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Results for “Decompression, Surgical”

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PubMed1996

Retrobulbar pressures measured during surgical decompression of the orbit.

AIMS/BACKGROUND: In Graves' ophthalmopathy the increase in volume of intraocular muscles and fat will cause elevated intraorbital pressure. In order to investigate the pressure levels involved, intraorbital pressure, or retrobulbar pressure (RBP) was measured continuously in orbits of patients with Graves' ophthalmopathy during surgical decompression. METHODS: Retrobulbar pressure was measured before and during surgical decompression using an intraorbitally applied pressure transducer. RESULTS: In eight patients with dysthyroid optic neuropathy (DON) RBPs between 17 and 40 mm Hg were recorded. At the end of the surgical procedure the mean RBP was reduced from 28.7 mm Hg to 18.7 mm Hg, the decrease ranging from 8 to 12 mm Hg, which showed a high correlation with the starting pressures (p < 0.001). In two cases without DON, pressures were 11 and 9 mm Hg. Forces exerted by spatula manipulation usually resulted in a RBP level of more than 70 mm Hg. CONCLUSIONS: This study shows that RBPs are markedly elevated in Graves' ophthalmopathy and that surgical decompression can result in a significant reduction in the intraorbital pressure. Optic nerve dysfunction in Graves' ophthalmopathy may not be caused exclusively by the direct pressure of swollen extraocular muscles upon the optic nerve, but also by a raised RBP. It is hypothesised that the damage inflicted upon the optic nerve can be caused in consequence by RBP induced incarceration of the nerve, compressed by surrounding periosteal lined orbital fat bulging posteriorly into the entrance of the optic canal.

Female↗

PubMed1997

Surgical decompression of thoracic outlet syndrome; is it a worthwhile procedure?

During a 20-year period from 1974 to 1994, 37 thoracic outlet decompressions were performed. There were 28 females and six males (ratio 5:1). The median age was 37 years (range 15-64). Symptoms were predominantly neurological in 29 limbs (78%), arterial in five limbs (14%) and venous in three limbs (8%). Limb pain and paraesthesia were the most common symptoms. Surgical decompression was performed via a supraclavicular approach in 24 limbs (65%) and a transaxillary approach in 13 limbs (35%). A cervical rib was excised in 21 limbs (57%), a first rib in 10 limbs (27%), a cervical and first rib in one limb (3%) and a cervical band in five limbs (13%). Arterial reconstruction was only required in three limbs (8%). There were a total of four complications (11%). The outcome of surgical decompression was assessed by using a questionnaire completed by the patient. Overall 27 patients (87%) felt that the operation was worthwhile. These results show that surgical decompression for thoracic outlet syndrome is a worthwhile procedure and is associated with relatively few complications.

Adolescent↗

PubMed1990

Improvement of pituitary function after surgical decompression for pituitary tumor apoplexy.

Hypopituitarism is a major manifestation of pituitary adenoma apoplexy. We postulated that the acute deterioration in pituitary function may be caused by compression of portal vessels and the pituitary stalk, secondary to a sudden increase in intrasellar contents. If this were the case, one would predict improvement in pituitary function to occur after surgical decompression. We studied pituitary function in eight patients presenting with the clinical syndrome of pituitary adenoma apoplexy before and on multiple occasions after urgent surgical decompression. Partial or complete hypopituitarism was seen in all subjects at the time of presentation. Serum cortisol levels were inappropriately low (5.9 +/- 1.4 micrograms/dL; 162.8 +/- 38 nmol/L) for the degree of stress in seven patients and appropriately elevated in only one subject (55.3 micrograms/dL; 1525.7 nmol/L). High normal increments in cortisol levels were noted in three subjects given test doses of cosyntropin. Patients were given glucocorticoids before, during, and for 2 days after surgery. Serum cortisol concentrations measured on or after the third day when glucocorticoids had already been stopped were normal in seven subjects and consistently low in one. These seven subjects were discharged on no replacement and were subsequently documented by dynamic testing to have normal pituitary-adrenal function. Gonadal function improved in two of four men and in one of two women who had hypogonadism on presentation. Improvement in thyroid function was documented in two of three subjects with preoperative hypothyroidism. Gradual improvement and almost complete resolution of the neuroophthalmological abnormalities occurred days to weeks after decompression. These observations demonstrate that urgent surgical decompression after pituitary tumor apoplexy was associated with improvement not only in neurological defects but also in pituitary function. The rapid improvement in pituitary function indicates not only that the hypopituitarism was reversible, but also that it might be caused by compression of the portal circulation and pituitary stalk by the sudden increase in intrasellar contents.

Adrenocorticotropic Hormone↗

PubMed1998

A case of Guyon syndrome with neuroapraxic block resolved after surgical decompression.

Guyon syndrome is the well-known ulnar entrapment at the wrist; usually surgical decompression improves the symptoms. Neurophysiological studies are essential to demonstrate the abnormality of ulnar nerve conduction at the wrist. We report a case of Guyon syndrome onset after 6 h of cycling. Neurophysiological study revealed ulnar neuroapraxic block at the wrist, and axonal impairment. Post-operative clinical and neurophysiological follow-up showed marked clinical improvement and neurophysiological resolution of abnormalities. To our knowledge, no cases of Guyon syndrome with neuroapraxic block are reported in the literature.

Apraxias↗

PubMed1992

Suggested MRI criteria for surgical decompression in acute spinal cord injury. Preliminary observations.

The effect of spinal cord compression identified with magnetic resonance imaging (MRI), on neurological prognosis, was retrospectively evaluated in 36 patients with acute spinal cord injury. Of the 21 patients without cord compression, 16 had potentially reversible injury (normal spinal cord or cord oedema), all having functional recovery. Of the 15 patients with cord compression, 3 had operative decompression. In the 12 patients who did not undergo surgery, the degree of recovery was directly related to the magnitude of spinal cord compression, only one of the patients with moderate or marked cord compression having useful motor function at follow up. In contrast, the 3 patients with surgical decompression had at least 2 grades of improvement, all having functional recovery. These findings raise the possibility that MRI may be used to identify a patient group who will benefit from surgical decompression. A numerical index is proposed to prospectively identify patients for surgical decompression, and further studies are underway to evaluate this.

Adolescent↗

PubMed1993

The effect of surgical decompression on neurologic outcome after lumbar fractures.

From 1980 until 1989, 69 patients with lumbar fractures resulting in incomplete paraparesis were admitted to the authors' medical center for treatment. Thirty had anterior vertebrectomy, including 18 who had posterior instrumentation and four who had anterior instrumentation. Twenty-two patients were treated with a posterolateral decompression and fusion, including four who also required an anterior decompression. Nineteen of the remaining 21 patients required posterior spine instrumentation and fusion only. The American Spinal Injury Association (ASIA) motor index score was determined for each patient pre- and postoperatively and used to compare these three treatment groups. Average follow-up period for the patients was 19 months. The improvement in ASIA motor score for all patients treated with decompression averaged 10 and similar improvement was obtained in those who were treated with posterior decompression (10.2 points). The average improvement in those who had vertebrectomy was 9.9 points. For those who had fusion without decompression, average improvement was 4.2 points. Comparing those patients who were surgically decompressed, either anteriorly or posteriorly, with those patients who only underwent fusion, the difference in neurologic improvement was statistically significant. Neurologic outcome after lumbar fractures is improved by surgical decompression. The neurologic outcome results were similar after anterior and posterior decompression.

Follow-Up Studies↗

PubMed1998

Effect of experimentally induced urethral obstruction and surgical decompression in utero on renal development and function in rabbits.

To investigate the effect of urethral obstruction during late fetal life on renal development and function, we developed a rabbit fetal model of obstructive nephropathy to examine the pathological and biochemical consequences of urethral obstruction and beneficial effects of early surgical decompression. Animals were divided into four groups, i.e., obstructed, early decompressed, late decompressed, and control. Fetal renal development was evaluated by histological examination and counting the number of glomeruli in the four groups. The number of renal glomeruli correlated with gestational age in the normal fetus (r = 0.90, P < 0.0001). Urethral ligation on gestational day 25 (full-term, 31 days) resulted in thinning of the renal cortex and significantly decreased the number of renal glomeruli. The concentration of urinary microalbumin was higher when urethral obstruction was maintained for 3 days than 1 day after urethral obstruction, although urinary beta2- microglobulin, Na, Cl, and osmotic pressure did not change during this period. Decompression of urethral obstruction 1 day after induction of urethral obstruction resulted in improvement in the severity glomerular hypoplasia compared with late decompression (P < 0.01). Our results suggest that the rabbit fetal model simulates fetal urethral obstruction in humans, and indicates that early surgical decompression may be effective in restoration of normal renal function.

Albuminuria↗

PubMed1989

Surgical decompression for thoracic outlet syndrome.

Fifty consecutive surgical decompression operations for thoracic outlet syndrome (TOS) were performed in 43 patients over a 7-year period. Of these, 54% presented with neurological symptoms alone; the others complained of symptoms of vascular or combined origin. Operations for decompression consisted of excisions of 14 cervical ribs, 22 first ribs, and 14 soft tissue or fibrous bands. In six limbs, cervical sympathectomy was also performed for patients who had secondary Raynaud's phenomenon. Surgery resulted in complete relief of symptoms in 37 limbs (74%) and an improvement was achieved in another 10 (20%). In three limbs (6%) surgery gave no benefit. There was no mortality. Thoracic outlet decompression via the supraclavicular approach gave good results in 94% of the patients.

Female↗

PubMed2005

Proprioceptive recovery of patients with cervical myelopathy after surgical decompression.

STUDY DESIGN: A prospective observational study. OBJECTIVES: To determine whether proprioceptive deficit recovers after surgery and whether proprioceptive evaluation can predict functional outcome in cervical myelopathy patients. SUMMARY OF BACKGROUND DATA: Proprioceptive sensation plays an important role in smooth, coordinated movement of the limbs. Information about proprioception ascends through the dorsal columns in the spinal cord. In severe compressive myelopathy, proprioceptive ability would be reduced and could be improved after surgical decompression. However, there have been few studies concerning proprioceptive impairment in cervical myelopathy. MATERIALS AND METHODS: The study group included 26 cervical myelopathy patients who underwent posterior surgical decompression. Knee proprioception was assessed by joint position sense, which was evaluated by measuring the error angle when the subjects tried to reproduce the predetermined angle by extension and by flexion. Proprioceptive deficit in the study group was evaluated, compared with age-matched normal subjects. Postoperative recovery and correlation to functional status was analyzed in the study group. The Japanese Orthopedic Association (JOA) scores were used for functional evaluation. RESULTS: The error angles were significantly higher in the study group than those in the control group before surgery. All patients in the study group finally had improvement of the error angles by a year after surgery. The average of error angles in the study group was improved 2 weeks after surgery; however, no changes were observed later. There was significant correlation between the improvement rate of the error angles 2 weeks after surgery and that of the JOA scores 2 years after surgery. There were 9 patients who had worsened proprioception 2 weeks after surgery either by extension or by flexion, all of whom had poor functional outcome. CONCLUSIONS: Knee proprioception was impaired in cervical myelopathy and recovered after surgical posterior decompression. Proprioceptive improvement at 2 weeks correlates with the degree of improvement in JOA scores at 2 years after surgery.

Adult↗

PubMed2002

[Surgical decompression of cervical arthrotic myelopathies: comparison of surgical anterior and posterior approaches].

PURPOSE OF THE STUDY: Operative treatment of cervical myelopathy has focused on decompression of the spinal cord to avoid neurological deterioration. Anterior or posterior operative techniques have been used to decompress the canal with variable success. The purpose of this study was to compare surgical results after subtotal corporectomy or discectomy with an anterior approach and laminectomy or laminoplasty with a posterior approach. MATERIAL AND METHODS: We reviewed 30 patients with cervical spondylolitic myelopathy who had undergone surgery between 1989 and 1998. Mean age was 55.8 years (range 28 to 82). There were 23 men and 7 women. An anterior approach was used for 14 patients to achieve subtotal corporectomy or anterior discectomy with strut grafting. A posterior approach was used in another 14 patients to achieve laminectomy or laminoplasty. Both anterior and posterior approaches were used for two patients. The severity of the pre- and postoperative neurological deficits was assessed with the Nurick scale. RESULTS: Average follow-up was 35.7 months (range 8 to 120). Neurological status improved in 83% of the patients. Improvement was better for those operated with the anterior approach for pain or brachialgia. The duration of the posterior procedures was, however, shorter with less blood loss. There was no statistical difference between the anterior or posterior approaches for motor function, sensory function, gait anomalies, or complications. CONCLUSION: Surgical treatment is effective in cervical spondylolitic myelopathy. The anterior approach is preferred in case of pain or brachialgia; the posterior approach is indicated in case of poor health status or for bedridden patients.

Activities of Daily Living↗

PubMed2006

Practice Advisory: utility of surgical decompression for treatment of diabetic neuropathy: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.

Surgical decompression at the site of anatomic narrowing has been promoted as an alternative treatment for patients with symptomatic diabetic neuropathy. Systematic review of the literature revealed only Class IV studies concerning the utility of this therapeutic approach. Given the current evidence available, this treatment alternative should be considered unproven (Level U). Prospective randomized controlled trials with standard definitions and outcome measures are necessary to determine the value of this therapeutic intervention.

Clinical Trials as Topic↗

PubMed1994

Surgical decompression of Chiari I malformation for isolated progressive sensorineural hearing loss.

Progressive sensorineural hearing loss has been associated with Chiari type I malformation. Retrocochlear features on auditory brainstem response testing have been reported; however, debate exists over the exact location of the defect. Surgical decompression may be beneficial if brainstem or vascular compression have played a significant role in the pathophysiology of the hearing loss. Lack of specific audiologic data before and after surgical decompression has kept surgical decision making theoretic. This report presents the case of a 10-year-old boy with a progressive, asymmetric sensorineural hearing loss without other neurologic abnormalities. He underwent a posterior fossa decompression that resulted in stable hearing over the 2 years he was followed postoperatively. Preoperative and postoperative audiologic and evoked response features are described, and the rationale for operating with symptoms limited to hearing loss is discussed.

Arnold-Chiari Malformation↗

PubMedDate not supplied

Surgical decompression in endocrine orbitopathy--a three-dimensional locating device ensures greater safety.

Numerous techniques have been described for surgical decompression in endocrine orbitopathy. Irrespective of the approach chosen, the procedure might involve hazards to important vessels and nerves near the base of the skull. When the optic nerve is compressed and relief of pressure at the orbital apex is necessary, the internal carotid artery and the cavernous sinus are at risk as well as the optic nerve itself. Although the use of modern optical instruments such as operating microscopes and endoscopes is now standard practice for this form of surgery, adequate topographical orientation is not achieved in every case. For this reason a computer-assisted locating device developed in this department has been employed by us in 7 cases of endocrine orbitopathy where surgical decompression was required. By using computer-tomographic or MR-tomographic image data, the positions of structures at risk can be plotted to within 0.6 mm. Used in conjunction with an operating microscope and with endoscopic techniques, the system proved helpful in all cases.

Adult↗

PubMed2002

Clinical, radiological and functional follow-up after surgical decompression of double aortic arch.

BACKGROUND: Double aortic arch (DAA) is a congenital vascular anomaly that causes tracheal and oesophageal compression. It requires surgical intervention in patients with severe symptoms. OBJECTIVE: To evaluate the clinical, radiological and functional follow-up after surgical relief of the compression. MATERIALS AND METHODS: Ten children (seven boys) with DAA were operated on at a mean age of 1.3 years (range 0.2-7.5). At a mean age of 10.1 years (range 5-18 years), a follow-up study was performed that included clinical, radiological and functional parameters. RESULTS: Seven children reported only mild respiratory symptoms and some trouble with swallowing. Preoperative fluoroscopy with spot images showed the mean tracheal diameter at the level of stenosis to be 37+/-23% of the maximal diameter. At the time of follow-up, this was 70+/-13%. The mean of the oesophageal diameter was 39+/-20% preoperatively and 47+/-16% postoperatively. Maximal expiratory flow volume (MEFV) curves of seven children showed typical characteristics of intrathoracic upper airway obstruction. Mean peak expiratory flow was significantly reduced (77+/-10% of predicted, P<0.0001). Bronchial hyper-reactivity, tested by methacholine challenge, was found in two patients. CONCLUSIONS: There was marked relief of clinical symptoms after surgical decompression of DAA in all patients. In spite of this, radiological narrowing of trachea and oesophagus persisted and lung function results were abnormal at long-term follow-up.

Adolescent↗

PubMed2005

Surgical decompression in dogs with thoracolumbar intervertebral disc disease and loss of deep pain perception: A retrospective study of 46 cases.

The case details and outcome after surgical decompression of 46 dogs with thoracolumbar intervertebral disc disease with loss of deep pain perception prior to surgery were reviewed. Nineteen dogs (41.3%) recovered with a median follow-up period of 12.5 months. Recovery was defined as an ambulatory paraparesis, or better, with urinary and fecal continence. There was a better outcome in dogs with loss of deep pain for less than 24 hours prior to surgery (19/41; 46.3% recovered) than in dogs without deep pain perception for more than 24 hours (0/5; 0% recovered). Dogs with deep pain perception present at two weeks postoperatively had significantly higher success rate (8/12; 66.7% recovered) than dogs without deep pain perception at this time period (1/10; 10.0% recovered). The return of deep pain perception by two weeks postoperatively can be a useful positive prognostic indicator.

Animals↗

PubMed1988

Results of surgical decompression in chronic tuberculous paraplegia.

The results of surgical decompression in 117 patients with chronic tuberculous paraplegia, defined as paraplegia persisting for more than 3 months, were reviewed. After surgery 90 patients were able to walk. Significant findings at surgery were marked extradural fibrosis with very little caseation and pus. The study showed that paraplegia of greater than 6 months' duration was associated with a poor result. There were no cases of reactivation of the disease in the follow-up period ranging from 1 year to 4 years.

Adolescent↗

PubMed2006

Surgical decompression for painful diabetic peripheral nerve compression and neuropathy: a comprehensive approach to a potential surgical problem.

Diabetic nerve decompression is not for every patient. There is a definite learning curve to the surgery and recovery process and the surgeon must be available to the patient for concerns during the recovery period. The surgery itself is not very complex and can be mastered over time. Pain relief and return to activity results have been excellent and overall, the surgical decompression patients fair better in regard to ulcer formation and amputation risk than those without decompression. It is essential to select patients carefully and to make sure that the testing and examination findings discussed in the article are present before surgery.

Decompression, Surgical↗

PubMed2001

Spinal radiation before surgical decompression adversely affects outcomes of surgery for symptomatic metastatic spinal cord compression.

STUDY DESIGN: A retrospective chart review was performed. OBJECTIVE: To determine whether preoperative spinal radiation increases the number of major wound complications in patients with cancer who have symptomatic spinal cord compression. SUMMARY OF BACKGROUND DATA: Many factors have increased the number of patients hospitalized with symptomatic spinal cord compression after spinal irradiation. The surgical management of metastatic spinal cord compression may be complicated by preoperative radiation. METHODS: A retrospective review of 123 patients admitted with symptomatic metastatic spinal cord compression from 1970 through 1996 was conducted. The final study population of 85 patients was separated into three treatment groups: 1) radiation only, 2) radiation followed by surgery, and 3) de novo surgery followed by radiation. RESULTS: The major wound complication rate for patients who had radiation before surgical decompression and stabilization was 32%, or threefold, higher than the 12% observed in patients who had de novo surgery (P < 0.05). No other clinical factor or condition predicted the development of a major wound complication. Patients treated initially with surgery had superior functional outcomes in an analysis stratified by Frankel grade (P < 0.05). Of the ambulatory patients who underwent de novo surgery, 75% remained ambulatory and continent 30 days after treatment, whereas only 50% of those treated with radiation before surgery had similar outcomes. CONCLUSIONS: Spinal radiation before surgical decompression for metastatic spinal cord compression is associated with a significantly higher major wound complication rate. In addition, preoperative spinal irradiation might adversely affect the surgical outcome.

Adult↗