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Effects of Microselective Neurotomy on Foca. Spa.ticity a.d Description of the Surgica. Technique

Open Journa. of Modern Neurosurgery 2021年第3期11卷 144-156页

作者： sergio a. sacchettoni Joyce Bola.os Na.oleon Torres Jua. P. a.ud Penelope Ma.tilla.Luis Sa.a.a. Ma.ia.Ferna.da.Va.ga. Julio Rodriguez-Wulff Ra.dy Ba.la.a.es Rica.do Gomez Service of Neurosurgery Hospital Vargas de Caracas Caracas Venezuela Service of Neurosurgery Centro Medico Docente La Trinidad Caracas Venezuela Neurologica. Unit “NeuroQX” Centro Médico Integra Caracas Venezuela Université Grenoble a.pes Grenoble France

We studied the microselective neurotomy (MSN) a.d its a.va.ta.es to a.levia.e disa.ling spa.ticity. The best indica.ion for MSN is foca. spa.ticity. We performed 298 MSN, 87 nerves on the upper limb, 211 nerves on the lower limb) in 68 pa.ients. The initia. ca.ses were: stroke, cra.ia. tra.ma. postopera.ive complica.ions a.d multiple sclerosis. MSN procedures were performed on the media. nerve (n = 40) for wrist a.d finger flexion;musculo-cuta.eus nerve (n = 38) for elbow flexion;ulna.is nerve (n = 9) for cubita. devia.ion of the ha.d;ga.trocnemius nerve (n = 98) a.d soleus nerve (n = 49) for equinus foot, tibia. posterior nerve (n = 45) for va.us foot, a.d fa.cicles (or bundles) of the flexor digitorum for “cla.” toes (n = 19). The ma.n preopera.ive test to identify the responsible nerve wa. a.neuromuscula. block with loca. a.esthesia.(lidoca.ne or bupiva.a.ne) injected into the site of the nerve connecting the spa.tic muscle. During surgery, the identified nerve wa. exposed a.d its epineurium opened. Nerve bundles were tea.ed a.a.t into individua. rootlets a.d a.number of rootlets cut were previously pla.ned, a.cording to the spa.ticity. Follow-up wa. performed for up to 10 yea.s, with a.mea. period of 29 months. Results demonstra.ed a.reduction of limb spa.ticity of 2 to 3 points: modified a.hworth sca.e (Ma.). Pa.n a.d clonus were a.so diminished in the a.fected limb. In some ca.es, volunta.y movement wa. once a.a.n possible. MSN is a.useful a.terna.ive in those ca.es of foca. spa.ticity where physiothera.y a.d nerve block with botulinum toxin or phenol no longer produce sa.isfa.tory results.

关键词： Foca. Spa.ticity Microselective Neurotomy Neurosurgery of Spa.ticity

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Dyna.ic Cerebra. Microdia.ysis during Pa.lidotomy a.d Tha.a.otomy in Pa.kinson’s Disea.e: a.Prelimina.y Neurochemica. Study

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Open Journa. of Modern Neurosurgery 2020年第2期10卷 284-296页

作者： sergio a. sacchettoni Jua. P. a.ud Na.oleon Torres Yngo Ga.cía.Da.iel a. Ona. Jua. Luis Rodulfo Jua. Félix Del Corra. Pedro Ra.a.Ra.a.l Ga.era.Luis Hernández Service of Neurosurgery Hospital and School of Medicine JJ Vargas Universidad Central de Venezuela Caracas Venezuela Unit of Surgica. Resea.ch Hospital and School of Medicine JJ Vargas Universidad Central de Venezuela Caracas Venezuela Univ. Grenoble a.pes CEA LETI Clinatec France La.ora.ory of Beha.iora. Physiology Faculty of Medicine Universidad de Los Andes Mérida Venezuela

In Pa.kinson’s disea.e (PD), dopa.inergic neurons reduce the regula.ion of gluta.a.ergic (gluta.a.e-Glu) input from the cortex to neostria.um (ca.da.e a.d puta.en nuclei) consequently lea.ing to a.hypera.tivity of globus pa.lidus interna. (GPi) neurons tha. relea.e ga.ma.a.ino-butyric a.id (Ga.a. into the tha.a.ic ventrola.era. (VL) nucleus. The objective of the present experiment wa. to mea.ure cha.ges in Ga.a.a.d Glu in the ca.da.e a.d the tha.a.us of 2 pa.ients during the a.plica.ion of electrica. stimuli following either a.pa.lidotomy or a.tha.a.otomy. Proper insertion of the electrode wa. tested by a.plying high frequency electrica. pulses (HFEP). During these procedures, we obta.ned neurochemica. informa.ion pla.ing cerebra. (CMD) microdia.ysis probes in ca.da.e nucleus a.d VL nucleus of ipsi- a.d contra.la.era. tha.a.us. In VL tha.a.us, extra.ellula. Ga.a.decrea.ed during HFEP, tending to rea.h previous levels once HFEP wa. fina.ized. Following the pa.lido- or tha.a.otomy Ga.a.decrea.ed a.a.n. Simila.ly, in the contra.a.era. VL tha.a.us, extra.ellula. Ga.a.levels showed a.simila. but less pronounced profile but did not show a.y decrement a.ter the lesion. Ca.da.e Glu decrea.es when HFEP is a.plied to the GPi a.d recovers to previous levels a.ter HFEP, but did not decrea.e a.a.n a.ter lesion (GPi-tomy), instea. it continued to rise. These results suggest tha. HFEP exerts a.simila. but reversible biochemica. effect a. thermopa.lido- or thermotha.a.otomy on Ga.a.extra.ellula. concentra.ion in the ipsila.era. VL tha.a.us. We a.so observe a.dista.t effect of HFEP, but not of thermolesion, on contra.a.era. tha.a.ic Ga.a.a.d ipsila.era. ca.da.e Glu.

关键词： Cerebra. Microdia.ysis Pa.kinson’s Disea.e Pa.lidotomy Tha.a.otomy Ba.a. Ga.glia Circuit Cerebra. Electromodula.ion DBS

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Intra.erebra. Microdia.ysis in Neurosurgery for Obsessive-Compulsive Disorder: Report of 2 Prelimina.y Ca.es

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Open Journa. of Modern Neurosurgery 2020年第3期10卷 371-381页

作者： sergio a. sacchettoni Ra.a.l Ga.era.Jua. F. Del Corra. Jua. P. a.ud a.íba. Pinero Luis Teneud Na.oleón Torres Ra.a.l Roja. Pedro Ra.a.Félix Guerrero Edga. González Mónica.Bifa.o Dely Ya.a.a.Luis Hernández Hospita. a.d School of Medicine JM Va.ga. Universidad Central de Venezuela Caracas Venezuela Centro Medico-Docente La.Trinida. Caracas Venezuela Neurology Mobile System a.socia.es Miami FL USA La.ora.ory of Physiology of Beha.ior Universidad de Los Andes Mérida Venezuela University of Grenoble-a.pes CEA LETI Clinatec France

Neurosurgery for psychia.ric disorders, nota.ly for obsessive-compulsive disorder (OCD), wa. initia.ed in Venezuela.in the deca.e of 1970, a.d consisted since tha. time in the cla.sic stereota.tic a.terior cingulotomy. In order to know further a.out the physiopa.hology of this disorder, we performed intra.erebra. microdia.ysis in 2 pa.ients who were opera.ed on. The a.m wa. to mea.ure cha.ges in extra.ellula. neurotra.smitters within the ba.a. ga.glia. The microdia.ysis probes were stereota.tica.ly pla.ed in the right ca.da.e nucleus a.d in the dorsomedia. nucleus of the right tha.a.us. The microdia.ysis wa. done before the left cingulotomy, during the pa.se a.d a.ter the right cingulotomy. Gluta.a.e a.d ga.ma.a.inobutyric a.id (Ga.a. cha.ges were simila. in the ca.da.e nucleus of both pa.ients, wherea. in the dorsomedia. nucleus the cha.ges were opposite a.ong the 2 pa.ients. a.though this study does not bring enough da.a.to expla.n such differences yet, the existence of dyna.ic cha.ges in the neurochemistry of the ba.a. ga.glia.during cingulotomy shows tha. intra.erebra. microdia.ysis ca. help in the understa.ding of the pa.hophysiology of OCD a.d eventua.ly in the design of new surgeries with better results.

关键词： Psychia.ric Neurosurgery Psychosurgery Obsessive-Compulsive Disorder Intra.erebra. Microdia.ysis

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