Journal of neurosurgery
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Journal of neurosurgery · Jun 1994
Randomized Controlled Trial Clinical TrialThe effect of single-application topical ophthalmic anesthesia in patients with trigeminal neuralgia. A randomized double-blind placebo-controlled trial.
To evaluate the reported benefit of ipsilateral single-application ophthalmic anesthetic eyedrops in patients with typical trigeminal neuralgia, a randomized double-blind placebo-controlled trial was performed. Forty-seven patients were randomly assigned to receive two drops of either proparacaine (25 cases) or saline placebo (22 cases). The experimental and placebo groups were equivalent in regard to patient age, distribution of trigeminal neuralgia pain, duration of pain, current medication regimens, and number of prior procedures performed. ⋯ During follow-up monitoring, 11 patients in the test drug group and 14 in the placebo group required surgery because of persistent pain (p = 0.24). The results of this study indicate that single-application topical ophthalmic anesthesia reduces neither the severity nor the frequency of pain in comparison to placebo administration. Although a simple and safe treatment, the single application of topical ophthalmic eyedrops provides no short- or long-term benefit to patients with trigeminal neuralgia.
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Journal of neurosurgery · Jun 1994
Review Case ReportsFamilial occurrence of subependymoma. Report of two cases.
Subependymomas are unusual tumors believed to arise from the bipotential subependymal cell. Previous reports of familial occurrence of subependymoma have involved monozygous twins and siblings. The authors describe the first reported occurrence of fourth ventricular subependymoma in a father and son, suggesting the possibility of direct inheritance.
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Journal of neurosurgery · Jun 1994
Assessment of bladder function after lumbar decompressive laminectomy for spinal stenosis: a prospective study.
Lumbar spinal stenosis is a common problem in elderly patients. In its more advanced forms, it typically causes intractable leg pain, but many patients also manifest varying degrees of bladder dysfunction. The goal of lumbar decompressive laminectomy is relief of leg pain and paresthesias, yet some patients also achieve improvement in bladder function. ⋯ Maximum urine flow rates also improved, but the results of cytometrography and electromyography, urine flow pattern, and bladder capacity were unchanged postoperatively. Cystoscopy detected previously undiagnosed malignancy of the lower urinary tract in two patients (10%). It is concluded that lumbar decompressive laminectomy can have a beneficial effect on bladder function in a significant number of patients with advanced lumbar spinal stenosis.
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Journal of neurosurgery · Jun 1994
The treatment of chronic thoracic segmental pain by radiofrequency percutaneous partial rhizotomy.
Forty-five patients, 12 men and 33 women with an age range of 17 to 88 years (median 52 years), were selected for a posterior thoracic percutaneous partial rhizotomy (PPR) based on the following criteria. Each patient had at least a 6-month history of irradiating pain that followed the segmental pattern of an intercostal nerve and had not responded to conservative treatment. In addition, no causal treatment was available and there was a temporary positive response to an intercostal blockade with lidocaine. ⋯ After a follow-up period of 13 to 46 months (median 24 months) results were evaluated in 41 patients; five patients had undergone reintervention. Excellent long-term results were achieved in 20 patients (48.8%), good results in 15 (36.6%), and poor results in six (14.6%). It is concluded, that when conservative treatment fails, thoracic PPR may prove an effective and safe treatment for chronic segmental thoracic pain.
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Journal of neurosurgery · Jun 1994
Seizure control following tumor surgery for childhood cortical low-grade gliomas.
Detailed preoperative electroencephalographic (EEG) studies are now recommended for children with seizures and cortical tumors to define seizure foci prior to surgery. To develop a historical perspective for better evaluation of results from series reporting tumor removal combined with resection of seizure foci, the authors reviewed seizure outcome in 60 children with seizures and low-grade neoplasms treated consecutively since 1981 by surgical resection without concomitant EEG monitoring or electrocortical mapping. Forty-seven of the 60 tumors were totally or near-totally resected; 45 patients were seizure-free and two were significantly improved 1 year following surgery. ⋯ In contradistinction, the best seizure control was seen in patients with totally resected low-grade gliomas or gangliogliomas who had experienced seizures for less than 1 year (concordance rates for being seizure-free ranged from 78% to 86%). Long-term seizure control remained excellent. These results suggest that seizure control can be obtained 2 years following tumor surgery in the majority of children with presumed tumors after extensive tumor resection without concomitant EEG monitoring or electrocortical mapping.