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1.
Acta Chir Orthop Traumatol Cech ; 87(5): 340-345, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33146602

RESUMO

PURPOSE OF THE STUDY Subacromial impingement is one of the most common reasons for shoulder pain. The surgical management of this condition has recently become the focus of criticism because of the rising number of surgical procedures and the lack of superiority of surgical over conservative treatment. In this prospective comparative study, we compared standardised conservative care with surgical treatment and placed special emphasis on the patients' ability to work. MATERIAL AND METHODS A total of 106 patients (25 women, 81 men; mean age: 45.4 12.3 years) were included in this prospective comparative clinical study. Patients in the non-operative arm (n = 42) received standardised physiotherapy. Patients in the surgical arm (n = 38) underwent arthroscopic subacromial decompression. All patients were followed up at 3, 6 and 12 months. Shoulder function (Constant score), pain (Numerical Rating Scale), and the duration of inability to work were assessed. RESULTS Shoulder function and pain improved significantly with both kinds of treatment. At no time of follow up we detected significant differences between the two treatment options. An analysis of the patients' ability to work showed that conservative treatment was superior to surgical treatment at 3-month follow-up (0.3 versus 5.0 weeks; p < 0.001) and between 4 and 6-month after intervention (0.2 versus 1.6 weeks; p = 0.032). DISCUSSION In the study presented here, significant improvements in function (Constant score) and pain (NRS) were achieved in both the non-operative and the surgical arm. There were no significant differences between the two groups at any time point. These results are similar to those reported by other authors in recent studies. Unlike other research work, however, our study demonstrated a major difference in the development and duration of inability to work. CONCLUSIONS Conservative and surgical treatment of subacromial impingement syndrome led to similar outcomes for shoulder pain and function at 3, 6 and 12 months after intervention. However, patients who were managed conservatively returned to work significantly earlier than patients who underwent surgery. Key words: subacromial impingement, shoulder, constant score, pain, ability to work.


Assuntos
Síndrome de Colisão do Ombro , Artroscopia , Tratamento Conservador , Descompressão Cirúrgica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Síndrome de Colisão do Ombro/cirurgia , Dor de Ombro/etiologia , Dor de Ombro/terapia , Resultado do Tratamento
2.
No Shinkei Geka ; 48(10): 957-961, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33071233

RESUMO

A 77-year-old man presented with a 6-month history of progressive right optic neuropathy secondary to compression by the ipsilateral internal carotid artery(ICA). We performed anterior clinoidectomy and optic canal unroofing. Subsequently, we wrapped the ICA with a polytetrafluoroethylene tape, pulled the vessel laterally, and sutured the tape to the dura mater at the anterior skull base for optimal decompression. An inflammatory mass lesion was observed around the ICA, which led to further compression of the optic nerve. Histopathological examination of the resected specimen showed an inflammatory granuloma. The patient's visual field deficit showed partial improvement postoperatively. Transposition using a tape might be an effective surgical alternative for compressive optic neuropathy.


Assuntos
Artéria Carótida Interna , Doenças do Nervo Óptico , Idoso , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Descompressão Cirúrgica , Granuloma/complicações , Granuloma/diagnóstico por imagem , Granuloma/cirurgia , Humanos , Masculino , Nervo Óptico/diagnóstico por imagem , Nervo Óptico/cirurgia , Doenças do Nervo Óptico/diagnóstico por imagem , Doenças do Nervo Óptico/etiologia , Doenças do Nervo Óptico/cirurgia
3.
Zhonghua Wai Ke Za Zhi ; 58(11): 892-896, 2020 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-33120454

RESUMO

With the advantages of less operative injury and quicker postoperative recovery time, percutaneous endoscopic spine surgery system is currently one of the most widely used minimal invasive spine surgery techniques in China. However, this technique usually requires surgeon to operate in a single cannula, which brings much inconvenience such as limited vision, small range of motion and low efficiency. Meanwhile, the increasingly popular technique of unilateral biportal endoscopic (UBE) surgery possesses the advantages of better operation visual field, more flexible in operation, shorter learning curve period, handier surgical instruments for spine surgeon, and minimize radiation dosage caused by intraoperative fluoroscopy when comparing with single cannula endoscopic technique, since UBE requires an additional portal for surgical instruments while the anther portal is placed for arthroscope and pressure pump irrigation system. This technique has been applied to the treatment of degenerative diseases of cervical and lumbar spine, facet cyst, spinal epidural lipomatosis and abscess, and has achieved satisfactory clinical results.


Assuntos
Descompressão Cirúrgica , Endoscopia , Doenças da Coluna Vertebral/cirurgia , Coluna Vertebral/cirurgia , China , Endoscopia/instrumentação , Endoscopia/métodos , Humanos , Vértebras Lombares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos
4.
Medicine (Baltimore) ; 99(44): e22997, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126379

RESUMO

BACKGROUND: Many complications are associated with thoracic open decompression surgery, such as dural tears and neurological deficits. The clinical outcomes are also not satisfactory. Full-endoscopic decompression of the lumbar spinal canal has achieved satisfactory results for the treatment of lumbar spinal stenosis. This surgery may be used for the treatment of thoracic ossification of the ligamentum flavum (OLF) under local anesthesia. The aim of our study is to introduce the surgical techniques used for full-endoscopic decompression for thoracic OLF and to evaluate its safety and efficacy. METHODS: Fourteen patients with thoracic OLF (4 combined with dural ossification) underwent full-endoscopic decompression surgery. An interlaminar approach was performed. The anchoring method was used to establish the working passage. Spinal cord exposure began at a space between the ossification and the spinal cord, and dorsal and contralateral decompression were performed with the "Over the Top" technique. The modified Japanese Orthopedic Association score (11 points) was used to evaluate the efficacy during follow-up. At the same time, the visual analogue scale score for assessing back pain before and after the operation was evaluated. RESULTS: The average operation time was 159.73 ±â€Š62.09 minutes, and the hospitalization time was 7.43 ±â€Š1.79 days. The follow-up period ranged from 8 to 22 months. Neurological function was improved. There were no serious complications. Dural tears occurred in 5 patients, intraoperative neurological deterioration occurred in 1 patient, and intraoperative headache and neck pain occurred in 1 patient. CONCLUSION: Full-endoscopic decompression is an effective, safe surgical technique for thoracic OLF even the cases combined with dural ossification.


Assuntos
Ligamento Amarelo/cirurgia , Estenose Espinal/cirurgia , Vértebras Torácicas/cirurgia , Adulto , Descompressão Cirúrgica , Endoscopia , Feminino , Humanos , Ligamento Amarelo/patologia , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica , Estudos Retrospectivos , Resultado do Tratamento
6.
BMC Neurol ; 20(1): 354, 2020 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-32962645

RESUMO

BACKGROUND: In acute large anterior circulation infarct patients with large core volume, we evaluated the role of optic nerve sheath diameter (ONSD) change rates in prediction of malignant progression. METHODS: We performed a retrospective observational study including patients with anterior circulation acute ischemic stroke with large ischemic cores from January 2010 to October 2017. Primary outcome was defined as undergoing decompressive surgery or death due to severe cerebral edema, and termed malignant progression. Patients were divided into malignant progressors and nonprogressors. Malignant progression was divided into early progression that occurred before D1 CT, and late progression that occurred afterwards. Retrospective analysis of changes in mean ONSD/eyeball transverse diameter (ETD) ratio, and midline shifting (MLS) were evaluated on serial computed tomography (CT). Through analysis of CT at baseline, postprocedure, and at D1, the predictive ability of time based change in ONSD/ETD ratio in predicting malignant progression was evaluated. RESULTS: A total of 58 patients were included. Nineteen (32.8%) were classified as malignant; 12 early, and 7 late progressions. In analysis of CTpostprocedure, A 1 mm/hr. rate of change in MLS during the CTbaseline-CTpostprocedure time phase lead to a 6.7 fold increased odds of early malignant progression (p < 0.05). For ONSD/ETD, 1%/hr. change lead to a 1.6 fold increased odds, but this association was trending (p = 0.249). In the CTD1, 1%/day change of ONSD/ETD in the CTbaseline-CTD1 time phase lead to a 1.4 fold increased odds of late malignant progression (p = 0.021) while 1 mm/day rate of change in MLS lead to a 1.5 fold increased odds (p = 0.014). CONCLUSIONS: The rate of ONSD/ETD changes compared to baseline at D1 CT can be a predictor of late malignant progression along with MLS. ONSD/ETD change rates evaluated at postprocedure did not predict early malignant progression.


Assuntos
Edema Encefálico/etiologia , Nervo Óptico/patologia , Acidente Vascular Cerebral/patologia , Edema Encefálico/patologia , Edema Encefálico/cirurgia , Craniotomia , Descompressão Cirúrgica , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nervo Óptico/diagnóstico por imagem , Seleção de Pacientes , Estudos Retrospectivos , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/cirurgia , Tomografia Computadorizada por Raios X/métodos
7.
Vestn Oftalmol ; 136(4. Vyp. 2): 193-200, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32880139

RESUMO

PURPOSE: To evaluate the effectiveness of bony orbital decompression in patients with dysthyroid optic neuropathy (DON). MATERIAL AND METHODS: The study analyzed 255 patients with thyroid eye disease (TED) and bony orbital decompression. Those among them who had DON as an indication for surgery were investigated further. Patients underwent standard ophthalmological examination, computer perimetry, color vision assessment using Ishihara tables, relative afferent pupillary defect (RAPD), computed tomography (CT) of the orbit, and in some cases optical coherence tomography (OCT) of the optic nerve. RESULTS: Final analysis included 31 patients (52 eyes). On 13 orbits, only lateral wall decompression was performed, and medial wall decompression was the only intervention in 7 orbits. In other cases, these techniques were performed either simultaneously - in 14 orbits, or alternately - in 18 orbits. In the postoperative period, all patients showed significant positive dynamics in terms of visual acuity, visual field, and proptosis. In all cases, decrease of the amount of orbital inflammation was observed. Exophthalmos significantly decreased after surgery and averaged 20.5±3.1 mm, which is 4.7 mm less than the initial one. All changes were statistically significant (p<0.01). CONCLUSION: Bony orbital decompression is an effective and safe treatment option for DON resistant to high doses of glucocorticoids. In the vast majority of cases, this intervention is the only way to improve and stabilize visual function in this severe category of patients.


Assuntos
Oftalmopatia de Graves/cirurgia , Doenças do Nervo Óptico/cirurgia , Descompressão Cirúrgica , Humanos , Nervo Óptico , Órbita/cirurgia , Técnica de Amplificação ao Acaso de DNA Polimórfico , Estudos Retrospectivos , Resultado do Tratamento
8.
Medicine (Baltimore) ; 99(38): e21973, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32957316

RESUMO

OBJECTIVE: The goal of this study was to review relevant studies in order to determine the efficacy of decompression with fusion versus decompression in the treatment of lumbar spinal stenosis. METHODS: Using appropriate keywords, we identified relevant studies using PubMed, the Cochrane library, and Embase. Key pertinent sources in the literature were also reviewed, and all articles published through October 2019 were considered for inclusion. For each study, we used odds ratios, mean difference (MD), and 95% confidence interval (95% CI) to assess and synthesize outcomes. RESULTS: We found 13 studies that were consistent with this meta-analysis with a total of 29066 patients. Compared with decompression, decompression with fusion significantly increased the incidence of complications (RR: 1.41, 95%CI: 1.26-1.57), the length of hospital stay (WMD: 1.868, 95%CI: 1.394-2.343), operative time (WMD: 80.399, 95%CI: 44.397-116.401), estimated blood loss (WMD: 309.356, 95%CI: 98.008-520.704) and Zurich claudication questionnaire in symptom severity (WMD: 0.200, 95%CI: 0.006-0.394). The reoperation rate was lower in the decompression with fusion group than the decompression group but without significant difference (RR: 0.91, 95%CI: 0.82-1.00). There was no significant difference between 2 groups in visual analog scale (leg pain and back pain), ODI, Short Form 36 Health Survey physical component summary, Short Form 36 Health Survey mental component summary, and Zurich claudication questionnaire physical function. CONCLUSION: Decompression with fusion has no significant clinical advantages in treatment of lumbar spinal stenosis when compared with decompression.


Assuntos
Descompressão Cirúrgica/métodos , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Perda Sanguínea Cirúrgica , Avaliação da Deficiência , Humanos , Tempo de Internação , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Reoperação
9.
Vasc Health Risk Manag ; 16: 331-341, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32982262

RESUMO

Purpose: Physiological tests may aid in diagnosing median arcuate ligament syndrome (MALS). MALS is a symptomatic compression of the celiac artery causing symptoms similar to chronic mesenteric ischemia (CMI) of atherosclerotic etiology. Simultaneous use of visible light spectroscopy (VLS) and laser doppler flowmetry (LDF) during upper endoscopy may detect microcirculatory changes in these patients. Patients and Methods: In a single-center, prospective comparative cohort, 25 patients were evaluated for MALS. Patients with a consensus diagnosis of MALS (n=15) underwent a gastroscopy assisted, transmucosal microcirculatory assessment with LDF and VLS. Results were compared to individuals with normal intestinal circulation (n=38) evaluated with duplex ultrasonography, and to patients with chronic mesenteric ischemia (n=32). Treatment response was evaluated clinically at 1, 3, 6, and 12 months, and with ultrasound, VLS and LDF at three months. Health-related quality of life (QoL) was assessed with Euroqol (EQ-5D-5L), preoperatively, and 12 months postoperatively. Results: Preoperative mean transmucosal oxygen saturation was significantly lower in patients with MALS (SO2 76±6), as compared to healthy individuals (SO2 81±4), p=0.02. An overall significant improvement in SO2 after surgical decompression of the celiac artery was found (SO2 81±3.7, p=0.05). Eleven (92%) patients with clinical improvement after laparoscopic decompression had a definitive diagnosis of MALS. Median follow-up was 18 months (4-24 months). Four of the five dimensions investigated with EQ-5D-5L improved. Conclusion: VLS detected a significantly lower baseline transmucosal SO2 in patients with MALS as compared to control subjects with normal intestinal circulation. An improvement in SO2 after laparoscopic decompression was found, supporting a possible ischemic etiology in our patient population.


Assuntos
Artéria Celíaca/fisiopatologia , Duodeno/irrigação sanguínea , Gastroscopia , Fluxometria por Laser-Doppler , Síndrome do Ligamento Arqueado Mediano/diagnóstico , Microcirculação , Circulação Esplâncnica , Estômago/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Velocidade do Fluxo Sanguíneo , Estudos de Casos e Controles , Descompressão Cirúrgica , Feminino , Humanos , Laparoscopia , Masculino , Síndrome do Ligamento Arqueado Mediano/fisiopatologia , Síndrome do Ligamento Arqueado Mediano/cirurgia , Isquemia Mesentérica/diagnóstico , Isquemia Mesentérica/fisiopatologia , Oclusão Vascular Mesentérica/diagnóstico , Oclusão Vascular Mesentérica/fisiopatologia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Qualidade de Vida , Recuperação de Função Fisiológica , Análise Espectral , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
10.
Middle East Afr J Ophthalmol ; 27(2): 142-144, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874051

RESUMO

A cerebrospinal fluid (CSF) leak is a rare complication after orbital surgery. We reported a 49-year-old man who presented with CSF leakage after transcaruncular medial wall decompression for proptosis due to thyroid eye disease. He underwent an endoscopic endonasal approach to surgical repair of the defect with nasoseptal flap. Rhinorrhea was stopped immediately after endoscopic repair.


Assuntos
Descompressão Cirúrgica/efeitos adversos , Oftalmopatia de Graves/cirurgia , Pneumocefalia/etiologia , Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Vazamento de Líquido Cefalorraquidiano/etiologia , Vazamento de Líquido Cefalorraquidiano/cirurgia , Endoscopia , Exoftalmia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/cirurgia , Estudos Retrospectivos , Retalhos Cirúrgicos , Tomografia Computadorizada por Raios X
11.
Ann Surg ; 272(5): 738-743, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32833768

RESUMO

OBJECTIVE: The purpose of this population-based study was to compare decompressing stoma (DS) as bridge to surgery (BTS) with emergency resection (ER) for left-sided obstructive colon cancer (LSOCC) using propensity-score matching. SUMMARY BACKGROUND DATA: Recently, an increased use of DS as BTS for LSOCC has been observed in the Netherlands. Unfortunately, good quality comparative analyses with ER are scarce. METHODS: Patients diagnosed with nonlocally advanced LSOCC between 2009 and 2016 in 75 Dutch hospitals, who underwent DS or ER in the curative setting, were propensity-score matched in a 1:2 ratio. The primary outcome measure was 90-day mortality, and main secondary outcomes were 3-year overall survival and permanent stoma rate. RESULTS: Of 2048 eligible patients, 236 patients who underwent DS were matched with 472 patients undergoing ER. After DS, more laparoscopic resections were performed (56.8% vs 9.2%, P < 0.001) and more primary anastomoses were constructed (88.5% vs 40.7%, P < 0.001). DS resulted in significantly lower 90-day mortality compared to ER (1.7% vs 7.2%, P = 0.006), and this effect could be mainly attributed to the subgroup of patients over 70 years (3.5% vs 13.7%, P = 0.027). Patients treated with DS as BTS had better 3-year overall survival (79.4% vs 73.3%, hazard ratio 0.36, 95% confidence interval 0.20-0.65) and fewer permanent stomas (23.4% vs 42.4%, P < 0.001). CONCLUSIONS: In this nationwide propensity-score matched study, DS as a BTS for LSOCC was associated with lower 90-day mortality and better 3-year overall survival compared to ER, especially in patients over 70 years of age.


Assuntos
Neoplasias do Colo/cirurgia , Colostomia , Obstrução Intestinal/cirurgia , Idoso , Neoplasias do Colo/mortalidade , Descompressão Cirúrgica , Procedimentos Cirúrgicos Eletivos , Emergências , Feminino , Humanos , Obstrução Intestinal/mortalidade , Masculino , Países Baixos , Complicações Pós-Operatórias/mortalidade , Pontuação de Propensão , Sistema de Registros , Estudos Retrospectivos , Taxa de Sobrevida
12.
Orv Hetil ; 161(31): 1302-1306, 2020 08.
Artigo em Húngaro | MEDLINE | ID: mdl-32750016

RESUMO

Our objective is to propose a novel surgical technique, the microscope-assisted odontoid resection via submandibular retropharyngeal "key-hole" approach. The patient suffered a traumatic cervical spine injury due to a motorcycle accident. We removed the upper two-thirds of the CII vertebra's odontoid process along with the cortical fragment causing the medullar compression. With this surgical technique the velopharyngeal insufficiency, occurring at the traditional transoral surgery, is avoidable while the access to the odontoid process is insured. The MRI confirmed ventral injury to the meninges, which increases the risk of wound healing complications and sepsis so along with the high risk of velopharyngeal insufficiency occurring at the transoral surgery, stood in favour of the new method. During the submandibular "key-hole" technique besides the use of tissue-glue, tamponing the meninges damage with multiple layers of viable soft tissue could be performed. The postoperative CT and MR imaging confirmed the complete decompression of the medulla oblongata. The patient's tetraplegic state entirely regressed, and eight months after the surgery he became self-sufficient. From now on, the surgical method we used could be a considerable alternative to the classic transoral transpharyngeal or endoscopic endonasal odontoid resection. Orv Hetil. 2020; 161(31): 1302-1306.


Assuntos
Descompressão Cirúrgica/métodos , Endoscopia/métodos , Processo Odontoide/cirurgia , Compressão da Medula Espinal/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Processo Odontoide/diagnóstico por imagem , Período Pós-Operatório , Compressão da Medula Espinal/diagnóstico por imagem , Resultado do Tratamento
13.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(8): 1005-1011, 2020 Aug 15.
Artigo em Chinês | MEDLINE | ID: mdl-32794670

RESUMO

Objective: To study the effectivenss of lower extremity Dellon triple nerve decompression in the treatment of early-stage diabetic Charcot foot. Methods: The clinical data of 24 patients with Eichenholtz stage 0-1 diabetic Charcot foot who were admitted between September 2017 and February 2019 were retrospectively analyzed. Among them, 14 cases were treated with lower extremity Dellon triple nerve decompression (treatment group), and 10 cases were treated with conservative treatment such as immobilization the affected limbs and nutritional nerve drugs (control group). There was no significant difference between the two groups ( P>0.05) in gender, age, diabetes duration, diabetic foot duration, Eichenholtz stage, and the blood glucose level, bone mineral density (T value), nerve conduction velocity, and two-point discrimination before treatment. Before treatment and at 6 months after treatment, bone mineral density (T value) was measured by dual energy X-ray absorptiometry to evaluate the improvement of osteoporosis. The electromyogram of the lower limbs was used to detect the conduction velocity of the common peroneal nerve, deep peroneal nerve, and tibial nerve, and to evaluate the recovery of nerve function. The two-point discrimination in plantar region was used to evaluate the recovery of skin sensation. Results: Both groups were followed up 6-12 months, with an average of 6.5 months. In the treatment group, 3 patients showed numbness around the incisions, all recovered after 12 months, without affecting the prognosis; all the incisions healed by first intention, and there was no complication such as incision infection, nonunion, or vascular and nerve injury. At 6 months after treatment, there was no significant difference in nerve conduction velocity, bone mineral density (T value), and two-point discrimination when compared with the values before treatment ( P>0.05) in the control group; but the above indicators in the treatment group were significantly improved when compared with preoperative ones, and were all significantly better than those in control group ( P<0.05). Conclusion: Lower extremity Dellon triple nerve decompression can improve the symptoms of Eichenholtz stage 0-1 diabetes Charcot foot, and has the advantages of less trauma, faster recovery, and fewer complications.


Assuntos
Diabetes Mellitus , Pé Diabético/cirurgia , Neuropatias Diabéticas/cirurgia , Descompressão Cirúrgica , Humanos , Extremidade Inferior , Estudos Retrospectivos
14.
Lancet Neurol ; 19(9): 784-796, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32822636

RESUMO

Trigeminal neuralgia is a very painful neurological condition with severe, stimulus-evoked, short-lasting stabbing pain attacks in the face. The past decade has offered new insights into trigeminal neuralgia symptomatology, pathophysiology, and treatment, leading to a change in the classification of the condition. An accurate diagnosis is crucial because neuroimaging interpretation and clinical management differ among the various forms of facial pain. MRI using specific sequences should be a part of the diagnostic workup to detect a possible neurovascular contact and exclude secondary causes. Demonstration of a neurovascular contact should not be used to confirm a diagnosis but rather to facilitate surgical decision making. Carbamazepine and oxcarbazepine are drugs of first choice for long-term treatment, whereas microvascular decompression is the first-line surgery in medically refractory patients. Advances in neuroimaging techniques and animal models will provide further insight into the causes of trigeminal neuralgia and its pathophysiology. Development of more efficacious treatment options is highly warranted.


Assuntos
Gerenciamento Clínico , Neuralgia do Trigêmeo/diagnóstico por imagem , Neuralgia do Trigêmeo/fisiopatologia , Animais , Anticonvulsivantes/farmacologia , Anticonvulsivantes/uso terapêutico , Carbamazepina/farmacologia , Carbamazepina/uso terapêutico , Descompressão Cirúrgica/métodos , Humanos , Neuroimagem/métodos , Oxcarbazepina/farmacologia , Oxcarbazepina/uso terapêutico , Medição da Dor/efeitos dos fármacos , Medição da Dor/métodos , Neuralgia do Trigêmeo/classificação , Neuralgia do Trigêmeo/terapia
15.
Zhonghua Yi Xue Za Zhi ; 100(31): 2435-2440, 2020 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-32819059

RESUMO

Objective: To compare clinical outcomes of microsurgical bilateral decompression via unilateral approach (MBDU) between trans longissimus and iliocostalis approach, a novel lateral paraspinal approach(LPA), and classic Wiltseapproach for single level degenerative lumbar stenosis. Methods: LPA approach was researched by imaging measurement and cadaver anatomy. Retrospective analysis of a total 124 cases(male/female 75/49, aged(55±14) years) received single-level MBDU due to degenerative lumbar stenosis from 2016 to 2018 in Beijing Tiantan Hospital. Patients were categorized into two groups according to spinal canal morphology. Group A: trefoil shape (n=48), received MBDU via LPA; Group B: round & oval shape (n=76), received MBDU via Wiltse approach. Clinical parameters, including visual analogue scale (VAS) of pain, OswestryDability Index (ODI), satisfaction rate were assessed before the operation and at the latest follow-up. The internal fixation and intervertebral fusion were evaluated by X-ray and CT.The data were compared with single sample t test between the two groups. Results: The feasibility of trans longissimus and iliocostalis approach was proved by imaging measurement and anatomic study. The tube's maximum tilt angle in LPA group was 65°, and it was 40°in Wiltse group. There was no significantly difference in the operating time, bleeding and drainage volume between the two groups((120±27) min vs (115±32) min, (104±31) ml vs (110±41) ml, (50±15) ml vs (47±18) ml, respectively, t=1.246,-1.917,1.730,all P>0.05). In both groups, VAS and ODI scores significantly improved at the latest follow-up when compared with those before the operation (all P<0.05), but those were all comparable between the two groups(all P>0.05). The excellent rate of subjective satisfaction for the clinical efficacy in group A and B was 89.6%(43/48) and 86.8%(66/76) respectively (χ(2)=0.208,P>0.05). Conclusions: LPA approachfor microsurgical bilateral decompression via unilateral approach (MBDU) in degenerative lumbar stenosis is safe and effective, it has advantages in direct vison of contralateral nerve root canal decompression for trefoil shaped spinal canal.


Assuntos
Fusão Vertebral , Estenose Espinal/cirurgia , Adulto , Idoso , Constrição Patológica , Descompressão Cirúrgica , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
16.
Orthopade ; 49(9): 751-761, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32857166

RESUMO

BACKGROUND: Carpal tunnel syndrome, a compressive neuropathy of the median nerve at the wrist and cubital tunnel syndrome, a compressive neuropathy of the ulnar nerve at the elbow, are the two most common peripheral nerve compression syndromes. Chronic compressive neuropathy of peripheral nerves causes pain, paraesthesia and paresis. Treatment strategies include conservative options, but only surgical decompression can resolve the mechanical entrapment of the nerve with proven good clinical results. However, revision rates for persistent or recurrent carpal tunnel syndrome is estimated at around 5% and for refractory cubital tunnel syndrome at around 19%. Common causes for failure include incomplete release of the entrapment and postoperative perineural scarring. THERAPY: Precise diagnostic work-up is obligatory before revision surgery. The strategy of revision surgery is first complete decompression of the affected nerve and then providing a healthy, vascularized perineural environment to allow nerve gliding and nerve healing and to avoid recurrent scarring. Various surgical options may be considered in revision surgery, including neurolysis, nerve wrapping and nerve repair. In addition, flaps may provide a well vascularized nerve coverage in the case of recurrent carpal tunnel syndrome. In the case of recurrent cubital tunnel syndrome, anterior transposition of the ulnar nerve is mostly performed for this purpose. RESULTS: In general, revision surgery leads to improvement of symptoms, although the outcome of revision surgery is less favourable than after primary surgery and complete resolution of symptoms is unlikely.


Assuntos
Síndrome do Túnel Ulnar , Reoperação , Síndrome do Túnel Ulnar/cirurgia , Descompressão Cirúrgica , Humanos , Procedimentos Neurocirúrgicos , Nervo Ulnar
17.
Plast Reconstr Surg ; 146(2): 381-388, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740591

RESUMO

BACKGROUND: Patients undergoing trigger-site deactivation surgery for headaches report a high prevalence (approximately 37 percent) of prior head or neck injury. Traditional medical treatment often fails to treat these posttraumatic patients. It is unclear whether surgery mirrors these poor outcomes. This study aims to describe the characteristics of posttraumatic headache surgery patients and compare their postoperative results to those of patients without a history of head or neck injury. METHODS: One hundred forty-two patients undergoing trigger-site deactivation surgery were prospectively enrolled. Patients were requested to complete a preoperative questionnaire on headache history, including the Migraine Headache Index and information on prior head or neck injury. Follow-up surveys were requested at approximately 12 months postoperatively. RESULTS: Seventy patients (49 percent) reported a history of head or neck injury, and 41 (29 percent) classified the injury as the precipitating event leading to their headache onset. Patients with a precipitating event were significantly less likely to report a family history of migraine. There was no significant difference in mean preoperative Migraine Headache Index between cohorts. At 12 months postoperatively, there was no significant difference in Migraine Headache Index reduction between groups. The proportion of patients who experienced at least a 50 and 80 percent improvement in Migraine Headache Index per group, respectively, was 83 and 67 percent (atraumatic), 76 and 68 percent (posttraumatic), and 71 and 63 percent (precipitating event). CONCLUSIONS: This study suggests that surgical outcomes in posttraumatic headache patients are comparable to those without injury. Trigger-site deactivation surgery candidates with a history of injury can therefore expect similar outcomes as reported for patients overall. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Traumatismos Craniocerebrais/complicações , Descompressão Cirúrgica/estatística & dados numéricos , Transtornos de Enxaqueca/cirurgia , Lesões do Pescoço/complicações , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/etiologia , Medição da Dor/estatística & dados numéricos , Resultado do Tratamento
18.
Plast Reconstr Surg ; 146(2): 187e-195e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740592

RESUMO

BACKGROUND: Recent clinical experience with migraine surgery has demonstrated both the safety and the efficacy of operative decompression of the peripheral nerves in the face, head, and neck for the alleviation of migraine symptoms. Because of the perceived novelty of these procedures, and the paranoia surrounding a theoretical loss of clinical territory, neurologists have condemned the field of migraine surgery. The Patient Safety Subcommittee of the American Society of Plastic Surgeons ventured to investigate the published safety track record of migraine surgery in the existing body of literature. METHODS: A comprehensive review of the relevant published literature was performed. The relevant databases and literature libraries were reviewed from the date of their inception through early 2018. These articles were reviewed and their findings analyzed. RESULTS: Thirty-nine published articles were found that demonstrated a substantial, extensively replicated body of data that demonstrate a significant reduction in migraine headache symptoms and frequency (even complete elimination of headache pain) following trigger-site surgery. CONCLUSIONS: Migraine surgery is a valid method of treatment for migraine sufferers when performed by experienced plastic surgeons following a methodical protocol. These operations are associated with a high level of safety. The safety and efficacy of migraine surgery should be recognized by plastic surgeons, insurance companies, and the neurology societies.


Assuntos
Descompressão Cirúrgica/métodos , Transtornos de Enxaqueca/cirurgia , Procedimentos Neurocirúrgicos/métodos , Nervos Periféricos/fisiopatologia , Descompressão Cirúrgica/efeitos adversos , Humanos , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/fisiopatologia , Procedimentos Neurocirúrgicos/efeitos adversos , Medição da Dor , Resultado do Tratamento
19.
Georgian Med News ; (303): 21-27, 2020 Jun.
Artigo em Russo | MEDLINE | ID: mdl-32841175

RESUMO

The aim of the study was to analyze the results of treatment with biportal endoscopic decompression of patients with spinal stenosis. The treatment results of 62 patients who underwent surgery (for discectomy) (for decompression) in the period from March 2018 to June 2019 were analyzed. All 62 patients were operated by biportal endoscopy at the spine surgery clinic of the State Institution "Institute of Traumatology and Orthopedics of the National Academy of Medical Sciences of Ukraine". Pain intensity was assessed using a visual analogue pain scale (VAS), patient satisfaction and quality of life was assessed using a modified MacNab scale and the Oswestry Disability Index (ODI), respectively, 1 week, 3 months and 6 months after surgery. Perioperative data were also evaluated (duration of surgery and length of stay in the hospital, blood loss and complications). X-ray results were evaluated using pre- and postoperative MRI (6-8 weeks after surgery). According to the results of studies in the postoperative period, a positive trend was observed. So, the indicator of back pain according to VAS after surgery decreased to 0,9±1,4 points, and the indicator of pain in the leg according to VAS on average in the postoperative phase was 1,28±1,1 points, respectively. Assessing perioperative data, in the group of patients the level of blood loss was 34,8±16,2, and the length of stay in the hospital was 2,9±1,3 days. Among the complications, 4 cases of point wound of the dural membrane and 1 case of linear wound of the dural membrane, more than 1 cm long with the contents of the dural sac entering the epidural space, which required conversion to an open operation with suturing the defect, were noted. Biportal endoscopic spinal surgery is an effective method of treating lumbar spinal stenosis, which has several advantages over open surgery (less tissue trauma, less blood loss, high patient satisfaction with the treatment result). UBE has an advantage over microscopic technique in terms of achieving complete decompression in an enlarged arthroscopic field without restricting the movement of the instrument due to the use of an independent portal, and continuous irrigation with saline during surgery is a great advantage to prevent infection.


Assuntos
Estenose Espinal/cirurgia , Descompressão Cirúrgica , Endoscopia , Humanos , Vértebras Lombares , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento , Ucrânia
20.
Mymensingh Med J ; 29(3): 560-567, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32844794

RESUMO

Variety of conditions may be responsible for low back pain but lumber spinal canal stenosis is an important cause of low back pain. Lumber spinal canal stenosis usually presents with low backache with neurogenic claudication and shortness of walking distance in adult patient. Surgical management of lumbar spinal canal stenosis by decompression surgery is effective method. This prospective interventional study was performed in patient with clinical features like low back pain with radicular pain, neurogenic claudication, signs of root compression, positive MRI findings attending in department of Orthopaedic Surgery Mymensingh Medical College Hospital and Private Hospital from July 2016 to June 2019. Thirty patients were evaluated among those 20(66.6%) were 50 years and above. The mean age was 47.5±1.6 years. Male to female ratio was roughly 8:1. Almost all of the patients had low backache with radiation to the back of the thigh and leg with motor weakness (60%). About 66.6% of the patients had sensory deficit and 83.3% had neurogenic claudication. Majority (80.0%) of the patients at presentation had a suffering of 12 or >12 months. The mean duration of suffering was 14.7±5.1 months. About 55% of the patients were able to perform heel-walking and 36.0% tip-toe walking. Nearly 57% of the patients had sensory deficit along the distribution of 1st sacral nerve and 53.3% along the distribution of lumber 5 nerves. Diagnosis shows that 16.6% of patients had L4 lesion, 50% L5, 10.0% patients had L4 & L5 and 46.6% S1. Laminectomy was done in 26.6% of patients, laminectomy and disectomy in 33.3% and laminectomy, discectomy & foraminal decompression in 40.0% of patients. Twenty five (83.5%) of patients was free from symptoms. Eighty percent (80.0%) of patients shows minimal disability and 20.0% moderate disability on the basis of Oswestry Disability Index, while by MacNab criteria, most (80%) of patients was excellent, 10% good and another 10% fair. Repeated measure ANOVA statistics showed that mean Oswestry score decreased significantly from 54.5% at baseline to 22% at the end of 1 year (p<0.001).


Assuntos
Laminectomia , Estenose Espinal/cirurgia , Adulto , Constrição Patológica , Descompressão Cirúrgica , Feminino , Humanos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Canal Vertebral/cirurgia , Resultado do Tratamento
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