Comparison of the Cross-Sectional Area of Longus Colli Muscle Between Patients With Cervical Radicular Pain and Healthy Controls.

BACKGROUND: Previous studies have shown atrophy of paravertebral lumbar muscles in patients with lumbar radicular pain and have proposed rehabilitative approaches based on these findings. However, changes in cervical paravertebral muscles in patients with cervical radicular pain are still unknown. OBJECTIVE: The aim of this study was to compare the cross-sectional area (CSA) of the longus colli muscle (LCM) in patients with cervical radicular pain and healthy controls via ultrasound measurement. STUDY DESIGN: Case-control study. SETTING: Outpatients who came for treatment to the neurosurgery clinic. PARTICIPANTS: A total of 20 patients with more than 4 weeks of cervical radicular pain and 20 healthy matched (for body mass index, age, and gender) control subjects. INTERVENTIONS: Ultrasound measurements. MAIN OUTCOME MEASURES: The CSA of the LCM at the level of C5-C6 was measured by ultrasound with the subject in supine position. Also, Neck Disability Index (NDI), and visual analogue scale (VAS) scores were reported by patients. An independent-sample t test was used for investigation of differences in CSA and other variables in both groups. RESULTS: A total of 20 patients with cervical radicular pain with a mean age of 42.4 years (standard deviation [SD] = 7 years) and 20 healthy matched controls with mean age of 40.7 years (SD = 7 years) participated in the study. Patients with cervical radicular pain showed smaller CSA of the LCM bilaterally compared with controls (mean difference: 0.37 [SD = 0.15]; P < .001). In the patient group, there were no significant differences between the CSA of the LCM in the involved and noninvolved sides. No correlations between the CSA of the LCM and VAS, Neck Disability Index, symptom duration, gender, BMI, and age of the patients were found. CONCLUSIONS: This is the first study to show via ultrasound assessment that patients with cervical radicular pain had smaller bilateral CSA of the LCM in comparison with healthy controls. It is also not clear whether atrophy of the LCM in patients with cervical radicular pain is a consequence or a cause of the pain. Reduction in the stability of the neck due to atrophy of the LCM could make the cervical spine region susceptible to more injuries, which might be prevented by functional and strengthening exercises. LEVEL OF EVIDENCE: III.

Coil Embolization of Intracranial Aneurysms: A Six-Month Follow-Up Study.

BACKGROUND: Rupture of the intracranial aneurysms is associated with a high risk of bleeding and a high incidence of mortality if left untreated. OBJECTIVES: The aim of this study is to report our experience in managing intracranial aneurysms using coil embolization and to report the 6-month follow-up outcome of the patients. PATIENTS AND METHODS: From January 2010 to December 2012, a series of 90 nonrandomized consecutive patients (mean age: 44.6 ± 14.9 years) with intracranial aneurysms underwent endovascular coil embolization in our center. We excluded patients with dissecting, blood blister-like, or false aneurysms. All patients were evaluated by four-vessel angiography to determine the shape, size, number and location of the aneurysms. We recommended a six-month follow-up control angiography. However, only 38 of them participated in this follow-up imaging. The data were analyzed by chi-square, fisher exact and t-tests and alpha was considered lower than 5%. RESULTS: Immediately after the procedure, the total occlusion was seen in 76 (86.4%), subtotal occlusion in six (6.8%), and partial occlusion in six patients (6.8%). There was no significant relationship between the aneurysm size, aneurysm neck size, and location of the aneurysm with total or subtotal occlusions. Eleven patients (12.5%) experienced some complication during the procedure including two tears, three focal neurological signs, three vision disturbances, and three bleedings in the aneurysm. Major complications were significantly higher in the posterior aneurysm compared to the anterior ones (55.6% versus 44.4% of the major complications; P value = 0.015). Among patients who underwent control angiography, 34 patients (89.4%) had no change, two (5.3%) had new growth and two (5.3%) had widening of the neck after 6 months follow-up. Although aneurysms that remained unchanged after six months follow-up angiography had total occlusion after the procedure, it was 50% for aneurysms that had any changes in 6 months follow-up angiography (P value = 0.01). CONCLUSION: Coil embolization showed successful outcomes in the treatment of intracranial aneurysms with a low complication rate.

Comparison of endovascular coiling and surgical clipping for the treatment of intracranial aneurysms: A prospective study.

BACKGROUND: Management of intracranial aneurysms has made debates about the best treatment modality in recent years. The aim of this study was to compare the interventional outcomes between two groups of patients, one treated with endovascular coiling and the other treated with surgical clipping. METHODS: This prospective study included 48 patients with intracranial aneurysms who underwent endovascular coiling (27 patients) or surgical clipping (21 patients) from July 2011 to August 2013. A neurologist examined patients in admission and followed them by phone call 1-year after intervention. RESULTS: Mean modified Rankin Scale (MRS) score at the time of admission in endovascular group was 2.86 ± 0.974 whereas it was 3.81 ± 1.078 in surgical clipping group (P = 0.0040). Focal neurologic signs were higher in clipping during procedures (P = 0.0310). Of 37 patients who followed up for a year, 19 were in endovascular group and 18 in surgical clipping group. At 1 year follow-up, MRS improvement was statistically significant in coiling group (P = 0.0090), but not in clipping group (P = 0.8750). Mean difference of MRS score at the time of admission and at one year later, was 0.947 ± 1.224 in endovascular group and 0.111 ± 2.083 in surgical group (P = 0.3000). CONCLUSION: There was no statistically significant difference at 1 year outcome between two groups. We recommend further interventional studies with larger sample sizes for better evaluation of the modalities.

Microvascular decompression for trigeminal neuralgia using the 'Stitched Sling Retraction' technique in recurrent cases after previous microvascular decompression.

BACKGROUND: Microvascular decompression is a well-known therapeutic option for trigeminal neuralgia. It is considered safe and effective, and is the surgical treatment of choice for the malady. However, there is no standard technique for it and different authors have proposed different techniques of performing it. In this study, we observe the clinical results of the so-called 'stitched sling retraction' technique for recurrent cases of trigeminal neuralgia. METHODS: Twelve consecutive patients with recurrent trigeminal neuralgia after previous microvascular decompression(s) were admitted to our institution form February 2009 to February 2011 and underwent microvascular decompression of the trigeminal nerve using the 'stitched sling retraction' technique. In this technique, the offending loop of the superior cerebellar artery is retracted from the nerve and, using a silk thread loop around it, is suspended to the adjacent tentorium. RESULTS: All patients experienced pain resolution during the immediate post-operative period or within the first 6 months after surgery. They were followed for 24 to 38 months. No recurrence occurred. CONCLUSIONS: The 'stitched sling retraction' technique shows promising preliminary results in recurrent cases of trigeminal neuralgia after previous microvascular decompression(s). Since it is a 'transposing' technique, it might be associated with less recurrence rates (due to resuming of the neurovascular conflict) than the classic interposing technique, which uses a prosthesis between the offending vessel and the trigeminal nerve.