By Johannes Schramm
This quantity of Advances and Technical criteria in Neurosurgery covers a few very important new advancements in sensible neurosurgery and endovascular treatment. within the Technical criteria part various subject matters are thought of, together with optic pathway gliomas, pineal lesions, cavernous sinus meningiomas and the everlasting challenge of teen and repetitive head harm. Endovascular remedy of a number of lesions is now universal perform and the state-of-the-art in endovascular therapy for acute ischemic stroke is reviewed. An appraisal of the proof on no matter if there's a position for microsurgical vascular decompression for crucial high blood pressure increases fascinating questions. the amount is done through contributions on neurosurgical therapy of cluster complications and occipital nerve stimulation.
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Extra info for Advances and Technical Standards in Neurosurgery: Volume 42
Conclusion ONS is a safe and efficacious treatment for a variety of headache disorders. Should medical therapy fail, patients may benefit from and should be encouraged towards ONS trials. The exact mechanism of action for peripheral neurostimulation is not concretely known, but most likely its effects are due to multiple mechanisms. While complications like lead migration do arise, perioperative preventative measures may help to reduce the incidence of such complication. Should complications like lead migration arise, novel approaches to corrective surgery have been thoroughly described in the literature.
Though less common than migraine, other conditions such as occipital neuralgia and cluster headache can be quite disabling, and may progress to chronic, intractable states. Of those who cope with headaches, approximately 5 % suffer from daily headaches (transformed migraine and chronic daily headaches). Moreover, 1–2 % may be poorly responsive to medical treatment modalities. 4: Headache attributed to hypothalamic or pituitary hyper- or hyposecretion Number of successful trials 18 21 10 7 7 4 3 4 3 1 1 18 21 10 7 7 4 3 4 3 1 1 Number of patients 28 24 11 8 7 5 5 5 4 1 1 28 24 11 8 7 5 5 5 4 1 1 88 100 80 60 80 75 100 100 64 88 91 88 100 80 60 80 75 100 100 Trial success rate (%) 64 88 91 7 6 4 1 1 3 1 0 15 19 8 7 6 4 1 1 3 1 0 Number of permanent systems still used at last follow-up 15 19 8 100 86 100 33 25 100 100 0 83 90 80 100 86 100 33 25 100 100 0 Long-term implanted success rate (%) 83 90 80 88 86 80 20 20 75 100 0 54 79 73 88 86 80 20 20 75 100 0 Intent-to-treat success rate (%) 54 79 73 Table 1 Patient outcomes from a study by Mammis et al.
The left occipital lead was then replaced during revision surgery (b) Occipital Nerve Stimulation 31 reported following ONS, including the following: lead migration, infection, wound erosion, device failure, muscle spasms, and pain [1, 19]. Most commonly, lead migration is associated with ONS [18, 19] (Fig. 4). Often lead migration may require surgical intervention. Schwedt et al. demonstrated lead migration rates of 33 % after 6 months, 60 % after 2 years, and 100 % after 3 years . In the authors’ experience, lead migration occurred in 7 % of patients.
Advances and Technical Standards in Neurosurgery: Volume 42 by Johannes Schramm