Journal of neurosurgery
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Journal of neurosurgery · Feb 1991
Dorsal root ganglionectomy for failed back surgery syndrome: a 5-year follow-up study.
Dorsal root ganglionectomy has been suggested as a method for the treatment of chronic intractable radicular pain, with theoretical advantages over dorsal rhizotomy, which does not interrupt ventral root afferents. The indications for these procedures in patients with persistent pain following lumbosacral spine surgery are not well established. Long-term results have been reported infrequently, and no published series has a mean follow-up period of more than 30 months. ⋯ Loss of sensory and motor function was reported frequently by patients. A minority of patients had reduced or eliminated analgesic intake. These results suggest that dorsal root ganglionectomy has a limited role in the management of failed back surgery syndrome, and that methods to select patients to receive this procedure should be refined or alternative approaches should be considered.
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Journal of neurosurgery · Feb 1991
Use of MR imaging-compatible Halifax interlaminar clamps for posterior cervical fusion.
Twenty-one patients requiring posterior cervical fusion were treated with magnetic resonance (MR) imaging-compatible Halifax interlaminar clamps for internal fixation. Various levels were involved: the C1-2 level in eight cases, the C4-5 level in four, the C5-6 level in three, the C6-7 level in three, the C4-6 level in two, and the C5-7 level in one. Bilateral clamps were used in 18 cases and unilateral clamps in three. ⋯ Follow-up diagnostic studies revealed rigid fixation and fusion in all cases. The MR imaging-compatibility of the clamps allowed excellent follow-up studies with minimal artifact. Because of their ease of use, rigid stabilization, good results, lack of complications, and compatibility with MR imaging, the Halifax interlaminar clamp with bone grafting provides an ideal method for posterior cervical stabilization.
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Journal of neurosurgery · Feb 1991
Case ReportsTreatment of intractable arterial hemorrhage during stereotactic brain biopsy with thrombin. Report of three patients.
Of 165 consecutive patients undergoing computerized tomography- or magnetic resonance imaging-guided stereotactic brain biopsies at the Cleveland Clinic between June, 1987, and November, 1989, four patients (2.4%) developed arterial hemorrhage refractory to conventional efforts to secure hemostasis. Craniotomy was performed in one of these patients to control the hemorrhage; in the other three, 0.5 to 2 cc of thrombin (5000 U/cc) was slowly injected via the biopsy cannula, resulting in immediate control of bleeding in all three cases. Postoperatively, the first two patients treated with 1 to 2 cc of thrombin were slow to awaken; one had evidence of vasospasm by transcranial Doppler ultrasound studies and multiple infarcts on cranial computerized tomography, while the other had a moderate-sized frontal hematoma with intracranial hypertension. ⋯ The third patient, treated with 0.5 cc of thrombin, had an uneventful postoperative course. Thrombin is highly effective for stopping intractable arterial hemorrhage during stereotactic brain biopsy; however, it is a vasospastic agent and may have been responsible for the cerebral infarctions in one patient. Therefore, thrombin should be used only as a last resort, short of craniotomy, to control intractable arterial hemorrhage during stereotactic brain biopsy.
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Journal of neurosurgery · Feb 1991
Acute subdural hematoma: morbidity, mortality, and operative timing.
Traumatic acute subdural hematoma remains one of the most lethal of all head injuries. Since 1981, it has been strongly held that the critical factor in overall outcome from acute subdural hematoma is timing of operative intervention for clot removal; those operated on within 4 hours of injury may have mortality rates as low as 30% with functional survival rates as high as 65%. Data were reviewed for 1150 severely head-injured patients (Glasgow Coma Scale (GCS) scores 3 to 7) treated at a Level 1 trauma center between 1982 and 1987; 101 of these patients had acute subdural hematoma. ⋯ The following variables statistically correlated (p less than 0.05) with outcome; motorcycle accident as a mechanism of injury, age over 65 years, admission GCS score of 3 or 4, and postoperative ICP greater than 45 mm Hg. The time from injury to operative evacuation of the acute subdural hematoma in regard to outcome morbidity and mortality was not statistically significant even when examined at hourly intervals although there were trends indicating that earlier surgery improved outcome. The findings of this study support the pathophysiological evidence that, in acute subdural hematoma, the extent of primary underlying brain injury is more important than the subdural clot itself in dictating outcome; therefore, the ability to control ICP is more critical to outcome than the absolute timing of subdural blood removal.