Ablative neurosurgery for movement disorders related to cerebral palsy.

This article aims to describe the roles, operative strategies and outcomes of neuroablative procedures in treatment of movement disorders related to cerebral palsy (CP). The authors reviewed relevant medical literatures concerning ablative neurosurgical procedures for CP. Neurosurgery is an appropriate option for treatment of intractable movement disorders in CP. Destructive therapies can be selectively operated upon, on the brain, spinal cord, nerve root and peripheral nerve. Because all of them carry irreversible properties, presurgical evaluation and decision making for the surgery are critical. Selection of the procedures should be tailored for individual cases. Selective dorsal rhizotomy (SDR) is mostly suitable for CP children with spastic diplegia who are potential ambulators. Selective peripheral neurotomy (SPN) aims to diminish localized hypertonia. Intractable painful spasticity in an entire useless limb can be effectively treated by dorsal root entry zone lesion (DREZotomy). Stereotactic coagulation of specific targets in the brain is appropriate for more diffuse movement disorders or hyperkinesias confined to one side of the body. Combined surgery should be employed in management of more complicated abnormalities or coexisting neurologic and orthopedic disorders. Neuroablation remains an alternative to neuromodulation therapy, especially in circumstances when the latter is unavailable.

Therapeutic and survival outcomes following treatment of primary central nervous system lymphoma: a 12-year case study.

AIM: The study primarily aimed to investigate therapeutic and survival outcomes following definitive treatment of primary central nervous system lymphoma (PCNSL). METHODS: All patients with histopathologically proven PCNSL at our institute between 1998 and 2009 were recruited. The collated data included demographic, laboratory, neuroimaging, therapeutic and survival aspects. RESULTS: Of 85 participants with the mean age of 52.8 years, 79 underwent neurosurgical procedures endeavoring for diagnosis or decompression. Fifty patients who received definitive treatment in our institute were evaluated for therapeutic response. In multivariate analysis, there was no variable associated with good response rate. Eastern Cooperative Oncology Group (ECOG) performance status >1 and elevated cerebrospinal fluid (CSF) protein level >45 mg/dL were significant prognostic factors of poor survival outcome as estimated by Cox regression analysis. The patients treated by high-dose methotrexate (HD-MTX)-based protocols with or without radiotherapy (RT) achieved significantly longer median survival than those treated by RT alone or other kinds of chemotherapy. CONCLUSION: Neurosurgical procedure plays an important role for diagnosis of PCNSL. Surgical resection has no role in curative treatment and should be discarded unless considerable mass effect develops. HD-MTX should be considered as the primary chemotherapy for individuals agonizing from the disease.