A multiinstitutional study was conducted to evaluate the technique, dose-selection parameters, and results of gamma knife stereotactic radiosurgery in the management of trigeminal neuralgia. Fifty patients at five centers underwent radio-surgery performed with a single 4-mm isocenter targeted at the nerve root entry zone. Thirty-two patients had undergone prior surgery, and the mean number of procedures that had been performed was 2.8 (range 1-7). The target dose of the radiosurgery used in the current study varied from 60 to 90 Gy. The median follow-up period after radiosurgery was 18 months (range 11-36 months). Twenty-nine patients (58%) responded with excellent control (pain free), 18 (36%) obtained good control (50%-90% relief), and three (6%) experienced treatment failure. The median time to pain relief was 1 month (range 1 day-6.7 months). Responses remained consistent for up to 3 years postradiosurgery in all cases except three (6%) in which the patients had pain recurrence at 5, 7, and 10 months. At 2 years, 54% of patients were pain free and 88% had 50% to 100% relief. A maximum radiosurgical dose of 70 Gy or greater was associated with a significantly greater chance of complete pain relief (72% vs. 9%, p = 0.0003). Three patients (6%) developed increased facial paresthesia after radiosurgery, which resolved totally in one case and improved in another. No patient developed other deficits or deafferentation pain. The proximal trigeminal nerve and root entry zone, which is well defined on magnetic resonance imaging, is an appropriate anatomical target for radiosurgery. Radiosurgery using the gamma unit is an additional effective surgical approach for the management of medically or surgically refractory trigeminal neuralgia. A longer-term follow-up review is warranted.

NBI-3001 appears to have an acceptable safety and toxicity profile when administered intratumorally in patients with recurrent malignant glioma.

No abstract

Stereotactic radiosurgery under local anesthesia with the Leksell Gamma Knife can effectively treat some patients with recurrent tic douloureux after unsuccessful medical/surgical procedures. Seven of 12 patients have shown complete relief or improvement of their trigeminal neuralgia. No complications have been observed.

HE clinical manifestations of discharges of seizures now termed temporal-lobe epilepsy, have been recognized since the article of Jackson TM in 1888. That the origin is in the uncinate region was reported by Jackson and Cohnan 1~ in 1898. The development of electroencephalography was necessary to provide a confirmatory test and a reliable means to distinguish these states of seizures. Jasper and Kershman 12 observed in 1941 that patients with psychomotor episodes usually had sharp waves and rhythms of 6 per sec., often synchronous bilaterally, and sometimes localized in the frontotemporal regions. It seemed clear to them from the nature of these disturbances that the temporal lobe and subjacent structures in the archipallium were the regions involved primarily. The first clear correlation of the clinical features and the loci of anteriortemporal spikes either unilaterally or bilaterally, as well as their detection by recording during sleep, came from Gibbs et al. 6 in 1948. With the identification of states of focal seizures in the temporal regions some afflicted patients who were not relieved by anticonvulsant medication were given surgical therapy by Penfield and Flanigin TM in 1950 and by Bailey and Gibbs 3 in 1951. Subsequent long-term follow-up studies and confirmation of similar results by numerous other surgeons 2,4,7-9,i6,19 have established this method of treatment for clearly focal temporal epilepsy. The consensus of results is that at least two-thirds of patients have complete or very good relief from seizures

We studied the first clinical manifestations of 72 complex partial seizures (CPS) in 17 drug-resistant patients. CPS were indicated to be of hippocampal-amygdalar origin by scalp and depth EEG. We asked: (a) Do all CPS of hippocampal-amygdalar origin start with an initial motionless stare and/or oroalimentary automatisms? (b) If not, what other clinical manifestations appear at onset of the CPS? Results showed that approximately 39% of CPS begin with motionless staring, 25% with nonfocal discrete movements, 21% with oroalimentary automatisms, 10% with perseverative stereotyped automatisms, and 6% with vocalizations. Nonfocal discrete movements and oroalimentary automatisms were identified as the most common second and third clinical sequential manifestations during a CPS. We conclude that although approximately 60% of CPS of hippocampal-amygdalar origin start with motionless staring or oroalimentary automatisms, 40% do not.

No abstract

The Leksell Gamma Knife is a useful and safe method to perform thalamotomy and pallidotomy in selected older patients with Parkinson''s disease and related movement disorders. In this preliminary report, 2 of 3 patients with severe intention tremor were relieved of their symptoms by thalamotomy, as were 4 of 7 patients with Parkinson''s tremor. Four of 8 patients had significant improvement of contralateral rigidity following pallidotomy.