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3 results

  • Chapter 21 - Stem Cells and Brain Repair: Ethical Considerations

  • from Part III - Future Developments
  • Edited by Stephen Honeybul
  • Book:
    Ethics in Neurosurgical Practice
    Published online:
    29 May 2020
    Print publication:
    18 June 2020, pp 214-223

  • Summary

    The rapid advance of research in stem cells has opened the door for their potential use in cell-based therapies to treat neurological conditions some of them incurable to date. Encouraging studies in animal models are moving into early phase clinical trials that hold realistic promise for the future. However, important ethical challenges remain as stem cells are translated from preclinical research to the clinical realm.Translation of stem cell–based therapies must be framed within a rigorous scientific and ethical process. This framework extends to the continuum of basic science in the laboratory, subsequent animal studies to the execution of early and late phase clinical trials in humans.Neurosurgery will play a fundamental role in the stem cell therapies of the future. New neurosurgical techniques and instruments will be developed for the delivery of stem cells to single or multiple targets within the CNS. Neurosurgeon’s roles will expand as stem cells move from clinical trials to effective potential therapies. This chapter will review selected stem cell ethical issues, that may inform and guide the practicing neurosurgeon in a rapidly moving field of great scientific promise, as well as ethical challenges

  • Clinical improvements following bilateral anterior capsulotomy in treatment-resistant depression

  • L. Subramanian, T. Bracht, P. Jenkins, S. Choppin, D. E. J. Linden, G. Phillips, B. A. Simpson
  • Journal:
    Psychological Medicine / Volume 47 / Issue 6 / April 2017
    Published online by Cambridge University Press:
    15 December 2016, pp. 1097-1106
  • Background

    The purpose of this study was to evaluate a programme of lesion surgery carried out on patients with treatment-resistant depression (TRD).

    Method

    This was a retrospective study looking at clinical and psychometric data from 45 patients with TRD who had undergone bilateral stereotactic anterior capsulotomy surgery over a period of 15 years, with the approval of the Mental Health Act Commission (37 with unipolar depression and eight with bipolar disorder). The Beck Depression Inventory (BDI) before and after surgery was used as the primary outcome measure. The Montgomery–Asberg Depression Rating Scale was administered and cognitive aspects of executive and memory functions were also examined. We carried out a paired-samples t test on the outcome measures to determine any statistically significant change in the group as a consequence of surgery.

    Results

    Patients improved on the clinical measure of depression after surgery by −21.20 points on the BDI with a 52% change. There were no significant cognitive changes post-surgery. Six patients were followed up in 2013 by phone interview and reported a generally positive experience. No major surgical complications occurred.

    Conclusions

    With the limitations of an uncontrolled, observational study, our data suggest that capsulotomy can be an effective treatment for otherwise TRD. Performance on neuropsychological tests did not deteriorate.

  • 28 - Central nervous system infections and inflammation

  • from Section 4 - Neurointensive care
  • Edited by Basil F. Matta, David K. Menon, Martin Smith
  • Book:
    Core Topics in Neuroanaesthesia and Neurointensive Care
    Published online:
    05 December 2011
    Print publication:
    13 October 2011, pp 430-444

  • Summary

    This chapter explains anaesthetic procedures for selected neurosurgeries without craniotomy. It discusses neurosurgeries that include the transsphenoidal pituitary surgery, ventriculoperitoneal shunts and allied procedures, third ventriculostomy, stereotactic neurosurgery, functional neurosurgery, and deep brain stimulation (DBS). In contrast to most neuro anaesthetic procedures, the anaesthetist can be required to increase intracranial pressure (ICP) in order to facilitate exposure and surgical excision of the pituitary tumour. The chapter describes various anaesthetic techniques, including local anaesthesia with or without conscious sedation on an awake patient and methods that involve general anaesthesia, either throughout the entire procedure or temporarily as in an asleep-awake-asleep technique. The decision for general anaesthesia is best made before surgery after careful pre-operative assessment, as the presence of a stereotactic head frame can complicate airway management, and any unplanned conversion to general anaesthesia in the midst of the procedure carries significant risk.