[Deep brain stimulation of the subthalamic nucleus for parkinson's disease: awake vs asleep]. / Elektrostimulyatsiya subtalamicheskogo yadra pri bolezni Parkinsona: pod narkozom ili v soznanii?

BACKGROUND: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is known to be an effective and safe neurosurgical procedure for Parkinson's disease (PD). Traditionally, awake implantation of stimulation system is carried out using microelectrode registration and intraoperative stimulation. Development of neuroimaging technologies enables direct STN imaging. Therefore, asleep surgery without additional intraoperative verification is possible. This approach reduces surgery time and can potentially decrease the incidence of hemorrhagic and infectious complications. The advantages of one method or another are being discussed. OBJECTIVE: To assess the benefits and limitations of various methods for DBS system implantation for bilateral STN stimulation, to study the issues of stereotaxic accuracy, efficiency and safety of asleep and awake electrode implantation into STN. MATERIAL AND METHODS: We reviewed the articles published in the PubMed database. Searching algorithm included the following keywords: «asleep DBS¼, «Parkinson's disease¼, «subthalamic nucleus¼, «3T MRI¼, «SWI¼, «SWAN¼. RESULTS: There were 31 articles devoted to asleep DBS of STN including 4 meta-analyses, 3 prospective controlled studies, 13 retrospective controlled studies and 11 studies without a control group. CONCLUSION: Asleep implantation of electrodes for DBS of STN can be performed only after a clear imaging of STN boundaries with high-quality MRI.

[Radiosurgical hypophysectomy in cancer pain treatment. Literature review and clinical case]. / Radiokhirurgicheskaya gipofizektomiya v lechenii farmakorezistentnoi onkologicheskoi boli. Obzor literatury i opisanie klinicheskogo sluchaya.

Cancer pain is one of the main problem in modern medicine. According European Society for Medical Oncology data, cancer pain prevalence is 64% among patient with terminal stage of disease and in 46% standard pain therapy was ineffective. Radiosurgical hypophysectomy is one of the important and perspective method in cancer pain treatment. This method could be offered patient with chronic disease. According literature review, endocrinology complications were very rare and occurred 10 months after therapy. Value of analgesic effect was 70-90%. In some trials, procedure was effective not only nociceptive, but also in neuropathic pain. More trials require for determination of indications and mechanism of action. The case of successful relief of resistant pain in patient with pancreatic cancer by means of radiosurgical hypophysectomy is described.

[Spinal cord stimulation in the treatment of chronic pain]. / Khronicheskaya elektrostimulyatsiya spinnogo mozga u patsientov s khronicheskoi bol'yu.

Despite the numerous analgesic drugs, the prevalence of intractable neuropathic pain remains high making up about 5%. Intervention methods, including methods of chronic electrostimulation, are used to treat these patients. Spinal cord stimulation (SCS) is the most common surgical method worldwide that replaced destructive and ablation procedures. Currently, common tonic SCS, HF-10 stimulation and burst SCS are applied, and the choice of method is based on clinical and neurophysiological data. Also, the introduction of nanomaterial-enabled neural stimulation could significantly minimize surgery risk.