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At least 19 recordsLinked to original sources
PubMed1989

Effects of hydrocephalus and surgical decompression on cortical norepinephrine levels in neonatal cats.

Norepinephrine (NE) changes during hydrocephalus, and the effects of surgical decompression on these changes, were studied using a new model of neonatal hydrocephalus. Kittens 4 to 10 days old received intracisternal injections of a sterile solution of 25% kaolin. Control kittens were injected similarly with sterile injectable saline. Ultrasonography was used to follow the progression of ventriculomegaly and the initial effects of the shunts. A subgroup of hydrocephalic animals was shunted using a cerebrospinal fluid lumbar-peritoneal catheter. Hydrocephalic animals were killed at approximately 25 days of age (16-21 days after kaolin injection). Surgical decompression was performed at 12, 16, and 17 days after kaolin injection; these animals were killed 30 days after the shunts were inserted. Control animals were killed at 29 and 53 days of age, to correlate with the ages of the hydrocephalic and shunted animals, respectively. Cortical samples equivalent to Brodmann's areas 4, 22, and 17 were measured for NE using high-performance liquid chromatography. Hydrocephalus caused NE levels to decrease significantly in all cortical areas. These alterations followed a rostrocaudal gradient in severity, with mean reductions of 65.8, 83.9, and 95.8% in areas 4, 22, and 17, respectively. Partial recovery occurred in animals that received shunts 16 and 17 days after kaolin injection, such that NE reductions of 75.7, 56.2, and 81.6% were noted in areas 4, 22, and 17, respectively. Shunting at 12 days after kaolin injection produced complete recovery in areas 4 and 22, with only a 67.7% decrease in area 17. These results suggest that the projection fibers from the locus ceruleus are damaged by the direct effects of hydrocephalus. Axotomy or neuropraxia of these fibers could result in decreases in NE throughout the cerebral cortex. In addition, there appears to be a period of time during which surgical decompression will allow neuropraxic fibers to recover with partial restoration of NE levels. Earlier insertion of a shunt appears to allow for more recovery than later decompression.

Animals↗
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↗
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↗
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↗
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↗
PubMed1992

Treatment of symptomatic diabetic neuropathy by surgical decompression of multiple peripheral nerves.

Symptomatic diabetic sensorimotor polyneuropathy is considered progressive and irreversible. The hypothesis that symptoms of diabetic neuropathy may be due to entrapment of peripheral nerves was investigated in a prospective study from 1982 to 1988 in which diabetics (38 type I, 22 type II) had surgical decompression of 154 peripheral nerves in 51 upper extremities and 31 lower extremities. Mean postoperative follow-up was 30 months (range 6 to 83 months). Considering the entire series, an excellent final result was noted for motor function in 44 percent and for sensory function in 67 percent of the decompressed nerves. Ten percent of the patients were not improved, and 2 percent were worse in sensorimotor function. Upper extremity nerve decompressions achieved better results than lower extremity nerve decompressions. Improvement in postoperative electrodiagnostic studies varied in relationship to the preoperative electrodiagnosis. Improvement was noted in 100 percent of those nerves with the preoperative diagnosis of "localized entrapment," 80 percent for "peripheral neuropathy with superimposed entrapment," and 50 percent for "peripheral neuropathy." Progressive neuropathy occurred in a nontreated limb of 50 percent of those patients whose surgically treated limb maintained improvement. The results of this study suggest that symptoms of sensorimotor diabetic neuropathy may be due partly to compression of multiple peripheral nerves. The results further suggest that surgical decompression of such nerves may result in symptomatic improvement.

Adult↗
PubMed1990

Surgical decompression without transposition for ulnar neuropathy: factors determining outcome.

Fifty-one surgical decompressions without nerve transposition for ulnar neuropathy were performed in 46 patients. All of the patients were men with an average age of 59 years at the time of surgery. The follow-up range was between 5 and 32 months (average, 17.8 months). The disease involved the nondominant arm in 24 patients (52%) and was bilateral in 5 (11%). In 23 cases (50%), no predisposing condition could be identified, whereas 15 patients (33%) abused alcohol and 8 patients (17%) had diabetes mellitus. Fifty-seven percent of the patients helped by surgery had symptoms for less than 1 year, whereas only 30% of patients with symptoms for more than 1 year had symptomatic improvement. The relative magnitude of the slowing of ulnar nerve conduction velocity across the elbow was not significantly correlated with the success of decompression in relieving symptoms. Ulnar nerve conduction velocities across the elbow were 36.13 +/- 11.76 m/s in those responding to surgery and 38.97 +/- 13.91 m/s in those not responding (c = 0.06, dF = 50, P less than 0.3). A total of 37 patients showed symptomatic improvement after decompression. Simple decompression of the ulnar nerve was performed under local anesthesia without transposition of the nerve. In all of these cases, compression of the nerve occurred predominantly in the epicondylar groove. Narrowing of the nerve in the groove was present in 28 cases (55%); scar tissue was found adhering to the nerve in 21 cases (41%); and two pseudoneuromas were found (4%). Forty-one operations (80%) resulted in symptomatic improvement, typically noted by the patient within the first month postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Arthroscopy update #4. Arthroscopic subacromial decompression. Surgical technique.

Arthroscopic subacromial decompression is the arthroscopic equivalent of the standard open procedure. Although technically demanding, it facilitates early rehabilitation. The rotator cuff is inspected from the articular and bursal side. Initial results in 102 patients with one to three years of follow-up indicate a satisfaction rate of 84% in 67 patients with stage II disease, and 91% in 35 patients with stage III disease. For both stage II and selected stage III cases, 80% of the results were reported as excellent or good on the objective UCLA rating scale.

Arthroplasty↗
PubMed1991

Surgical decompressive procedures for cervical spondylotic myelopathy. A study using magnetic resonance imaging.

Twenty-two patients who underwent a surgical decompressive procedure for cervical spondylotic myelopathy were studied with magnetic resonance imaging to evaluate the effectiveness of their decompressive procedures. Twelve patients were judged as adequately decompressed by magnetic resonance imaging criteria. Ten patients exhibited evidence of residual cord indentation. This along with cord atrophy, gliosis, and abnormal spine curvature presumably contributed to residual deficit in several patients. One patient underwent a second decompressive procedure for residual cord indentation, which subsequently improved, as seen on his second postoperative magnetic resonance image. Magnetic resonance imaging was useful in distinguishing mechanical problems from intrinsic cord damage or atrophy. Magnetic resonance imaging should be used after operation in patients with residual deficit to detect patients who may be considered for a second decompressive procedure.

Cervical Vertebrae↗
PubMed1986

Studies on cerebral oxygen metabolism, blood flow, and blood volume, in patients with hydrocephalus before and after surgical decompression, using positron emission tomography.

Cortical oxygen utilization, oxygen extraction, blood flow, and blood volume, have been measured in patients with hydrocephalus before and after surgical decompression using positron emission tomography (PET). The hydrocephalus subjects fell into two categories: patients with recent-onset obstructive hydrocephalus and symptoms of raised intracranial pressure due to obstruction of cerebrospinal fluid (CSF) drainage by posterior fossa or third ventricular cerebral tumours, and patients with hydrocephalus of more insidious onset that was associated either with congenital abnormalities, or which was idiopathic. The hydrocephalus subjects had a significantly reduced level of mean cortical oxygen utilization (rCMRO2) and mean cortical blood flow (rCBF) compared with age-matched normal controls. Patients with recent-onset obstructive hydrocephalus associated with cerebral neoplasia had inappropriately low levels of cortical blood flow compared with their levels of cortical oxygen utilization, all having elevated levels of cortical oxygen extraction (rOER). Levels of cortical blood flow in the group of patients with more insidious-onset hydrocephalus matched levels of cortical rCMRO2, all these subjects having normal levels of rOER. All those hydrocephalus subjects who had a raised cortical oxygen extraction preoperatively increased their cortical blood flow following cerebral decompression. No improvement, however, was noted in their mean cortical oxygen utilization. By contrast, those hydrocephalus subjects with normal baseline levels of cortical extraction showed no improvement in mean cortical blood flow, oxygen utilization, or cognitive function after surgical intervention. It is concluded that if cortical oxygen extraction is elevated, hydrocephalic patients are likely to improve their cortical blood flow following cerebral decompression.

Adult↗
PubMed1979

Treatment of experimental brain oedema following sudden decompression, surgical wound, and cold lesion with vasoprotective drugs and the proteinase inhibitor "Trasylol".

The study was performed on 81 cats with three models of experimental brain oedema: sudden decompression, surgical wound, and cold injury. During the experiments blood pressure, central venous pressure, and intracranial pressure were recorded. The blood-brain-barrier was tested with Evans blue solution. The gray and white matter tissue was sampled at the end of the experiment, and the water content and sodium and potassium concentrations were determined. The animals with the same experimental model were divided into three groups: untreated, treated with the vasoprotective agents, and treated with the protease inhibitor Trasylol. In the sudden decompression model after balloon deflation, white matter haemorrhages and oedema development were found in gray matter and basal nuclei. In animals treated with the vasoprotective drugs, haemorrhages were not observed, and oedematous changes were less pronounced. The Trasylol effect on oedema development was not significant in this model. In the surgical wound model, oedematous changes were observed after 24 hours following the lesion. Oedema occurred in the white matter, as in the animals with cold lesions. In both models--surgical wound and cold lesion--the beneficial effect of Trasylol was shown, while the effect of Aescorin was less evident. The results obtained seemed to testify to the usefulness of both Trasylol and vasoprotective drugs in the prevention and treatment of brain oedema in neurosurgical patients.

Animals↗
PubMedDate not supplied

Surgical decompression of posterior tibial neurovascular complex in treatment of certain chronic plantar ulcers and posterior tibial neuritis in leprosy.

Seventy-one cases of posterior tibial neurovascular surgical decompression in leprosy are analyzed and reviewed. Thirteen had chronic refractory posterior tibial neuritis while 58 had chronic nonhealing plantar ulcers. The plantar ulcers were associated with posterior tibial neuritis and/or vascular insufficiency. The clinical and operative findings together with the results are presented and the physiopathology of neurovascular compression is discussed. The operative procedure is described. The presence of pale granulation tissue in a nonhealing ulcer seems to be a characteristic finding in these cases. Neurovascular compression in the tunnel, behind and also below the malleolus, was present in all. In operative procedures, the importance of incising the inferior calcaneal bands is stressed. The results show that the neuritis was cured in all cases, while in 53 of 58 cases the plantar ulcers healed in a short period after the decompression. This stresses the value of this procedure. The prophylactic potential of this procedure needs to be evaluated.

Adolescent↗
PubMed1990

Epidural haematoma requiring surgical decompression following repeated cervical epidural steroid injections for chronic pain.

We report a case of epidural haematoma following a steroid injection into the cervical epidural space. The complication occurred on the seventh such injection over a 2 year period for chronic spinal pain. Surgical decompression over the seventh cervical and the upper 3 thoracic vertebrae was required to alleviate the symptoms of paralysis and anaesthesia. The patient subsequently required skin grafting to the surgical site and two trans-urethral resections of the prostate gland during his 6 week hospital admission. He made a full recovery.

Chronic Disease↗
PubMed1988

Suprasellar tuberculoma developing during treatment of tuberculous meningitis requiring urgent surgical decompression.

An adult patient on treatment for tuberculous meningitis developed visual failure due to a tuberculoma compressing both optic nerves and chiasm. Although continued anti-tuberculous chemotherapy is the treatment of choice for intracranial tuberculoma, the rapid deterioration in vision necessitated urgent surgical decompression, which resulted in complete recovery of vision.

Adult↗
PubMedDate not supplied

[Surgical decompression of the fornix humeri, comparison of 2 procedures: resection of the ligament and Neer's method of anterior acromioplasty].

The impingement-syndrome is caused by a conflict between the humeral head, the rotator cuff and the coracoacromial arch. Degenerative changes in the rotator cuff appear to be the cause when conservative treatment fails, surgical decompression may be resorted to. The two methods commonly applied are the resection of the coracoacromial ligament and Neer's anterior acromioplasty. In this retrospective study 52 patients were followed up of whom 31 had ligament resection and 21 had acromioplasty. The average follow up time was 10 months. Excellent and good results were achieved by ligament resection in 16 patients (52%) and by acromioplasty in 12 patients (57%). Satisfactory results had 10 (32%) patients after ligament resection and 8 patients (38%) after acromioplasty. In 5 cases (16%) unsatisfactory results were achieved by ligament resection and in 1 case (5%) after acromioplasty. Statistically the results did not differ at the 5% level of error. Both methods retain the length of the acromion which is important as it is the attachment of the deltoid muscle and determines the functional lever arm of this muscle. The superior results of acromioplasty in cases with rotator tears suggest that this procedure could be beneficial as a routine decompression in these cases. Theoretically the acromioplasty creates more space for the reconstructed cuff.

Acromion↗
PubMed1986

Surgical decompression of the facial nerve in the treatment of chronic cluster headache.

The nervus intermedius (NI) appears to be the main conduit for the associated symptoms of cluster headache (CH) and perhaps for the pain as well. Subtle injury of the facial nerve and NI might initiate mechanisms responsible for CH. Five patients with chronic CH unresponsive to medication underwent surgical decompression of the root exit-entry zone of the facial nerve, and in two patients the trigeminal nerve root was also decompressed. In two patients, the pain syndrome was markedly relieved for as long as two years. In one patient, initial improvement was obscured by narcotic addiction. In two patients, the operation was a failure. The NI was identified as a separate bundle in only one of five patients and decompressions may not have affected that component of the facial nerve.

Adult↗