scholarly journals How I do it: parietal trans-sulcal para-fascicular approach to lateral thalamic/internal capsule cavernous malformation

2021 ◽  
Author(s):  
Michael Amoo ◽  
Kieron J. Sweeney ◽  
Ronan Kilbride ◽  
Mohsen Javadpour
Keyword(s):  
White Matter ◽  
Cavernous Malformation ◽  
Internal Capsule ◽  
Complete Resection ◽  
Brain Lesions ◽  
Tubular Retractor ◽  
Surgical Technology ◽  
Feasible Alternative ◽  
Traditional Approaches ◽  
Deep Brain

Abstract Background The surgical management of deep brain lesions is challenging, with significant morbidity. Advances in surgical technology have presented the opportunity to tackle these lesions. Methods We performed a complete resection of a thalamic/internal capsule CM using a tubular retractor system via a parietal trans-sulcal para-fascicular (PTPF) approach without collateral injury to the nearby white matter tracts. Conclusion PTPF approach to lateral thalamic/internal capsule lesions can be safely performed without injury to eloquent white matter fibres. The paucity of major vessels along this trajectory and the preservation of lateral ventricle integrity make this approach a feasible alternative to traditional approaches.

Stereotactic Minimally Invasive Tubular Retractor System for Deep Brain Lesions

2008 ◽  
Vol 63 (suppl_4) ◽  
pp. ONS334-ONS340 ◽  
Author(s):  
Jeffrey P. Greenfield ◽  
William S. Cobb ◽  
A. John Tsouris ◽  
Theodore H. Schwartz
Keyword(s):  
White Matter ◽  
Glioblastoma Multiforme ◽  
Metastatic Lesion ◽  
Brain Lesions ◽  
Gross Total Resection ◽  
Total Resection ◽  
Tubular Retractor ◽  
White Matter Tracts ◽  
Stereotactic Navigation ◽  
Deep Brain

Abstract Objective: Deep-seated supratentorial intraparenchymal and intraventricular brain lesions can be difficult to access without causing significant trauma to the overlying cortex and intervening white matter tracts. Traditional brain retractors use multiple blades, which do not exert pressure in an equally distributed fashion. Tubular retractors offer an advantage. Although a commercially available frame-based tubular retractor system is on the market (COMPASS; Compass, Inc., Rochester, MN), we modified existing off-the-shelf equipment at our institution into a frameless tubular brain retractor. Methods: We used 14- to 22-mm METRx (Medtronic, Minneapolis, MN) tubular retractors in combination with a frameless stereotactic navigation system to remove 10 deep lesions. Histological findings included 6 periventricular metastases, 1 insular glioblastoma multiforme, 1 periventricular glioblastoma multiforme, 1 intraventricular meningioma, and 1 hippocampal cavernous malformation. Results: Radiographic gross total resection was achieved in all patients. One patient experienced a transient worsening of an existing preoperative Wernicke’s aphasia; otherwise, there were no intra- or postoperative complications. One patient with radiographic gross total resection of a metastatic lesion experienced a local recurrence of disease, requiring stereotactic radiosurgery. Conclusion: A frameless stereotactic tubular retractor system for deep brain lesions can be assembled with equipment already available at many institutions. Use of this system can decrease incision and craniotomy size, decrease retractor-induced trauma to overlying cortex, and help prevent damage to underlying white matter tracts.

Intracranial Tubular Retractor Systems: A Comparison and Review of the Literature of the BrainPath, Vycor, and METRx Tubular Retractors in the Management of Deep Brain Lesions

2020 ◽  
Vol 143 ◽  
pp. 134-146
Author(s):  
Nikolas Echeverry ◽  
Samuel Mansour ◽  
Gerard MacKinnon ◽  
Jude Jaraki ◽  
Stephen Shapiro ◽  
...  
Keyword(s):  
Brain Lesions ◽  
Review Of The Literature ◽  
Tubular Retractor ◽  
Deep Brain

scholarly journals Distance to white matter trajectories is associated with treatment response to internal capsule deep brain stimulation in treatment-refractory depression

2020 ◽  
Vol 28 ◽  
pp. 102363
Author(s):  
Luka C. Liebrand ◽  
Samuel J. Natarajan ◽  
Matthan W.A. Caan ◽  
P. Richard Schuurman ◽  
Pepijn van den Munckhof ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
White Matter ◽  
Treatment Response ◽  
Brain Stimulation ◽  
Internal Capsule ◽  
Refractory Depression ◽  
Treatment Refractory ◽  
Deep Brain

Which white matter bundles are associated with treatment efficacy in deep brain stimulation of the ventral internal capsule for OCD and MDD?

2017 ◽  
Vol 10 (2) ◽  
pp. 443
Author(s):  
L.C. Liebrand ◽  
M.W.A. Caan ◽  
P.R. Schuurman ◽  
P. van den Munckhof ◽  
D. Denys ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
White Matter ◽  
Brain Stimulation ◽  
Treatment Efficacy ◽  
Internal Capsule ◽  
Deep Brain ◽  
Stimulation Of

scholarly journals Distance to white matter trajectories is associated with treatment response to internal capsule deep brain stimulation in treatment-resistant depression

2019 ◽  
Author(s):  
Luka C. Liebrand ◽  
Samuel J. Natarajan ◽  
Matthan W.A. Caan ◽  
P. Rick Schuurman ◽  
Pepijn van den Munckhof ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
White Matter ◽  
Treatment Response ◽  
Brain Stimulation ◽  
Internal Capsule ◽  
Anatomical Landmarks ◽  
Treatment Resistant ◽  
White Matter Tracts ◽  
Resistant Depression ◽  
Deep Brain

ABSTRACTObjectiveDeep brain stimulation (DBS) is an innovative treatment for treatment-resistant depression. DBS is usually targeted at specific anatomical landmarks, with patients responding to DBS in approximately 50% of cases. Attention has recently shifted to white matter tracts to explain DBS response, with initial open-label trials targeting white matter tracts yielding much higher response rates (>70%).MethodsWe associated distance to individual white matter tracts around the stimulation target in the ventral anterior limb of the internal capsule to treatment response. We performed diffusion magnetic resonance tractography of the superolateral branch of the medial forebrain bundle and the anterior thalamic radiation in fourteen patients that participated in our randomized clinical trial. We combined the tract reconstructions with the postoperative images to identify the DBS leads and estimated the distance between tracts and leads, which we subsequently associated with treatment response.ResultsStimulation closer to both tracts was significantly correlated to a larger symptom decrease (r=0.61, p=0.02), suggesting that stimulation more proximal to the tracts was beneficial. There was no difference in lead placement with respect to anatomical landmarks, which could mean that differences in treatment response were driven by individual differences in white matter anatomy.ConclusionsOur results suggest that deep brain stimulation of the ventral anterior limb of the internal capsule could benefit from targeting white matter bundles. We recommend acquiring diffusion magnetic resonance data for each individual patient.

Deep brain stimulation of the posterior limb of the internal capsule in the treatment of central poststroke neuropathic pain of the lower limb: case series with long-term follow-up and literature review

2020 ◽  
Vol 133 (3) ◽  
pp. 830-838 ◽  
Author(s):  
Andrea Franzini ◽  
Giuseppe Messina ◽  
Vincenzo Levi ◽  
Antonio D’Ammando ◽  
Roberto Cordella ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Lower Limb ◽  
Internal Capsule ◽  
Posterior Limb ◽  
Vas Score ◽  
The Mean ◽  
Deep Brain ◽  
Stimulation Of

OBJECTIVECentral poststroke neuropathic pain is a debilitating syndrome that is often resistant to medical therapies. Surgical measures include motor cortex stimulation and deep brain stimulation (DBS), which have been used to relieve pain. The aim of this study was to retrospectively assess the safety and long-term efficacy of DBS of the posterior limb of the internal capsule for relieving central poststroke neuropathic pain and associated spasticity affecting the lower limb.METHODSClinical and surgical data were retrospectively collected and analyzed in all patients who had undergone DBS of the posterior limb of the internal capsule to address central poststroke neuropathic pain refractory to conservative measures. In addition, long-term pain intensity and level of satisfaction gained from stimulation were assessed. Pain was evaluated using the visual analog scale (VAS). Information on gait improvement was obtained from medical records, neurological examination, and interview.RESULTSFour patients have undergone the procedure since 2001. No mortality or morbidity related to the surgery was recorded. In three patients, stimulation of the posterior limb of the internal capsule resulted in long-term pain relief; in a fourth patient, the procedure failed to produce any long-lasting positive effect. Two patients obtained a reduction in spasticity and improved motor capability. Before surgery, the mean VAS score was 9 (range 8–10). In the immediate postoperative period and within 1 week after the DBS system had been turned on, the mean VAS score was significantly lower at a mean of 3 (range 0–6). After a mean follow-up of 5.88 years, the mean VAS score was still reduced at 5.5 (range 3–8). The mean percentage of long-term pain reduction was 38.13%.CONCLUSIONSThis series suggests that stimulation of the posterior limb of the internal capsule is safe and effective in treating patients with chronic neuropathic pain affecting the lower limb. The procedure may be a more targeted treatment method than motor cortex stimulation or other neuromodulation techniques in the subset of patients whose pain and spasticity are referred to the lower limbs.

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