Surg Neurol
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Chronic neuropathic pain after injury to a peripheral nerve is known to be resistant to treatment. Peripheral nerve stimulation is one of the possible treatment options, which is, however, not performed frequently. In recent years we have witnessed a renewed interest for PNS. The aim of the present study was to evaluate the long-term clinical efficacy of PNS in a group of patients with peripheral neuropathic pain treated with PNS since the 1980s. ⋯ In selected patients with peripheral neuropathic pain PNS remains effective even after more than 20 years.
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Endovascular coil treatment is being used increasingly as an alternative to clipping for some ruptured intracranial aneurysms. The relative benefits of these 2 approaches have yet to be fully established. The aim of this study was to compare the clinical outcome, resource consumption, and cost-effectiveness of endovascular treatment vs surgical clipping in a developing country. ⋯ Patients with aneurysmal SAH whom we judged to require coiling had higher charges than patients who could be treated by clipping. The benefits of apparent decrease in length of stay in the endovascular group were offset by higher procedure price and cost of consumables. There was no significant difference in clinical outcome at 6 months. We have proposed a risk scoring system to give guidelines regarding the choice of treatment considering size of aneurysm and resource allocation.
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The authors retrospectively studied the incidence and characteristics of radiologically documented adjacent-segment degeneration after single-level diskectomy and subsequent cervical arthroplasty using the Bryan (Medtronic Sofamor Danek; Memphis, TN) disk prosthesis. ⋯ The rate of adjacent-segment degeneration was higher than that observed in previous studies. Adjacent-segment degeneration documented a tendency toward HO. A longer follow-up period is necessary to investigate and document the different types of degeneration seen at levels adjacent to artificial Bryan cervical disk prostheses.
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Cerebral vasospasm is a widespread and potentially treatable complication after aneurysmal SAH. Aggressive treatment often includes hemodynamic augmentation, although the exact mechanism by which such therapy leads to improved cerebral blood flow and reduced neurologic deficits is incompletely established. This case report is only the second to provide compelling evidence that hypertension can lead to direct dilation of vasospastic arteries, thereby providing valuable insight into its potential mechanism. ⋯ The present case illustrates that extreme hypertension can lead to direct dilation of vasospastic arteries and suggests that hypertensive-type hemodynamic therapy may act not only through increasing the pressure gradient across vasospastic arteries but also via direct induction of arterial vasodilation.
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Lesions ventral and ventrolateral to the neuraxis at the CCJ can pose a significant management problem owing to their strategic location. Conventional direct posterior approaches sometimes may not allow adequate visualization of the entire tumor base without significant manipulation of the brain stem and spinal cord. Here, we describe an approach that allows safe access to a ventrolaterally extending chordoma originating from the second and third cervical vertebrae. ⋯ When a direct posterior approach makes it difficult or impossible to reach tumors extending to the far lateral margins of the spine and soft tissues, the posterior-lateral approach described here allows excellent visualization and safe access with minimal neural retraction for treating these laterally situated lesions. We describe the surgical technique for a combined approach as an alternative to the direct posterior or anterior retropharyngeal approach.