Neurosurgery clinics of North America
-
Neurosurgeons and hospitalists are turning to comanagement arrangements to address medical problems in surgical patients. Compared with traditional medical consultation, comanagement lets the hospitalist share authority and responsibility for patient care. It is associated with improved provider satisfaction and more efficient care, but impact on clinical outcomes is uncertain. Shared responsibility for patient care requires careful planning to avoid conflicts and fragmentation of care.
-
Neurosurg. Clin. N. Am. · Oct 2014
ReviewIntrathecal pain pumps: indications, patient selection, techniques, and outcomes.
Intrathecal drug delivery represents an advanced modality for refractory chronic pain patients as well as intractable spasticity. This article reviews the advantages and indications for intrathecal therapy, as well as recommendations for proper patient selection using a multidisciplinary team to provide a global assessment of the impact of chronic pain on the patient's well-being. The goals and expectations of trialing are discussed alongside advantages and disadvantages of several trialing techniques. A discussion of outcomes is presented for patients with chronic pain due to both malignant and nonmalignant causes.
-
Chronic pain impairs the quality of life for millions of individuals and therefore presents a serious ongoing challenge to clinicians and researchers. Debilitating chronic pain syndromes cost the US economy more than $600 billion per year. This article provides an overview of the epidemiology, clinical presentation, and treatment outcomes for craniofacial, spinal, and peripheral neurologic pain syndromes. Although the authors recognize that the diagnosis and treatment of the chronic forms of neuropathic pain syndromes represent a clinical challenge, there is an urgent need for standardized classification systems, improved epidemiologic data, and reliable treatment outcomes data.
-
Trigeminal neuralgia (TN) is a neurologic disorder, defined by paroxysmal electric shocklike painful attacks in 1 or more trigeminal nerve branches. Treatment of TN is diverse and includes minimally invasive percutaneous techniques, which consist of balloon compression, glycerol rhizotomy, and radiofrequency thermocoagulation. Although all 3 techniques are generally safe, efficient, and effective, a clear consensus has not been reached regarding their specific indications and degree of efficacy. The aim of this article is to describe the percutaneous treatments available for TN and outline their characteristics, technique, indications and efficacy.
-
Motor cortex stimulation produces significant relief of symptoms in many forms of refractory chronic pain disorders.