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Biomedical subjects

B S Nashold

Publications and source records attributed to B S Nashold.

At least 73 records · Page 4Linked to original sources
PubMed1987

Stereotactic mesencephalic tractotomy for the relief of thalamic pain.

Twenty-seven patients with pain of central origin following cerebral hemisphere or brain stem infarction underwent stereotactic mesencephalic tractotomy. Twenty-one (77.8%) were pain free or significantly improved at discharge. Twenty-four were available for later review and 1p (66.7%) reported relief up to 5 years later. The target site was revised after the first 14 patients, reducing the number obtaining long term relief (lesion I, at the level of the superior colliculus--75%; lesion II, at the level of the inferior colliculus--58.3%), but substantially decreasing the incidence of disorders of ocular function from 83.3% to 16.7%.

Adolescent↗
PubMed1987

Nucleus caudalis DREZ lesions for facial pain.

The records of the first 18 patients with intractable facial pain treated with nucleus caudalis dorsal root entry zone lesions were reviewed. The pain etiology varied but the largest group was that of post-herpetic neuralgia. Within the immediate postoperative period 90% of patients had satisfactory pain relief in comparison to 58% on subsequent follow-up. Seventy-one percent of those with post-herpetic neuralgia had satisfactory relief on subsequent follow-up. Favorable results tended to correlate with a lesser preoperative sensory deficit, pain restricted to trigeminal distributions and pain of a burning or lancinating/penetrating quality.

Adult↗
PubMed1987

Conus medullaris nerve root avulsions.

The association of avulsive lesions and pain has been well established in avulsions of the brachial plexus from the cervical spinal cord, but avulsive lesions of the conus medullaris have not previously been recognized or documented by direct observation. Six patients with intractable lower-extremity pain due to avulsion of nerve roots from the conus medullaris were treated by thoracolumbar laminectomy and dorsal root entry zone (DREZ) lesions. Patients with avulsion of lumbosacral roots from the conus medullaris have a characteristic clinical presentation. They are usually young men who, as a result of a motorcycle accident, have suffered multiple pelvic or long-bone fractures or traumatic amputation of part of the lower extremity. Early in their course there is pain not directly attributable to the injured part. The pain is described as intense and burning, with episodic radiation and electric shock-like sensations in the injured or phantom limb. If the leg is intact, there is usually a dermatomal pattern to the distribution of the pain and neurological deficit. A myelogram often reveals a traumatic pseudomeningocele similar to those seen in the cervical region after avulsion of the brachial plexus. Surgical exploration of the conus medullaris usually reveals the extent of nerve root avulsion, and an appropriate DREZ operation can be performed.

Adult↗
PubMed1986

Further experience utilizing the Gildenberg technique for computed tomography-guided stereotactic biopsies.

Initial experience using the Gildenberg technique for computed tomography-guided stereotactic biopsies is reviewed. Of 50 patients, adequate tissue was obtained in 49. In one patient, the stereotactic frame was unable to reach the selected biopsy site. In 32 of 49 patients, the diagnosis was obtained with one biopsy; in the remainder, two to five samples were required. In 4 cases, a subsequent craniotomy was performed; these provided similar histopathological tissue and in no case was the diagnosis altered. The lesions were categorized by CT as ring-enhancing lesions (REL), enhancing lesions with surrounding low density (ELLD), and low density lesions with and without peripheral areas of enhancement. Of the REL, 21 of 23 were primary tumors. Of the ELLD, 5 of 13 were primary tumors; the remainder had a wide spectrum of disease. Of the low density lesions without enhancement, 6 were primary tumors and 1 was an inflammatory process. Three patients had low density lesions with peripheral areas of enhancement and proved to have malignant primary tumors. The remaining patients had multiple lesions with both primary and metastatic disease. Twelve RELs were biopsied in multiple sites. An accurate diagnosis was best obtained by performing the first biopsy in the enhancing rim with additional biopsies as needed in the low density center. Homogeneous lesions could be biospied with target selection based upon a primary regard for safety rather than imaging characteristics. Three patients had transiently increased hemiparesis and one had a transient decrease in level of consciousness after biopsy.(ABSTRACT TRUNCATED AT 250 WORDS)

Biopsy↗
PubMed1986

Sacrococcygeal rhizotomy for perineal pain.

Chronic pain in the perineum is a difficult neurosurgical problem. This article evaluates the effectiveness of sacrococcygeal rhizotomy in 28 patients who had cancer-related pain or coccydynia, underwent rhizotomy, and were followed for an average of 3 years. Good pain relief was obtained in 53% (10 of 19 patients) with malignant pain, as opposed to 22% (2 of 9 patients) with nonmalignant pain. Sacral rhizotomy is a reasonable treatment for cancer-related perineal pain, but it is ineffective for coccydynia and other benign perineal pain problems.

Adult↗
PubMed1986

DREZ lesions for relief of pain related to spinal cord injury.

Fifty-six patients with intractable pain following a spinal cord injury were treated with dorsal root entry zone (DREZ) lesions. After a follow-up period ranging from 6 months to 6 years, 50% of patients had good pain relief. Certain pain syndromes tended to respond better to DREZ lesions than did others. Patients with pain extending caudally from the level of the injury and patients with unilateral pain were most likely to obtain pain relief from the procedure; diffuse pain and predominant sacral pain did not respond as well.

Adult↗
PubMed1985

A new stereotactic instrument for use with computerized tomography and magnetic resonance imaging.

The new stereotactic instrument has the advantages of use with computerized tomography (CT) or magnetic resonance imaging (MRI) without special adaptations of instruments, brain targets transferred directly from CT or MRI to apparatus, and use with conventional stereotactic techniques. The apparatus is designed to meet present demands of neurosurgical facilities of good standards and capabilities, encompassing present and future developments towards more efficient and less invasive brain operations.

Brain Diseases↗
PubMed1985

Use of intraoperative stimulation in the selection of target sites for CT-guided stereotactic biopsies.

We have utilized intraoperative stimulation to establish the functional nature of tissue to be biopsied in 20 patients undergoing CT-guided stereotactic biopsies. We have performed from 1-4 stimulations at 2-100 Hz using a monopolar and/or bipolar electrode at the intended target sites. Thresholds for motor and sensory response have been obtained. Stimulation results have ranged from sensory changes to tonic/clonic motor activity of the contralateral body and face.

Biopsy↗
PubMed1985

Dorsal root entry zone lesions for post-amputation pain.

Chronic pain following an amputation may involve the stump, the phantom limb, or both. Operations such as rhizotomy, cordotomy, stump revision, and dorsal column stimulation have been unsuccessful in treating this condition. This study evaluates the effectiveness of dorsal root entry zone (DREZ) coagulation for this pain problem. The authors studied 22 patients with amputations due to trauma, gangrene, or cancer. All developed post-amputation pain, underwent a DREZ procedure, and were followed from 6 months to 4 years after surgery. Overall, only eight (36%) of these 22 patients had pain relief. However, good results were obtained in six (67%) of nine patients with phantom pain alone, and in five (83%) of six patients with traumatic amputations associated with root avulsion. Poor results were obtained in patients with both phantom and stump pain, or stump pain alone. The DREZ procedure has a limited, but definite, place in the treatment of post-amputation pain.

Adult↗
PubMed1985

Intraoperative evoked potentials recorded in man directly from dorsal roots and spinal cord.

Direct spinal cord surface recordings of evoked spinal cord potentials have been made in 26 patients during neurosurgical procedures for intractable pain. Monopolar recordings at the dorsal root entry zone after peripheral nerve stimulation have been made at multiple levels for segmental localization and to monitor the state of the afferent path and dorsal horn. Dorsal root and dorsal column conduction has been tested on diseased and intact sides. Normal afferent conduction velocity was found to have an overall mean of 61.33 m/sec for cervicothoracic and lumbosacral peripheral nerves, and 50 m/sec for the dorsal columns. The normal mean amplitude for the slow negative wave (N1) recorded at the root entry was 52.54 muV, while that for the dorsal column conducted response recorded within 4 cm of the stimulus point on the dorsal columns was 347.5 muV. Several different placements of stimulating and recording electrodes are described, as well as their application. An interpretation of the resulting data is proposed.

Adult↗
PubMed1984

CT-guided stereotactic biopsies using a modified frame and Gildenberg techniques.

Eighteen patients underwent CT guided stereotactic biopsies using either a Riechert-Mundinger stereotactic frame modified for use in the CT scanner or the CT-based intracranial landmark technique of Gildenberg and a Todd-Wells frame. In seven patients undergoing biopsy with the modified frame technique, representative tissue samples were obtained in all cases. Eleven patients had biopsies using the Gildenberg technique and representative tissue samples were obtained in 10 of the 11. No major postoperative complications occurred in either group. Both techniques allowed samples of intracranial tissue to be obtained safely and efficiently. The modified frame technique provided a higher degree of accuracy while the Gildenberg technique required significantly less CT time and provided a satisfactory degree of accuracy. In seven patients with ring enhancing lesions, biopsies of the enhancing rim provided diagnostic tissue while biopsy of the central low density center of the lesion in three patients provided necrotic material which was useful in histologically grading the tumour.

Adolescent↗
PubMed1984

Dorsal root entry zone lesions for the treatment of postherpetic neuralgia.

These investigators attempted to diminish postherpetic neuralgia in 17 patients by making dorsal root entry zone (DREZ) lesions. They describe the clinical syndrome of pain after herpes zoster, the incidence of which increases with age, and discuss its pathology. They briefly review the medical and surgical treatment of postherpetic neuralgia. The results and complications of the DREZ procedure are reported.

Electrocoagulation↗
PubMed1984

Dorsal root entry zone lesions for the treatment of post-herpetic neuralgia.

Post-herpetic pain was treated in 12 patients using dorsal root entry zone ( DREZ ) lesions. All patients had failed to receive adequate pain relief from conservative therapy consisting of transcutaneous nerve stimulation, carbamazepine, and/or amitriptyline. Dorsal root entry zone lesions were made to include the involved dermatomes plus one-half of the dermatomes above and below the painful areas. Eight patients reported good pain relief with follow-up periods ranging from 6 to 21 months. A ninth patient obtained satisfactory pain relief, but the superior 1 cm of the original painful area was not included in the distribution of the DREZ lesions. Patients whose lesions were performed using a thermally controlled lesion probe suffered no significant postoperative neurological deficit. Dorsal root entry zone lesions appeared to be a satisfactory treatment for post-herpetic neuralgia in patients who have failed to respond to more conservative modes of therapy.

Adult↗
PubMed1984

Stereotaxic thalamotomy for treatment of posttraumatic movement disorders.

Stereotaxic ventrolateral thalamotomies have been successful in treating a wide spectrum of involuntary movement disorders, but very little has been reported concerning their use in posttraumatic movement disorders (MD's). This procedure has been used to treat 11 patients who developed persistent MD following severe closed head injuries. Among these, seven had action tremors, nine hemiballismic movements, two choreoathetoid movements, and two truncal ataxia. In two patients the MD was significant bilaterally, and in eight patients more than one type of MD was present. Standard thermal lesions based on the middle anterior commissure-posterior commissure line, 10 to 15 mm lateral to the midline, were performed following stimulation. Within the immediate postoperative period, all 11 patients had some degree of improvement in their MD; five showed marked improvement, four moderate improvement, and two minor improvement. One patient had recurrence of the MD 24 hours postoperatively requiring a second procedure, with marked improvement subsequently. In five of the six patients who underwent a left-sided procedure, a transient increase in preoperative dysarthria was noted. Nine patients had follow-up examinations 2 months to 3 years following surgery. Some persistent improvement in the MD was noted in all. Of three patients whose dysarthria was worse at 3 to 4 months, subsequent improvement was noted at 9 to 12 months in two. Stereotaxic thalamotomy appears to be an effective form of treatment for persistent posttraumatic MD. The major limitation is increased postoperative dysarthria. Further studies to evaluate risk factors associated with dysarthria and further refinement to prevent its occurrence are needed.

Adolescent↗
PubMed1984

Dorsal root rhizotomy and avulsion in the cat: a comparison of long term effects on dorsal horn neuronal activity.

We performed an extracellular microelectrode analysis of the neuronal activity of cells located in deeper laminae of dorsal horns that had been deafferented by ipsilateral lumbar dorsal root rhizotomy or avulsion. Special attention was given to those cells that were recorded in preparations that were more than 6 weeks chronic. We compared the results to those obtained in nondenervated controls and in experiments in which the spinal cord was acutely transected at a midthoracic level, but had intact dorsal roots. There was an increase in ipsilateral flank and contralateral input in the chronically deafferented as compared to nondenervated controls. Differences were observed between long term rhizotomized and avulsed dorsal horns. Receptive fields extended on to flank and thoracic dermatomes after rhizotomy, often requiring only light cutaneous stimuli. Receptive fields were more restricted with avulsion injury, generally requiring moderate to strong, superficial or deep pinch. Histological analysis revealed consistent differential damage to the medial portion of Lissauer's tract with avulsion injury and subsequently more gliosis in the substantia gelatinosa. The loss of this propriospinal pathway may explain the lack of receptive field expansion on to the thoracic dermatomes and the stronger natural stimuli that were required. A higher percentage of cells with bilateral and inhibitory receptive fields was found in experiments in which the spinal cord was transected at a midthoracic level than in the controls. Ipsilateral excitatory receptive fields were also expanded as compared with control observations, but were not found on the flank.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1984

Current status of the DREZ operation: 1984.

The DREZ operation was introduced in 1976 as a method to control deafferentation pain associated with brachial plexus injury. Since then, 250 DREZ operations have been done at Duke Medical Center. At present, the best results of pain relief occur in brachial and lumbosacral root avulsions, paraplegia, and postherpetic pain. Post-DREZ complications have been reduced by the introduction of new lesion techniques, including the recent use of the laser. The neural basis of deafferentation pain is still not solved, nor is the therapeutic effect of the DREZ lesion known.

Brachial Plexus↗
PubMed1984

Theoretical aspects of radiofrequency lesions in the dorsal root entry zone.

The history and physical principles of radiofrequency (rf) lesion making are reviewed. The advantages of the rf lesion method are presented, with emphasis on its importance in small, critical regions such as the dorsal root entry zone (DREZ). The evolution and specifications of a satisfactory DREZ rf electrode are described. DREZ lesion sizes for this electrode at specific electrode tip temperatures were experimentally determined in animals and were used as a guide to determine acceptable clinical lesioning parameters. Emphasis is placed on lesion temperature monitoring and on the stability of electrode penetration into the spinal cord to achieve consistent and safe results.

Electrocoagulation↗