Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2007
Clinical TrialMinimally invasive placement of epidural plate electrodes under local anaesthesia in spinal cord stimulation.
In the treatment of pain syndromes of different aetiologies a change has occurred from destructive interventions to stimulation procedures. Spinal cord stimulation is the best known example of this treatment strategy. It is used often in patients with persistent neuropathic pain syndromes in an extremity, for instance following low back surgery. ⋯ Besides this, the laminectomy procedure can subsequently result in new pain complaints due to the invasiveness of the procedure. To solve both problems we have modified the implantation technique. By using a tubular retractor system (METRx system, Medtronic Sofamor Danek, Memphis, TN), originally developed for minimally invasive degenerative disc surgery, it is possible to reach the epidural spinal space and introduce the plate electrode with a small approach under local anaesthesia both allowing trial stimulation and avoiding severe postoperative backache related to the approach in these patients.
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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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Spinal cord stimulation (SCS) is a well established therapy in the treatment for chronic pain. SCS has also been shown to increase peripheral blood flow and is now an accepted treatment in the management of ischemic limb pain and angina. There is a growing body of evidence that cervical spinal cord stimulation also increases cerebral blood flow (CBF) in both animal and human models. SCS could potentially impact on the treatment of cerebral vasospasm and stroke by an increase in CBEF The utility of SCS is also being explored in novel applications such as adjunctive tumor therapy, where resistance to therapy conferred by tissue hypoxia may be ameliorated by CBF augmentation.
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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.