis of movement
disorders.
Positron Emission Tomography Studies in Movement Disorders 263
David J. Brooks
Positron emission tomography (PET) scanning provides a sensitive means
of detecting and characterizing regional changes in brain metabolism and
receptor binding in movement disorders. PET allows the quantitative exami¬
nation of regional cerebral blood flow, regional glucose and oxygen metabo¬
lism, and brain pharmacology. In this article, the particular use of PET to
determine the effects of therapeutic stereotactic surgery, including trans¬
plantation, on brain function in Parkinson s disease and in tremor patients
is highlighted.
The History of Surgery for Movement Disorders 283
Philip L. Gildenberg
Treatment of movement disorders by interruption of pathways within the
nervous system has been a goal of neurosurgeons for the past century.
When human stereotactic surgery was introduced 50 years ago, a major
advance was made in surgical treatment of Parkinson s disease and other
disorders of the motor system. Since then, the field has experienced a period
of progressive growth, then abrupt decline, and now is more active than
ever before and continuing to grow rapidly. Recent progress in computer
science, imaging techniques, neurophysiology, and stereotactic targeting
has provided the fuel for future progress.
Surgical Treatment Options in Parkinson s Disease 295
William C. Koller, Steve Wilkinson, Rajesh Pahwa, and Edison K. Miyawaki
Surgical treatment of Parkinson s disease has become an important mode
of therapy for advanced disease. Both ablative lesions and, more recently,
deep brain stimulation have been employed. Various brain areas, including
the thalamus, globus pallidus, and subthalamus, have been target sites.
Ablative Surgery for Movement Disorders: Anatomic Localization
Techniques 307
Douglas Kondziolka and L. Dade Lunsford
The increased use of ablative movement disorder surgery, pallidotomy, and
thalamotomy must be followed by our better understanding of regional
neuroanatomy, use of imaging and physiologic techniques for targeting,
and methods of lesion creation. The safety of these techniques has been
viii CONTENTS
established; efficacy will require additional studies. Selection of appropriate
patients and our understanding of outcomes will assist the surgeon in
choosing between ablative surgeries and other forms of management.
Ablative Therapy for Movement Disorders: Thalamotomy for
Parkinson s Disease 317
Victor L. Perry and Frederick A. Lenz
Thalamotomy for Parkinson s disease is a well established procedure that
has been in use for more than 40 years. Technologic advances, such as
computerized and magnetic resonance imaging, and refinement of stereotac
tic techniques have increased the safety and efficacy of this procedure.
Current studies reveal good results in 70% to 90% of patients. Reported
transient neurologic deficits occur in up to 60% of patients undergoing
this procedure, although the highest permanent complication rates have
decreased to around 10% to 20%. These data suggest the safety and efficacy
of thalamotomy as a primary therapeutic option for selected patients with
parkinsonian tremor.
Pallidotomy for Parkinson s Disease 325
Andres M. Lozano and Anthony E. Lang
The major motor disturbances in Parkinson s disease are thought to bo
caused by overactivity of the GABAergie internal segment of the globu.s
pallidus (GPi), which acts as a brake on the motor thalamus and the
cortical motor system to produce the slowness, rigidity, and poverty of
movement characteristic of parkinsonian states. The goal of pallidotomy is
to reduce this excessive inhibition on the motor system in patients with
Parkinson s disease who continue to be significantly disabled despite phar
macotherapy. GPi can be identified with a high degree of precision through
microelectrode recording and stimulation. Micro and macrostimulation can
be used to map the position of the optic tract and the internal capsule, two
structures that are at risk with pallidotomy. Although the optimal lesion
size and location within the pallidum is yet to be determined, unilateral
lesions in the sensorimotor portion of GPi are associated with striking
improvements in drug induced involuntary movements, bradykinesia,
tremor, and rigidity and to a lesser extent on gait and postural disturbances.
Pallidotomy Technique and Results: The New York University
Experience 337
Ron L. Alterman and Patrick J. Kelly
The authors relate the Now rk L niw r ft t perieniv with 171 pallidoto
mies performed on 1W) con ecHti .e p iiieir ner a vear period. Details
of their patient selection irileii i ¦ p i. ri . it rumple, preliminary clinical
results, and surgical tomplii.it mis ttiv K p. iled. I he coiulude that unilat¬
eral posteroventral p, Ilkiotmir. ¦ . .iti .mil oilectke tovUiiu nt fora subset
of Parkinson s disease paiu il . In ¦ utter ith ligidiH, bradykinesia,
tremor, and L dopa mdiue.i •! Uti. n. l ihcnfr with Parkinson s Plus
syndromescanbedetmiti.ih i If li •!•. ithpositron. missiontomography
and donotimpro euitb pillkM m I ( routine port. rmance of bilateral
pallidotomy remains iontr.n i i I
Surgery for Dystonia 345
Jerrold L. Vitek
The functional organization of basal gnngiia thalamocortical circuitry and
its application to surgical approaches for dystonia are discussed in this
CONTENTS ix
article. A model for dystonia based on neuronal recordings from patients
with dystonia is presented, followed by a review of the literature concerning
the role of ablative surgery for the treatment of dystonia. Lastly, alternative
approaches for the surgical treatment of dystonia are discussed.
Ablative Therapy for Movement Disorders: Complications in the
Treatment of Movement Disorders 367
Deon F. Louw and Kim J. Burchiel
Presently, there is a renaissance in the surgical treatment of movement ,
disorders. Prompted by the growing recognition of the limitations of drug
therapy, this resurgence has been further promoted by progress in neuronal
transplantation, advances in neuroimaging and stereotactic surgical tech¬
niques, and innovative therapies, such as deep brain stimulation for abnor¬
mal movements. Mortality associated with thalamotomy and pallidotomy
is rare, but morbidity is not inconsiderable, particularly in the elderly and
those with preexisting brain damage. Judicious patient selection and physio¬
logic confirmation of stereotactic targets are cornerstones to complication
avoidance.
Ablative Therapy for Movement Disorders: Does Thalamotomy Alter
the Course of Parkinson s Disease? 375
Ronald Reginald Tasker
Although there is no confirmed evidence that therapy alters the course
of Parkinson s disease, some follow up of patients who have undergone
thalamotomy has suggested it might slow or even halt the progress of the
disease. A retrospective semiquantitative assessment of 55 patients undergo¬
ing bilateral thalamotomy and 31 undergoing unilateral operation confirms
the previously held notion that postencephalitic disease or clinical onset
below age 40 may progress so slowly as to appear arrested after thalamot¬
omy. Patients left with no tremor and minimal rigidity after completion of
unilateral or bilateral surgery, whether their disease is of youthful onset,
postencephalitic or not, may also appear to follow stable courses postopera
tively. This occurs in patients whose tremor and rigidity have been con¬
trolled by bilateral thalamotomy and also in those in whom unilateral tremor
and rigidity have been controlled by unilateral surgery in the absence of
significant tremor and rigidity on the other side of the body. Possible expla¬
nations are discussed.
Deep Brain Stimulation for Movement Disorders 381
Philip A. Starr, Jerrold L. Vitek, and Roy A. E. Bakay
Chronic deep brain stimulation (DBS) is a promising technique for the
treatment of movement disorders. Thalamic stimulation is now an estab¬
lished surgical procedure for parkinsonian and essential tremor. Pallidal
and subthalamic stimulation are under active investigation as treatments
for Parkinson s disease. Although high frequency DBS at these sites has
similar behavioral effects as lesioning, the physiologic mechanisms underly¬
ing the beneficial effect of DBS is not well understood and may be extremely
complex. DBS offers a potential advantage over ablative therapy because
stimulation induced complications are reversible, and the stimulation pa¬
rameters are adjustable to minimize complications and maximize therapeu¬
tic effects. With this added safety, bilateral stimulation or use of a stimulator
following a prior procedure may be preferable to bilateral ablative proce¬
dures.
X CONTENTS
Special Article
Neonatal Applications of Neuroendoscopy 405
Jaime A. Alvarez and Alan R. Cohen
Neuroendoscopy is a minimally invasive technique that has revolutionized
the management of multiple intracranial conditions. Neuroendoscopic tech¬
niques can be safely applied to the newborn in selected circumstances, but
the indications, surgical technique, and the potential pitfalls and complica¬
tions must be completely understood to ensure a successful outcome in
these fragile patients.
Index 415
Subscription Information Inside back cover
CONTENTS x*
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| spelling | Surgical treatment of movement disorders Roy A. e. Bakay, guest ed. Philadelphia [u.a.] Saunders 1998 XIV S., S. 203 - 419 Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Dyskinésie Movement Disorders surgery Stereotaktische Hirnoperation (DE-588)4057326-6 gnd rswk-swf Cerebrale Bewegungsstörung (DE-588)4147488-0 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Cerebrale Bewegungsstörung (DE-588)4147488-0 s Stereotaktische Hirnoperation (DE-588)4057326-6 s DE-604 Bakay, Roy A. E. Sonstige oth HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=008074834&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Surgical treatment of movement disorders Dyskinésie Movement Disorders surgery Stereotaktische Hirnoperation (DE-588)4057326-6 gnd Cerebrale Bewegungsstörung (DE-588)4147488-0 gnd |
| subject_GND | (DE-588)4057326-6 (DE-588)4147488-0 (DE-588)4143413-4 |
| title | Surgical treatment of movement disorders |
| title_auth | Surgical treatment of movement disorders |
| title_exact_search | Surgical treatment of movement disorders |
| title_full | Surgical treatment of movement disorders Roy A. e. Bakay, guest ed. |
| title_fullStr | Surgical treatment of movement disorders Roy A. e. Bakay, guest ed. |
| title_full_unstemmed | Surgical treatment of movement disorders Roy A. e. Bakay, guest ed. |
| title_short | Surgical treatment of movement disorders |
| title_sort | surgical treatment of movement disorders |
| topic | Dyskinésie Movement Disorders surgery Stereotaktische Hirnoperation (DE-588)4057326-6 gnd Cerebrale Bewegungsstörung (DE-588)4147488-0 gnd |
| topic_facet | Dyskinésie Movement Disorders surgery Stereotaktische Hirnoperation Cerebrale Bewegungsstörung Aufsatzsammlung |
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