Neurosurgery
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Blast-related neurotrauma is associated with the severest casualties from Operation Iraqi Freedom (OIF). A consequence of this is cerebral vasospasm. This study evaluated all inpatient neurosurgical consults related to battle injury from OIF. ⋯ Traumatic vasospasm occurred in a substantial number of patients with severe neurotrauma, and clinical outcomes were worse for those with this condition. However, aggressive open surgical and endovascular treatment strategies may have improved outcome. This was the first study to analyze the effects of blast-related injury on the cerebral vasculature.
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To analyze treatment procedures and treatment outcomes of painful missile-caused nerve injuries and factors influencing the outcome. ⋯ The treatment outcome of painful nerve injury depends on several factors, including the type of pain syndrome, severance of nerve injury, and absence of pain paroxysms. Drug therapy (carbamazepine, amitriptyline, or gabapentin) should be recommended, at least as a part of treatment, for patients with reinnervation pain, deafferentation pain, and complex regional pain syndrome Type II. Nerve surgery should be recommended for patients with posttraumatic neuralgia, either as the first treatment choice (acute nerve compression or intraneural foreign particles) or after unsuccessful pharmacological treatment (other causes of neuralgic pain).
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Clinical Trial
Long-term results of microsurgical treatment of lumbar spinal stenosis by unilateral laminotomy for bilateral decompression.
Laminectomy and bilateral laminotomy are the standard procedures for decompression of lumbar spinal stenosis (LSS). With the aim of less invasiveness and better preservation of spinal stability, the technique of unilateral laminotomy for bilateral decompression (ULBD) was developed. However, limited follow-up data exist to determine the efficiency and outcome of ULBD. Therefore, the authors present their 10-year experience with ULBD and postoperative long-term results. ⋯ ULBD allows achievement of good and long-lasting operative results in patients with LSS. Postoperative deterioration, recurrences, and spinal instability are infrequent. For the authors, ULBD is the preferred technique to treat symptomatic LSS.
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Clinical Trial
Temporal lobe surgery for intractable epilepsy in children: an analysis of outcomes in 126 children.
Temporal lobectomy is a well-established neurosurgical procedure for temporal lobe epilepsy. In this study, we conducted a retrospective review of children with drug-resistant temporal lobe epilepsy to evaluate seizure outcome after temporal lobe surgery. ⋯ Temporal lobe resections for epilepsy in children are effective and safe procedures, with a favorable impact on seizure control. Repeat temporal resections for recurrent seizures may also be effective in restoring a seizure-free outcome to children.
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To report on the clinical characteristics of pain and factors influencing pain intensity in patients with missile-caused nerve injuries. ⋯ Pain syndromes after missile-caused nerve injury differ significantly regarding time of pain onset, pain characteristics, and other symptoms and signs. The type of pain syndrome, multiple nerve damage, and early onset of pain are independent predictors of initial pain intensity. Although medical history and physical examination are the main diagnostic keys, nerve exploration preceded by a nerve block and sympathetic block are safe and useful adjuvant diagnostic procedures.