ABSTRACT
Introduction: Directional Leads (dLeads) represent a new technical tool in Deep Brain Stimulation (DBS), and a rapidly growing population of patients receive dLeads. Research question: The European Association of Neurosurgical Societies(EANS) functional neurosurgery Task Force on dLeads conducted a survey of DBS specialists in Europe to evaluate their use, applications, advantages, and disadvantages. Material and methods: EANS functional neurosurgery and European Society for Stereotactic and Functional Neurosurgery (ESSFN) members were asked to complete an online survey with 50 multiple-choice and open questions on their use of dLeads in clinical practice. Results: Forty-nine respondents from 16 countries participated in the survey (n = 38 neurosurgeons, n = 8 neurologists, n = 3 DBS nurses). Five had not used dLeads. All users reported that dLeads provided an advantage (n = 23 minor, n = 21 major). Most surgeons (n = 35) stated that trajectory planning does not differ when implanting dLeads or conventional leads. Most respondents selected dLeads for the ability to optimize stimulation parameters (n = 41). However, the majority (n = 24), regarded time-consuming programming as the main disadvantage of this technology. Innovations that were highly valued by most participants included full 3T MRI compatibility, remote programming, and closed loop technology. Discussion and conclusion: Directional leads are widely used by European DBS specialists. Despite challenges with programming time, users report that dLeads have had a positive impact and maintain an optimistic view of future technological advances.
ABSTRACT
Introducción. La encefalopatía posterior reversible (EPR) es una entidad clinicorradiológica caracterizada típicamente por cuadros de cefalea, alteraciones visuales y crisis epilépticas, asociada a edema vasógeno corticosubcortical reversible en la neuroimagen. Objetivo. Presentar una revisión de los aspectos fisiopatológicos de esta entidad y también de las asociaciones de la EPR descritas en la bibliografía. Desarrollo. Existe una serie de factores desencadenantes bien conocidos, como las crisis hipertensivas, la eclampsia o ciertos medicamentos. La descripción de cada vez más casos atípicos desde un punto de vista clínico y radiológico, así como de posibles nuevos factores desencadenantes, obliga a una redefinición de la entidad. Conclusiones. La EPR es un conjunto de manifestaciones clínicas y radiológicas que no se pueden enmarcar dentro la palabra síndrome. Aunque la EPR se ha comunicado como irreversible en ciertos casos, el concepto de reversibilidad debemantenerse en la definición de esta entidad, ya que, en la mayor parte de los casos, el rápido control de la condición desencadenante de la EPR permite la reversibilidad de las lesiones (AU)
Introduction. Posterior reversible encephalopathy (PRE) is a clinical and radiological entity that is typically characterized by headache, visual disturbances and seizures associated with cortical and subcortical reversible vasogenic edema in neuroimaging. Aim. To present a review of the pathophysiology of this entity, and also the associations of the PRE described in the literature. Development. Given its clinical presentation, often nonspecific and variable, magnetic resonance imaging is essential for diagnosis. There are a number of well-known triggers, such as hypertensive crisis, eclampsia or certain drugs. The description of increasingly atypical cases from clinical and radiological point of view, and possible new triggers, requires a redefinition of this entity. Conclusions. The PRE is a set of clinical and radiological manifestations that may not be framed within the word syndrome. lthough, the PRE has been reported in some cases irreversible, reversibility concept should be maintained in the definition of this entity, since in most cases the rapid control of the triggering condition allows reversibility of the lesions (AU)
