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  • 1
    Language: English
    In: Journal of neurology, neurosurgery and psychiatry, 2019-03, Vol.90 (3), p.249-249
    Description: Correspondence to Professor Peter C Warnke, Neurosurgery, University of Chicago, Chicago, IL 60637, USA; pwarnke@surgery.bsd.uchicago.edu A new way to look at epilepsy surgery outcomes Three fields of neurosurgery have truly lived up to the aspirations of evidence-based medicine with multiple randomised controlled trials published in top impact journals: epilepsy surgery and movement disorder surgery and to a lesser degree stereotactic radiosurgery.1–3 The JNNP paper of Vogt et al 4adds another layer of granularity to the epilepsy surgery literature and shows quite clearly that randomised prospective trials in neurosurgery—so badly needed in many areas—are feasible and very useful. [...]epilepsy surgery is badly underused partly due to the fear of patients when facing major craniotomies plus neuropsychological sequelae and we owe it to our patients to provide solid data on the procedures we offer and recommend. The biggest criticism comes from a different realm—technological advance: open selective amygdala-hippocampectomy might soon be replaced by interstitial stereotactic laser amygdala-hippocampectomy with equal efficiency but significantly less morbidity avoiding craniotomies and sparing the lateral temporal lobe completely.7 The Stereotactic Laser Ablation in Temporal Epilepsy (SLATE) trial is currently conducted to provide prospective multi-institutional data.
    Subject(s): Clinical Neurology ; Epilepsy ; Lasers ; Life Sciences & Biomedicine ; Neurosciences & Neurology ; Neurosurgery ; Psychiatry ; Science & Technology ; Surgery
    ISSN: 0022-3050
    E-ISSN: 1468-330X
    Source: Hellenic Academic Libraries Link
    Source: Web of Science - Science Citation Index Expanded - 2019〈img src="http://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /〉
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  • 2
    Language: English
    In: Neurosurgery, 2017-05-01, Vol.80 (5), p.744-745
    Subject(s): Cysts ; Morbidity ; Multivariate analysis ; Neurosurgery ; Pediatrics ; Radiation therapy ; Surgeons ; Surgery ; Tumors
    ISSN: 0148-396X
    E-ISSN: 1524-4040
    Source: Alma/SFX Local Collection
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  • 3
    Language: English
    In: Small (Weinheim an der Bergstrasse, Germany), 2014-12, Vol.10 (24), p.5137-5150
    Description: The blood‐brain barrier (BBB) remains a formidable obstacle in medicine, preventing efficient penetration of chemotherapeutic and diagnostic agents to malignant gliomas. Here, a transactivator of transcription (TAT) peptide‐modified gold nanoparticle platform (TAT‐Au NP) with a 5 nm core size is demonstrated to be capable of crossing the BBB efficiently and delivering cargoes such as the anticancer drug doxorubicin (Dox) and Gd3+ contrast agents to brain tumor tissues. Treatment of mice bearing intracranial glioma xenografts with pH‐sensitive Dox‐conjugated TAT‐Au NPs via a single intravenous administration leads to significant survival benefit when compared to the free Dox. Furthermore, it is demonstrated that TAT‐Au NPs are capable of delivering Gd3+ chelates for enhanced brain tumor imaging with a prolonged retention time of Gd3+ when compared to the free Gd3+ chelates. Collectively, these results show promising applications of the TAT‐Au NPs for enhanced malignant brain tumor therapy and non‐invasive imaging. A transactivator of transcription (TAT) peptide‐modified gold nanoparticle platform (TAT‐Au NP) with a 5 nm core size is demonstrated to be capable of crossing the BBB efficiently and delivering doxorubicin and Gd3+ contrast agents to brain tumor tissues for enhanced malignant brain tumor therapy and magnetic resonance imaging.
    Subject(s): Animals ; Anthracyclines ; Antibiotics, Antineoplastic - administration & dosage ; Antibiotics, Antineoplastic - pharmacokinetics ; Antibiotics, Antineoplastic - therapeutic use ; Blood ; Blood-Brain Barrier ; Brain ; Brain cancer ; Brain Neoplasms - drug therapy ; Brain Neoplasms - pathology ; Cancer ; Chelates ; Chemotherapy ; Contrast agents ; Contrast Media ; doxorubicin ; Doxorubicin - administration & dosage ; Doxorubicin - pharmacokinetics ; Doxorubicin - therapeutic use ; gadolinium ; Glioma - drug therapy ; Glioma - pathology ; Gliomas ; Gold ; Gold - chemistry ; gold nanoparticle ; gold nanoparticles ; Imaging ; Magnetic Resonance Imaging ; malignant glioma ; Metal Nanoparticles ; Mice ; Nanoparticles ; Peptides ; Platforms ; TAT peptide ; Therapy ; Tumors
    ISSN: 1613-6810
    E-ISSN: 1613-6829
    Source: Hellenic Academic Libraries Link
    Source: Alma/SFX Local Collection
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  • 4
    Language: English
    In: Acta neurochirurgica, 2019-07-04, Vol.161 (10), p.2059-2064
    Description: Background While multiple trials have employed stereotactic stem cell transplantation, injection techniques have received little critical attention. Precise cell delivery is critical for certain applications, particularly when targeting deep nuclei. Methods Ten patients with a history of ischemic stroke underwent CT-guided stem cell transplantation. Cells were delivered along 3 tracts adjacent to the infarcted area. Intraoperative air deposits and postoperative T2-weighted MRI fluid signals were mapped in relation to calculated targets. Results The deepest air deposit was found 4.5 ± 1.0 mm (mean ± 2 SEM) from target. The apex of the T2-hyperintense tract was found 2.8 ± 0.8 mm from target. On average, air pockets were found anterior (1.2 ± 1.1 mm, p  = 0.04) and superior (2.4 ± 1.0 mm, p  〈 0.001) to the target; no directional bias was noted for the apex of the T2-hyperintense tract. Location and distribution of air deposits were variable and were affected by the relationship of cannula trajectory to stroke cavity. Conclusions Precise stereotactic cell transplantation is a little-studied technical challenge. Reflux of cell suspension and air, and the structure of the injection tract affect delivery of cell suspensions. Intraoperative CT allows assessment of delivery and potential trajectory correction.
    Subject(s): Cell suspensions ; Clinical Neurology ; Clinical trials ; Functional Neurosurgery – Other ; Injection ; Interventional Radiology ; Ischemia ; Life Sciences & Biomedicine ; Magnetic resonance imaging ; Medical materials ; Medicine ; Medicine & Public Health ; Minimally Invasive Surgery ; Neurology ; Neuroradiology ; Neurosciences & Neurology ; Neurosurgery ; Science & Technology ; Stem cell transplantation ; Stem cells ; Surgery ; Surgical Orthopedics ; Technical Note - Functional Neurosurgery - Other ; Trajectories ; Transplantation ; Tubes
    ISSN: 0001-6268
    E-ISSN: 0942-0940
    Source: Web of Science - Science Citation Index Expanded - 2019〈img src="http://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /〉
    Source: Alma/SFX Local Collection
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  • 5
    Language: English
    In: Journal of neurology, neurosurgery and psychiatry, 2018-05, Vol.89 (5), p.542-548
    Description: ObjectiveTo determine the outcomes of combined stereo-electroencephalography-guided and MRI-guided stereotactic laser interstitial thermal therapy (LITT) in the treatment of patients with drug-resistant mesial temporal lobe epilepsy (mTLE).MethodsWe prospectively assessed the surgical and neuropsychological outcomes in 21 patients with medically refractory mTLE who underwent LITT at the University of Chicago Medical Center. We further compared the surgical outcomes in patients with and without mesial temporal sclerosis (MTS).ResultsOf the 21 patients, 19 (90%) underwent Invasive EEG study and 11 (52%) achieved freedom from disabling seizures with a mean duration of postoperative follow-up of 24±11 months after LITT. Eight (73%) of 11 patients with MTS achieved freedom from disabling seizures, whereas 3 (30 %) of 10 patients without MTS achieved freedom from disabling seizures. Patients with MTS were significantly more likely to become seizure-free, as compared with those without MTS (P=0.002). There was no significant difference in total ablation volume and the percentage of the ablated amygdalohippocampal complex between seizure-free and non-seizure-free patients. Presurgical and postsurgical neuropsychological assessments were obtained in 10 of 21 patients. While there was no group decline in any neuropsychological assessment, a significant postoperative decline in verbal memory and confrontational naming was observed in individual patients.ConclusionsMRI-guided LITT is a safe and effective alternative to selective amygdalohippocampectomy and anterior temporal lobectomy for mTLE with MTS. Nevertheless, its efficacy in those without MTS seems modest. Large multicentre and prospective studies are warranted to further determine the efficacy and safety of LITT.
    Subject(s): Electrodes ; Electroencephalography ; Epilepsy ; Lasers ; Patients ; Surgery ; Surgical outcomes ; Systematic review
    ISSN: 0022-3050
    E-ISSN: 1468-330X
    Source: Hellenic Academic Libraries Link
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  • 6
    Language: English
    In: Frontiers in human neuroscience, 2020-11-09, Vol.14, p.584005-584005
    Description: Objectives: To study whether and to what extent the therapeutic impedance and current change under long-term deep brain stimulation (DBS) with constant stimulation settings, which could inform the role of constant current stimulation. Methods: Therapy impedance and current measurements were retrospectively collected from patients with Parkinson’s disease (PD) undergoing DBS of subthalamic nucleus (STN) or essential tremor (ET) undergoing ventral intermediate nucleus (VIM). Baseline and follow-up measurements were obtained for intervals of at least 6 months without changes in stimulation settings. The single longest interval of constant stimulation for each electrode was included. Temporal trends in impedance and current were analyzed as absolute and relative differences and as rate of change. Results: Impedance and current data from 79 electrodes (60 in STN, 19 in VIM) in 44 patients (32 with PD, 12 with ET) met inclusion criteria. Duration between baseline and follow-up measurements with constant stimulation settings was 17 months (median, with interquartile range of 12-26 months) in the mixed group. Therapy impedance decreased by 27 ± 12 Ω/year (mean ± 2 standard errors; p 〈 0.0001), and therapy current increased at a rate of 0.142 ± 0.063 mA/year (p 〈 0.0001). Similar results were observed in the STN and VIM subgroups. Conclusions: Impedance decreases gradually over time, even when stimulation settings are kept constant. The rate of decrease is smaller than previously reported, suggesting that changes in stimulation settings contribute to impedance drift. Stimulation-independent impedance drift is gradual but relevant to constant-current programming.
    Subject(s): current ; DBS ; Deep brain stimulation ; Drift ; Electrical stimuli ; Electrodes ; Human Neuroscience ; impedance ; Movement disorders ; Neurodegenerative diseases ; Parkinson's disease ; Patients ; Solitary tract nucleus ; Statistical analysis ; STN ; Subthalamic nucleus ; Tremor ; VIM ; voltage
    ISSN: 1662-5161
    E-ISSN: 1662-5161
    Source: PubMed Central
    Source: Alma/SFX Local Collection
    Source: DOAJ Directory of Open Access Journals - Not for CDI Discovery
    Source: ProQuest Central
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  • 7
    Language: English
    In: Epilepsia (Copenhagen), 2020-06, Vol.61 (6), p.1190-1200
    Description: Objective Corpus callosotomy is an effective palliative treatment for drug‐resistant Lennox‐Gastaut syndrome (LGS). Laser interstitial thermal therapy has been increasingly used in the treatment of epilepsy. Here, we assess the safety and effectiveness of minimally invasive stereotactic laser anterior corpus callosotomy (SLACC) for drop attacks in LGS. Methods We reviewed sequential cases of patients with medically intractable LGS who underwent SLACC using a two‐cannula technique between November 2014 and July 2019. Pre‐ and postoperative magnetic resonance imaging was used to measure the anteroposterior length of callosal ablation (contrast‐enhancing lesion) and estimated disconnection (gap in tract projections on diffusion tensor imaging). Patients were followed longitudinally to assess clinical outcomes. Results Ten patients were included in this study. The median age was 33 (range = 11‐52) years, median duration of epilepsy was 26 (range = 10‐49) years, and median duration of postoperative follow‐up was 19 (range = 6‐40) months. In the anteroposterior direction, 53 ± 7% (mean ± SD) of the corpus callosum was ablated and 62 ± 19% of the corpus callosum was estimated to be disconnected. Six (60%) of 10 patients achieved 〉80% seizure reduction, two (20%) of whom became seizure‐free. Eight (80%) patients had 〉80% reduction in drop attacks, five (50%) of whom became free of drop attacks. Three patients subsequently underwent laser posterior callosotomy with further improvement in drop attacks and/or overall seizure frequency. One patient had an asymptomatic intracerebral hemorrhage along the cannula tract. One patient developed significant aggression after becoming seizure‐free. Significance Seizure outcomes following SLACC were comparable to previously reported outcomes of open callosotomy, with reasonable safety profile. SLACC appears to be an effective alternative to open anterior corpus callosotomy with minimal postoperative discomfort and a short recovery period.
    Subject(s): Convulsions & seizures ; corpus callosotomy ; Corpus callosum ; drop attacks ; Epilepsy ; Hemorrhage ; laser ablation ; Lasers ; Lennox‐Gastaut syndrome ; Magnetic resonance imaging ; Patients ; Seizures ; vagus nerve stimulation
    ISSN: 0013-9580
    E-ISSN: 1528-1167
    Source: Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals
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  • 8
    Language: English
    In: Neurosurgery, 2019-09, Vol.85 (3), p.E569-E574
    Description: BACKGROUND AND IMPORTANCE:Corpus callosotomy is an effective palliative treatment for medically intractable Lennox-Gastaut syndrome (LGS) that disrupts the interhemispheric synchronization of epileptiform discharges. However, traditional open corpus callosotomy carries a significant risk of surgical complications associated with craniotomy and a parafalcine approach to the corpus callosum. Here, we report 2 cases of anterior corpus callosotomy using MRI-guided stereotactic laser interstitial thermal therapy (LITT) as a minimally invasive technique for mitigating the risks of craniotomy while achieving favorable outcomes. CLINICAL PRESENTATION:Two patients with medically intractable LGS underwent stereotactic laser anterior corpus callosotomy using a 2 laser-fiber approach. Ablation of 70%-80% of the corpus callosum was confirmed by postoperative MRI diffusion tensor imaging and volumetric analysis. Marked reduction of epileptiform activity was observed in both patients during postoperative video-EEG studies as compared to preoperative video-EEG studies. Freedom from disabling seizures including drop attacks was achieved in 1 patient for 18 mo, and more than a 90% reduction of disabling seizures was achieved in the other patient for 7 mo with cognitive improvement and without surgical complications. CONCLUSION:These early data demonstrate the technical feasibility, safety, and favorable outcomes of MRI-guided stereotactic laser anterior corpus callosotomy in patients with LGS, making it a potentially safe and effective alternative to traditional open corpus callosotomy and other stereotactic methods including radiofrequency ablation and radiosurgery due to the ability to monitor the ablation in real time with MRI.
    Subject(s): Ablation ; Ablation (Surgery) ; Adult ; Care and treatment ; Clinical Neurology ; Corpus Callosum - surgery ; Electroencephalography ; Humans ; Laser Therapy - methods ; Lasers ; Lennox Gastaut Syndrome - surgery ; Life Sciences & Biomedicine ; Magnetic Resonance Imaging - methods ; Male ; Medical research ; Medicine, Experimental ; Methods ; Minimally Invasive Surgical Procedures - methods ; Neuronavigation - methods ; Neurosciences & Neurology ; Neurosurgery ; Patients ; Radiosurgery ; Science & Technology ; Seizures (Medicine) ; Surgery ; Treatment Outcome ; Volumetric analysis
    ISSN: 0148-396X
    E-ISSN: 1524-4040
    Source: Web of Science - Science Citation Index Expanded - 2019〈img src="http://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /〉
    Source: Get It Now
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  • 9
    Language: English
    In: Journal of neurology, neurosurgery and psychiatry, 2013-08, Vol.84 (8), p.828-828
    Description: Schumpeter's principle of creative destruction which describes how new products and processes will render older ones obsolete is in full swing here. 4 As to pituitary adenoma resection, Ammirat et al 1 tried to elucidate which approach is superior using the technique of systematic review and meta-analysis. 5 The authors tried their best to shed some light on the controversy of endoscopic versus microscopic resection of pituitary adenomas and showed that differences if any in outcome are minute and the data quality is poor and so there is no justification to advocate aggressively one technique over the other.
    Subject(s): Endoscopy ; Endoscopy - methods ; Female ; Funding ; Humans ; Male ; Meta-analysis ; Microsurgery - methods ; NEUROSURGERY ; Neurosurgical Procedures - methods ; Pituitary gland ; Pituitary Neoplasms - surgery ; Quality ; Systematic review ; Tumors
    ISSN: 0022-3050
    E-ISSN: 1468-330X
    Source: Hellenic Academic Libraries Link
    Source: BMJ Journals - NESLi2
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  • 10
    Language: English
    In: Journal of Neurology, Neurosurgery and Psychiatry, 2013-12, Vol.84 (12), p.1384-1391
    Description: The treatment of metastatic brain lesions remains a central challenge in oncology. Because most chemotherapeutic agents do not effectively cross the blood–brain barrier, it is widely accepted that radiation remains the primary modality of treatment. The mode by which radiation should be delivered has, however, become a source of intense controversy in recent years. The controversy involves whether patients with a limited number of brain metastases should undergo whole brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS) delivered only to the radiographically visible tumours. Survival is comparable for patients treated with either modality. Instead, the controversy involves the neurocognitive function (NCF) of radiating cerebrum that appeared radiographically normal relative to effects of the growth from micro-metastatic foci. A fundamental question in this debate involves quantifying the effect of WBRT in patients with cerebral metastasis. To disentangle the effects of WBRT on neurocognition from the effects inherent to the underlying disease, we analysed the results from randomised controlled studies of prophylactic cranial irradiation in oncology patients as well as studies where patients with limited cerebral metastasis were randomised to SRS versus SRS+WBRT. In aggregate, these results suggest deleterious effects of WBRT in select neurocognitive domains. However, there are insufficient data to resolve the controversy of upfront WBRT versus SRS in the management of patients with limited cerebral metastases.
    Subject(s): Blood-brain barrier ; Brain cancer ; Brain Neoplasms - radiotherapy ; Brain Neoplasms - secondary ; Brain Neoplasms - surgery ; Cancer ; Cancer therapies ; Care and treatment ; Cell cycle ; Chemotherapy ; Cognition ; Cognition - radiation effects ; COGNITIVE NEUROPSYCHOLOGY ; Combined Modality Therapy ; Cranial Irradiation - adverse effects ; Cranial Irradiation - methods ; Cranial Irradiation - mortality ; Evaluation ; Humans ; Medical prognosis ; MEMORY ; Metastasis ; NEUROONCOLOGY ; Neuropsychological Tests ; NEUROSURGERY ; Radiation therapy ; Radiosurgery ; Radiosurgery - adverse effects ; Radiosurgery - methods ; Radiosurgery - mortality ; RADIOTHERAPY ; Usage ; Whole brain radiotherapy
    ISSN: 0022-3050
    E-ISSN: 1468-330X
    Source: Hellenic Academic Libraries Link
    Source: BMJ Journals - NESLi2
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