Acta neurochirurgica
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Acta neurochirurgica · Jan 2015
Long-term outcome and prognostic factors after C2 ganglion decompression in 68 consecutive patients with intractable occipital neuralgia.
Occipital neuralgia is a rare cause of severe headache characterized by paroxysmal shooting or stabbing pain in the distribution of the greater occipital or lesser occipital nerve. In cases of intractable occipital neuralgia, a definite cause has not been uncovered, so various types of treatment have been applied. The aim of this study is to evaluate the prognostic factors, safety, and long-term clinical efficacy of second cervical (C2) ganglion decompression for intractable occipital neuralgia. ⋯ In the current study, C2 ganglion decompression provided durable, adequate pain relief with minimal complications in patients suffering from intractable occipital neuralgia. Due to the minimally invasive and nondestructive nature of this surgical procedure, C2 ganglion decompression is recommended as an initial surgical treatment option for intractable occipital neuralgia before attempting occipital nerve stimulation. However, further study is required to manage the pain recurrence associated with longstanding nerve injury.
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Acta neurochirurgica · Jan 2015
Delayed relief of hemifacial spasm after microvascular decompression: can it be avoided?
Although microvascular decompression (MVD) surgery has been widely accepted as an effective treatment for hemifacial spasm (HFS), delayed relief cases have been frequently reported. Therefore, the value of an immediate redo MVD should be discussed. ⋯ Despite being a reasonable remedy for HFS in the hands of an experienced neurosurgeon, sometimes small vessels can be missed while managing the main offending arteries during MVDs, which might account for the delayed relief. Therefore, reexamination of the AMR is necessary for unimproved patients; if a positive result is recorded, an immediate redo MVD is suggested.
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Occipital nerve stimulation is increasingly used in the treatment of primary headache disorders. We describe a surgical technique applying preoperative fluoroscopy and intraoperative tactile orientation designed to reduce radiation exposure and provide reproducible results. ⋯ The use of tactile orientation solely during surgery reduces radiation exposure and decreases the duration of surgery. This technique allows reproducible results of final electrode position.
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Acta neurochirurgica · Jan 2015
Influence of cumulative surgical experience on the outcome of poor-grade patients with ruptured intracranial aneurysm.
The expansion of endovascular techniques for intracranial aneurysms has led to a global decrease in vascular neurosurgery activity. This situation might impact neurosurgeons' level of expertise, even though they all might have to deal with this surgically challenging pathology. In that context, we wanted to assess the impact of cumulative surgical experience on the outcome of patients with poor-grade subarachnoid haemorrhage (SAH) and intracerebral haemorrhage (ICH) treated by microsurgery. ⋯ This study suggests a direct impact of cumulative experience on the course of ruptured aneurysm surgery and pleads for the use of training and simulation programmes dedicated to neurovascular surgery.