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Introduction. Deep brain stimulation (DBS) of subthalamic nucleus (STN) is widely accepted treatment of Parkinson's disease (PD) patients. It has been reported that PD patients undergoing STNDBS procedure are at elevated risk to experience wide range of mental disorders that include delirium and other psychotic disorders, mood disorders, anxiety disorders and neurocognitive disorders. Here we present a case of PD patient who developed psychiatric complications following bilateral STN-DBS implantation. Case report. A 72-year old male patient with a 12-year history of PD was referred for bilateral STN-DBS implantation procedure. The patient had no past history of mental disorders and was physically healthy based on standard clinical and laboratory investigations. On preoperative Magnetic Resonance Imaging neither the STN nor red nucleus were reliably visible. Therefore, it was decided to implant bilateral STN leads according to anterior commissure -- posterior commissure indirect targeting method and with intraoperative microstimulation and macro-stimulation of STN. The procedure was uneventful. However, next day after the procedure the patient developed typical delirium symptoms, which resolved during the next few days. However, a few weeks after the procedure the patient developed acute psychosis with visual hallucinations, delusions of persecution and reference, severe anxiety symptoms, psychomotoric agitation and disorganized speech. After one month inpatient treatment of psychosis, the patient developed depressive disorder with symptoms of apathy and cognitive decline. The patient was discharged home on psychiatric treatment that included antipsychotic and antidepressant medication and his DBS stimulation was switched to monopolar bilateral stimulation. During treatment his psychosis symptoms remitted but the patients developed moderate severity depressive symptoms, which started to regress after switching to bipolar STN stimulation. [ABSTRACT FROM AUTHOR]

Brain MRI voxel based morphometry (VBM) is known as a research tool for neurodegenerative and psychiatric disorders. The aim of this study was to evaluate a possible association of cortical thickness, cortical and subcortical volume in PD pa-tients.with neuropsychiatric disturbancies after deep brain stimulation, sleep impairment and quality of life. Methods. Twenty-eight PD patients (14 men and 14 women, median age 58 years) were evaluated for sleep disturbances with PDSS, quality of life with PDQ-39, SF-36 and underwent brain MRI. Twenty-two of these patients underwent STN-DBS and observed for neuropsychiatric complications after STN-DBS implantation surgery. Control group consisted of 28 healthy volunteers who were matched by age and gender. Automated voxel based image analysis was performed with the FreeSurfer software. Results. PD patients with nocturnal hallucinations had prominent basal ganglia volume reduction. Distressful dreams were associated with limbic system and frontal white matter changes. Volumetric analysis showed significant differences in cortical thickness between STN-DBS patients with and without postoperative neuropsychiatric complications in 13 gyruses on the right hemisphere and in 7 gyruses on the left hemisphere. White matter volume analysis showed also its reduction in the left caudal middle frontal area. Foundings suggest that neuropsychiatric complications after DBS can be associated with excitation of frontal-striatum-thalamus and temporal-parietal circuits. Decreased social functioning in PD patients can be associated with white matter reduction in cingulate area. Conclusions. Neuropsychiatric complications after DBS can be associated with excitation offrontal-striatum-thalamusand temporal-parietal circuits. PD patients with nocturnal hallucinations had prominent basal ganglia volume reduction [ABSTRACT FROM AUTHOR]

Aim: Treatment of craniopharyngiomas remains challenging. The aim of this study was to evaluate results of initial surgical management of craniopharyngiomas via the extended pterional approach., Material and Methods: Nineteen patients (10 female; median age of 23 years; ranging from 10 months to 67 years) undergone initial surgery for craniopharyngiomas through the extended pterional approach. Data were retrospectively collected by reviewing medical records, operative reports and imaging results., Results: The median size of craniopharyngiomas was 3.2 cm (range 1.3 - 4.8). Visual deterioration (n=12) and headache (n=10) were the most common symptoms on admission. After surgery, one patient died due to medical complications, 12 patients developed diabetes insipidus and eight patients developed anterior pituitary dysfunction. Median follow-up period was 9 years (range 2 - 13). Patients with progression of craniopharyngioma (n=5) when compared to patients without progression of craniopharyngioma (n=14) were significantly younger at the time of surgery, had less visual deterioration before surgery and had higher rates of not changed vision after surgery. Children had larger craniopharyngiomas when compared to adults., Conclusion: Initial surgery for craniopharyngioma via the extended pterional approach is a safe and effective treatment option with low postoperative mortality, and acceptable postoperative morbidity and recurrence rate.