Publications
Concept, neuroanatomy and surgical techniques
MR-guided focused ultrasound (MRgFUS) offers new perspectives for safe and efficient lesioning inside the brain. The issue of target coverage remains primordial and sub-optimally addressed or solved in the field of functional neurosurgery.
Since the first clinical application of the incisionless magnetic resonance–guided focused ultrasound (MRgFUS) technology only small series of patients have been reported, and thus only extrapolations of the procedure-related risks could be offered. In this study, the authors analyze side-effects and targeting accuracy in 180 consecutive treatments with MRgFUS for chronic therapy-resistant idiopathic Parkinson’s disease (PD), essential tremor (ET), cerebellar tremor (CT), and neuropathic pain (NP), all performed in their dedicated center.
Radiofrequency (RF) subthalamotomies have been proposed since the 1960s to treat patients suffering from Parkinson's disease (PD). Recently, the magnetic resonance (MR)-guided focused ultrasound technology (MRgFUS) offers the possibility to perform subthalamic thermocoagulations with reduced risks and optimized accuracy. We describe here the initial results of the MRgFUS pallidothalamic tractotomy (PTT), an anatomical and physiological update of the earlier subthalamotomies.
EEG techniques
Oscillatory and coherent EEG activity is increasingly recognized as a fundamental hallmark of cortical integrative functions. We aimed to study deviations from the norm of different resting EEG parameters in Parkinson's disease (PD) patients. We compared spectral parameters of the resting EEG of PD patients (n=24, median age 67 years) to those of healthy controls (n=34, median age 62 years).
Patients with severe and chronic neurogenic pain are known to exhibit excess EEG oscillations in the 4- to 9-Hz theta frequency band in comparison with healthy controls. The generators of these excess EEG oscillations are localized in the cortical pain matrix. Since cortex and thalamus are tightly interconnected anatomically, we asked how thalamic activity and EEG are functionally related in these patients.
Das Buch spannt einen Bogen von den anatomischen und physiologischen Voraussetzungen der Schmerzempfindung über unterschiedliche medizinische Methoden der Schmerzbekämpfung bis zur gestalterischen Auseinandersetzung mit Schmerz in Literatur und Kunst.
Epilepsy, Tinnitus and Neuropsychiatry
During stereotactic functional neurosurgery, stimulation procedure to control for proper target localization provides a unique opportunity to investigate pathophysiological phenomena that cannot be addressed in experimental setups. Here we report on the distribution of response modalities to 487 intraoperative thalamic stimulations performed in 24 neurogenic pain (NP), 17 parkinsonian (PD) and 10 neuropsychiatric (Npsy) patients.
This reference presents a new collection of diagrams of the human thalamus, basal ganglia, and adjoining structures for accurate targeting in stereotactic functional neurosurgery. This guide consists of a series of maps in the three stereotactic planes and comparisons between brains with similar and differing intercommissural distances to help specialists pinpoint precise targets, map through anatomic variations, and develop computerized models for stereotactic functional neurosurgery. Paired with a CD that allows for the enlargement and reader-friendly analysis of maps and illustrations found within the text, this source stands as the first atlas of the human thalamus and basal ganglia to focus on combined high stereotactic precision and anatomical resolution.
We simultaneously recorded local field potentials (LFP) in the thalamus and EEG on the scalp of 17 patients suffering from neurogenic pain, epilepsy and movement disorders. The EEG of 11 patients displayed enhanced power in the theta frequency range (4–8Hz). The thalamic LFP of 14 patients peaked in the theta range. The theta coherence between EEG and LFP was significant for 12 patients and reached strengths up to 70%. These findings suggest that enhanced theta rhythmicity occurs in tight functional thalamocortical loops and is a major element in all three diseases investigated.
Essential Tremor
Anatomical knowledge of the structures to be targeted and of the circuitry involved is crucial in stereotactic functional neurosurgery. The present study was undertaken in the context of surgical treatment of motor disorders such as essential tremor (ET) and Parkinson’s disease (PD) to precisely determine the course and three-dimensional stereotactic localisation of the cerebellothalamic and pallidothalamic tracts in the human brain.
This reference presents a new collection of diagrams of the human thalamus, basal ganglia, and adjoining structures for accurate targeting in stereotactic functional neurosurgery. This guide consists of a series of maps in the three stereotactic planes and comparisons between brains with similar and differing intercommissural distances to help specialists pinpoint precise targets, map through anatomic variations, and develop computerized models for stereotactic functional neurosurgery. Paired with a CD that allows for the enlargement and reader-friendly analysis of maps and illustrations found within the text, this source stands as the first atlas of the human thalamus and basal ganglia to focus on combined high stereotactic precision and anatomical resolution.
Positive symptoms arise after lesions of the nervous system. They include neurogenic pain, tinnitus, abnormal movements, epilepsy and certain neuropsychiatric disorders.
Neurogenic Pain
Since the first clinical application of the incisionless magnetic resonance–guided focused ultrasound (MRgFUS) technology only small series of patients have been reported, and thus only extrapolations of the procedure-related risks could be offered. In this study, the authors analyze side-effects and targeting accuracy in 180 consecutive treatments with MRgFUS for chronic therapy-resistant idiopathic Parkinson’s disease (PD), essential tremor (ET), cerebellar tremor (CT), and neuropathic pain (NP), all performed in their dedicated center.
Stereotactic central lateral thalamotomy (CLT) has been applied as a treatment for chronic intractable neuropathic pain. However, it is not clear whether this intervention influences the emotional and cognitive impairments observed in patients who have chronic neuropathic pain.
Recent technological developments open the field of therapeutic application of focused ultrasound to the brain through the intact cranium. The goal of this study was to apply the new transcranial magnetic resonance imaging–guided focused ultrasound (tcMRgFUS) technology to perform noninvasive central lateral thalamotomies (CLTs) as a treatment for chronic neuropathic pain.
Parkinson
MR-guided focused ultrasound (MRgFUS) offers new perspectives for safe and efficient lesioning inside the brain. The issue of target coverage remains primordial and sub-optimally addressed or solved in the field of functional neurosurgery.
Since the first clinical application of the incisionless magnetic resonance–guided focused ultrasound (MRgFUS) technology only small series of patients have been reported, and thus only extrapolations of the procedure-related risks could be offered. In this study, the authors analyze side-effects and targeting accuracy in 180 consecutive treatments with MRgFUS for chronic therapy-resistant idiopathic Parkinson’s disease (PD), essential tremor (ET), cerebellar tremor (CT), and neuropathic pain (NP), all performed in their dedicated center.
Radiofrequency (RF) subthalamotomies have been proposed since the 1960s to treat patients suffering from Parkinson's disease (PD). Recently, the magnetic resonance (MR)-guided focused ultrasound technology (MRgFUS) offers the possibility to perform subthalamic thermocoagulations with reduced risks and optimized accuracy. We describe here the initial results of the MRgFUS pallidothalamic tractotomy (PTT), an anatomical and physiological update of the earlier subthalamotomies.