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Results for “Decompression, Surgical”

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At least 289 records · Page 16Linked to original sources

PubMed2003

Paget-Schroetter syndrome therapy: failure of intravenous stents.

BACKGROUND: The purpose of this study is to show that intravenous stents (IS) are contraindicated in patients with thrombosis of the axillary-subclavian vein (Paget-Schroetter syndrome). METHODS: Twenty-two patients had IS placed after balloon dilatation of the venous compression in the thoracic outlet. Each of the patients receiving IS had the diagnosis made less than 6 weeks after vein occlusion, previous thrombolytic therapy, and poststent anticoagulants. (All were performed in outside hospitals. In no case was surgical decompression of the "externally constricted venous tunnel" performed.) The 22 patients receiving IS were compared with a similar group of 384 patients seen less than 6 weeks after thrombosis who were treated with "optimal therapy," ie, thrombolysis and prompt transaxillary resection of the first rib with venous tunnel decompression. RESULTS: All 22 patients with IS reoccluded their axillary-subclavian vein from 1 day to 6 weeks after insertion. All were retreated with thrombolytic therapy and first rib resection. Ten remained patent and 7 remained occluded but developed adequate collateral circulation. All 17 were asymptomatic. Five remained occluded with minimal collateral circulation. Attempts were made to reopen them a third time. All 5 are receiving long-term anticoagulants. In contrast the 384 patients managed with optimal therapy were significantly improved without retreatment or anticoagulants. CONCLUSIONS: From our study, there is no indication for use of IS in patients with Paget-Schroetter syndrome; in fact, from our experience it is contraindicated when compared with the optimal therapy group. Other authors corroborate this conclusion in recent review articles.

Adolescent↗

PubMed2001

Peroneal tenosynovitis following ankle sprains.

Peroneal tenosynovitis has a variety of causes which include inversion injury of the ankle. It is rarely reported and frequently misdiagnosed. We report the operative findings and outcome of surgical decompression in 19 patients who clinically presented following inversion injury with features suggestive of peroneal tenosynovitis. A review of the literature of this pathology is presented.

Adult↗

PubMedDate not supplied

Gas-containing otogenic brain abscess.

BACKGROUND: Gas-containing brain abscesses are very rare. Two mechanisms may be responsible for the presence of intracavitary gas: bacterial fermentation or penetration through an abnormal communication between the exterior and the intracranium. The need to search for this potential communication is considered an indication for open surgery. We report the case of a surgically treated gas-containing brain abscess originating from an undiagnosed chronic otitis media. CASE DESCRIPTION: A 54-year-old man developed acute neurologic deterioration, becoming comatose within 24 hours. A contrast-enhanced computed tomography (CT) scan disclosed a gas-containing cystic mass in the right temporal lobe. Urgent surgical decompression revealed the presence of an abscess, which was excised. During the same surgery, we performed a radical mastoidectomy, removing a previously undiagnosed attic cholesteatoma. Neither procedure revealed a discontinuity of the floor of the middle cranial fossa. Cultures grew a mixed flora. Antibiotics were administered for 6 weeks. The patient made a complete neurologic recovery. CONCLUSION: This report demonstrates that otogenic brain abscesses may contain gas due to fermentation of nonclostridial bacteria.

Bacterial Infections↗

PubMed1997

Efficacy of surgical treatment in traumatic central cord syndrome.

BACKGROUND: Controversy surrounds the treatment of traumatic central cord syndrome (TCCS), as there are strong advocates for nonsurgical treatment for most patients. However, conservative treatment has been shown to yield a longer period of discomfort from pain and weakness in certain cases. METHODS: In a retrospective review of 114 patients presenting with acute or chronic TCCS from 1988-94, four different age groups were separately observed under different treatments. Motor and sensory recovery were assessed. RESULTS: Better results were achieved in younger patients, with or without radiographic abnormalities, and in patients with clinically correlated encroaching cord lesions who received early surgical decompression. CONCLUSIONS: Surgical intervention for TCCS must be addressed with careful clinical and radiographic survey. Removal of offending lesions in the subacute period results in significant motor and sensory improvement in short-term and long-term follow-up.

Acute Disease↗

PubMed2000

Increased MRI signal intensity in association with myelopathy and cervical instability: case report and review of the literature.

BACKGROUND: Increased T2-weighted signal intensity in patients with cervical myelopathy has been extensively reviewed in the literature. A variety of etiologies with similar MRI appearances have been described; attempt at correlation of MRI findings with clinical presentation and outcomes after treatment has led to a limited consensus. METHODS: We present a case of cervical myelopathy with associated hyperintense T2-weighted signal characteristics, secondary to cervical spondylosis and instability. RESULTS: Rapid resolution of radiographic abnormalities after surgical decompression and fusion was noted. Clinical improvement did not parallel radiographic resolution. CONCLUSION: These findings are important in considering the pathophysiology of MRI changes in cervical myelopathy.

Aged↗

PubMed1996

Carpal tunnel syndrome in amyotrophic lateral sclerosis and late onset cerebellar ataxia.

We report on clinical and electrophysiological findings and management in nine patients who developed carpal tunnel syndrome during the course of amyotrophic lateral sclerosis and late onset cerebellar ataxia, two neurodegenerative diseases. The patients were treated with surgical decompression (five cases) and local steroid injections (four cases). Only one showed lasting relief of symptoms and significantly improved distal conduction in the median nerve at follow-up after 2 to 3 months. The symptoms and conduction data remained unchanged in three patients who could be followed for more than 1 year. We think that axonal neuropathy plays an important role in the development of carpal tunnel syndrome in these patients and accounts for the failure of the standard treatments.

Aged↗

PubMed1996

Cubital tunnel syndrome caused by tophaceous gout.

We report a case of cubital tunnel syndrome caused by tophaceous gout. The ulnar nerve was compressed by a tophus at the distal cubital tunnel. Surgical decompression relieved the symptoms.

Decompression, Surgical↗

PubMed2002

Carpal tunnel syndrome: a series observed at Jordan University Hospital (JUH), June 1999-December 2000.

One hundred and eighty five consecutive patients with carpal tunnel syndrome (CTS) seen at Jordan University Hospital (JUH) over an 18-month-period were studied retrospectively. Mean age=45 years (range 19-80); 156 females, 29 males. The most common predisposing factors were stressful manual work, followed by diabetes mellitus and obesity (body mass index, BMI>29). The most frequent symptoms were nocturnal hand paresthesiae. The respective sensitivities of Tinel and Phalen signs were 61 and 46%. The diagnostic yield of nerve conduction studies (NCS) was 80% and the most sensitive NCS technique was the median palm-to-wrist (PW) technique with a yield of 61%. Seventy percent of the hands with electrophysiological CTS were moderate and severe. One hundred and forty patients received conservative treatment and 45 underwent surgical decompression.

Adult↗

PubMed1997

Coiling of the vertebral artery presenting with neuralgic pain.

A rare case of radicular pain in the arm due to compression of the C6 nerve root by coiling of the vertebral artery is reported; the diagnosis was confirmed by computed tomography (CT), magnetic resonance (MR) angiography and echocolordoppler. Although the enlargement of an intervertebral foramen by a tortuous vertebral artery has been described previously, the occurrence of radicular pain is exceptional. Magnetic resonance imaging (MRI), MR angiography and echocolordoppler allow to differentiate foraminal enlargement due to vascular anomalies of the vertebral artery from that more commonly due to tumor compression, mainly from neurinoma. Surgical decompression may be considered in symptomatic cases.

Adult↗

PubMed1996

Suction injuries in children leading to acute compartment syndrome of the interosseous muscles of the hand: case reports.

Compartment syndromes of the interosseous musculature in the hands of children is a relatively rare phenomenon and is usually associated with crush injury, severe burn, or ischemic events. Two cases of intrinsic compartment syndrome in children, secondary to suction injuries of the hand, are presented. Two children experienced suction injuries to the upper extremity when their hands were caught in a swimming-pool intake pipe filtration system. The filtration system intake suction developed enough negative pressure to induce an acute compartment syndrome of the interosseous muscles, requiring acute surgical decompression. Early diagnosis, prompt surgical decompression, and early postoperative rehabilitation of this unusual etiology of compartment syndrome of the hand provided a favorable and functional outcome.

Accidents↗

PubMed2003

An infant with an intradural lipoma of the cervical spine extending into the posterior fossa.

BACKGROUND: Intradural lipomas of the cervical spine are very rare. These tumours show no association with spinal dysraphism. We describe an infant with cervical spinal cord lipoma. Surgical decompression of the cord resolved all neurologic deficits. CASE DESCRIPTION: An 8 month old female infant presented with retarded development of motor function in the limbs, in addition to dysphagia. Computed tomography identified a tumour of fat density that extended from the medulla to C7. Magnetic resonance imaging showed hyperintensity on both T1- and T2-weighted images. A fat-suppression sequence demonstrated an area of signal enhancement in the dorsal portion of the tumour following administration of gadolinium. The adjacent spinal cord was normal. Partial removal of the tumour was performed together with decompressive laminoplasty. The enhancing region proved to be fibrous tissue. Motor development resumed in the week following operation. CONCLUSION: Retarded motor development was the main manifestation of this infant's rare spinal tumour. Neuroimaging was of considerable diagnostic value; in particular, fat-suppression magnetic resonance imaging demonstrated details of the tumour and surrounding structures. Decompressive laminoplasty and laminectomy with partial removal of the tumour was effective in reversing clinical deficits.

Cervical Vertebrae↗

PubMed2002

Endovascular management of venous thrombotic diseases of the upper torso and extremities.

Central venous thrombosis in the upper torso can be either primary, occurring as a result of longstanding extrinsic compression, or secondary, resulting from an acquired intrinsic occlusive disease or foreign body. As in lower extremity deep vein thrombosis (DVT), anticoagulation therapy is the mainstay of therapy in upper torso and upper extremity DVT. However, in the presence of severely symptomatic acute thrombosis, pharmacologic and/or mechanical thrombolytic therapy represent the main invasive form of therapy for these conditions. After clearance of the acute thrombotic component, definitive management in patients with underlying anatomic abnormalities can be undertaken. Primary subclavian axillary vein thrombosis caused by extrinsic obstruction at the thoracic outlet is treated with thrombolytic therapy and anticoagulation followed by surgical decompression, whereas secondary causes of central venous obstruction and thrombosis are usually amenable to endovascular treatment with balloon angioplasty and stent placement. Postoperative interval anticoagulation is usually recommended. In addition to clinical follow-up, imaging follow-up with duplex sonography or conventional venography is usually recommended to assess the presence of restenosis and/or residual compression.

Angiography, Digital Subtraction↗

PubMed2002

The natural history of lumbar degenerative spinal stenosis.

The purpose of this review is to present current information on the natural course of lumbar spinal stenosis. As the population becomes older this condition is encountered more frequently. The diagnosis accuracy has improved and the number of cases detected is increasing intemationally. Because of the relative unpredictability of surgical treatment, good knowledge of natural evolution and of the predictive factors influencing the course of the disease is crucial. Unfortunately, and in contrast with numerous surgical series few studies have dealt with natural evolution. In addition to anecdotal reports, a few non randomized studies will be reviewed. Only one randomized study has compared shortand long term results of medical versus surgical treatment. Most of these studies are retrospective, with methodological flaws and are difficult to compare. At the present time no scientifically based recommandations can be made to LSS. patients at diagnosis. Similarly predictors of success of medical and surgical treatment still need to be identified. However results of the studies analyzed in this review suggest that a substantial proportion of patients do not automatically deteriorate and will remain unchanged or even improved by medical means. They also suggest that patients with severe baseline symptoms, block stenosis and degenerative spondylolisthesis tend to require surgical decompression. Randomized studies with the necessary ethical precautions are needed to obtain clear-cut conclusions.

Decompression, Surgical↗

PubMedDate not supplied

Hip spine syndrome: management of coexisting radiculopathy and arthritis of the lower extremity.

BACKGROUND CONTEXT: Significant lumbar spinal stenosis and lower extremity arthritis may coexist in the elderly. This combination of lumbar stenosis with radiculopathy and lower extremity arthritis may lead to diagnostic uncertainty. PURPOSE: To describe the findings of hip spine syndrome, a constellation of symptoms with extensive overlap of radiculopathy and lower extremity arthritis. CONCLUSIONS: Evaluation of the patient with lower extremity pain in consideration for total joint arthroplasty should include functional inquiry of the spinal nerves. Diagnostic tests and injections may allow an informative weighting of the patient's symptoms, leading to a better understanding of the patient's pain syndrome. There is a group of patients who have a total hip arthroplasty and then develop or may continue to have pain of groin and buttock, secondary to sciatica of lumbar spinal stenosis. For the patient undergoing total hip arthroplasty with asymptomatic spinal stenosis, there may be increased neurological risk at surgery, related to the stenosis. The patient with both conditions may require surgical decompression of the lumbar stenosis as well as joint arthroplasty of the arthritic joint.

Arthritis↗

PubMed1996

Vestibular nerve dysfunction and decompression in Engelmann's disease.

Vestibular nerve dysfunction as the major neuro-otological symptom in one of the osteopetrosis group of bone disorders is unusual. We describe a patient with Engelmann's disease who presented in this manner and who benefited from an eighth nerve decompression procedure. Surgical decompression of the internal auditory meatus to relieve vertigo has to our knowledge not been previously reported in this condition.

Adult↗

PubMed2002

Inter-observer reproducibility and responsiveness of a clinical severity scale in surgically treated carpal tunnel syndrome.

OBJECTIVES: To test a recently proposed carpal tunnel syndrome (CTS) clinical severity scale for reproducibility between two observers (neurosurgeon and neurophysiologist) before surgery, for responsiveness to changes in clinical status 6 months after surgery, and for correlations with the electrophysiological findings and 'Boston Carpal Tunnel Syndrome Questionnaire' (BQ). MATERIAL AND METHODS: The tests were applied prospectively to a consecutive series of 254 hands with idiopathic CTS, referred for surgical decompression. The hands belonged to 219 subjects (177 women and 42 men, mean age 55.6). RESULTS: Percentage agreement between the two observers in assigning severity to the same class was 78% and Cohen coefficient kappa was 0.69 (P < 0.001). The scale was found to be responsive to changes in clinical status after surgery. Direct correlations were also found between the scale and patient age, duration of symptoms, BQ scores and the neurophysiological severity scale. The significance of these associations was maintained for 6 months after the operation. CONCLUSION: This clinical severity scale is simple, reproducible and sensitive for evaluating severity of CTS in patients undergoing surgery.

Adult↗

PubMed2006

Spontaneous spinal epidural hematoma in a 4-month-old infant.

STUDY DESIGN: A case report and a review of literature. OBJECTIVES: To present the first youngest infant of a 4-month-old boy with spontaneous spinal epidural hematoma in cervicothoracic spine. SETTING: National Cheng Kung University Hospital, Tainan, Taiwan. METHODS: A 4-month-old boy who initially presented with irritable crying, neck stiffness, and fever followed by progressive quadriparesis. Magnetic resonance imaging (MRI) of the spine disclosed a space-occupying lesion on the right posterior-lateral aspect of the cervicothoracic spinal canal. Laminectomy with reconstruction in situ from C4 to T4 was performed 5 days after the onset of symptoms. RESULTS: The boy had gradual improvement of his neurological status. Follow-up visit 1 year later, the infant's growth and development was within normal limit without any neurological deficits; his repeat MRI showed complete fusion of each implanted lamina and well expansion of the spinal cord. CONCLUSIONS: Prompt surgical decompression is valuable, irrespective of the time interval between symptom onset and operation in infant.

Cervical Vertebrae↗

PubMed1998

Current management of thyroid-associated ophthalmopathy in Europe. Results of an international survey.

OBJECTIVE: To determine how expert thyroidologists assess and treat thyroid-associated ophthalmopathy (TAO), and if TAO affects treatment of coexistent Graves' hyperthyroidism. DESIGN: Members of the European Thyroid Association (ETA) were invited to answer a questionnaire which gave details of an index patient and nine variants differing in age, severity of TAO, thyroid state and the presence of diabetes. Eighty-four responses were received from 19 European countries, representing approximately 60% of the clinically active ETA members. RESULTS: Disease-modifying treatment was not considered necessary by 18% for the index case with diplopia and proptosis but 77% used steroids alone or with another treatment; 5% used radiotherapy alone and 18% used it in combination with steroids. Worsening of eye signs after 8 weeks induced a significant shift away from steroids to radiotherapy, surgery, or other immunosuppression. For treatment of associated hyperthyroidism, antithyroid drugs were chosen by 84%, thyroidectomy by 10% and radioiodine by 6%. In recurrent hyperthyroidism, thyroidectomy was preferred by 43%, antithyroid drugs by 32%, and radioiodine by 25%. Major alterations in management of TAO were noted for only 2 of the 9 variants. Optic nerve involvement produced a more thorough evaluation of TAO as an in-patient, and a preference for surgical decompression (42%). The presence of diabetes induced a greater use of surgery at the expense of steroids, but there was disagreement over the role of radiotherapy in diabetes. CONCLUSION: Marked geographical variation was noted, particularly in the treatment of thyroid-associated ophthalmopathy. Observed consensus was nation-wide rather than Europe-wide. The appropriate treatment of the patient with thyroid-associated ophthalmopathy, especially with diabetes or deteriorating eye signs, is controversial even amongst thyroid specialists.

Antithyroid Agents↗