Stereotactic subthalamic nucleus lesioning for the treatment of Parkinson's disease.

This study was performed to evaluate the effectiveness and safety of unilateral STN lesioning in 23 patients with PD. L-Dopa intake and dyskinesia, Hoehn & Yahr, Schwab & England, and UPDRS motor scores were recorded pre- and postoperatively. Stereotactic MRI and CT and macrostimulation were used to establish target coordinates. A single RF lesion was performed. All patients underwent postoperative MRI. Contralateral tremor arrest and decrease of rigidity and bradykinesia should be regarded as hallmarks to STN stimulation. All recorded parameters were significantly improved after a mean follow-up of 13.5 months. Patients with STN lateral territory lesioning (alpha <0.05), younger than 61 years and with a duration of the disease between 6 and 9 years (alpha >0.05) did better than the others. The recurrence rate was 10%. Two patients developed dyskinesias which were completely resolved by a Vim/VOp lesion. Other significant complications were rare. The authors conclude that unilateral STN lesioning is a safe and very effective procedure to treat PD.

Motor performance after posteroventral pallidotomy and VIM-thalamotomy in Parkinson's disease: a 1-year follow-up study.

Twenty-three patients with Parkinson's disease underwent stereotactic surgery. To study the long-term motor performance, the patients were evaluated at the pre-operative period and at the 1st, 3rd, 6th, and 12th post-operative months, with the following scales: Unified Parkinson's Disease Rating Scale (UPDRS) motor score and Larsen's Scale for Dyskinesias. The patients under levodopa therapy were assessed both in "on" and "off" periods. Fourteen unilateral ventrolateral thalamotomies (VLT), 4 unilateral posteroventral pallidotomies (PVP), 2 bilateral PVP, and 3 VLT with contralateral PVP were performed. The motor improvement was significant and long-lasting in the "off" period, except for 2 patients. The "on" period quality improved, mainly due to the control of dyskinesias. The improvement of dyskinesias was long-lasting for the majority of the patients. There was no significant decrease in the levodopa dose. Three patients showed permanent complications, but none was severe.

Patients with epileptic seizures and cerebral lesions who underwent lesionectomy restricted to or associated with the adjacent irritative area.

PURPOSE: To analyze the best surgical procedure for patients with epileptic seizures and cerebral lesions-i.e., resection restricted to the lesion or resection associated with the adjacent irritative area-based on the clinical evolution of patients' seizure outcome and electroencephalographic (EEG) and electrocorticographic (ECoG) findings. METHODS: This study comprised 37 patients with epileptic seizures and cerebral lesions, ranging in age from 9 to 66 years. Patients were divided into two groups: Group 1 consisted of 21 patients with medically intractable epilepsy, Group 2 of 16 patients with medically controlled epilepsy. Eleven of the 21 patients in Group 1 (Subgroup A) underwent surgical resection of the cerebral lesion and adjacent irritative area as shown by ECoG. For the remaining 10 patients in Group 1 (Subgroup B), the resection was restricted to the lesion. The 16 patients in Group 2 all underwent lesionectomies. RESULTS: Of the 11 patients in group 1 who underwent resection of the cerebral lesion and adjacent irritative area, 91% became seizure free. Sixty percent of the remaining patients in group I whose resections were restricted to the lesion also became seizure free, as did all the patients in group 2. An overall analysis of the EEGs for all patients showed a statistically significant decrease in paroxysmal activity. CONCLUSIONS: In patients with uncontrolled seizures, resection of the cerebral lesion associated with the irritative area shows a tendency to obtain better seizure-outcome results than restricted lesionectomy.

[Image guided stereotactic approach of central nervous system lesions: accuracy, morbidity, mortality]. / Abordagem estereotáxica guiada por imagem de lesões do sistema nervoso central. Precisão diagnóstica, morbidade, mortalidade.

We studied seventy-five patients with brain lesions biopsied by stereotaxis from March 1993 to December 1998 at Universidade Federal de São Paulo-Escola Paulista de Medicina. The three most frequent lesions were: metastasis, low grade astrocytomas and glioblastoma multiforme. The morbidity rate was 2.66% due to: one case of scalp infection in a patient with thalamic cyst; and a partial seizure during surgery in a patient with lymphoma. The mortality rate was 1.33% due to increasing of cerebral edema after biopsy and the patient died after one week. The diagnostic accuracy was 89.33%.

[Stereotaxic thalamotomy and pallidotomy with computerized planning in Parkinson's disease: short-term evaluation of motor function in 50 patients]. / Talamotomia e palidotomia estereotáxica com planejamento computadorizado no tratamento da doença de Parkinson. Avaliação do desempenho motor a curto prazo de 50 pacientes.

We evaluated the motor function of 50 patients with Parkinson's disease, who underwent stereotaxic surgery with computerized planning, without ventriculography (ventrolateral thalamotomy- VLT- and/or posteroventral pallidotomy- PVP) before and one month after surgery. 27 unilateral TVL, 10 unilateral PVP, 6 bilateral PVP, and 7 TVL with PVP were performed. The motor evaluation was performed with the Unified Parkinson's Disease Rating Scale, motor score, during on and off periods. We observed a global motor improvement in all groups. The improvement of dyskinesias was obtained in the contralateral side of the body, in the PVP groups. From the 50 patients, 16 (32%) presented post-operative complications, 9 of these (56.25%) improved completely, 6 (37.25%) improved partially, and 1 (6.25%) did not improve during the first month. These results were considered satisfactory, and a long term analysis will show whether these benefits are long lasting or not.

[Temporal lobe epilepsy. Surgical treatment]. / Epilepsia do lobo temporal. Tratamento cirúrgico.

The authors report the surgical management of 32 patients with medically intractable seizures. In all cases the epileptiform focus present in the temporal region was demonstrated by electroencephalography. Our report was made up of 14 male patients and 18 female patients. Their ages ranged from 9 to 62 years. The material was divided into two groups. The first, with eighteen patients with cerebral lesion (like gliomas, arteriovenous malformation, epidermoid tumor) demonstrated on the CT scan and MR imaging underwent to lesion resection: in some cases with adjacent irritative area (guided by electrocorticography) out of eloquent zone, the removal of this irritative area was done. The second, with fourteen patients without cerebral expansive lesion; the MR imaging showed mesial temporal sclerosis in eight cases; all the patients of this group underwent to temporal lobectomy; the histopathologic exam showed temporal sclerosis in nine cases and normal brain in five. The postoperative follow-up showed better results in the cases with expansive cerebral lesion (83.4% seizure free) than the cases without that lesion (71.4% seizure free).