Biomedical subjects

Ralph J Mobbs

Publications and source records attributed to Ralph J Mobbs.

8 recordsLinked to original sources

PubMed2006

Endoscope-assisted microvascular decompression for trigeminal neuralgia: technical case report.

OBJECTIVE: Microvascular decompression may fail to relieve trigeminal neuralgia because a compressing vessel at the root entry zone may be overlooked during surgery. Alternatively, effective decompression may not always be achieved with the visualization provided by the microscope alone. We theorized that the addition of an endoscope would improve the efficacy of microvascular decompression. METHODS: We retrospectively reviewed microvascular decompression of the trigeminal nerve in 114 patients. Before closure, the endoscope was used to inspect the root entry zone. When visualization with the microscope was poor, the endoscope was used to identify an aberrant vessel and to perform or improve the subsequent decompression. RESULTS: Of 114 patients who underwent microvascular decompression, 113 successfully underwent endoscopy. In 38 patients (33%), endoscopy revealed arteries that were poorly seen (25%) or not seen at all (8%) with the microscope. At a mean follow-up period of 29 months, the pain was completely relieved in 112 patients (99.1%), all of whom were off medication. Complications included trigeminal dysesthesias in nine patients and a wound infection, partial hearing loss, and complete hearing loss in one patient each. The overall complication rate was 9%. CONCLUSION: Endoscopy is a simple and safe adjunct to microscopic exploration of the trigeminal nerve. The markedly improved visualization increases the likelihood of identifying the offending vessel and consequently of achieving satisfactory decompression of the nerve. Thus far, the success rate has been high, and the complication profile is comparable to that of other large series.

Adult↗

PubMed2004

The importance of the journal club for neurosurgical trainees.

The enormous volume of published literature in the field of neurosurgery represents an impossible task for the trainee or consultant neurosurgeon to digest. The aim of this paper is to review the views of current accredited trainees as to how best achieve the goals of information acquisition in combination with a heavy clinical workload. The views of 22 accredited trainees in the field of neurosurgery in Australia and New Zealand are reviewed. The recommendations from this study are that journal clubs are paramount to neurosurgical training for acquisition of new information, the frequency of meetings should be monthly and papers discussed should be those that impact significantly on management and standard of care and be founded on evidence-based medicine criteria.

Clinical Competence↗

PubMed2003

Entrapment neuropathy of the ulnar nerve by a constriction band: the role of MRI.

The diagnosis of ulnar nerve entrapment at the elbow has relied primarily on clinical and electrodiagnostic findings. Magnetic resonance imaging (MRI) has been used in the evaluation of peripheral nerve entrapment disorders to document signal and configurational changes in nerves. In this case report we review the MRI and operative findings of a rare constriction band causing ulnar nerve compression at the elbow. We review the sensitivity and specificity in diagnosing ulnar nerve entrapment at the elbow as defined by MRI findings.

Elbow Joint↗

PubMed2003

Mesh electrode for peripheral nerve stimulation.

The implanted peripheral nerve stimulator has a role for pain relief in well-selected patients with pain in a peripheral nerve distribution. We describe an electrode to help simplify the surgical implantation of a peripheral nerve stimulator and also to reduce the possibility of electrode migration following implantation. Design details of the electrode are discussed, as are notes on surgical technique.

Electric Stimulation↗

PubMed2003

Death after late failure of endoscopic third ventriculostomy: a potential solution.

OBJECTIVE: Late failure after successful third ventriculostomy is rare, and death caused by failure of a previously successful third ventriculostomy has been reported on four occasions. We describe a simple innovation that adds little morbidity and has the potential to reduce the advent of death after late failure of endoscopic third ventriculostomy. METHODS: After endoscopic fenestration of the floor of the third ventricle, a ventricular catheter and subcutaneous reservoir are placed via the endoscope path. With acute blockage and neurological deterioration, cerebrospinal fluid can be removed via needle puncture of the reservoir until consultation with a neurosurgeon. RESULTS: From 1979 to 2003, more than 240 endoscopic third ventriculostomies have been performed at our institution, with one death after late failure. The revised technique was devised after this death and has been performed on 21 patients to date. CONCLUSION: The addition of a reservoir adds little time and morbidity to the procedure and offers the potential to sample cerebrospinal fluid, measure intracranial pressure, and reduce mortality associated with late failure of endoscopic third ventriculostomy.

Death↗

PubMed2002

Effect of cervical hard collar on intracranial pressure after head injury.

BACKGROUND: Patients suffering head trauma are at high risk of having a concomitant cervical spine injury. A rigid cervical collar is usually applied to each patient until spinal stability is confirmed. Hard collars potentially cause venous outflow obstruction and are a nociceptive stimulus, which might elevate intracranial pressure (ICP). This study tested the hypothesis that application of a hard collar is associated with an increase in ICP. METHODS: A prospective series of 10 head-injured patients with a postresuscitation Glasgow coma scale score of nine or less had ICP measurements before and after cervical hard collar application. RESULTS: Nine out of 10 patients had a rise in ICP following application of the collar. The difference in pre- and postapplication ICP was statistically significant (P < 0.05). CONCLUSIONS: Early assessment of the cervical spine in head-injured patients is recommended to minimize the risk of intracranial hypertension related to prolonged cervical spine immobilization with a hard collar.

Adolescent↗

PubMed2002

Endoscopic assisted posterior decompression for spinal neoplasms.

The authors describe a technique for anterior thoracic decompression via a posterolateral approach for spinal metastatic disease followed by anterior and posterior column stabilization. We discuss the benefits of decompression via a posterolateral approach including minimization of cord retraction, avoidance of thoracotomy, early mobilization and shorter hospital stay. Technical details are reviewed and difficulties of the approach discussed.

Decompression, Surgical↗

PubMed2002

The dangers of diagnostic laparoscopy in the head injured patient.

Pneumoperitoneum during laparoscopy has been known to result in a rise in intracranial pressure (ICP) in experimental studies. There are no reports of the effect of pneumoperitoneum during diagnostic laparoscopy in patients suffering closed head injuries. We present the case of a 39 year old male with a closed head injury. Diagnostic laparoscopy was performed while intracranial pressure was monitored. ICP increased from 9 mmHg to over 60 mmHg within 10 min of pneumoperitoneum. Laparoscopy was terminated and the ICP returned to normal levels within 35 min. The authors recommend that pneumoperitoneum laparoscopy should not be used in the trauma setting where head injury is suspected.

Accidents, Traffic↗