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1.
Oper Neurosurg (Hagerstown) ; 23(5): 374-381, 2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36227252

RESUMO

BACKGROUND: Detailed anatomic visualization of the root entry zone of the trigeminal nerve is crucial to successfully perform microvascular decompression surgery (MVD) in patients with trigeminal neuralgia. OBJECTIVE: To determine advantages and disadvantages using a 3-dimensional (3D) exoscope for MVD surgery. METHODS: A 4K 3D exoscope (ORBEYE) was used by a single surgical team for MVD in a retrospective case series of 8 patients with trigeminal neuralgia in a tertiary center. Clinical and surgical data were collected, and advantages/disadvantages of using the exoscope for MVD were recorded after each surgery. Descriptive statistics were used to summarize the data. RESULTS: Adequate MVD of the trigeminal nerve root was possible in all patients by exclusively using the exoscope. It offered bright visualization of the cerebellopontine angle and the root entry zone of the trigeminal nerve that was comparable with a binocular operating microscope. The greatest advantages of the exoscope included good optical quality, the pronounced depth of field of the image for all observers, and its superior surgeon ergonomics. Disadvantages were revealed with overexposure at deep surgical sites and the lack of endoscope integration. In 6 patients, facial pain improved significantly after surgery (Barrow Neurological Institute pain intensity score I in 5 and III in 1 patient), whereas it did not in 2 patients (Barrow Neurological Institute score IV and V). No complications occurred. CONCLUSION: Utilization of a 3D exoscope for MVD is a safe and feasible procedure. Surgeons benefit from better ergonomics, excellent image quality, and an improved experience for observers.


Assuntos
Cirurgia de Descompressão Microvascular , Neuralgia do Trigêmeo , Dor Facial , Humanos , Cirurgia de Descompressão Microvascular/métodos , Estudos Retrospectivos , Nervo Trigêmeo/diagnóstico por imagem , Nervo Trigêmeo/cirurgia , Neuralgia do Trigêmeo/complicações , Neuralgia do Trigêmeo/diagnóstico por imagem , Neuralgia do Trigêmeo/cirurgia
2.
World Neurosurg ; 166: e504-e510, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35842175

RESUMO

OBJECTIVES: Microvascular decompression (MVD) has grown as a first-line surgical intervention for severe facial pain from trigeminal neuralgia and/or hemifacial spasm. We sought to examine the safety and cost-benefits of discharging patients with MVD within 1 day of admission. METHODS: We retrospectively reviewed patients undergoing MVD at our institution from 2008 to 2020. Patients were sorted by 1 day, 2 days, or >2 days until discharge and by year from 2008 to 2013, 2014 to 2018, or 2019 to 2020. Patient presenting characteristics, intraoperative measures, and complications were documented. Statistical differences were calculated by one-way analysis of variance and χ2 analyses. RESULTS: Our cohort included 976 patients undergoing MVD, with 231 (23.6%) between 2008 and 2013, 517 (52.9%) between 2014 and 2018, and 228 (23.3%) between 2019 and 2020. Over time, postoperative admission rates to the critical care unit, total inpatient hospital admission times, and Barrow Neurological Institute scores at first follow-up decreased. Postoperative complications, including cerebrospinal fluid leak, decreased significantly. In addition, patients discharged within 1 day of admission incurred a total hospital cost of $26,689, which was $3588 lower than patients discharged within more than 1 day of admission, P < 0.0001. Discharging carefully selected patients who are appropriate for discharge within 1 day of admission could translate to a potential cost-savings of $255,346 per year in our clinical practice. CONCLUSIONS: In our experience, MVDs are a safe, elective intervention. Our findings suggest that postoperative day 1 discharge in patients with an uncomplicated postoperative course may be safe while improving hospital resource use.


Assuntos
Espasmo Hemifacial , Cirurgia de Descompressão Microvascular , Neuralgia do Trigêmeo , Redução de Custos , Espasmo Hemifacial/complicações , Espasmo Hemifacial/cirurgia , Humanos , Pacientes Internados , Tempo de Internação , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Neuralgia do Trigêmeo/complicações , Neuralgia do Trigêmeo/cirurgia
3.
Eur J Pain ; 23(1): 66-71, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29978526

RESUMO

BACKGROUND: Patients with non-dental orofacial pain syndromes will often primarily consult general dentists and other dental specialists. Early and correct diagnosis and therapy is crucial to prevent chronification. METHODS: We assessed the experience of dentists (general dentists and dental specialists; n = 533) and knowledge level of dental students (n = 130) on the diagnosis and treatment of non-dental orofacial pain. We used an anonymized survey containing 14 items with the four main themes (1) prescription patterns, (2) treatment strategies in non-dental orofacial pain, (3) interdisciplinary cooperation, and (4) self-assessment of knowledge as well as post-graduate education. RESULTS: Ninety-two percent of dental students stated that they feel either 'not at all' (56%) or only 'somewhat' (36%) prepared for the diagnosis or treatment of non-dental orofacial pain. Only 23% of the dentists reported 'good' or 'very good' confidence for the diagnosis of non-dental orofacial pain. NSAID were the analgesics of choice when the pain is unspecific (25%) or even neuralgic (10%). Dentists referred patients with non-dental orofacial pain mostly to ENT-physicians (59%), oral and maxillofacial surgeons (54%) or TMD specialists (51%). CONCLUSION: Interdisciplinary pain treatment seems to be well acknowledged, however, with a focus on referral within the community of dental specialists. Dental curricula and post-graduate trainings need to implement the diagnosis and treatment options of non-dental orofacial pain.


Assuntos
Competência Clínica , Odontólogos , Dor Facial/diagnóstico , Encaminhamento e Consulta , Estudantes de Odontologia , Adulto , Síndrome da Ardência Bucal/complicações , Síndrome da Ardência Bucal/diagnóstico , Dor Facial/etiologia , Dor Facial/terapia , Feminino , Alemanha , Humanos , Masculino , Neuralgia Pós-Herpética/complicações , Neuralgia Pós-Herpética/diagnóstico , Otolaringologia , Autoavaliação (Psicologia) , Cirurgia Bucal , Inquéritos e Questionários , Transtornos da Articulação Temporomandibular/complicações , Transtornos da Articulação Temporomandibular/diagnóstico , Síndrome da Disfunção da Articulação Temporomandibular/complicações , Síndrome da Disfunção da Articulação Temporomandibular/diagnóstico , Odontalgia/complicações , Odontalgia/diagnóstico , Neuralgia do Trigêmeo/complicações , Neuralgia do Trigêmeo/diagnóstico
4.
Cephalalgia ; 22(4): 251-5, 2002 May.
Artigo em Inglês | MEDLINE | ID: mdl-12100085

RESUMO

A total of 26 episodes of V-1 trigeminal neuralgia attacks have been recorded in two female patients. Autonomic phenomena were assessed according to a semiquantitative scale. Attacks lasted 17 +/- 5 s. Mild lacrimation without conjunctival hyperaemia, rhinorrhea or ptosis was observed, even in relatively long lasting episodes. This is in clear contradiction with SUNCT (shortlasting, unilateral, neuralgiform headache with conjunctival injection, tearing and rhinorrhea) attacks that are always dramatically accompanied by both lacrimation and conjunctival injection of the symptomatic side from the very onset of symptoms. Carbamazepine provided complete and sustained relief of symptoms in both patients. Herein we will show differential autonomic features of V-1 trigeminal neuralgia vs. SUNCT that will both aid the clinician to distinguish both syndromes and stress that both entities are nosologicaly different.


Assuntos
Nervo Oftálmico/fisiopatologia , Lágrimas/metabolismo , Neuralgia do Trigêmeo/fisiopatologia , Idoso , Blefaroptose/etiologia , Carbamazepina/uso terapêutico , Túnica Conjuntiva/patologia , Diagnóstico Diferencial , Feminino , Cefaleia/complicações , Cefaleia/diagnóstico , Humanos , Hiperemia/etiologia , Pessoa de Meia-Idade , Mucosa Nasal/metabolismo , Pressão/efeitos adversos , Recidiva , Neuralgia do Trigêmeo/complicações , Neuralgia do Trigêmeo/diagnóstico , Neuralgia do Trigêmeo/tratamento farmacológico , Neuralgia do Trigêmeo/etiologia
5.
J Orofac Pain ; 9(2): 138-46, 1995.
Artigo em Inglês | MEDLINE | ID: mdl-7488983

RESUMO

Ongoing pain, intermittent sharp pain, or intermittent dull aching pain around the teeth can evoke the suspicion of tooth pathology. However, when no dental cause can be found clinically or radiographically, the differential diagnosis involving neuropathic pain and pulpal pathology is still a challenge. Neuropathic facial pains are still too often misdiagnosed as tooth pain of dental origin, resulting in unnecessary dental extraction or endodontic therapy. The purpose of this study was to determine if electronic thermography was able to differentiate neuropathic facial pains presenting as toothache from pulpal pathology. Electronic thermography was used to compare asymptomatic subjects and subjects with neuropathic facial pains. Asymptomatic subjects and subjects with trigeminal neuralgia, pre-trigeminal neuralgia, and pulpal pain without periapical pathology showed no thermographic difference in the territory of the pain complaint when compared to the opposite nonpainful side. Patients with sympathetically maintained traumatic trigeminal neuralgia (atypical odontalgia) and half of the group with sympathetically independent traumatic trigeminal neuralgia presented with "hot" thermograms. The other half of the patients with sympathetically independent traumatic trigeminal neuralgia displayed "cold" thermograms in the area of their pain complaints. Electronic thermography was the least selective test for the group showing "cold" thermogram patterns (80% agreement with the thermographic characterization criteria). These data suggest that electronic thermography may be helpful in differentiating neuropathic pains from pulpal pathology.


Assuntos
Dor Facial/diagnóstico , Dor Facial/etiologia , Pulpite/diagnóstico , Termografia , Odontalgia/diagnóstico , Neuralgia do Trigêmeo/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neuropeptídeos/fisiologia , Valor Preditivo dos Testes , Pulpite/complicações , Sensibilidade e Especificidade , Pele/irrigação sanguínea , Sistema Nervoso Simpático/fisiopatologia , Odontalgia/etiologia , Neuralgia do Trigêmeo/complicações , Vasoconstrição , Vasodilatação
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