ABSTRACT
BACKGROUND: The micro-lesion effect (MLE) has been observed in many Parkinson's disease (PD) patients after deep brain stimulation (DBS) surgery. For subthalamic nucleus (STN) stimulation, the MLE has been reported as a predictor of the long-term efficacy of DBS. However, the research on the MLE in the globus pallidus internus (GPi) is insufficient. In this report, we conducted a study of the correlation between the MLE and improvement of GPi DBS. METHODS: From July 2014 to November 2015, 36 PD patients underwent GPi DBS in our hospital. The patients were evaluated before DBS and postoperatively at 24 h, 1 week, 2 weeks, 3 weeks, 6 months and 1 year. The evaluated items included the following: the UPDRSIII score with and without medication, off time per day and severe dyskinesia time per day. The dose of L-dopa, magnitude and duration of MLE were also recorded. RESULTS: There were 32 patients with a postoperative MLE. In these 32 cases, the dose of L-dopa decreased from 960.5 ± 257.8 mg (range, 550-1550) to 910.4 ± 207.5 mg (range, 550-1250). There is a correlation between the magnitude of the MLE in UPDRSIII and the improvement degree of DBS at 6 and 12 months compared with the preoperative findings when off medication. The duration of the MLE is also an indication of the improvement of DBS in the long term when off medication. However, there was no correlation with on medication. Compared with the preoperative state, the UPDRSIII score, off time and severe dyskinesia time had improved postoperatively. CONCLUSIONS: The MLE of GPi is a predictor of PD patients who would benefit from DBS in the long term. Medication may have some conflicting effects on the MLE. The exact mechanism of the MLE requires further exploration.
Subject(s)
Deep Brain Stimulation/adverse effects , Globus Pallidus/surgery , Parkinson Disease/surgery , Postoperative Complications/etiology , Adult , Aged , Female , Humans , Male , Middle Aged , Postoperative Complications/epidemiologyABSTRACT
Herein, circularly polarized light is utilized to trigger an enantioselective polymerization reaction, resulting in the synthesis of an optically active polymer from racemic monomers in the absence of any chiral dopant or catalyst.
ABSTRACT
BACKGROUND: Cavernous sinus hemangioma (CSH) is a rare type of benign vascular tumor. Microsurgery for CSH treatment usually results in profuse bleeding and cranial nerve injury. Radiosurgery is an alternative treatment for CSH. The objective of this study was to elucidate the efficacy and safety of gamma knife surgery (GKS) for the treatment of CSH. METHODS: A total of 32 patients with CSH underwent 34 times of GKS as a primary and exclusive treatment from 2009 to 2015 at West China Hospital. The diagnosis was mainly based on findings of magnetic resonance imaging. The treatment was performed with the Leksell Gamma Knife model C. The follow-up period was from 12-67 months. Changes in imaging results and signs or symptoms were analyzed. Studies of patients who had undergone radiosurgery and microsurgery were compared. RESULTS: Clinical improvement was observed after GKS in 26 of 27 patients who presented with signs or symptoms of CSH. Tumor shrinkage was detected in all cases. A reduction in tumor volume of 0-25%, 26%-50%, 51%-75%, and 76%-100% was observed in 3, 2, 8, and 19 cases, respectively. Remarkable tumor shrinkage occurred within 6-12 months after GKS. According to a retrospective analysis of 151 patients diagnosed with CSH, 77 patients underwent GKS without any complications, 17 of 74 patients were treated with microsurgery and exhibited persistent complications, and 1 patient died. CONCLUSIONS: GKS is a safe and effective treatment for most cases of CSH. The concept of GKS as an adjuvant treatment for CSH requires reconsideration.
