British journal of neurosurgery
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Anterior cervical discectomy (ACD) is standard practice for cervical radiculopathy. Irrespective of the precise method used, it involves more or less complete disc removal with resultant anatomical and biomechanical derangements, and frequently the insertion of a bone or prosthetic graft. Anterior cervical foramenotomy is an alternative procedure that allows effective anterior decompression of the nerve root and lateral spinal cord, whilst conserving the native disc, preserving normal anatomy and movement, and protecting against later degeneration at adjacent spaces as far as possible. ⋯ The surgeon's impression of improvement paralleled that of the patients. There was one complication with discitis. Anterior cervical foramenotomy is a safe and effective treatment for cervical radiculopathy caused by posterolateral cervical disc prolapse or uncovertebral osteophyte, and might also reduce adjacent segment degeneration.
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Review Comparative Study
Stereotactic neurosurgery for disabling tremor in multiple sclerosis: thalamotomy or deep brain stimulation?
Disabling tremor is common in multiple sclerosis and up to 75% of patients experience tremor at some point during their disease. The treatment of this tremor, however, remains challenging. Pharmacotherapy in general has been disappointing and stereotactic neurosurgery is becoming increasingly popular. ⋯ Other common adverse effects like hemiparesis, dysarthria, swallowing difficulties, balance disorder, etc., was reported in both procedures. Numerous studies have attempted to assess the efficacy and safety of thalamotomy and DBS in the treatment of MS tremor, but no standardized outcome measures were used. Nonetheless, the data suggest that both thalamotomy and thalamic DBS are comparable procedures for tremor suppression and that adverse effects can occur with both procedures.
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The objective of the study was to assess the long-term efficacy of fluoroscopically-guided cervical nerve root block as a non-surgical treatment for cervical radicular pain. This was a retrospective study of 19 consecutive patients who had undergone cervical nerve root blocks over a period of 18 months, at a regional neurosurgery referral centre in the UK. Two of these patients underwent a second procedure; therefore, the number of total nerve root blocks was 21. ⋯ Mean VAS scores at 6 month follow-up were broken up into 3 categories to indicate the level of pain relief. These categories were: VAS decrease of less than 20 points indicating no relief (12 procedures, 57.1%); VAS decrease 20 - 40 points, i.e. moderate relief (three procedures, 14.3%); VAS decrease of greater than 40 points, i.e. significant relief (six procedures, 28.6%). CNRB has limited efficacy for definitive treatment of nerve root pain, but may lead to significant short term relief, in a subgroup of such patients.
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Intrathecal baclofen (ITB) is a well-established method of treating spasticity in children with cerebral palsy. In our series, eight children with primary or dystonia secondary to cerebral palsy have benefited from ITB. ⋯ The approach is different in dystonia secondary to cerebral palsy, where ITB can be used to palliate the spastic component, but other methods are necessary to treat the primary disease. We currently have three children in our series, where ITB in conjunction with deep brain stimulation (DBS) was used with satisfactory results.
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Infection is a serious complication of external ventricular drain (EVD) and various strategies have been adopted to minimize its occurrence. The use of an extended subcutaneous tunnel (50-60 cm) was previously described, but has since received little attention in the literature. The authors reviewed their experience with this technique, with emphasis on the rate of infection and predisposing risk factors. ⋯ The extended subcutaneous tunnel technique did not affect the daily infection risk on a week-to-week basis. The 'long EVD' does not appear to offer any distinct advantage over the standard tunnelling technique in our unit. However, this is essentially an audit within a single centre, and the findings should be interpreted with caution and with the understanding that individual institutions may have their unique patterns and risks of EVD infection.