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Results for “Decompression, Surgical”

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PubMed1985

Brain stem auditory evoked potentials in Arnold-Chiari malformation: possible prognostic value and changes with surgical decompression.

Symptomatic Arnold-Chiari malformation (Chiari II) is a recently described clinical entity, the natural history and surgical management of which remain controversial. The brain stem auditory evoked potentials (BAEPs) have been described as abnormal in 50 to 86% of children with myelomeningocele. We present the case of a full-term infant with myelomeningocele, shunted hydrocephalus, and Chiari II malformation who was surgically treated by decompression when she was 3 weeks old. BAEPs recorded immediately after decompression showed dramatic improvement over BAEPs recorded immediately before decompression, an improvement that could not be attributed to maturation of the central nervous system. It is postulated that in further large series the degree of abnormality in BAEPs may be of value in predicting the clinical course of these patients. The current status of BAEPs as they apply to the evaluation of posterior fossa anomalies is reviewed.

Arnold-Chiari Malformation↗

PubMed1979

Comparison of the effects of surgical decompression and resection of local edema in the therapy of experimental brain trauma. Investigation of ICP, EEG and cerebral metabolism in cats.

The effect of decompressive trepanation was compared to that of surgical resection of the traumatized tissue in the course of traumatic brain edema in standardized experimental brain trauma. Following a right parietal cold injury, the following parameters were monitored continuously in 12 cats: ventricular pressure, epidural pressure over both hemispheres, arterial and central venous pressure and heart rate. The EEG was evaluated continuously, using a computer (power spectra). After catheterization of the superior sagittal sinus, cerebral arteriovenous differences of glucose, lactate, O2 and CO2 were calculated. 6 animals were treated surgically when showing elevated intracranial pressure ICP and markedly altered EEG. In 3 animals, the right hemisphere was decompressed by extensive resection of bone and dura. In 3 further animals, the softened brain tissue of the cold lesion was resected and the skull defect closed. 6 untreated animals were used in controls. A decompression by skull hemiresection for ablation of the injured cortex abolished the high intracranial pressure, but only the latter method seemed to prevent further damage. This could be demonstrated by the EEG registration, and by the normalization of arteriovenous metabolite differences. Only animals treated with edema resection had a normal arousal reaction and survived the trauma. The results indicate, that only an ablation of the local injury will prevent further damage to the brain. After decompressive trepanation alone, the progression of tissue edema is not interrupted. As can be seen from the literature, the poor results obtained even from extensive decompressive operations in traumatic brain edema, indicate that the further development of edema is independent of the intracranial pressure, whereas the favorable results of resection of lobar contusions show an interruption of the spread of dysbolism.

Animals↗

PubMed1998

Results of surgical decompression of ulnar nerve in leprosy.

Ulnar neurolysis in 279 cases of leprosy was performed with objectives of relief in neuritic pain and impending/ existing sensory motor loss of varying extent. Of the above, 193 could be followed between 3-10 years. Neuritic pain was first to disappear. 48.7% of the 193 cases showed sensory recovery. Motor power gain and/or further fall in muscle power was prevented as a result of preventive neurolysis in 173 (89.6%) cases. In this series benefits of appropriate and timely surgical intervention have been observed.

Adolescent↗

PubMedDate not supplied

Direct decompressive surgical resection in the treatment of spinal cord compression caused by metastatic cancer: a randomised trial.

BACKGROUND: The standard treatment for spinal cord compression caused by metastatic cancer is corticosteroids and radiotherapy. The role of surgery has not been established. We assessed the efficacy of direct decompressive surgery. METHODS: In this randomised, multi-institutional, non-blinded trial, we randomly assigned patients with spinal cord compression caused by metastatic cancer to either surgery followed by radiotherapy (n=50) or radiotherapy alone (n=51). Radiotherapy for both treatment groups was given in ten 3 Gy fractions. The primary endpoint was the ability to walk. Secondary endpoints were urinary continence, muscle strength and functional status, the need for corticosteroids and opioid analgesics, and survival time. All analyses were by intention to treat. FINDINGS: After an interim analysis the study was stopped because the criterion of a predetermined early stopping rule was met. Thus, 123 patients were assessed for eligibility before the study closed and 101 were randomised. Significantly more patients in the surgery group (42/50, 84%) than in the radiotherapy group (29/51, 57%) were able to walk after treatment (odds ratio 6.2 [95% CI 2.0-19.8] p=0.001). Patients treated with surgery also retained the ability to walk significantly longer than did those with radiotherapy alone (median 122 days vs 13 days, p=0.003). 32 patients entered the study unable to walk; significantly more patients in the surgery group regained the ability to walk than patients in the radiation group (10/16 [62%] vs 3/16 [19%], p=0.01). The need for corticosteroids and opioid analgesics was significantly reduced in the surgical group. INTERPRETATION: Direct decompressive surgery plus postoperative radiotherapy is superior to treatment with radiotherapy alone for patients with spinal cord compression caused by metastatic cancer.

Combined Modality Therapy↗

PubMed1996

Outcome of surgical decompression of the second cervical root for cervicogenic headache.

OBJECTIVE: There is limited information on the surgical treatment of cervicogenic headache (CH). The objective of this study is to analyze the utility of microsurgical decompression of the second cervical (C2) root and ganglion as a treatment for CH. METHODS: Thirty-nine sequential C2 root and ganglion decompressions, performed for the treatment of CH on 35 patients at the Dartmouth-Hitchcock Medical Center during a 70-month period, were analyzed retrospectively. Preoperative factors and intraoperative findings were evaluated with respect to outcome. RESULTS: At a mean follow-up of 21 months, 12 patients (13 sides) were pain free, and 15 were adequately improved (18 sides). Treatment eventually failed in eight patients. No patient, however, was worse after surgical intervention. There was no major morbidity or mortality associated with the operation. The eight patients with unsatisfactory outcome were evaluated for a possible second operation, and four underwent it. One patient of the four is pain free after 28 months, and two gained adequate improvement at 3 and 12 months. The fourth patient required a third operation but has achieved adequate relief at 6 months. Thus, the overall success rate (either pain free or with adequate improvement) was 90%. No specific prognostic factors could be established, other than the accepted diagnostic criteria and successful anesthetic blockade of the C2 root and ganglion. CONCLUSION: The results suggest that microsurgical decompression of the C2 root and ganglion has some utility in treating CH. The accepted diagnostic criteria and success of anesthetic blockade of C2 should identify the subset of patients with CH predominantly caused by C2 root or ganglion effect at this level, which may favor surgical treatment.

Adult↗

PubMed1992

Bone regrowth after surgical decompression for lumbar spinal stenosis.

We reviewed 40 patients treated surgically for lumbar stenosis at an average time of 8.6 years after operation. In 32, total laminectomy had been performed and in eight bilateral laminotomy, both at one or more levels. Of the 16 patients with degenerative spondylolisthesis, ten had had a concomitant spinal fusion. Patients were assigned to one of four groups according to the amount of bone regrowth: group 0 had no regrowth and groups I, II, and III, had mild, moderate or marked regrowth, respectively. Only 12% of the patients showed no bone regrowth; 48% were assigned to group I, 28% to group II and 12% to group III. Imaging studies showed varying degrees of recurrent stenosis in patients with moderate or marked bone regrowth. All patients with degenerative spondylolisthesis showed bone regrowth, which was more severe in those who had not had a fusion. The clinical results were satisfactory in most of the patients with mild or no bone regrowth and significantly less good in those with moderate or marked regrowth. In the group with degenerative spondylolisthesis, the proportion of satisfactory results was significantly higher in patients who had had spinal fusion. The long-term results of surgery for lumbar stenosis depend both upon the amount of bone regrowth and the degree of postoperative vertebral stability.

Adult↗

PubMedDate not supplied

Intracranial pressure and surgical decompression for traumatic brain injury: biological rationale and protocol for a randomized clinical trial.

Commonly, severe traumatic brain injury (TBI) patients undergo amputation of contused brain; the rationale being that edema in presumed unsalvageable cerebrum increases intracranial pressure (ICP). Neuro-critical care expends great effort to control ICP and prevent secondary injury. Non-randomized investigations have employed hemicraniectomy with duraplasty after developing refractory ICP. We undertook a randomized pilot of hemicraniectomy with duraplasty as the initial surgery for severe TBI patients. Goals included reduced ICP therapeutic intensity and return to the operating room, and improved neurological outcome. Upon hospital presentation, the study was to randomize 92 patients with midline shift greater than the size of a surgically removable hematoma. One group was to receive standardized hemicraniectomy and duraplasty; the other would undergo 'traditional' craniotomy (with brain amputation at the neurosurgeon's discretion). A standardized medical protocol followed. The six-month Glasgow Outcome Scale was the primary outcome, with secondary measures including quality of life one year after TBI, duration and frequency of elevated ICP, intensive care unit (ICU) therapeutic intensity, operating room return, and ICU and hospital lengths-of-stay. This article presents the biological rationale and the evidence-based standardized protocols of the study and its outcome measures. The study has stopped and a phase III outcome trial is being organized.

Adult↗

PubMedDate not supplied

Adjuvant surgical decompression gastrostomy: audit of a procedure coming of age.

BACKGROUND/AIMS: Adjunctive decompression gastrostomy has been a popular alternative to nasogastric suction in the care for general surgical patients suffering from postoperative ileus--avoiding discomfort and adverse sequelae of nasogastric tubes. Patient benefit thus correlates with procedural safety and ileus duration. These baseline data of decision-making were scrutinized in a general surgical patient population. METHODOLOGY: Retrospective analysis of a prospective data set. Two hundred and fifty-nine patients undergoing emergency (n=208) or elective procedures (n=51) received decompression gastrostomy when prolonged ileus or noncompliance with nasogastric suction were anticipated. Procedural complications, incidence of postoperative pneumonia and duration of postoperative ileus assessed by daily oral fluid intake vs. gastric drainage volumes were prospectively documented. RESULTS: Gastrostomy complications comprised 0.4% with minor morbidity only. The incidence of pneumonia was 4.5%. Postoperative ileus was nil in 17%, 1-3 days in 48%, 4-5 days in 16%, 6-8 days in 12% and 9-23 days in 7%. CONCLUSIONS: Adjuvant Stamm-Kader gastrostomy is a safe procedure. The incidence of pneumonia was comparatively low and a pertinent prophylactic effectivity appears plausible but remains unproven due to study design. Postoperative ileus exceeding 3 days affects 35%, exceeding 5 days 19% and exceeding 8 days only 7% of pertinent patients, and ileus duration cannot be predicted at the time of surgery. Thus, a substantial number of patients may be overtreated by prophylactic adjuvant surgical gastrostomy. The procedure improves patient's comfort and avoids complications of nasogastric suction. Prophylactic surgical gastrostomy remains a timely adjunct to general surgery but the indication should be individualized.

Adult↗

PubMed1995

Management of spontaneous extramedullary spinal haematomas: results in eight patients after MRI diagnosis and surgical decompression.

Spinal cord compression due to extradural and subdural haemorrhage is a neurosurgical emergency. Differences in clinical presentation in relation to localisation of the haematoma, value of MRI as a diagnostic tool, surgical treatment, and prognosis were investigated in a retrospective case series of eight patients with extradural (n = four) and subdural (n = four) haematomas. Results of MRI were compared with operative findings and proved to be of high sensitivity in defining the type of bleeding and delineating craniocaudal extension and ventrodorsal location. Surgical treatment by decompressive laminectomy, haematoma evacuation, and postoperative high dose corticosteroids resulted in resolution of symptoms in five patients and improvement in the clinical situation in two patients. One patient with a chronic subdural haematoma had a second operation because of arachnoidal adhesions. One patient presented with a complete cord transection syndrome due to an acute subdural haematoma and remained paraplegic. It is concluded that prompt, reliable, and non-invasive diagnosis by MRI leads to efficient surgical treatment and a favourable outcome in this rare condition.

Adult↗

PubMed1998

[Ulna impaction syndrome therapy: decompressive surgical procedures of the head of the ulna].

The ulnar impaction syndrome can be defined as the impaction of the ulnar head against the triangular fibrocartilage complex and ulnar carpus. As a result of this pattern, painful degeneration of the TFCC occurs. Wrist arthroscopy offers a certain diagnostic tool. In addition, arthroscopic debridement of the TFCC shows a high success rate of 70 to 80 percent. After failed arthroscopic debridement, ulnar shortening osteotomy reduces ulnar load significantly. Malunion of the radius resulting in posttraumatic ulna-plus variance should be treated by correction osteotomy with lengthening of the radius. If arthrosis of the distal radioulnar joint is combined with ulnar impaction syndrome, the hemiresection procedure of Bowers or the method of Kapandji-Sauvé are the methods of choice.

Arthroscopy↗

PubMed1999

Radiologic and computed tomography image evaluation of bone regrowth after wide surgical decompression for lumbar stenosis.

STUDY DESIGN: Retrospective study of bone regrowth after decompressive surgery for lumbar spinal stenosis. OBJECTIVES: To assess bone regrowth at the operation site, to compare the bone regrowth rate calculated from plain radiographs with computed tomographic image examinations, to determine the effects of bone regrowth on clinical outcome, and to investigate the factors promoting bone regrowth. SUMMARY OF THE BACKGROUND DATA: Moderate or marked bone regrowth in a surgical defect has been reported in most patients after decompression for lumbar spinal stenosis. Postoperative bone regrowth is related to recurrence of neurologic symptoms in the middle of and later on in follow-up periods. METHODS: Twenty-three patients who underwent decompressive surgery for lumbar spinal stenosis, with an average follow-up of 8 years, were evaluated retrospectively regarding the degree of bone regrowth at the posterior arch. Early postoperative radiographs and computed tomographic images were compared with those obtained at final follow-up. Bone regrowth at the operation sites was evaluated as a regrowth percentage of the original laminectomy site. RESULTS: Decompressive surgery caused bone regrowth to occur at the operation site in most of the patients. However, this regrowth was mild because the mean bone regrowth rate evaluated from plain radiographs averaged 11% and from computed tomographic images 7.7%. In only 20% of the patients was the bone regrowth rate more than 20%. Changes were found to be more elevated at the facet joint level than at the pedicle level. Evaluations of regrowth obtained from plain films and computed tomographic image examinations were compared. Radiographs seemed to overestimate the bone regrowth. The association of postoperative spinal instability with the development of new bone was statistically significant. No relation between bone regrowth and clinical outcome was found. CONCLUSIONS: Bone regrowth in a surgical defect occurs in most patients after posterior decompression. In this study the bone regrowth rate was mild and did not affect the clinical outcome.

Adult↗

PubMed2005

Duration and severity of clinical signs as prognostic indicators in 30 dogs with thoracolumbar disk disease after surgical decompression.

The objective of this study was to evaluate the duration and severity of neurological dysfunction as prognostic indicators for the final outcome in 30 dogs with thoracolumbar intervertebral disk disease, treated surgically with hemilaminectomy without concurrent prophylactic fenestration. The lesion localization was assessed comparing plain radiographic, myelographic and surgical findings and success rates were evaluated during case follow-up. Evidence of a single disk extrusion existed in 17 dogs on survey spinal radiographs, while myelography revealed definite spinal cord compression in 28 cases and was inconclusive in the remaining two cases. Case follow-up continued for a period ranging from 3 months to 2 years post-operatively, depending on the degree of neurological dysfunction on presentation and owner compliance. The severity of clinical signs and the interval elapsing prior to decompressive surgery did not correlate with the case outcome, with 12 of 20 dogs (60%) that exhibited the most pronounced neurological dysfunction (paraplegia with or without analgesia) regaining voluntary motor function during the follow-up period. Recurrences proven to be disk-related did not occur in any dog throughout the post-surgical observation period. It was concluded that the time elapsing from loss of motor function and the severity of clinical signs is not an objective method to predict the case outcome.

Animals↗

PubMed1988

Surgical decompression of branch retinal vein occlusions.

Many patients with branch retinal vein occlusions can develop significant long-term diminution of vision due to such complications as macular edema, retinal neovascularization, and vitreous hemorrhage. One of us (S.C.) developed a new surgical procedure that involves sectioning or decompression of the common sheath connecting the artery and vein at the crossing where a branch retinal vein occlusion occurs. The patient whose case we report had a visual acuity improvement from 20/200-2 to 20/25+1 eight months after surgery.

Female↗

PubMed1987

Tandem lumbar and cervical spinal stenosis. Natural history, prognostic indices, and results after surgical decompression.

Spondylotic degeneration can give rise to concurrent stenosis of the lumbar and cervical portions of the spinal canal in tandem. Symptomatic tandem spinal stenosis (TSS) is characterized by the triad of intermittent neurogenic claudication, progressive gait disturbance, and findings of mixed myelopathy and polyradiculopathy in both the upper and lower extremities. Nineteen patients with clinically symptomatic and myelographically proven disease were studied retrospectively. Surgical intervention was directed at decompression of the stenotic lesions in both the cervical and lumbar regions. The most symptomatic level was usually treated first. After a mean follow-up period of 22 months, an excellent outcome was obtained in five patients (26%), four improved (21%), five deteriorated despite initial improvement (26%), and one was unchanged. Three patients could not be traced for follow-up review, and there was one postoperative death. Postoperative improvement correlated inversely with symptom duration. Sphincter disturbance, radiculopathy, myelography, cerebrospinal fluid analysis, and electrophysiological data were not prognostically significant. The presentation of TSS mimics amyotrophic lateral sclerosis and other forms of motor-neuron disease. In contrast to these conditions, however, TSS is amenable to treatment. Operative sequence and technique could not be related to outcome. Functional recovery in TSS depends on early diagnosis and timely surgical intervention.

Aged↗

PubMedDate not supplied

Characteristics of patients successfully treated for cervicogenic headache by surgical decompression of the second cervical root.

We have recently reported 90% success in a series of patients undergoing microsurgical decompression of the second cervical (C2) nerve root and ganglion for cervicogenic headache. Review and analysis of our database was carried out in order to cull factors characterizing patients amenable to this surgical treatment. Thirty-five sequential C2 decompressions performed on 31 patients who were pain-free or significantly improved in follow-up were evaluated retrospectively. Preoperative factors and intraoperative findings were analyzed for prognostic significance. The diagnosis of cervicogenic headache was made using established criteria and success of CT-guided C2 anesthetic blockade in alleviating the headache. Numerous historical factors noted preoperatively including age, sex, history of trauma, autonomic symptoms, visual changes, and many others were not able to be well correlated with outcome in univariate analysis. Likewise, no strong correlation could be made for findings on physical examination. Thus, no specific prognostic factors could be established, other than the accepted diagnostic criteria and successful anesthetic blockade of the C2 root and ganglion. These factors should identify the subset of patients with cervicogenic headache predominantly due to C2 root or ganglion effect and thus may favor a surgical treatment.

Adult↗

PubMed1992

Spontaneous spinal epidural hematoma causing paraplegia: resolution and recovery without surgical decompression.

Spontaneous spinal epidural hematomas are well-recognized but rare entities. The standard treatment for these hematomas has been prompt surgical evacuation. The authors report a case of a 76-year-old man who precipitously became paraplegic secondary to a spontaneous spinal epidural hematoma and then experienced the complete resolution of his neurological deficit and the hematoma. We conclude that conservative (nonoperative) management of spontaneous spinal epidural hematomas may be appropriate in those instances in which there is early and sustained neurological recovery confirmed by radiological resolution of the lesion.

Aged↗

PubMed1985

Surgical decompression of anterior and posterior malignant epidural tumors compressing the spinal cord: a prospective study.

Of 167 episodes of spinal epidural neoplastic compression, 86 were treated by operation. The surgical approach was prospectively selected according to the location of the tumor in the spinal canal. Decompression was achieved by 61 vertebral body resections (VBRs) and by 25 laminectomies. The indications for operation were: neurological relapse after previous radiotherapy, the need to make a tissue diagnosis, a radioresistant tumor, and neurological deterioration during radiotherapy. Before VBR, 28% (17 of 61) were still able to walk, 51% (31 of 61) were parAparetic, and 21% (13 of 61) were paraplegic. Bowel and bladder dysfunction was present in 49% (30 of 61). After VBR, the outcome of only 57 procedures was available for evaluation because of the postoperative death of 4 patients. Eighty per cent (46 of 57) were able to walk, 18% (10 of 57) were paraparetic, and 2% (1 of 57) were paraplegic. Ninety-three per cent had normal sphincter control. Before laminectomy, 8% (2 of 25) were ambulatory, 84% (21 of 25) were paraparetic, and 8% (2 of 25) were paraplegic. Bowel and bladder dysfunction was present in 76% (19 of 25). After laminectomy, only 23 procedures were evaluated because of the postoperative death of 2 patients. Thirty-nine per cent (9 of 23) were ambulatory, 35% (8 of 23) were paraparetic, and 26% (6 of 23) were paraplegic. Fifty-seven per cent regained normal sphincter control. The operative mortality was 7% (4 of 61) in VBR and 8% (2 of 25) in laminectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed2001

[Surgical decompression treatment of leprous neuritis at the Bom-Pastor Hospital (Brazilian Amazonia)].

PURPOSE: Only leprosy resource centres undertake surgery for neuritis. Patients' accessibility to this surgical procedure is poor because these centres are often far from their homes. The aim of our work is to study the feasibility of neuritis surgery in the field. METHODS: A surgeon trained in this surgery was recruited by Bom-Pastor hospital in Brazilian Amazonia, which is located 400 km away from the leprosy resource centre. Patients operated from May 1996 to December 1997 were enrolled in this retrospective study. RESULTS: A total of 45 operations were carried out during 17 procedures on 13 patients, among which 12 were multibacillary cases. The decompression surgery was performed with a median delay of 1 year after leprosy diagnosis and 3.5 months after the neuritis diagnosis. Among 17 operations, 14 were performed for painful neuritis of recent onset unsuccessfully treated with corticoids or recurring during the month after corticoids were withdrawn. The other three operations were performed for long-standing neuritis with paralysis and deformity. Pain was relieved in all the cases of recent neuritis, except for one patient who suffered from a serious steroid-dependant erythema nodosum leprosum. An improvement of motor function was observed in one out of three patients with long-standing neuritis. Adverse effects were few: a scar infection with a rapid recovery and a keloid scar. Two neurites recurred 2 and 10 months after the surgery. CONCLUSIONS: In an endemic leprosy region, field access to surgery for neuritis appears to prove real progress in the management of leprosy neuritis.

Adolescent↗