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Rapid and precise detection of significant data streams within a network is crucial for efficient traffic management. This study leverages the TabNet deep learning architecture to identify large-scale flows, known as elephant flows, by analyzing the information in the 5-tuple fields of the initial packet header. The results demonstrate that employing a TabNet model can accurately identify elephant flows right at the start of the flow and makes it possible to reduce the number of flow table entries by up to 20 times while still effectively managing 80% of the network traffic through individual flow entries. The model was trained and tested on a comprehensive dataset from a campus network, demonstrating its robustness and potential applicability to varied network environments.

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Background Arteriovenous malformations are potentially serious vascular anomalies that are rarely encountered in the eyelid and require a multidisciplinary approach. Objectives We would like to describe the technical and clinical aspects related to the treatment of palpebral arteriovenous malformation with selective embolization, followed by surgical resection. Methods A 40-year-old patient presented with an isolated high-flow palpebral arteriovenous malformation. Transarterial embolization, using a liquid embolic agent (PHIL™), was performed in this patient. Results Angiographic and clinical follow-up revealed good results with clinical regression of the mass. Conclusion Although endovascular treatment of palpebral arteriovenous malformations is technically challenging, good functional and cosmetic result was achieved. Arteriovenous malformation embolization using PHIL™ seems to be very effective and makes subsequent surgical procedure safe and feasible. Level IV Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.

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BACKGROUND AND PURPOSE: The objective of the study was to assess bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) for patients with advanced Parkinson disease (PD). MATERIAL AND METHODS: The study population included 5 patients with bilateral STN DBS who completed a 5-year postoperative follow-up period. In all patients electrodes (Model 3387 or 3389) were stereotactically bilaterally inserted into the STN using a Leksell stereotactic G frame. The clinical rating tests included Unified Parkinson's Disease Rating Scale (UPDRS) and two motor-timed tests derived from CAPIT (rapid movements between two points and stand-walk-sit test). All patients were assessed in off and on condition before implantation and 1, 3 and 5 years in medication on and off condition and stimulation on condition and stimulation off condition. To compare preoperative to postoperative UPDRS scores, only mean values and standard deviations are presented because of the small study population. RESULTS: The stimulation effect was noted in the off state, resulting in a 59% improvement in motor scores of UPDRS at 5-year follow-up, when compared to preoperative scores. In the on state the stimulation improved motor scores by 17%. At 5-year follow-up, reduction of daily levodopa dose was 50%. CONCLUSIONS: Bilateral STN DBS is an effective and safe treatment for patients with advanced PD. Bilateral STN DBS contributes to improvement of parkinsonian symptoms in the off state and levodopa-induced dyskinesia. This can be correlated with a 50% reduction of daily levodopa dose 5 years postoperatively.

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The aims of the study were to present the surgical technique of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) and to analyze our experience with the MedtronicStealthStation Treon neuronavigation system and Framelink 4.1 software in targeting STN using single-unit extracellular action potentials (microrecording). The prospective study included 2 patients with bilateral STN DBS. The STN boundaries were mapped using microrecording, without microstimulation and recording of kinesthetic cells. For macrostimulation the longest trajectory with neuronal activity characteristic of STN was chosen. The patients were assessed using Unified Parkinson's Disease Rating Scale UPDRS version 3 and Schwab and England Scale. Postoperatively we did not notice intracerebral haemorrhage. Also there were no transient or permanent side effects. The mean number of microelectrode tracts was 4 per STN. Framelink 4.1 software is reliable to plan individual microelectrode trajectories and help avoid the intraparenchymal vessels.

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BACKGROUND AND PURPOSE: Essential tremor is the most common tremorogenic movement disorder. In the majority of patients the progression of the disease is slow and the pharmacological treatment effectively alleviates tremor. In rare cases of increased essential tremor the surgical treatment (ventrolateral thalamotomy) is indicated. The goal of this study was to assess the effectiveness of unilateral thalamotomy in the treatment of essential tremor. MATERIAL AND METHODS: 10 stereotactic ventrolateral thalamotomies were performed in 9 patients for pharmacologically intractable essential tremor. Right thalamotomy was done in 5 patients and left thalamotomy in 4 patients. The study included five men and four women. Patients were assessed according to the Clinical Rating Scale for Tremor (CRST) before surgery and at 3, 12 and 24 months after thalamotomy. RESULTS: In the postoperative period there was a marked reduction of essential tremor in the contralateral arm and, to a lower extent, in the contralateral leg. The mean presurgery value for contralateral upper extremity postural tremor (scores 5/6 CRST) decreased from 3.5 to mean postsurgery value of 0.6. The tremor reduction contributed to 59% improvement in specific motor tasks of upper extremities (Part B of CRST) at 2 years follow-up. There was also improvement of functional disabilities (Part C of CRST) by 62% when compared to preoperative value 2 years postoperatively. CONCLUSIONS: Ventrolateral thalamotomy is a highly effective method in the treatment of essential tremor. The side effects related to surgery are rare and most of them are transient.

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BACKGROUND AND PURPOSE: To assess the effectiveness of unilateral thalamotomy for the treatment of parkinsonian tremor and other motor signs of Parkinson's disease (PD). MATERIAL AND METHODS: Between 1999 and 2004, 41 patients with idiopathic tremor dominant PD were treated surgically in the Neurosurgical Department of Postgraduate Medical Center in Warsaw. Stereotactic thalamotomy was performed with Leksell stereotactic frame (model G) using intraoperative macrostimulation. The patients were assessed according to the Unified Parkinson's Disease Rating Scale version 3. (UPDRS) before and after thalamotomy in the off state. The progression of PD was also evaluated according to the Hoehn and Yahr scale in the off state and also Schwab and England was used to assess the disability of the patients. The patients were evaluated before thalamotomy in the off state, and 3, 12, 24 and 36 months after surgery, according to the above mentioned clinical rating scales. RESULTS: The authors report their results among 41 patients who underwent stereotactic thalamotomy 3 years postoperatively. At 3 years follow-up (in the group of 19 patients) the contralateral tremor from the presurgical value of 11.2 (items 20 - 21 UPDRS) decreased to 2.6. The rigidity in contralateral limbs at 3 years follow-up was 1.7 (item 22 UPDRS) when compared to 2.8 (item 22 UPDRS) preoperative value. Thalamotomy had no effect on bradykinesia or other manifestations of PD such as balance or gait disturbance. There were 13 transient and 6 permanent complications. CONCLUSIONS: Thalamotomy using intraoperative macrostimulation in carefully selected patients is a beneficial operation for the control of medically refractory parkinsonian resting and postural tremor. The effect of unilateral thalamotomy on tremor is long lasting.

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BACKGROUND AND PURPOSE: The authors report the results of stereotactic surgery for severe posttraumatic tremor in 7 patients. MATERIAL AND METHODS: All patients were severely incapacitated in their daily living activities by mainly kinetic and postural components of Holmes tremor. The 7 patients underwent 8 stereotactic operations. The stereotactic target in all patients was the ventrolateral thalamus. Patients were evaluated using the Clinical Rating Scale For Tremor (CRST) before and up to 24 months after stereotactic thalamotomy. RESULTS: In the postoperative period there was marked amelioration in kinetic and postural components of Holmes tremor in contralateral upper and lower extremity. The mean presurgery value for contralateral upper extremity kinetic tremor (scores 5-6 CRST) dropped from 3.25 to mean postsurgery value of 0.5. There was also a marked functional improvement. It was reduced from a mean value of 71% of maximum disability according to CRST (scores 15-21, part C CRST, 0% independent, 100% total dependent) to 28.5% over 2-year follow-up. CONCLUSIONS: Ventrolateral thalamotomy alleviates effectively Holmes tremor and improves greatly performance of activities of daily living.

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There is little information on the efficacy of various surgical interventions in terms of health-related quality of life in Parkinson's disease (PD) patients. Most studies evaluated only motor symptoms of PD after surgical treatment avoiding subjective patient's assessment. The goal of this study is the assessment of surgical treatment of PD on quality of life using Parkinson's Disease Questionnaire (PDQ-39). To 134 patients PDQ-39 questionnaires were send, 91 of them responded. Among 91 patients 32 underwent unilateral thalamotomy, 38 unilateral pallidotomy and 21 bilateral staged pallidotomy. The patients were assessed at baseline and 3 to 6 months after surgery. The PDQ-39 recorded significant improvement in mobility, activity of daily living and stigma in thalamotomy and pallidotomy group. The most striking improvement was noticed in bilateral pallidotomy group. After bilateral pallidotomy improvement was noticed in mobility, ADL, emotional well being, stigma and bodily discomfort. Our results indicate that quality of life in PD patients after surgical treatment is measurable according to PDQ-39 and the most benefit is noted in patients who underwent bilateral staged pallidotomy.

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Many patients with Parkinson's disease (PD) suffer from severe bilateral appendicular off (bradykinesia, rigidity, tremor) and on (dyskinesia, dystonia) symptoms. After unilateral pallidotomy several of these patients still suffer from severe bradykinesia, rigidity, or dyskinesia of the ipsilateral side. In addition such symptoms as walking difficulty, freezing, trunk, neck, or facial dyskinesia are not significantly alleviated after unilateral pallidotomy. These patients seem to be good candidates for bilateral staged pallidotomy. The aim of this study is to evaluate the motor symptoms after staged bilateral pallidotomy in advanced PD patients. 34 patients were studied. The patients were assessed using UPDRS version 3, Hoehn and Yahr scale, Schwab and England scale before and up to 24 months after surgery in off and on state. In off drug state, the total motor score of the UPDRS compared to preoperative off drug state was improved by 61% at 24 months of follow-up. All cardinal features of PD improved significantly in postoperative drug off state compared to drug off state before bilateral pallidotomy--parkinsonian tremor (items 20-21) by 62%, rigidity (item 22 UPDRS) by 81% and bradykinesia (items 23-26) by 67%. Also gait including falling, freezing, walking (items 13-14-15 UPDRS) and gait and postural stability (items 29-30 UPDRS) showed good improvement by 69% with bilateral pallidotomy in off drug phases. There was minimal improvement in motor score of UPDRS in on state. Duration of dyskinesia and severity of dyskinesia (items 32-33 UPDRS) showed dramatic improvement after bilateral pallidotomy. Bilateral pallidotomy affords impressive elimination of all appendicular and truncal dyskinesias, dystonias, and generally improved all symptoms in off state.

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