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[Chronic intracerebral stimulation and abnormal movements: why and when? Major therapeutic advances in the 90s].

TECHNICAL ASPECTS: Surgical procedures for abnormal movements progressively evolved toward microinvasive techniques performed under stereotaxic control. The next advance was the development of well-tolerated intracerebral stimulation with reversible effects. The quality of the results depends on optimal definition of the stimulation target. Optimally, the surgical protocol includes stereotaxic ventriculography to identify targets followed by electrical activity recordings of the structures crossed by the electrode. Finally, a minute study of the stimulation effects is performed under sterotaxic control while the patient is awake. PARKINSON'S DISEASES: Indications for thalamic stimulation in Parkinson's disease have given way to subthalamic stimulation which improves tremor, bradykinesia and rigidity simultaneously. This result confirms the implication of the subthalamic nucleus in the pathogenesis of Parkinson syndromes. The palladium may be stimulated in Parkinson's patients with major iatrogenic involuntary movements. ESSENTIAL TREMOR: Thalamic stimulation is indicated for essential tremor. The efficacy of chronic stimulation is currently under evaluation in other indications.

Cerebral Cortex↗

Deep brain stimulation for movement disorders and pain.

Deep brain stimulation (DBS) is an expanding field within neurosurgery. With many neurosurgeons performing relatively small numbers of these procedures, detailed descriptions of the technical aspects and nuances of DBS may be worthwhile. We describe our technique for DBS, based on over 300 procedures. This methodology continues to evolve and is refined according to our own experience, our observations of others, technological innovations, and information derived from the neurosurgical literature. The indications for DBS in our service are outlined, the anatomical targets described, and the anaesthetic and surgical aspects detailed.

Deep Brain Stimulation↗

Current brain tumour models with particular consideration of the transplantation techniques. Outline of literature and personal preliminary results.

The most well known brain tumour models will be discussed. It is a series of animal experiments with an induced tumour and with heterologous and homologous transplantation. This work will deal especially with technical problems, which have not so far been satisfactorily resolved. With the aid of a stereotaxic operation method, the exactness of the technique of transplantation could be improved. The tumour contamination problem of the injection pathway as well as of the cerebral spinal fluid compartment is satisfactorily resolved. The authors have at their disposal a standardized cerebral glioma model in the rat in order to study the interstitial chemotherapy of brain tumours.

Animals↗

[Stereotaxic breast biopsy techniques have become the standard of care for mammographically suspicious lesions].

An optimal technique for the evaluation of nonpalpable, suspicious mammographic lesions should have a low technical failure rate, no false-negative results and should remove the lesion completely. Since most of these lesions are benign, the procedure should be carried out in an outpatient setting without general anesthesia. Cancer is missed in 2.6% of cases with excisional biopsy following needle localization. Furthermore, 50-83% of these patients undergo a second surgical intervention for definitive surgical treatment. In contrast, the rate of missed cancers is less than 0.7% following stereotaxic core or large-core biopsies. However, using these techniques, discordant results and histologic high-risk lesions need to be recognized and reexcized. The cost-effectiveness of stereotaxic vacuum-assisted core biopsy has been demonstrated. Stereotaxic breast biopsy techniques such as vacuum-assisted core biopsy and large-core biopsy for suspicious mammographic lesions have low false-negative rates and result in few histologic underestimations.

Biopsy↗

[Ultrasound-controlled stereotactic breast biopsy--description and initial clinical results of a new breast biopsy device].

UNLABELLED: The aim of this prospective study was first to describe a new dedicated 3D-ultrasound guided stereotaxic breast biopsy unit and second its specificity, sensitivity, accuracy and positive predictive value (concerning malignant and benign lesions). Technical considerations are noted and discussed. SUBJECTS AND METHODS: 45 women (aged between 20 and 77 years; mean age: 49.73 years) with sonographically suspect breast lesions were assigned to the new biopsy device (Sonopsy, NeoVision Corporation, Seattle). All biopsies were performed by an experienced radiologists (G. Wolf) and the results compared to the surgical biopsies. RESULTS: Sensitivity and accuracy was 93.3%, specificity 100%, the positive predictive value (concerning malignant lesions) 95.4% and (concerning benign lesions) 97.8%. In 9/45 biopsies (20%) complications were noted (1 hematoma, 2 collapses, 5 vasovagale reactions). In 13/45 Cases (28.9%) the suspect lesions were more distinctively, respectively more clearly defined on the conventional/dedicated sonography unit. CONCLUSION: This dedicated unit combines all advantages of sonographic and stereotaxic guided core biopsies. Our results show that this technique is a promising new method for breast biopsy.

Adult↗

[Stereotaxic radiosurgery:methods and indications in the treatment of cerebral arteriovenous malformations].

After Leksell and Steiner's pioneering experience with the use of the gamma units, another technically different system has been developed, using a linear accelerator. It's a very precise stereotactic radiosurgical approach which allows to deliver the necessary dose of radiation to the target volume while sparing the surrounding structures from potentially dangerous levels of radiation. This hyperselective irradiation is a new and complementary method of treatment of arteriovenous malformations located in central or functionally critical areas of the brain. The aim is to obtain a progressive and total obliteration of the lesion. The place of radiosurgery is obviously reserved for the patients who do not seem able to profit from the benefits of open surgery and/or embolization techniques.

Dose-Response Relationship, Radiation↗