Precutaneous radiofrequency neurolysis for trigeminal neuralgia

In this retrospective study efficiency of selective percutaneous radiofrequency neurolysis in the gasserian ganglion was evaluated in 200 patients with a mean follow-up of seven years by the senior author and co-workers at the Department of Neurosurgery at St. George's Hospital Beirut. Mean age of patients was 60 years with a predominant number of patients having essential neuralgia [184 patients]. Excellent relief was obtained in 92 patients with another 36 patients achieving pain relief after a second intervention. Sixty-nine patients had recurrence not amenable to repeat intervention. And another 3 patients had bad penetration of foramen ovale. Thirty-two patients required reintervention with glycerol and fibrin glue. Complications included sensory loss of cornea in 6 cases, anaesthesia dolorosa in 8 cases, coagulation of motor root of the fifth nerve in 2 cases, intense pain of the ear [paralysis of tensor tympani] in 4 cases and damage to oculomotor nerve in one case. The authors propose that radiofrequency rhizotomy may be a safe and effective procedure in the neurosurgical armamentarium for the treatment of patients having trigeminal neuralgia

Current surgical treatment of Parkinson's disease

There has been a renaissance in the surgical management of Parkinson's disease. This has been due to long-term effects of levodopa and a better understanding of the basal ganglia and its circuitry. Ablative surgery and neurostimulation are the only realistic surgical options at present. Although surgical treatments, such as ablation and stimulation are effective, they are not useful for stopping the progression or restoring the system. Neural transplantation helps restore the system by using a number of techniques. Targets mostly used are in the thalamus, globus pallidus and subthalamic nucleus. A number of factors must be considered including patient's age, disability and his wishes. Globus pallidus stimulation might be preferable for patients who suffer from dyskinesia as a major source of disability. Pallidotomy might be appropriate in cases where frequent stimulator adjustments are impractical. Subthalamic nucleus stimulation is more suitable for patients with significant off periods and in younger patients in whom it may be desirable to maintain intact circuitry. Fetal neural transplantation, stem cell transplantation, xenotransplantation, adrenal medullary transplantation and transplantation of genetically engineered cells are at various stages of development and research. Ethical issues surrounding these process are likely to arouse strong emotions and have to be carefully considered

Current surgical treatment of Parkinson's disease

There has been a renaissance in the surgical management of Parkinson's disease. This has been due to long-term effects of levodopa and a better understanding of the basal ganglia and its circuitry. Ablative surgery and neurostimulation are the only realistic surgical options at present. Although surgical treatments, such as ablation and stimulation are effective, they are not useful for stopping the progression or restoring the system. Neural transplantation helps restore the system by using a number of techniques. Targets mostly used are in the thalamus, globus pallidus and subthalamic nucleus. A number of factors must be considered including patient's age, disability and his wishes. Globus pallidus stimulation might be preferable for patients who suffer from dyskinesia as a major source of disability. Pallidotomy might be appropriate in cases where frequent stimulator adjustments are impractical. Subthalamic nucleus stimulation is more suitable for patients with significant off periods and in younger patients in whom it may be desirable to maintain intact circuitry. Fetal neural transplantation, stem cell transplantation, xenotransplantation, adrenal medullary transplantation and transplantation of genetically engineered cells are at various stages of development and research. Ethical issues surrounding these process are likely to arouse strong emotions and have to be carefully considered