Biomedical subjects

J M Taha

Publications and source records attributed to J M Taha.

29 records · Page 2Linked to original sources

PubMed1995

Long-term results of surgical treatment of idiopathic neuralgias of the glossopharyngeal and vagal nerves.

Physicians disagree about the best surgical treatment for patients with idiopathic neuralgias of the glossopharyngeal and vagal nerves after medical treatment has failed. Some favor percutaneous thermal rhizotomy, and other prefer extracranial section of the glossopharyngeal or branches of the vagal nerve, intracranial section of the glossopharyngeal and upper vagal rootlets, or microvascular decompression. However, the results of these procedures are limited to series with follow-up periods of less than 5 years or to series with longer follow-ups that were performed before the microneurosurgical era. We reviewed the long-term results of 14 patients with vagoglossopharyngeal neuralgia treated surgically at our center between 1976 and 1987 to determine the best treatment. Sixteen procedures were performed: 2 percutaneous thermal rhizotomies; 2 extracranial sections of the superior laryngeal nerve; and 12 intracranial glossopharyngeal and upper vagal rhizotomies, 4 with and 8 without microvascular decompression. The follow-ups ranged from 4 to 17 years (mean, 10 yr). All 14 patients who underwent percutaneous or intracranial rhizotomies were pain free. Two patients who underwent percutaneous rhizotomies developed persistent dysphagia and hoarseness. Both patients who underwent extracranial nerve section experienced pain recurrence 2 and 4 years later. Of 12 patients who underwent intracranial section of the glossopharyngeal and upper vagal rootlets, 2 developed dysphagia, which resolved completely in 1 patient and persisted mildly in the other; 1 had transient hoarseness; and 2 developed frequent coughing episodes, which persisted in 1 patient and resolved completely in the other. Side effects due to motor vagal deficits may be eliminated by intraoperative monitoring.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1995

Comparison of conventional and skull base surgical approaches for the excision of trigeminal neurinomas.

Trigeminal neurinomas have traditionally been excised through conventional approaches. Because symptomatic tumor recurrence exceeds 50% after conventional procedures, the authors evaluated the use of skull base approaches to achieve complete resection and a lower rate of symptomatic recurrence. Comparisons of skull base with conventional approaches to trigeminal neurinomas have been limited to small series with short-term follow-up periods. The authors reviewed their experiences with conventional (frontotemporal transsylvian, subtemporal-intradural, subtemporal-transtentorial, and suboccipital) and skull base (frontotemporal extradural-intradural, frontoorbitozygomatic, subtemporal anterior petrosal, and presigmoid posterior petrosal) surgical approaches for the excision of trigeminal neurinomas. In this paper they report the results of 15 patients with trigeminal neurinoma who underwent 27 surgical procedures between 1980 and 1990. Seventeen of the procedures used conventional and 10 used skull base approaches. All patients had tumors arising from Meckel's cave and the porus trigeminus either initially or on recurrence. Tumors located in the cavernous sinus recurred most frequently (83%); other tumors that recurred frequently were those located in Meckel's cave and the porus trigeminus (67%), and the posterior fossa (17%). The tumor extended into the anterolateral wall of the cavernous sinus in 38% of patients with cavernous sinus involvement. Tumor exposure and ease of dissection were superior with skull base approaches. Residual or recurrent tumors were found in 65% of patients following conventional approaches compared with 10% of patients following skull base approaches. Using skull base approaches, the surgeon was more accurate (90%) in estimating tumor excision than when using conventional approaches (43%). Perioperative complications were similar with both. The authors discuss the indications, advantages, and limitations of each approach. Based on anatomical considerations, they propose a strategy to best resect these tumors.

Adolescent↗

PubMed1995

A prospective 15-year follow up of 154 consecutive patients with trigeminal neuralgia treated by percutaneous stereotactic radiofrequency thermal rhizotomy.

There is a lack of prospective studies for the long-term results of percutaneous stereotactic radiofrequency rhizotomy (PSR) in the treatment of patients with trigeminal neuralgia. The authors present results in 154 consecutive patients with trigeminal neuralgia treated by PSR and prospectively followed for 15 years. Ninety-nine percent of the patients obtained initial pain relief after one PSR. Dysesthesia occurred in 31 patients (23%): in 7% with mild initial hypalgesia; in 15% with dense hypalgesia; and in 36% with analgesia. Dysesthesia was mild and did not require treatment in most patients. The corneal reflex was absent or depressed in 29 patients, and keratitis developed in three patients. In 19 of 22 patients with trigeminal motor weakness, the paresis resolved within 1 year. Of 33 patients who had pain recurrence, 10 patients had pain that was mild or controlled with medications, and 23 patients required additional surgical treatment. The authors estimated using Kaplan-Meier analysis that the 14-year recurrence rate was 25% in the total group: 60% in patients with mild hypalgesia, 25% in those with dense hypalgesia, and 20% in those with analgesia. Timing of pain recurrence varied according to the degree of sensory loss. All pain recurrences in patients with mild hypalgesia occurred within 4 years after surgery; 10% more of the patients with dense hypalgesia had pain recurrences within the first 10 years compared with patients with analgesia. The median pain-free survival rate was 32 months for patients with mild hypalgesia and more than 15 years for patients with either analgesia or dense hypalgesia. Of the 100 patients followed for 15 years after one or two PSR procedures, 95 patients (95%) rated the procedure excellent (77 patients) or good (18 patients). The authors conclude that PSR is an effective, safe treatment for trigeminal neuralgia. Dense hypalgesia in the painful trigger zone, rather than analgesia, should be the target lesion.

Adult↗

PubMed1995

Proximal-to-distal facial amplitude ratios as predictors of facial nerve function after acoustic neuroma excision.

Electrophysiological studies (for example, electroneuronography, nerve action potentials, absolute amplitudes of the muscle compound action potentials, and stimulation thresholds) do not accurately predict facial nerve function after the excision of acoustic neuromas. To eliminate individual nerve variability, the authors measured the ratio of the amplitudes of muscle compound action potentials produced by stimulating the facial nerve at the brainstem proximally and at the internal auditory meatus near the transverse crest distally after total tumor excision in 20 patients. The mean tumor size was 36 mm. The facial nerves were anatomically intact in all patients after tumor excision. The follow-up period ranged from 14 to 28 months. Facial nerve outcome was determined by a modified House-Brackmann grading scale. Initial facial nerve function was measured at Days 4 to 7 postoperatively, and final function was the grade at last follow up. The following results were obtained: all patients with proximal-to-distal amplitude ratios greater than 2:3 had Grade III or better initial function and Grade I final facial nerve function; 90% of patients with amplitude ratios between 1:3 and 2:3 had Grade III or worse initial facial nerve function, and 100% of these patients had Grade III or better final facial nerve function; all patients with amplitude ratios less than 1:3 had Grade IV or worse initial and final facial nerve function. The authors conclude that the proximal-to-distal amplitude ratios after acoustic neuroma excision can accurately predict postoperative facial nerve function.

Action Potentials↗

PubMed1994

Intraoperative monitoring of the vagus nerve during intracranial glossopharyngeal and upper vagal rhizotomy: technical note.

Intracranial section of the glossopharyngeal and upper vagal rootlets for the treatment of vagoglossopharyngeal neuralgia may cause dysphagia or vocal cord paralysis from injury to the motor vagal rootlets in 10% to 20% of cases. To minimize this complication, we recently applied a technique of intraoperative monitoring of the vagus nerve (previously described by Lipton and McCaffery to monitor the recurrent laryngeal nerve during thyroid surgery) in a patient undergoing intracranial rhizotomy for vagoglossopharyngeal neuralgia. By inserting an electrode in the ipsilateral false vocal cord and stimulating the rostral vagal rootlets intraoperatively under general anesthesia, we could differentiate the rostral vagal motor rootlets from the sensory rootlets. In this patient, the technique allowed us to preserve a rostral vagal rootlet, which if sectioned, could have caused dysphagia or vocal cord paralysis. We conclude that intraoperative monitoring of the rostral vagal rootlets is an important technique to minimize complications of upper vagal rhizotomy.

Adult↗

PubMed1994

The role of hemispherectomy in the treatment of holohemispheric hemimegaloencephaly.

The role of hemispherectomy in treating holohemispheric hemimegaloencephaly, a unilateral brain malformation, is still not well defined. The authors describe the cases of five infants presenting with intractable seizures, progressive neurological deficits, and severe developmental delay. Electroencephalography (EEG) showed generalized polyspikes from the megaloencephalic hemisphere and progressive slowing on the opposite side in all children; contralateral seizure spikes occurred in three children. Three of the five children underwent hemispherectomy for intractable seizures before 2 years of age, after which the seizures subsided completely in two children and improved remarkably in the third. Preoperative Wada testing proved useful in evaluating pharmacologically the effect of hemispherectomy on contralateral polyspikes. Postoperative EEG revealed the absence of polyspikes in the operated hemisphere and decreased slowing on the contralateral side. Psychomotor development in the surgically treated infants exceeded that of the children not undergoing hemispherectomy. Of the two children treated medically, one died at 4 years of age in status epilepticus and the other (now 5 years old) has frequent seizures and severe developmental delay. Based on these results, hemispherectomy appears to be a useful procedure for controlling seizures and improving psychomotor development in children with hemimegaloencephaly involving the entire hemisphere. Surgery in infancy can prevent or minimize seizure foci and encephalopathic changes that may develop in the contralateral hemisphere. Staging the procedure and exercising meticulous hemostasis make surgery relatively safe in infants who otherwise may have significant blood loss associated with increased blood flow to the megaloencephalic hemisphere.

Anticonvulsants↗

PubMed1993

Sigmoid sinus thrombosis after closed head injury in children.

In the literature, clinical descriptions of sigmoid sinus thrombosis occurring after closed head injury in children are rare. One to 5 days after trauma to the back of the head, five children (aged 1 to 7 yr) presented with gait ataxia, vomiting, and headache. Trauma was mild in four children. Computed tomography of all the children, performed within 5 days after the injury, showed focal hyperdensity in the region of the left sigmoid sinus. Four children had extra-axial hyperdense collections along the left transverse sinus, and three had skull fractures adjacent to the left sigmoid sinus. Magnetic resonance imaging (MRI) of all the children, performed 2 to 6 days after injury, showed left sigmoid-sinus thrombosis and decreased flow or thrombosis within the lateral third of the left transverse sinus. All the children had MRI scans 4 to 6 weeks after their diagnosis and were followed up for 1 to 12 months. In four children whose symptoms subsided completely within 2 to 10 weeks, MRI showed recanalization of the sigmoid sinus within 4 to 6 weeks after injury. In one child whose symptoms resolved after 6 months, sigmoid-sinus thrombosis persisted with the formation of collateral flow. We conclude that traumatic sigmoid-sinus thrombosis should be suspected when a child has persistent or delayed gait ataxia and vomiting after injury to the back of the head. Computed tomography characteristically demonstrated focal hyperdensity within the sigmoid sinus that we term the dense sigmoid-sinus sign. Because the sinus recanalized and the symptoms subsided in most children within 6 weeks, we conclude that prophylactic medical or surgical intervention is not indicated.

Child↗

PubMed1993

Implantation of intracerebral depth electrodes for monitoring seizures using the Pelorus stereotactic system guided by magnetic resonance imaging. Technical note.

The Pelorus stereotactic system guided by magnetic resonance imaging was used to implant intracerebral depth electrodes for monitoring seizure activity. This stereotactic system is frameless and does not require the use of a computer. It is based on the concept of a ball-and-socket type stereotactic arc director and uses the center-of-arc principle to establish a trajectory for electrode placement. The system not only allows the use of the orthogonal approach, but also provides ample working space and flexibility to choose different entry points and trajectory angles.

Adolescent↗

PubMed1991

Intracranial infection after missile injuries to the brain: report of 30 cases from the Lebanese conflict.

This study reviews the features of 30 intracranial infections complicating 600 penetrating head injuries from missiles in patients treated at the American University of Beirut Medical Center between 1981 and 1988. The follow-up period ranged from 1 month to 7 years (mean, 2.5 years). Sixteen patients had a brain abscess, 9 had cerebritis, 2 had an infected intracerebral hematoma, and 5 had meningitis. Infection developed 4 days to 7 years after the initial debridement. The infecting organisms were Gram positive in 11 patients (36%), Gram negative in 12 (40%), and a combination of Gram positive and Gram negative in 2 (7%). Twenty-four patients (80%) had wound dehiscence or cerebrospinal fluid leakage at the time the infection appeared. There was a 76% correlation between the organisms cultured from the dehiscent scalp wound and the brain. Twenty-three patients had intracranial retention of bone. Infection developed in 16 of the 30 patients (70%) around bone fragments, in 4 around a metallic fragment, in 2 around absorbable gelatin sponge, and in 3 along the missile tract; 2 had an infected intracerebral hematoma, and 3 had meningitis. At least one of the following risk factors was present in each patient: extensive brain injury, coma, trajectory through an air sinus, cerebrospinal fluid fistula, inadequate initial debridement, or incomplete dural closure. The incidence of intracranial infection in patients with postoperative retention of bone was 4% in the absence of scalp wound dehiscence, compared with 84.6% when wound dehiscence was present. Ten patients (43%) still retained a bone fragment measuring less than 1 cm after excision of a brain abscess or treatment of cerebritis or meningitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone and Bones↗

PubMed1991

Missile injuries to the brain treated by simple wound closure: results of a protocol during the Lebanese conflict.

This is a prospective study of the treatment of penetrating missile injuries to the brain without intracranial surgery carried out at the American University of Beirut Medical Center between 1981 and 1988. Of 600 patients treated for missile injuries to the head, 32 satisfied the study criteria. There were 27 shrapnel and 5 bullet injuries. The mean patient age was 23 years (range, 3-51 years). Twenty patients had intracranial indriven bone fragments. Six patients had exposed brain tissue. The mean follow-up was 3.5 years (range, 1-7.5 years). The superficial entry wound was debrided and closed without drainage in the Emergency Room within a mean of 3 hours (range, 0.5-6 hours), and the patient received methicillin for 14 days. All patients survived and had no or improved neurological deficits. No leakage of the cerebrospinal fluid, infection, or seizures occurred in 31 patients. One patient with indriven bone fragments had leakage of the cerebrospinal fluid and developed seizures and a brain abscess 20 days after the injury. The management of penetrating missile injuries to the brain without intracranial surgery in a select patient population is a reasonable option. This treatment becomes important for a surgeon facing large numbers of casualties, or when operative personnel or resources are limited or unavailable.

Adolescent↗

PubMed1990

An unusual cause for trigeminal neuralgia: contralateral meningioma of the posterior fossa.

Twenty cases of facial neuralgia associated with tumors of the contralateral posterior fossa were collected from the world literature. Only four of these conform to the description of typical trigeminal neuralgia. We report on a fifth such case with a critical review of the literature. Subtotal excision of the tumor improves the pain and may convert a carbamazepine-resistant neuralgia into a responsive one. Total excision is often followed by a cure. Faced with such a case, the tumor should always be excised first, as this usually cures the neuralgia. Surgical treatment of the neuralgia in the presence of the tumor may be followed by disastrous results. An alternative hypothesis to the pathogenesis of the contralateral neuralgia is presented.

Aged↗