Acta neurochirurgica
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Acta neurochirurgica · Jan 1993
Long-term results after percutaneous retrogasserian glycerol rhizotomy in patients with trigeminal neuralgia.
We have evaluated the long-term results of percutaneous retrogasserian glycerol rhizotomy (PRGR) in 60 patients with classical trigeminal neuralgia. Complete initial pain relief was achieved in 93% of the patients. Numbness was initially reported by 3/4 of the patients and at follow-up by 1/3, while long-lasting dysaesthesias were an important side effect in 38% of previously untreated patients. ⋯ We are unable to identify predictors of recurrent neuralgia after PRGR, although major recurrences were more common in patients with unchanged facial sensation postoperatively. In conclusion, PRGR offers safe and reliable relief of pain in patients with trigeminal neuralgia. In spite of the high incidence of recurrence and of long-lasting dysaesthesias it is, in our opinion, the method of choice in the elderly, and particularly suitable for patients at high risk.
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Acta neurochirurgica · Jan 1993
Somatosensory evoked potentials and intracranial pressure during chronic dilatation of an artificial extraparenchymal space-occupying lesion in cats.
Somatosensory evoked potentials (SEP) and intracranial pressure (ICP) were studied in cats, suffering from a chronic space-occupying lesion produced by enlargement of an epidural balloon over the left sensomotory cortex. Our study shows that latency alterations of SEP are not dependent on the degree of ICP. ⋯ Regarding the clinical importance of SEP measurements, we concluded that they are not suitable for estimating the degree of ICP. However, they are useful to evaluate tissue damage caused by mass effects in the acute and chronic phase of various space-occupying processes.
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Acta neurochirurgica · Jan 1993
Ultrasonic DREZ-operations for treatment of pain due to brachial plexus avulsion.
One, if not the only effective way of treating pain due to preganglionic avulsion of the brachial plexus is the Dorsal Root Entry Zone (DREZ) lesion procedure. In 1985 the author began to use ultrasound as a lesion-maker for operations in the DREZ. Since then, 127 (3 patients were operated on twice) DREZ-Operations have been carried out on 124 patients suffering from chronic pain due to brachial plexus avulsion. ⋯ Analysis of the results after ultrasonic DREZ-operations revealed that ultrasonic DREZ-sulcomyelotomy was the most effective technical modality. Immediately after operation good pain relief was obtained in 103 (96%) out of the 107 patients operated on with the ultrasonic DREZ-sulcomyelotomy method, and in 15 (75%) out of the 20 patients with ultrasonic discontinuous DREZ-lesions. The total follow-up study (47.5 months on average) revealed 87% good results overall.
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In this article the technique of CT-Guided Selective Cordotomy is described. The advantages of CT guidance in percutaneous cordotomy are the measurement of spinal cord diameters at the lesion site for each individual patient, direct visualization of target electrode relations, demonstration of spinal cord displacement during the procedure and localization of the electrode system in a specific part of the spinothalamic tract. ⋯ In 33 of the 54 cases, the cordotomy was selective enough to be successful with a local denervation of the area where the pain was dominant. Except for one temporary hemiparesis and one temporary ataxia, no complications or side effects were observed.
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In 40 patients with chronic thoracic spinal pain of more than 12 months duration which failed to respond to conservative treatment and with a previous evaluation by specialists, mainly neurologists and orthopaedic surgeons, the diagnosis of facet syndrome was made. This diagnosis was based on clinical criteria and a transient positive response to a prognostic blockade of the medial branch of the dorsal ramus of the thoracic spinal nerve. They were selected to undergo percutaneous radiofrequency denervation of the facet joints. ⋯ After a follow-up of 18-54 (average 31) months in 36 cases (3 patients had died because of malignancy, and 1 had undergone a spinal fusion), 16 patients (44%) were pain-free, 14 patients (39%) had more than 50% pain-relief and in 6 cases (17%) the result was poor. Adverse effects consisted of postoperative pain in 5 patients (12.5%). When conservative treatment fails, percutaneous thoracic facet denervation can be a safe and beneficial therapy in chronic thoracic spinal pain originating from the facet joints.