Neurosurgery
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The authors report the results of DREZ thermocoagulation in 35 patients since March 1980. This technique was applied not only in patients with deafferentation pain after brachial plexus avulsion, but also for postamputation phantom limb pain and pain caused by injury to the spine and spinal cord, by peripheral nerve lesions, and by multiple sclerosis. Independent of etiology, the duration of the pain syndrome, and the quality and projection of the pain, the overall results have been satisfactory and long-lasting.
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Dorsal root entry zone coagulation (DREZ) lesions for pain were made in 41 patients at the National Hospitals during 1980 through 1983. In 34 patients the operation was an attempt to relieve pain due to avulsion of the brachial plexus. Of these patients, 95% were male and 91% had received their injury in road traffic accidents. ⋯ Postoperative motor or sensory changes occurred in 50% of the patients, but these were significant in only 12%. In later patients in this series, pre-, peri-, and postoperative monitoring of somatosensory evoked potentials was used. Evoked potential monitoring indicated subclinical posterior column damage ipsilateral to avulsion before DREZ lesion making in about 50% of the cases; in some cases, postoperative changes were detected.
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Case Reports
Cerebrospinal fluid rhinorrhea 34 years after trauma: a case report and review of the literature.
Posttraumatic cerebrospinal fluid (CSF) rhinorrhea has been recognized since the 17th century, and its association with intracranial infection has been well documented. However, CSF rhinorrhea usually presents during the 1st month after trauma. Cases presenting more than 3 months after trauma are unusual. The authors report a case of CSF rhinorrhea that presented 34 years after head injury.
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An attempt has been made to identify and manage patients symptomatic from both cervical and lumbar spinal stenosis. The order of operative intervention was related to the degree of myelopathy and radiculopathy. Patients requiring cervical surgery first had absolute stenosis with a spinal canal equal to or less than 10 mm in anteroposterior diameter. ⋯ The surgical management included extensive, multiple level laminectomy, unroofing of the lateral recesses, and foraminotomy. Neurolysis and untethering of the spinal cord was essential. Significant improvement was shown by 90% of these patients.