Cerebellar pacemaker patients: an update.

Of the initial group of 38 patients in whom we have used cerebellar stimulation for treatment of intractable behavioral pathology, 25 continue to have beneficial effects. However, there have been significant technical problems due to failure of the equipment. While impairing treatment, these complications have provided inadvertent controls. The procedure must still be considered developmental at this time, despite promising therapeutic efficacy.

The cerebellar pacemaker for intractable behavioral disorders and epilepsy: follow-up report.

Thirty-eight patients who were intractably ill with a variety of behavioral disorders have been treated at Tulane with a chronically implanted cerebellar pacemaker. Included in the series ara schizophrenics, depressives, epileptics with behavioral pathology, and patients with severe organic brain pathology. The patients who have responded best to the treatment are those with depression, those with behavioral pathology consequent to epilepsy, and those with psychotic behavior consequent to structural brain damage. Results obtained in the chronic schizophrenic patients have been less favorable. The follow-up period ranges from a few months to 27 months. Overall, the results continue to be encouraging. Twenty-one percent of the patient group displayed structural evidence of cerebellar pathology that was not detected before operation, a finding which suggests that cerebellar damage may induce psychotic behavior.

Chronic cerebellar stimulation in the modulation of behavior.

From March 1976 until March 1979, 28 patients with disabling emotional symptoms were studied in the Psychiatry and Neurosurgery Departments at Tulane University, and pre-selected for cerebellar electrode implantation and subsequent cerebellar stimulation. This series include 12 patients with different types of schizophrenia; 7 epileptic patients with Grand Mal and/or psychomotor attacks, and concomitant psychiatric symptoms; 5 patients with intractable depression; and 4 patients with miscellaneous psychiatric symptoms. Follow-up results are graded as excellent, good, fair and poor. The authors conclude that significant improvement were observed in many patients, and the results, although preliminary and incomplete, are encouraging.

Safety of mini-dose heparin administration for neurosurgical patients.

A course of small doses of heparin given subcutaneously before and after elective operations has been reported to reduce the incidence of deep venous thrombosis and pulmonary embolism in general surgical patients. To test the safety of mini-dose heparin for neurosurgical patients, mini-dose heparin was used for 150 adult patients undergoing elective neurosurgical procedures. No operative complications were thought to be related to heparin administration. Postoperatively, there were four wound seromas, two hematomas, and one non-fatal pulmonary embolus. Seven patients died postoperatively, of whom five had no evidence of pulmonary embolus. Although no conclusions were drawn as to the effectiveness of mini-dose heparin in preventing deep venous thrombosis or pulmonary emboli, it was believed that the method could be used safely and without fear of increased intracranial or intraspinal bleeding for neurosurgical patients.

Abdominal pseudocysts and ascites formation after ventriculoperitoneal shunt procedures. Report of four cases.

The authors report three patients with abdominal pseudocysts and one with cerebrospinal fluid ascites as late complications of ventriculoperitoneal shunts. The presenting signs and symptoms were those of intraabdominal abnormality, with no neurological symptoms suggestive of shunt malfunction.