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Biomedical subjects

B S Nashold

Publications and source records attributed to B S Nashold.

At least 19 recordsLinked to original sources
PubMed1992

Swallowing in torticollis before and after rhizotomy.

To determine risk factors for dysphagia after ventral rhizotomy, videofluoroscopic barium swallowing examinations were done on 41 spasmodic torticollis patients before and after surgery. Radiologic abnormalities were present in 68.3% of the patients before surgery, but these were only mildly abnormal in the majority. After surgery 95.1% showed radiologic abnormalities which were moderate or severe in one-third of the patients. Swallowing abnormalities correlated significantly with duration of torticollis and subjective complaints of swallowing difficulty both before and after surgery, but not with age, sex, or type of torticollis. The major acute postoperative finding was aggravation of preexisting pharyngeal dysfunction. Follow-up from about half of our original sample showed that gradual improvement occurred from 4 to 24 weeks after surgery by subjective report. We review the innervation of intrinsic and extrinsic pharyngeal musculature, and suggest that C1-3 rhizotomies and selective sectioning of the spinal accessory nerve are responsible for aggravation of pharyngeal swallowing dysfunction in the acute postsurgical period.

Adult↗
PubMed1992

The history of neurosurgical procedures for the relief of pain.

Pain has been a major medical problem from the beginning of recorded history. Since the earliest medical writings, there have been innumerable procedures designed to relieve pain and its suffering. In this study, we have reviewed both the early medical writings of various civilizations and the first modern publications, to compile a history of neurosurgical procedures for the relief of pain.

Analgesia↗
PubMed1992

Deafferentation syndrome in the rat: effects of sex, age, and lesion type.

A deafferentation syndrome can be produced in Sprague-Dawley rats following dorsal root sections. The behavior may be objective evidence of dysesthesias, thus serving as an experimental model to study chronic dysesthesias caused by deafferentation in humans. This article examines the effects of sex, age, and lesion type on the expression of the deafferentation syndrome in Sprague-Dawley rats. No significant differences were found in the expression of the deafferentation syndrome with respect to age and weight in male rats within the ranges studied. Sex and lesion type did alter the expression of the syndrome.

Aging↗
PubMed1992

Trigeminal nucleus caudalis dorsal root entry zone: a new surgical approach.

New radiofrequency lesion dorsal root entry zone (DREZ) electrodes for relief of facial pain were designed based on a neuroanatomic study in man of the trigeminal nucleus caudalis at the cervicomedullary junction. The human brainstems of 3 normal postmortem specimens were sectioned with measurements and relationships of the trigeminal nucleus caudalis, segmental tracts, spinocerebellar tracts and dorsal columns. Two right-angle DREZ electrodes were made by Radionics for producing DREZ lesions in the trigeminal nucleus caudalis to treat deafferentation facial pain.

Brain Stem↗
PubMed1991

Temporal lobectomy for epilepsy in a three year old: a twenty year followup.

Few series have analyzed the results of temporal lobectomy in the pediatric age group. In this paper, we present a child who underwent successful temporal lobectomy for medically intractable complex partial seizures at the age of three. A twenty year followup is provided. This case is significant because of the young age at which the surgery was performed, the long term followup which was obtained, and the successful result. Followup included multiple clinic visits, electroencephalograms (EEG), and psychological testing. The patient is currently seizure free and functioning well in society.

Anticonvulsants↗
PubMed1990

Anterior temporal lobectomy for complex partial seizures: evaluation, results, and long-term follow-up in 100 cases.

We report evaluation and results in 100 patients who had undergone anterior temporal lobectomy for intractable complex partial seizures. Average follow-up was 9.0 years (range, 2 to 21 years). In the 2nd postoperative year, 63% were seizure free, 16% were significantly improved, and 21% were considered not significantly improved. Mean number of seizures in the last group was 27% of preoperative levels. Surgical results did not change significantly in subsequent postoperative years; good outcomes tended to persist over the longer term. We also examined the utility of continuous depth electrode monitoring in the evaluation of patients with independent bitemporal interictal epileptiform activity. Despite limited numbers of subjects in this category, there was a trend toward improved surgical outcome when such subjects were evaluated with depth electrodes.

Adolescent↗
PubMed1990

Swallowing function in patients with spasmodic torticollis.

We examined the oropharyngeal swallowing ability of 43 patients with spasmodic torticollis using a videofluoroscopic procedure. Twenty-two (51.2%) demonstrated objective evidence of swallowing abnormalities; 15 (34.9%) had subjective complaints. Delayed swallowing reflex and vallecular residue were more frequent (p less than 0.0046) than any other abnormality. The constellations of abnormalities were consistent with neurogenic, postural, and mixed neurogenic-postural types of dysphagia.

Adult↗
PubMed1990

Pain and spinal cysts in paraplegia: treatment by drainage and DREZ operation.

About 10% of paraplegics suffer from intractable pain. The onset of pain may be immediate or delayed for months to several years after the injury. The delayed onset of pain is highly suggestive of the development of a spinal cyst. This is a report of 18 paraplegics who developed a delayed onset of intractable pain who were found at the time of surgery to have associated spinal cord cysts. Treatment consisted of the dorsal root entry zone (DREZ) operation in addition to evacuation of the cyst. Burning pain was the most common complaint occurring years after the trauma. In this study we compared the relationship between the onset and character of the pain, the time of the spinal injury, the operative findings, and the results of the DREZ procedure and evacuation of the traumatic spinal cyst. We believe that the combination of paraplegia, pain and spinal cyst has not been emphasized in the neurosurgical literature although it is well known that cystic formation can follow spinal trauma. Two patients developed spinal cysts with nontraumatic lesions of the spinal cord. A single cyst was found in 14 patients while four had two separate cysts. The diagnosis was made on the basis of history and clinical examination with radiographic confirmation using delayed CT scan and myelography and more recently magnetic resonance imaging. Intraoperative ultrasound was employed in the study of some patients. All patients were treated with combined DREZ lesions and evacuation of the cysts with good pain relief in 77.7%.

Adult↗
PubMed1990

Stereotactic mesencephalotomy.

Within the mesencephalon lie nuclear masses and fiber tracts that connect higher and lower portions of the neuraxis. The pathways subserving epicritic (discriminatory) sensation and protopathic (motivational) sensation are adjacent to one another and can be localized precisely with stereotaxy. Discrete thermal lesions overflowing between the direct spinothalamic and quintothalamic pathways laterally and the more diffuse ascending pathways medially can be created. By careful target selection the surgeon can avoid significant damage to adjacent structures and offer relief of central or malignant pain without substantial sensory disturbance. At the same time the emotional disturbances that often persist with other remedies are reduced. Intraoperative electrophysiologic monitoring may help minimize unwanted and distressing side effects. It is fortunate that nature has designed the upper brain stem in such a fashion to allow effective pain relief procedures. Although stereotactic mesencephalotomy is not a panacea, it offers relief of pain syndromes that cannot otherwise be helped while abolishing the associated emotional problems that otherwise can be relieved only by psychosurgical procedures.

Chronic Disease↗
PubMed1989

The DREZ procedure: an update on technique.

The DREZ operation was first done in 1975 on a patient with arm pain following a brachial plexus avulsion. Since then approximately 500 patients have undergone the DREZ procedure under our care for treatment of various pain syndromes including deafferentation pain, post-herpetic neuralgia, and post-paraplegia pain. We report several modifications in instrumentation and technique. Currently, we use two types of electrodes for lesion production. The first is the standard 0.25 mm diameter, thermocouple, temperature monitoring electrode which has a 2 mm long tip for introduction into the spinal cord. A second type, recently modified from the original, is used only for lesioning the nucleus caudalis in patients with trigeminal post-herpetic neuralgia. Its tip is 3 mm long with insulation along the first 1 mm. This allows lesioning of the caudalis nucleus while sparing the more superficial spinocerebellar tracts. We no longer lesion only the dorsal root entry zones at each root level but include all the contiguous substantia gelatinosa between roots. With lesions only 1 mm apart this greatly increases the number of lesions and decreases the incidence of incomplete postoperative pain relief. In patients undergoing caudalis lesioning, we make two rows of lesions, one above the other, from C2 to slightly above the obex. This prevents sparing of the facial midline with resultant residual pain. Finally, lesions are made by heating the electrode tip to 75 degrees C for exactly 15 sec, thus allowing for a more uniform lesion. With these modifications, we have a decreased incidence of incomplete pain relief as well as a decreased incidence of complications, especially in patients undergoing caudalis lesioning.

Chronic Disease↗
PubMed1989

Nucleus caudalis DREZ for facial pain due to cancer.

Five cancer patients underwent nucleus caudalis DREZ operations for medically refractory facial pain. Etiologies included a posterior fossa microglioma, a lacriminal gland carcinoma, a temporal meningioma, a parasellar tumor (craniopharyngioma), and an orbital fibrosarcoma. Postoperative results were graded as excellent (complete pain relief), good (pain decreased, activity not limited), fair (pain present, but less than before surgery, activity limited), and poor (pain same or worse than before surgery). Immediately following surgery, all patients reported good or excellent pain relief. On later followup (mean = 14.4 mo), three of our five patients reported a significant improvement in pain and level of activity. The remaining two patients reported that the pain was less than before surgery but that their activity was still limited because of the pain. We conclude that the nucleus caudalis DREZ operation is useful in treating medically refractory facial pain due to cancer. At this time, it appears that patients with burning pain, no hyperesthesias, and no previous neuroablative procedures have the better chance at a successful outcome.

Adult↗
PubMed1989

Traumatic extradural spinal cysts: a case report and review of the literature.

Extradural spinal cysts, although unusual, are well-documented entities. The majority are of congenital origin while only a few with a clear cut traumatic pathogenesis are reported. We present a case of a traumatic extradural spinal cyst which presented as a progressive radiculopathy following a penetrating injury. We also review the literature concerning traumatic extradural spinal cysts and show that they can occur following a wide variety of spinal trauma. The trauma must involve sufficient force to cause a dural rent and iatrogenic causes are included. The differences and similarities between traumatic and congenital cysts are shown, and treatment is discussed. The prognosis following surgical resection is shown to be excellent.

Adult↗
PubMed1988

Thalamic pain and stereotactic mesencephalotomy.

The severe pain that can be experienced by stroke patients is refractory both to drugs and to non-medical therapies. Various surgical procedures are widely advocated for its relief, stereotactic mesencephalic tractotomy in particular providing good results. Twenty seven patients with pain of central origin following stroke underwent stereotactic mesencephalic tractotomy by thermocoagulation at one of two alternative sites. Fourteen had lesions created at the original target adjacent to the superior colliculus, 75% reporting long term relief of their pain. Of this group, 83% had residual postoperative ocular dysfunction (50% symptomatic) and two died soon after surgery. Thirteen patients had surgery at the revised target at the level of the inferior colliculus: 58% had long term pain relief, 23% had ocular problems (none symptomatic) and mortality was nil.

Adult↗
PubMed1988

The deafferentation syndrome in the rat: effects of intraventricular apomorphine.

A deafferentation syndrome, produced in rats by dorsal root ganglionectomies, is expressed as scratching of partially deafferented limb areas and/or biting of anesthetic limb areas. This self-mutilation may be objective evidence of dysesthesias, thus serving as an experimental model to study chronic dysesthesias and/or pain from deafferentation in man. This study included behavioral observations of the syndrome and the effects of intraventricular apomorphine, a dopamine agonist, on its expression. Thirty-eight female Sprague-Dawley rats underwent unilateral C5-T2 dorsal root ganglionectomies followed immediately by stereotactically guided cannulation of the right lateral ventricle in 20 of the rats. For 2 weeks continuously via an osmotic minipump, 10 rats received apomorphine (5 micrograms/h) and 10 others received L-ascorbate (the vehicle). Rats with ganglionectomies only, as well as those receiving L-ascorbate, demonstrated early onset, more severe and later onset, less severe biting groups (P less than 0.05 Mann-Whitney U). Animals receiving apomorphine exhibited low autotomy scores irrespective of time of bite onset. Among the control groups, but not the experimental animals, the earlier the onset of biting, the more severe was the autotomy. The rats receiving vehicle via the minipump had earlier bite onsets than the rats in the ganglionectomy only group. This may indicate that the presence of the minipump is a stress which can accelerate the onset of biting. Intraventricular apomorphine can affect the deafferentation syndrome in the rat; it seems to decrease the level of autotomy and disrupt the relationship of bite onset with degree of biting.

Afferent Pathways↗