Acta neurochirurgica
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Acta neurochirurgica · Jan 1996
Case ReportsChronic precentral stimulation in trigeminal neuropathic pain.
The results of Deep Brain Stimulation in deafferentation pain syndromes, in particular in thalamic pain, indicate that excellent long-term pain relief can hardly ever be achieved. We report 7 cases using Motor-Cortex-Stimulation for treating severe trigeminal neuropathic pain syndromes, i.e., dysaesthesia, anaesthesia dolorosa and postherpetic neuralgia. The first implantation of the stimulation device for precentral cerebral stimulation was performed in June 1993, the last in September 1995. ⋯ Initially these patients reported a good to excellent pain relief. In three of 6 patients a good to excellent pain control was maintained for a follow-up period of 5 months to 2 years. In the remaining three patients the positive effect decreased over several months.
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Acta neurochirurgica · Jan 1996
Results of DREZ coagulations for pain related to plexus lesions, spinal cord injuries and postherpetic neuralgia.
The results of 58 dorsal root entry zone (DREZ) thermocoagulation procedures in 51 patients are reported. The postoperative analgesic effect was judged by the patients as being good (more than 75% pain reduction), fair (25-75% pain reduction) or poor (less than 25% pain reduction). Of the 14 patients who underwent surgery for pain due to cervical root avulsion, 10 (77%) had permanently good (8) or fair (2) pain relief after a mean follow up period of 76 months, another 2 (15%) experienced recurrence to the preoperative level (initially 1 good, 1 fair) after more than 2 and 4 years, respectively. ⋯ Minor neurological deficits were noted in 9 cases (18%). DREZ lesions revealed to be an effective procedure in patients with pain related to root avulsion and paraplegia. In contrast, it seems to be less successful for painful states due to other plexus lesions or postherpetic neuralgia.
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Acta neurochirurgica · Jan 1996
Electrophysiological investigation of hemifacial spasm: F-waves of the facial muscles.
In patients with hemifacial spasm (HFS), the spasm is due to cross-compression of the facial nerve by a blood vessel. There are currently two hypotheses for the mechanism of HFS: 1) the spasm is caused by ephaptic transmission and an increase in excitability at the site of compression; and 2) the spasm is caused by hyperexcitability in the facial nerve nucleus. In peripheral nerves, F-waves, which result from the backfiring of antidromically activated anterior horn cells, have been proposed as indices of proximal motoneuron conduction and anterior horn cell excitability. ⋯ On the patient's spasm side, the F-wave duration, F/M amplitude ratio and frequency of F-wave appearance significantly increased compared with those of the normal side or healthy controls; minimum latency and chronodispersion did not significantly differ between these groups. In patients whose spasm disappeared completely following MVD, the abnormal muscle response (lateral spread), which is a characteristic sign of HFS, and the enhancement of the F-wave eventually also disappeared. Because of the correlation between HFS and F-waves, the authors' study supports the hypothesis that the cause of HFS is hyperexcitability of the facial motonucleus.
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Acta neurochirurgica · Jan 1996
Significance of intracranial pressure waveform analysis after head injury.
The authors have investigated the relationships between the amplitude of the ICP pulse wave, the mean values of ICP and CPP, and the outcome of 56 head injured ventilated patients. The ICP was monitored continuously using a Camino transducer (35 patients) or subdural catheter (21 patients). The mean Glasgow Coma Score was 6 (range 3-13; 5 patients had a GCS > 8 after resuscitation). ⋯ The RAP was significantly lower in patients who died or remained in the vegetative state. In 7 patients who died from uncontrollable intracranial hypertension RAP was oscillating or decreased to 0 or negative values well before brain-stem herniation. The combination of an ICP above 20 mmHg for a period longer than 6 hours with low correlation between the amplitude and pressure (RAP < 0.5) was described as an predictive index of an unfavourable outcome.
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Acta neurochirurgica · Jan 1996
The variations of Sylvian veins and cisterns in anterior circulation aneurysms. An operative study.
The anatomical variations of Sylvian vein and cistern were investigated during the pterional approach in 230 patients with 276 aneurysms of anterior circulation arteries, that were operated on at the Neurosurgical Department of Atatürk University Medical School. Erzurum, Türkiye. All patients underwent radical surgery for aneurysm by the right or left pterional approach. ⋯ We concluded that venous perfusion disorder of the brain is the most important factor during the pterional approach. Careful intraoperative assessment and protection of the Sylvian vein, which is a surgical pitfall, is an indispensable part of the operation. The recognition of the anatomical variations of the Sylvian vein and cistern, and the detailed knowledge of the microvascular relationships at that level will allow the neurosurgeon to construct a better and safter microdissection plan, to save time and can prevent postoperative neurological deficits.