Journal of neurosurgery
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Journal of neurosurgery · Mar 2002
Case ReportsBilateral cavernous sinus actinomycosis resulting in painful ophthalmoplegia. Case report.
The authors report the successful treatment of a 42-year-old man who suffered from recurrent painful ophthalmoplegia caused by bilateral cavernous sinus (CS) actinomycosis. A presumptive diagnosis of Tolosa-Hunt syndrome was made when he presented with left painful ophthalmoplegia. ⋯ Actinomycosis may present as a painful ophthalmoplegia with involvement of one or both CSs. Repeated imaging and possibly surgical exploration may be necessary to make a definitive diagnosis.
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Journal of neurosurgery · Mar 2002
Case ReportsLong-term results of expansive laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine: more than 10 years follow up.
The authors report the long-term (more than 10-year) results of cervical laminoplasty for ossification of the posterior longitudinal ligament (OPLL) of the cervical spine as well as the factors affecting long-term postoperative course. ⋯ When the incidence of surgery-related complications and the strong possibility of postoperative growth of OPLL are taken into consideration, the authors recommend expansive and extensive laminoplasty for OPLL.
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Journal of neurosurgery · Mar 2002
Comparative StudyEvaluation of prognostic factors and clinical outcome in elderly patients in whom expansive laminoplasty is performed for cervical myelopathy due to multisegmental spondylotic canal stenosis. A retrospective comparison with younger patients.
It remains unclear whether elderly patients with compressive cervical myelopathy can be expected to experience a promising surgery-related outcome after undergoing expansive laminoplasty. The purposes of this study were to evaluate the efficacy of expansive laminoplasty in elderly patients with cervical myelopathy due to multisegmental spondylotic canal stenosis and to analyze the effect of preoperative prognostic factors on outcome in elderly compared with younger patients. ⋯ Open-door expansive laminoplasty showed a promising effect on clinical outcome in elderly and younger patients with multisegmental cervical canal stenosis. Significant predictive factors for clinical outcome in the elderly patients were the duration of symptoms and the severity of stenosis, which may involve the static factor causing the cervical myelopathy. To improve the elderly patients' disability, surgery must be performed as early as possible before irreversible changes in the spinal cord develop.
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Journal of neurosurgery · Mar 2002
Comparative StudyTotal intravenous anesthesia for intraoperative monitoring of the motor pathways: an integral view combining clinical and experimental data.
Monitoring of descending corticospinal pathways by using motor evoked potentials (MEPs) has proven to be useful in preventing permanent neurological deficits during cranial and spinal procedures. Difficulties in interpretation of intraoperative changes in potentials may largely be attributed to the effects of anesthesia. Development of suitable intravenous anesthesia protocols specifically tailored for MEP monitoring, including plasma level target-controlled infusion (TCI), requires precise knowledge of the specific neurophysiological properties of the various agents. ⋯ Development of standardized total intravenous anesthesia/TCI protocols by using anesthetic agents such as propofol, remifentanil, ketamine, and midazolam, which have favorable pharmacokinetic and neurophysiological properties, will enhance the quality of intraoperative MEPs and promote the use of MEP monitoring as a useful tool to reduce surgery-related morbidity.
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Journal of neurosurgery · Mar 2002
Predictors of outcome in surgically managed patients with typical and atypical trigeminal neuralgia: comparison of results following microvascular decompression.
Microvascular decompression (MVD) has become one of the primary treatments for typical trigeminal neuralgia (TN). Not all patients with facial pain, however, suffer from the typical form of this disease; many patients who present for surgical intervention actually have atypical TN. The authors compare the results of MVD performed for typical and atypical TN at their institution. ⋯ In this study, MVD for typical TN resulted in complete postoperative pain relief in 80% of patients, compared with 47% with complete relief in those with atypical TN. Significant pain relief was achieved after 97% of MVDs in patients with typical TN and after 87% of these procedures for atypical TN. When patients were followed for more than 5 years, the long-term pain relief after MVD for those with typical TN was excellent in 73% and good in an additional 7%, for an overall significant pain relief in 80% of patients. In contrast, following MVD for atypical TN, the long-term results were excellent in only 35% of cases and good in an additional 16%, for overall significant pain relief in only 51%. Memorable onset and trigger points were predictive of better postoperative pain relief in both atypical and typical TN. Preoperative sensory loss was a negative predictor for good long-term results following MVD for atypical TN.