Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2007
Clinical TrialFactors affecting spinal cord stimulation outcome in chronic benign pain with suggestions to improve success rate.
For patient selection, psychological factors like fear avoidance, depression, secondary gain or refusal to be weaned off narcotics should be avoided. Trial Stimulation is an important tool to reduce the rate of failed permanent implants, and to improve cost-effectiveness. The etiology of pain has a strong influence on the success rate. ⋯ The electrode fracture rate can be reduced by using the paramedian approach, the use of three wing silicone anchor placed immediately at the point of exit of the lead from the deep fascia and avoiding a hard plastic twist lock anchor. The displacements can be reduced by fixing the anchor to the deep fascia firmly, supplemented by the use of silicone glue, and by placing the implantable pulse generator (IPG) in the abdominal wall, instead of the gluteal region. The use of prophylactic antibiotics tends to reduce the infection rate.
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Acta Neurochir. Suppl. · Jan 2007
Did the partial contralateral C7-transfer fulfil our expectations? Results after 5 year experience.
Within the last decade contralateral C7-transfer has become a new source of axon donor in complete brachial plexus lesions. ⋯ The C7-transfer proved to be a safe transfer if at the time of operation no fascicles innervating wrist and finger extension are taken. Provided adequate biceps muscle organ function, active elbow flexion can be reconstructed in most of the patients. However, for median nerve reinnervation motor results are moderate up to now.
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Acta Neurochir. Suppl. · Jan 2007
In peripheral nerve regeneration environment enriched with activity stimulating factors improves functional recovery.
Enriched environment stimulates brain plasticity processes after brain lesion. Less is known about the influence of enriched environment with activity stimulating factors as determinants of functional outcome after peripheral nerve repair. ⋯ Our study aimed to elucidate if enriched environment influences functional results after peripheral nerve repair. The results in this rat sciatic nerve transection and repair model showed that environment enriched with activity stimulating factors can improve functional results.
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Acta Neurochir. Suppl. · Jan 2007
Intrathecal baclofen therapy: indications, pharmacology, surgical implant, and efficacy.
Intrathecal baclofen (ITB) therapy is an option for those in whom predominantly lower extremity spasticity is severe, problematic, and intractable to oral doses of medications and/or focal treatment. When delivered to the lumbar area, ITB avoids high concentrations from reaching the brain (4:1 ratio lumbar to brain cisterns). A screening test dose is done prior to implanting the pump via a lumbar puncture with 50 microg baclofen, working up to 100 microg if necessary. ⋯ Catheter complications are reduced by using a shallow-angle paramedian oblique insertion to the spine, and meticulous anchoring of the catheter. Threading the catheter to T6/7 rather than the traditional T10/11 can allow upper limb relief also. Long term efficacy is excellent, although catheter complications are frequent. and if not recognized and treated, can lead to significant effects of withdrawal of baclofen.
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Nerve tubes seeded with cultured Schwann cells have become a promising alternative to nerve autografts. However, the functional results of these bioartificial cellular grafts remain to be improved. To imitate the three-dimensional structure of peripheral nerves, we designed a Schwann cell-seeded intrinsic framework within a semipermeable biodegradable collagen nerve tube (Integra). ⋯ We conclude that the unique three-dimensional net allowed the settlement of Schwann cells onto the biodegradable filaments, which can be used as "artificial Bünger bands". With further refinements of the "artificial Bünger bands" and Schwann cell cultures there should be improved functional and histological results in the "bioartificial nerve graft" group.