Articles: surgery.
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Case Reports Clinical Trial
Intraoperative Doppler to measure cerebrovascular resistance as a guide to complete resection of arteriovenous malformations.
Intraoperative color Doppler ultrasound has been used to locate arteriovenous malformations (AVMs). We describe the use of spectral Doppler to measure flow resistance and resistive index (RI) of vessels around the nidus to distinguish feeding arteries from en passant and normal vessels. This is particularly helpful in small AVMs and aids in the identification of normal vessels and completeness of resection by ruling out persistent low RI flow. ⋯ Intraoperative duplex Doppler allowed more accurate localization of the AVM nidus. RI of the vessels around the AVM helped to distinguish vessels feeding the AVM from en passant vessels. Furthermore, comparison of pre-resection and postresection RI accurately indicated the completeness of resection.
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Since the first medical description of post-amputation phenomena reported by Ambrose Paré, persistent phantom pain syndromes have been well recognized. However, they continue to be difficult to manage. The three most commonly utilized terms include phantom sensation, phantom pain, and stump pain. ⋯ While numerous treatments have been described, there is little clinical evidence supporting drug therapy, psychological therapy, interventional techniques or surgery. This review will describe epidemiology, etiology and pathophysiological mechanisms, risk factors, and treatment modalities. The review also examines the effectiveness of various described modalities for prevention, as well as management of established phantom pain syndromes.
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This study aimed to (1) compare 2 scales in the assessment of first-stage implant surgery, (2) assess the interrater reliability of these scales, and (3) compare self-assessment with observer assessment. ⋯ Both the checklist and the global rating scales provided useful assessment data, and both were considered of value by the assessors and surgeons in providing feedback. The development of assessment and self-assessment skills in implant surgery is necessary if we are to establish a culture of commitment to lifelong learning.
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Acta neurochirurgica · Jul 2004
Case ReportsCT-guided percutaneous aspiration of Tarlov cyst as a useful diagnostic procedure prior to operative intervention.
Tarlov or perineural cysts are lesions of the nerve root most often found in the sacral region. Several authors recommend surgical treatment of symptomatic Tarlov cysts. However, successful surgical treatment is dependent on appropriate patient selection. In this article, we report three cases of a sacral perineural cyst, causing sciatic pain, and emphasize the usefulness of CT-guided percutaneous aspiration as an important diagnostic and prognostic procedure prior to definitive operative treatment.
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Published studies of intradiscal thermal annuloplasty (IDTA) have shown at most 50% pain relief as an improved outcome with little focus on functional improvement in the treatment of discogenic pain. Previous studies have used a number of criteria for patient selection including low back pain unresponsive to conservative care, no compressive radiculopathy, positive provocative discography and absence of previous surgery at the same symptomatic level. The purpose of present study is to examine the hypothesis that additional inclusion criteria for patient selection such as disc height, absence of degenerative disc disease (DDD) in untreated discs, absence of herniated nucleus pulposus or lumbar canal stenosis may improve the outcome of treatment. ⋯ We found dramatic improvement of pain scores and ADLs following IDTA when strict patient selection was applied. We believe that IDTA is an effective, minimally invasive treatment for discogenic pain in properly selected patients.