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Background and purpose Bilateral globus pallidus deep brain stimulation ( GPi- DBS) represents an effective and relatively safe therapy for different forms of refractory dystonia. The aim of this study was to assess, retrospectively, the effect of two different stimulation settings during GPi- DBS in 22 patients affected by primary generalized or multi-segmental dystonia. Methods Thirteen patients were stimulated using a voltage-controlled setting whilst in the other nine patients a current-controlled setting was used. Clinical features were evaluated for each patient at baseline, 6 months and 12 months after surgery by means of the Burke−Fahn−Marsden Dystonia Rating Scale. Results Globus pallidus deep brain stimulation was effective in all patients. However, comparing constant-current and constant-voltage stimulation, a better outcome was found in the current-controlled group during the last 6 months of follow-up. Conclusions Current-controlled stimulation is effective during GPi- DBS for primary dystonia and it could be a better choice than voltage-controlled stimulation over long-term follow-up. [ABSTRACT FROM AUTHOR]

Between January 2007 and March 2008, we prospectively studied all patients operated on for intracranial tumours in our Department of Neurosurgery. Preoperatively, all patients were interviewed by a neurologist to collect headache characteristics. Measurements of tumour and oedema volume were made using dedicated software for magnetic resonance imaging studies. Tumour histopathology was established by histological examination postoperatively. If headache improved postoperatively, a diagnosis of ‘headache attributed to intracranial neoplasm’ was made, according to the 2004 International Classification of Headache Disorders (ICHD-II). A multivariate logistic regression model was used to evaluate the association of headache with potential risk factors. We studied 206 subjects. The prevalence of tumour headache was 47.6%. Intracranial tumour headache was non-specific and in most cases could not be classified by current ICHD-II diagnostic criteria for primary headache syndromes. Its prevalence varied depending on volume, location and type of tumour, as well as on the patient's previous headache history. [ABSTRACT FROM AUTHOR]

The article presents a case of a 66-year-old man with a growth hormone (GH)-secreting pituitary tumour who experienced a headache fulfilling 2004 International Headache Society (IHS) diagnostic criteria for hypnic headache (HH). The complete cessation of headache attacks after trans-sphenoidal surgery reasonably points to a cause and effect relationship between the GH-secreting tumour and the HH. Moreover, it is noted that the pathophysiology of HH is still unknown.

Thunderclap headache is well known to be a presenting feature of a variety of causal events. Indeed, a primary form is considered in the International Classification of Headache Disorders-II, but such diagnosis must be made only after exclusion of a possible secondary cause. We report a case of late-onset idiopathic aqueductal stenosis presenting with thunderclap headache, in the absence of abnormal neurological findings or indirect signs of raised intracranial pressure. The patient recovered completely after endoscopic third ventriculostomy. This case indicates primary aqueduct stenosis as a possible, never previously reported, cause of thunderclap headache. [ABSTRACT FROM AUTHOR]

Poster: Clinical track: CNS PO-0863: Radiochemotherapy retreatment in high grade giomas recurrences A. Caroli, L. Vinante, P. Chiovati, T. Ius, M. Skrap, M. Arcicasa. [Extracted from the article]

Navigated transcranial magnetic stimulation (nTMS) is a novel technology in the field of neurosurgery for noninvasive delineation of cortical functional topography. Recent studies show that it can detect eloquent cortical areas directly, comparable to intraoperative direct cortical stimulation (DCS). The aim of this study was to evaluate the nTMS in comparison with functional magnetic resonance imaging (fMRI) in the setting of brain tumors involving motor areas. Thirteen consecutive patients affected by frontal lobe brain tumors were enrolled in the study. All patients received an fMRI and nTMS examination preoperatively. Consistency of preoperative mapping with intraoperative DCS was assessed off-line by means of the neuronavigation system: as result, nTMS produced statistically significant higher accuracy scores of the motor area localization than fMRI. Moreover, nTMS has fewer restrictions for preoperative functional mapping than fMRI and requires only a limited level of compliance: so it represents an useful and reliable technique during preoperative planning for surgical decision making in the clinical setting. [ABSTRACT FROM AUTHOR]

Bilateral globus pallidus deep brain stimulation (GPi-DBS) represents a validated, effective and relatively safe therapy for different forms of medically refractory dystonia. The goal of this study was to assess the effect of GPi-DBS in a homogeneous population of dystonic patients and to compare the clinical outcome using two different stimulation settings: a constant-current stimulation versus a constant-voltage stimulation. 22 patients affected by primary generalized or multisegmental dystonia underwent bilateral GPi-DBS. 13 patients were stimulated using a voltage-controlled setting while in the other 9 patients we used a current-controlled setting. Clinical features were evaluated for each patient at baseline, 6months and 12months after surgery by means of the Burke–Fahn–Marsden Dystonia Rating Scale (BFMDRS). In all the patients we found a statistically significant improvement both in motor and disability scores of BFMDRS. Moreover, we didn’t find any significant difference between current- and voltage-controlled stimulation at 6 and 12months after surgery in comparison to baseline while a better improvement occured in the last 6months follow-up in the current-controlled group. Our study shows that current-controlled stimulation could be more effective than voltage-controlled stimulation over long-term follow-up in dystonia. [Copyright &y& Elsevier]