Hydrocephalus: an underrated long-term complication of microvascular decompression for trigeminal neuralgia. A single institute experience.

BACKGROUND: Hydrocephalus is a common complication of posterior fossa surgery, but its real incidence after microvascular decompression (MVD) for idiopathic trigeminal neuralgia (TN) still remains unclear. The aim of this study was to focus on the potential association between MVD and hydrocephalus as a surgery-related complication. METHODS: All patients who underwent MVD procedure for idiopathic TN at our institute between 2009 and 2014 were reviewed to search for early or late postoperative hydrocephalus. RESULTS: There were 259 consecutive patients affected by idiopathic TN who underwent MVD procedure at our institution between 2009 and 2014 (113 men, 146 women; mean age 59 years, range 30-87 years; mean follow-up 40.92 months, range 8-48 months). Nine patients (3.47 %) developed communicating hydrocephalus after hospital discharge and underwent standard ventriculo-peritoneal shunt. No cases of acute hydrocephalus were noticed. CONCLUSIONS: Our study suggests that late communicating hydrocephalus may be an underrated potential long-term complication of MVD surgery.

A modified visual analogue scale for the assessment of chronic pain.

The present common evaluation of pain is scored through the use of visual analogue scale (VAS) to assess the intensity of pain and, sometimes, an additional table in which the frequency of pain attacks during the day is reported. We propose a modified 2D-VAS to assess both the intensity and the frequency (expressed by the percentage of the time in which pain is experienced during the day). Thus with only one scale and graphic representation, we can have a clear picture of the patient's condition before and during any treatment to relieve his pain.

The guidelines for the diagnosis and treatment of spasticity.

Spasticity is a predominant clinical sign appearing in different neurological diseases. It is always flanked by various degrees of muscle weakness. The clinical evaluation of a spastic patient is score according to varius internationally approved evaluation scales (Ashworth scale, muscle spasms scale, and FIM disability scale). The treatment of spasticity is mostly a symptomatic treatment aimed to relief muscle hypertonus thus increasing both motor performance and improving nursing. Many molecules are frequently being used orally with poor results or with the onset of undesired side effects. In fact oral baclofen, diazepam and tizanidine often have poor effect on spasticity and bring frequently to the appearance of undesired side effects caused by the concentration of these molecule at the brain level. Intrathecal baclofen is a good option to treat diffuse spasticity through the infusion of baclofen into the spinal CSF space. When baclofen is administered intrathecally at the spinal level it distributes with a concentration-gradient between caudal and rostral level of the spine that was calculated as 4:1 thus avoiding its concentration at the brain level when given at a therapeutical dosage. This fact avoids any undesired side effect due to the action of baclofen at the brain level. Botulinum toxin as well as peripheral neurotomies are very helpful in those cases in whom spasticity is mainly restricted to few muscular groups. A correct flow-chart to diagnose and treat the patient is mandatory to achieve the best results for each patient according to his spasticity and residual motor ability.

Upper eyelid gold weight implants in patients with facial nerve palsy. Surgical technique.

Facial nerve injuries produce lagophthalmos and consequent ocular disease caused by corneal exposure. The management of the affected eye in patients with facial palsy has been improved. Previously ointment, eye drops, taping, partial or complete tarsorrhaphy was the primary treatment of the inability to close the eyelid. Other mechanical techniques for reanimating lid closure, including palpebral springs, encircling the upper and lower eyelids with silicone or fascia lata, and temporalis muscle transfer. The most popular and widely used static procedure in facial nerve palsy is the upper eyelid gold weight implant. This procedure is the goal of the treatment for the restoration of function and cosmesis to the paralyzed eyelids. The surgical technique used for lid load insertion are described below.