A Comparison of Surgical Approaches for the Management of Tremor: Radiofrequency Thalamotomy, Gamma Knife Thalamotomy and Thalamic Stimulation

1999 ◽  
Vol 72 (2-4) ◽  
pp. 178-184 ◽  
Author(s):  
Ajay Niranjan ◽  
Ajay Jawahar ◽  
Douglas Kondziolka ◽  
L. Dade Lunsford
Keyword(s):  
Gamma Knife ◽  
Surgical Approaches ◽  
Thalamic Stimulation

Gamma knife surgery for trigeminal neuralgia: outcomes and prognostic factors

2005 ◽  
Vol 102 (3) ◽  
pp. 434-441 ◽  
Author(s):  
Jason Sheehan ◽  
Hung-Chuan Pan ◽  
Matei Stroila ◽  
Ladislau Steiner
Keyword(s):  
Trigeminal Neuralgia ◽  
Gamma Knife ◽  
Univariate Analysis ◽  
Gamma Knife Surgery ◽  
Long Term Results ◽  
Surgical Approaches ◽  
Content Type ◽  
Facial Numbness ◽  
Fine Print

Object. Microvascular decompression (MVD) and percutaneous ablation surgery have historically been the treatments of choice for medically refractory trigeminal neuralgia (TN). Gamma knife surgery (GKS) has been used as an alternative, minimally invasive treatment in TN. In the present study, the authors evaluated the long-term results of GKS in the treatment of TN. Methods. From 1996 to 2003, 151 cases of TN were treated with GKS. In this group, radiosurgery was performed once in 136 patients, twice in 14 patients, and three times in one patient. The types of TN were as follows: 122 patients with typical TN, three with atypical TN, four with multiple sclerosis—associated TN, and seven with TN and a history of a cavernous sinus tumor. In each case, the chosen radiosurgical target was located 2 to 4 mm anterior to the entry of the trigeminal nerve into the pons. The maximal radiation doses ranged from 50 to 90 Gy. The median age of the patients was 68 years (range 22–90 years), and the median time from diagnosis to GKS was 72 months (range 1–276 months). The median follow up was 19 months (range 2–96 months). Clinical outcomes and postradiosurgical magnetic resonance (MR) imaging studies were analyzed. Univariate and multivariate analyses were performed to evaluate factors that correlated with a favorable, pain-free outcome. The mean time to relief of pain was 24 days (range 1–180 days). Forty-seven, 45, and 34% of patients were pain free without medication at the 1-, 2-, and 3-year follow ups, respectively. Ninety, 77, and 70% of patients experienced some improvement in pain at the 1-, 2-, and 3-year follow ups, respectively. Thirty-three (27%) of 122 patients with initial improvement subsequently experienced pain recurrence a median of 12 months (range 2–34 months) post-GKS. Among those whose symptoms recurred, 14 patients underwent additional GKS, six MVD, four glycerol injection, and one patient a percutaneous radiofrequency rhizotomy. Twelve patients (9%) suffered the onset of new facial numbness post-GKS. Changes on MR images post-GKS were noted in nine patients (7%). On univariate analysis, right-sided neuralgia (p = 0.0002) and a previous neurectomy (p = 0.04) correlated with a pain-free outcome; on multivariate analysis, both right-sided neuralgia (p = 0.032) and patient age (p = 0.05) were statistically significant. New onset of facial numbness following GKS correlated with undergoing more than one GKS (p = 0.002). Conclusions. At the last follow up, GKS effected pain relief in 44% of patients. Some degree of pain improvement at 3 years post-GKS was noted in 70% of patients with TN. Although less effective than MVD, GKS remains a reasonable treatment option for those unwilling or unable to undergo more invasive surgical approaches and offers a low risk of side effects.

Surgical Approaches to the Brain Stem

1993 ◽  
Vol 4 (3) ◽  
pp. 457-468 ◽  
Author(s):  
Dennis Y. Wen ◽  
Roberto C. Heros
Keyword(s):  
Brain Stem ◽  
Surgical Approaches ◽  
The Brain

Palliative treatment of brain metastases with gamma knife

2001 ◽  
Vol 58 (7) ◽  
pp. 413-418 ◽  
Author(s):  
Jean Siegfried ◽  
G. Wellis ◽  
S. Scheib ◽  
D. Haller ◽  
A. M. Landolt ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Scale Score ◽  
Gamma Knife ◽  
Palliative Treatment ◽  
Rating Scale ◽  
Psychische Belastung ◽  
Performance Rating ◽  
Wird Eine

Das Gamma Knife ist ein stereotaktisch-radiochirurgisches Gerät, das erlaubt, radiologisch scharf begrenzte Hirntumore (oder arteriovenöse Missbildungen) mit einem Durchmesser von maximal 3,5 cm und einem Volumen von höchstens 25 cm3 zu behandeln. Diese Methode ist eine echte Alternative zur klassischen Behandlung von Hirnmetastasen mit operativer Entfernung und/oder Ganzhirnbestrahlung. Die Vorteile dieser Technik sind klar: die Methode ist nicht invasiv, die Behandlung benötigt nur eine Sitzung mit einer kurzen Hospitalisation von höchstens zwei bis drei Tagen, die physische und psychische Belastung ist gering, der Kopf wird weder rasiert noch verliert der Patient durch die Behandlung seine Haare; für eine befriedigende Überlebenszeit wird eine gute Lebensqualität erreicht und im Kostenvergleich mit alternativen Methoden (Operation und/oder anschließender Ganzhirnbestrahlung) wirtschaftlich günstiger. Von September 1994 bis Dezember 2000 wurden am Gamma Knife Zentrum in Zürich 140 an Hirnmetastasen leidende Patienten mit dieser Methode behandelt. Mit einer Überlebenszeit von durchschnittlich 263 Tagen und einem Maximum von drei Jahren entsprechen unsere Resultate denjenigen der Literatur mit weltweit über 30000 behandelten Patienten. Günstige Prognosen sind ein Karnofsky Performance Rating Scale Score zwischen 70 und 100, kleine Volumina der Metastasen, kontrollierter Primärtumor und fehlende oder stabile extrakranielle Metastasen.

Current Strategies in the Management of Spinal Metastatic Disease

Swiss Surgery ◽  
2003 ◽  
Vol 9 (2) ◽  
pp. 55-62 ◽  
Author(s):  
Bartanusz ◽  
Porchet
Keyword(s):  
Spinal Cord ◽  
Surgical Techniques ◽  
Cord Compression ◽  
Treatment Modalities ◽  
Surgical Approaches ◽  
Spinal Stabilization ◽  
Management Algorithm ◽  
Specific Manner ◽  
Extensive Surgery ◽  
Selection Of

The treatment of metastatic spinal cord compression is complex. The three treatment modalities that are currently applied (in a histologically non-specific manner) are surgery, radiotherapy and the administration of steroids. The development of new spinal instrumentations and surgical approaches considerably changed the extent of therapeutic options in this field. These new surgical techniques have made it possible to resect these tumours totally, with subsequent vertebral reconstruction and spinal stabilization. In this respect, it is important to clearly identify those patients who can benefit from such an extensive surgery. We present our management algorithm to help select patients for surgery and at the same time identifying those for whom primary non-surgical therapy would be indicated. The retrospective review of surgically treated patients in our department in the last four years reveals a meagre application of conventional guidelines for the selection of the appropriate operative approach in the surgical management of these patients. The reasons for this discrepancy are discussed.

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