Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Randomized Controlled Trial Comparative Study
The treatment of first division idiopathic trigeminal neuralgia with radiofrequency thermocoagulation of the peripheral branches compared to conventional radiofrequency.
The aim of this study was to prospectively evaluate and compare the effects of radiofrequency thermocoagulation of the first division branches of the trigeminal nerve (trigeminal peripheral division radiofrequency thermocoagulation, PRT) versus conventional radiofrequency (CRF) in the treatment of first division idiopathic trigeminal neuralgia (ITN). Fifty patients with first division ITN were randomly divided into two groups. The 20 patients in group 1 were treated with CRF, while the remaining 30 patients in group 2 were treated using PRT. ⋯ The recurrence rates of ITN at the 3-year follow-up were 25% and 27% for group 1 and group 2, respectively, and 35% and 40%, respectively, 5 years after treatment. There were no significant differences between groups 1 and 2 at any time. Our study demonstrates that PRT is an effective way to treat first division ITN.
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The Glasgow Outcome Scale (GOS) score is widely used to assess outcome after a subarachnoid hemorrhage (SAH). Patients who have recovered fully or with a mild disability (GOS scores 4 and 5) frequently complain about difficulties in conducting their daily activities. The Short Form-36 (SF-36) Health Survey is a questionnaire that assesses outcomes in multiple categories. ⋯ We conclude that patients continue to suffer neuropsychological deficits years after a SAH. The GOS score is a rough outcome measure that primarily focuses on physical functioning. SF-36 is a useful tool to include in the neuropsychological outcome assessment of patients with SAH.
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Between January 1996 and December 2003, our department treated 16 patients (10 men and 6 women; average age 57.5 years) by performing a laminectomy for thoracic myelopathy caused by ossification of the ligamentum flavum (OLF). We followed up all patients for 36 to 86 months (mean follow-up time, 57.3 months). The mean (+/-standard deviation) Japanese Orthopaedic Association score increased from 5.0+/-1.4 points before the operation to 7.7+/-1.9 points at the last follow-up (p<0.01). ⋯ An intraoperative dural tear was the main complication and none of the patients developed severe neurological complications. We conclude that laminectomy was both effective and safe in the treatment of thoracic OLF, but it must be performed with great care because of frequent dural adhesions to the OLF. The increase in kyphosis after the laminectomy was minimal when most of the facet joints were left intact and when the patient followed a back extensor exercise program post-operatively.
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Intradiploic cysts in the posterior fossa are rare. We report a post-traumatic intradiploic leptomeningeal cyst in an adult and review the diagnosis and pathogenesis of this lesion. A 28-year-old woman presented with a headache and a hard mass in the occipital region. ⋯ The dural defect was sutured primarily and covered with the autogenous outer table. An intradiploic cyst of the occipital bone can be detected in adults and might be caused by remote head injuries during childhood. Prompt surgical repair of the dural and bony defect in an adult patient has an excellent prognosis.