ABSTRACT
According to recent clinical data, motor cortex stimulation (MCS) is an alternative treatment for central pain syndromes. We present our minimally invasive technique of image guidance for the placement of the motor cortex-stimulating electrode and assess the clinical usefulness of both neuronavigation and vacuum headrest. Five patients suffering from central pain underwent MCS with the guidance of a frameless stereotactic system (BrainLab AG, Munich, Germany). The neuronavigation was used for identification of the precentral gyrus and accurate planning of the single burr hole. The exact location was reconfirmed by an intraoperative stimulation test. Postoperative clinical and neuroradiological evaluations were performed in each patient. The navigation system worked properly in all 5 neurosurgical cases. Determination of the placement of stimulating electrode was possible in every case. All patients obtained postoperative pain relief. No surgical complication occurred, and the postoperative course was uneventful in all patients. This preliminary experience may confirm image guidance as a useful tool for the surgery of MCS. Additionally, minimal and safe exposure can be achieved using a single burr hole and vacuum headrest.
Subject(s)
Deep Brain Stimulation , Facial Pain/therapy , Headache/therapy , Motor Cortex/surgery , Neuronavigation , Aged , Facial Pain/diagnostic imaging , Facial Pain/pathology , Female , Follow-Up Studies , Headache/diagnostic imaging , Headache/pathology , Humans , Male , Middle Aged , Motor Cortex/diagnostic imaging , Motor Cortex/pathology , Neuronavigation/instrumentation , Radiography , Retrospective Studies , Treatment Outcome , VacuumABSTRACT
BACKGROUND: Glycosphingolipids (GSL) are expressed on the surface of neuroectodermal cells. The correlation of a variety of distinct GSL with different primary brain tumors has been demonstrated. Three distinct GSL-component profiles (GSL-types I, II and III) of human gliomas have been defined by our group. The purpose of this study was to evaluate the correlation of the established GSL-types I-III with survival time and histopathological malignancy grading in 40 human gliomas. METHODS: Neutral and acidic GSL-component patterns, histopathological malignancy grade and survival time, and a number of other relevant variables were examined. Kaplan-Meier survival curves were analyzed with the log rank test. RESULTS: GSL-type I was expressed in 18 tumors (17 Glioblastoma multiforme (GBM) and 1 anaplastic astrocytoma (AA)). GSL-type II was expressed in 11 tumors (7 GBM, 3 AA, 1 low grade astrocytoma (LGA)). 10 patients presented with GSL-type III (3 GBM, 4 AA, 3 LGA). Kaplan Meier survival curves of GSL-types I-III differed significantly (p = 0.0231, log-rank-test). However, survival time correlated better to the WHO grades. Within a given malignancy grade, GSL-types gave additional informations about the proliferative properties. CONCLUSIONS: This is the first report of a correlation between survival time and human glioma neutral and acidic GSL-components. The results are in agreement with observations of other investigators. The analysis of GSL-type expression might give useful additional information about proliferative properties of human gliomas in a given malignancy grade. In particular, the early prediction of outcomes in anaplastic or low grade gliomas might be possible.
