Articles: microvascular-decompression-surgery.
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Current surgical treatments for refractory trigeminal neuralgia (TN) include microvascular decompression (MVD), percutaneous rhizotomy, and stereotactic radiosurgery (SRS). We aimed to map the trends of utilization of these procedures in the USA and examine factors associated with morbidities and discharge outcome. We performed a retrospective cohort study with time trends of patients admitted to US hospitals for TN between 1988 and 2008 who received MVD, percutaneous rhizotomy, or SRS as reported in the Nationwide Inpatient Sample. ⋯ For SRS, patient age and length of stay were found to be important by multivariate analysis on discharge. Mortality rates for MVD (0.22%), rhizotomy (0.42%), and SRS (0.12%) were low. The clinical practices for surgical treatment of TN have evolved over time with the rise of MVD and dwindling of rhizotomy procedures.
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Journal of neurosurgery · Oct 2013
Importance of awareness of the rhomboid lip in microvascular decompression surgery for hemifacial spasm.
The authors adopted the infrafloccular approach for microvascular decompression (MVD) surgery to treat hemifacial spasm (HFS). The inferior portion of the flocculus is retracted to observe the root exit zone of cranial nerve (CN) VII between CN IX and the flocculus. During the procedure, the rhomboid lip, a sheetlike layer of neural tissue forming the lateral recess of the fourth ventricle, is sometimes encountered. The existence of the rhomboid lip in cases of HFS was reviewed to determine the importance of the structure during MVD surgery. ⋯ A large rhomboid lip presents an impediment to MVD surgery in a significant minority of patients with HFS. It is seldom observed on preoperative MR images. Proper dissection of the rhomboid lip away from the arachnoid membrane and/or the lower CNs during MVD surgery provides good visualization of the root exit zone of CN VII and reduces injury of CNs IX and X, avoiding postoperative deficits like dysphagia.
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Neurosurgical review · Oct 2013
Microvascular decompression for hemifacial spasm: focus on late reoperation.
The objective of this study is to investigate late repeat microvascular decompression (MVD) with persistent or recurrent hemifacial spasm (HFS) and to compare the clinical characteristics, intraoperative findings, complications, and outcomes with first MVD. We analyzed MVDs performed at the University of Pittsburgh Medical Center between January 1, 2000 and December 31, 2007. Thirty-three patients who underwent late redo MVDs were classified as group I and 243 patients who underwent their first MVD as group II. ⋯ Intraoperative monitoring with lateral spread response (LSR) is an effective tool to evaluate adequate decompression. In patients with persistent LSR at the end of the procedure, facial nerve compression from a vein should be examined. We believe that it is important to undergo a repeat MVD for failed HFS relief irrespective of the timing of the operation.
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Journal of anesthesia · Oct 2013
Is microvascular decompression surgery a high risk for postoperative nausea and vomiting in patients undergoing craniotomy?
Patients undergoing microvascular decompression surgery often experience postoperative nausea and vomiting (PONV). However, there is little information about the incidence of PONV after microvascular decompression. We hypothesized that microvascular decompression is an especially high-risk procedure for PONV in patients undergoing neurosurgery, and investigated risk factors related to PONV after neurosurgery. ⋯ In this retrospective study, microvascular decompression surgery was an especially high-risk factor for PONV in patients undergoing craniotomy. It may be necessary to adopt a combination of prophylactic methods to reduce the incidence of PONV after microvascular decompression.
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Pathophysiological mechanisms underlying spinal cord injury (SCI) partially involve edema and formation of a hematoma. Myelotomy seems to be a promising intervention. However, the appropriate timing of myelotomy is still unknown in SCI. Here we aimed to determine the timing of microsurgical myelotomy in an animal model of SCI. ⋯ Myelotomy up to 48 h after SCI improves recovery in rats. The potential time window of myelotomy may be between 8 and 24 h after SCI.