Spinal cord stimulation in peripheral arterial disease. A cooperative study.

Percutaneous epidural stimulation of the low thoracic spinal cord was carried out in 41 patients with pain from peripheral arterial disease of the lower limbs. Results are reported relating to pain, claudication distance, peripheral blood flow, and trophic lesion changes. Following a trial period of stimulation, 37 patients had stimulators permanently implanted. After a mean poststimulation follow-up period of 25 months, substantial pain relief (75% to 100%) was obtained in 29 cases; claudication distance significantly increased in 15 cases; Doppler ultrasound recordings of lower-limb distal arteries showed a tendency toward normalization of pulse-wave morphology, with increase of amplitude in 12 of the 23 patients studied; a rise in skin temperature was also detected by thermography. Distal arterial blood pressure remained unchanged with stimulation. Ischemic cutaneous trophic lesions of less than 3 sq cm healed, but gangrenous conditions were not benefited. A placebo effect or the natural history of the disease can be excluded as the reason for these improvements. It is concluded that spinal cord stimulation is a valid alternative treatment for moderate peripheral arterial disorders when direct arterial surgery is not possible or has been unsuccessful.

Extensive craniofacial subcutaneous emphysema after evacuation of a chronic subdural haematoma.

An unusual complication of craniofacial subcutaneous emphysema after evacuation of a chronic subdural haematoma is reported. The emphysema caused massive swelling and deformity of the patient's head and face, as well as the occlusion of both eyes, and it resolved spontaneously. The possible mechanisms of development of emphysema are discussed.

Experimental arterial lesions after narrow-beam gamma irradiation used in stereotactic radiosurgery.

An experimental study on rats showing the arterial lesions caused by the beams of gamma irradiation used in stereotactic radiosurgery is presented. The common carotid artery of the rat was irradiated with a single narrow-beam of gamma radiation with a maximum dose of 30 and 60 Gy. The results were evaluated at 4, 12 and 24 weeks after irradiation. Several focal changes in the arterial walls were observed in all periods of study with a predominance of hyperplastic (proliferative) alterations at doses of 30 Gy, and hyaline degeneration at doses of 60 Gy. Total occlusion was not observed in any case. In conclusion, vascular hyperplasia is more prominent with the lower doses evaluated.

Long-term results of percutaneous gasserian ganglion lesions.

Percutaneous radiofrequency lesion of the Gasserian ganglion was performed between 1974 and 1984 in ninety-eight patients for the relief of trigeminal neuralgia. The average follow-up period was 4.5 years. Age, sex, and duration of illness were unrelated to outcome. Satisfactory analgesia was achieved in 68 patients. Thirty-one percent had return of pain (30 cases). Recurrent neuralgia occurred most frequently during first postoperative year (46%). Patients with marked sensory deficits had a reduced risk of recurrence. Postoperative complications included: reduced or absent corneal reflex (18 cases), corneal keratitis (3 cases) and anesthesia dolorosa (2 cases).

Hemodynamic changes from spinal cord stimulation for vascular pain.

The hemodynamic changes induced by spinal cord stimulation (SCS) have been studied in a group of 20 patients with peripheral vascular pain. The surgical technique consisted of the introduction of 1 or 2 electrodes in the subarachnoid space up to the level of the painful area, for mono or bipolar SCS. Several techniques have been used for evaluation of hemodynamic changes induced by SCS. Peripheral blood flow speed was measured by means of ultrasound Doppler, showing a raised maximum speed during stimulation, and a tendency of the pulse wave to return to normal. Thermography showed a marked increase of temperature in the painful area. Preoperatively, plethysmography showed an absence of the typical flow waveform, whilst postoperative recordings showed a small wave of progressively increasing amplitude. Scintigraphy with 201TI showed an increase in muscular blood flow in previously hypovascularized areas. The mechanism of action of SCS on peripheral blood flow and vascular pain is discussed.