Turk Neurosurg
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Combined analgesic regimens produce sufficient analgesia by additive or synergistic effects, and reduce the total dose of analgesics and minimise adverse effects. We investigated the metamizole, paracetamol and morphine combination with respect to postoperative pain treatment in lumbar disc surgery. ⋯ Addition of metamizole to paracetamol along with iv morphine PCA offers an advantage over single iv morphine PCA and paracetamol, with respect to early postoperative pain treatment and patient satisfaction.
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Coccydynia is a painful condition affecting quality of life. The majority of patients can be successfully treated by non-surgical means. Chemical neurolysis, cryoablation and radiofrequency thermocoagulation (RFT) of ganglion impar are also used in the treatment of visceral pelvic pain. We analyzed the efficacy of RFT of ganglion impar in patients with chronic coccydynia. ⋯ Our data suggest that RFT destruction of ganglion impar in patients with chronic coccydynia has an effective outcome and patients responding to RFT have significantly lower post-RFT pain scores. The most important factors determining success of this procedure is strict patient selection criteria and the technique of the procedure.
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Debate continues as to whether decompressive craniectomy (DC) is an effective treatment for severe traumatic brain injury (STBI). DC is mostly used as a second tier treatment option. The aim of this study was determined whether early bilateral DC is effective as a first tier treatment option in patients with STBI. ⋯ This study indicates that early bilateral DC can be effective for controlling ICP in STBI patients. It is likely the favorable outcome results for Group 2 patients reflects the relatively short time between trauma and surgery. Therefore, these data indicate early bilateral DC can be considered as a first tier treatment in STBI patients.
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More than two thirds of cerebral cavernomas are located supratentorially. The transsulcal approach without excision of the perilesional gliotic parenchyma and simple lesionectomy are keys to surgery on eloquent areas. ⋯ Asymptomatic cerebral cavernomas should be followed with regular MR scans. Symptomatic ones in noneloquent or accessible areas should be resected. Deeply situated cavernomas in eloquent areas should also be resected with the guidance of fMRI and stereotactic marking if available.
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Sacroiliac joint dysfunction is a disorder presenting with low back and groin pain. It should be taken into consideration during the preoperative differential diagnosis of lumbar disc herniation, lumbar spinal stenosis and facet syndrome. ⋯ It is concluded that sacroiliac joint dysfunction diagnosis requires a careful physical examination of the sacroiliac joints in all cases with low back and groin pain. The diagnosis is made based on positive response to the sacroiliac block. Sacroiliac fixation was found to be effective in carefully selected cases.