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Tytuł:
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Deep Brain Stimulation Surgery for Essential Tremor in a Patient with Type A Hemophilia.
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Autorzy:
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Palsma R; Department of Neurosurgery, University of Arizona College of Medicine, Tucson, Arizona, USA.
Gravbrot N; Department of Neurosurgery, University of Arizona College of Medicine, Tucson, Arizona, USA.
Bina R; Department of Neurosurgery, University of Arizona College of Medicine, Tucson, Arizona, USA.
Agastya M; Division of Hematology and Oncology, Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona, USA.
Kasoff WS; Department of Neurosurgery, University of Arizona College of Medicine, Tucson, Arizona, USA. Electronic address: .
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Źródło:
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World neurosurgery [World Neurosurg] 2020 Jul; Vol. 139, pp. 158-162. Date of Electronic Publication: 2020 Apr 10.
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Typ publikacji:
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Case Reports
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Język:
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English
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Imprint Name(s):
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Original Publication: New York : Elsevier
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MeSH Terms:
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Deep Brain Stimulation*
Coagulants/*therapeutic use
Essential Tremor/*therapy
Factor VIII/*therapeutic use
Hemophilia A/*drug therapy
Neurosurgical Procedures/*methods
Perioperative Care/*methods
Aged ; Blood Loss, Surgical/prevention & control ; Essential Tremor/complications ; Hemophilia A/complications ; Humans ; Infusions, Intravenous ; Male ; Postoperative Hemorrhage/prevention & control ; Prosthesis Implantation/methods ; Recombinant Proteins ; Ventral Thalamic Nuclei/surgery
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Contributed Indexing:
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Keywords: Deep brain stimulation; Essential tremor; Hemophilia
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Substance Nomenclature:
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0 (Coagulants)
0 (Recombinant Proteins)
9001-27-8 (Factor VIII)
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Entry Date(s):
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Date Created: 20200414 Date Completed: 20200907 Latest Revision: 20200907
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Update Code:
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20240105
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DOI:
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10.1016/j.wneu.2020.03.174
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PMID:
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32283321
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Background: Hemophilia is generally considered a contraindication to deep brain stimulation (DBS) and other elective intracranial surgery because of the elevated risk of perioperative hemorrhage. Two prior case reports have suggested, however, that DBS may be safe in patients with hemophilia who undergo appropriate factor replacement. Here, we describe a third case of DBS surgery for medically refractory essential tremor (ET) in a patient with hemophilia A.
Case Description: A 68-year-old right-handed man with mild hemophilia A presented for a 10-year history of bilateral (right greater than left), medically refractory ET. The patient was considered an appropriate candidate for DBS by a multidisciplinary movement disorders conference, and hematology consultation was obtained. Baseline preoperative laboratory results showed a quantitative factor VIII (FVIII) level of 38%. Perioperative management consisted of daily intravenous bolus doses of recombinant FVIII from the morning of surgery to postoperative day 10. The patient underwent uncomplicated unilateral DBS placement in the left ventralis intermedius thalamus. Intra- and postoperative imaging showed no hemorrhage. His postoperative course was uncomplicated except for a single self-limited episode of hematuria requiring no intervention.
Conclusions: DBS placement for ET may be safe in patients with coexisting hemophilia A if appropriate FVIII replacement is given, which may be delivered as bolus infusions rather than continuous infusion.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
