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PubMed1990

Circumspinal decompression for thoracic myelopathy due to combined ossification of the posterior longitudinal ligament and ligamentum flavum.

Ossification of the posterior longitudinal ligament (OPLL) combined with ossification of the ligamentum flavum (OLF) in the thoracic spine can result in serious myelopathy, leading to circumferential compression of the spinal cord in advanced stages of the disease. The authors performed circumspinal decompression (circumferential decompression of the spinal cord) on these patients. This operation consists of two steps: posterior and lateral decompression of the spinal cord by removal of the OLF (first step) and anterior removal of the OPLL for anterior decompression (second step), followed by interbody fusion. In the first step, two deep parallel gutters, covering the extent of the OPLL to be removed anteriorly, are drilled down from the rear into the vertebral body along both sides of the dura to easily and safely remove the OPLL anteriorly at the second step. In the second step, the surgical approach varies according to the affected level; costotransversectomy in the upper thoracic spine and standard thoracotomy in the middle or lower thoracic spine. According to the authors, circumspinal decompression is not an easy procedure, but from their results in 10 patients, they identify it as a radical and promising surgical procedure.

Adult↗
PubMed1992

Neurologic recovery associated with anterior decompression of spine fractures at the thoracolumbar junction (T12-L1).

Between 1981 and 1990, twenty-two patients with incomplete neurologic deficits after thoracolumbar junction fractures were treated by anterior decompression and stabilization. Two patients were unavailable for follow-up examination, eleven underwent spinal canal decompression within 48 hours of injury (Group A); and nine patients underwent surgical decompression in an average of 61 days after injury (Group B). Neurologic recovery was analyzed by a modified Frankel grading system, the ASIA motor point scale and conus medullaris function. Patients were followed for an average of 3.5 years (range, 6-92 months). No patients had any deterioration in neurologic function after surgery. Patients in Group A had a modified Frankel grade improvement with a median of two grades and a mean American Spine Injury Association motor point improvement of 21.1 +/- 4.1. Four of nine patients with conus medullaris deficits demonstrated complete functional bladder and bowel return postoperatively. Those patients in Group B had a modified Frankel grade improvement with a median of one grade and a mean ASIA motor point improvement of 7.6 +/- 1.7. None of the six patients with conus medullaris injuries showed complete improvement in bladder or bowel function postoperatively. The modified Frankel grade and ASIA motor point score improvements were significant when the two groups were compared (P less than 0.04 and P less than 0.01, respectively). In this series of patients, early anterior decompression for traumatic injuries at the thoracolumbar junction was associated with improved rates of neurologic recovery when compared to late decompression.

Adolescent↗
PubMed1996

Indirect spinal canal decompression in burst fractures treated with pedicle screw instrumentation.

STUDY DESIGN: Prospective evaluation of spinal canal areas in 67 consecutive burst fractures between T12 and L2 treated by reduction and stabilization with a pedicle fixator. OBJECTIVES: Assessment of the efficacy of "indirect" spinal canal decompression in a large series of burst fractures. SUMMARY OF BACKGROUND DATA: Up to 50% of burst fractures cause neurologic impairment. Reduction and posterior instrumentation is the most common surgical treatment. This also reduces spinal canal encroachment by indirect decompression. No consensus exists as to the consistency and adequacy of such indirect decompression. METHODS: Spinal canal areas were measured on preoperative and postoperative computed tomography scans. The degree of encroachment was compared with clinical and radiographic variables for possible correlation. RESULTS: Spinal canal encroachment was more severe among patients with neurologic deficits than among the neurologically intact. Postoperatively, mean encroachment was reduced from 35% to 12% at T12, from 37% to 17% at L1, and from 52% to 35% at L2. Loss (and postoperative restoration) of anterior vertebral height correlated best with the degree of canal encroachment (and its reduction), especially in Denis Type A burst fractures. In Denis Type B fractures, canal compromise usually was less severe and fragment reduction better in patients older than 40 years of age than in younger patients. CONCLUSIONS: Indirect decompression in burst fractures averages about half of the preexisting encroachment. Results are usually better at T12 and L1 than at L2. Additional or secondary decompression is rarely indicated if these fractures are treated early and by experienced surgeons. Burst Type B fractures in patients older versus younger than 40 years of age differ in many respects.

Adult↗
PubMed1997

Anterior decompression of foraminal stenosis below a lumbosacral transitional vertebra. A case report.

STUDY DESIGN: A case of unilateral far-out foraminal entrapment of the L5 spinal nerve below a transitional vertebra is presented with a review of the literature. OBJECTIVES: To describe management of a rare far-out foraminal stenosis below a transitional vertebra and to evaluate the surgical procedure and results. SUMMARY OF BACKGROUND DATA: Far-out foraminal stenosis with radiculopathy caused by bony spur formation secondary to anomalous articulation between the transverse process and the sacral ala is rarely reported. Decompression at this point traditionally has been performed through a posterior approach, similar to that performed for the far-out syndrome. There are no previous reports describing anterior decompression through an extraperitoneal approach. METHODS: The diagnosis was confirmed by computed tomography, magnetic resonance imaging, and selective radiculography. Anterior decompression was performed by resecting the bony spur using a wide muscle-splitting extraperitoneal approach. RESULTS: Anterior decompression was performed with minimal intervention to the spine and the trunk muscles. Good relief of low back pain and sciatica was obtained. CONCLUSIONS: Selective radiculography was the method of examination with the optimal diagnostic value for far-out foraminal stenosis. An anterior approach to the decompression of far-out foraminal stenosis below a lumbosacral transitional vertebra is a relatively simple and effective method.

Adult↗
PubMed2002

Rupture of the cell envelope by decompression of the deep-sea methanogen Methanococcus jannaschii.

The effect of decompression on the structure of Methanococcus jannaschii, an extremely thermophilic deep-sea methanogen, was studied in a novel high-pressure, high-temperature bioreactor. The cell envelope of M. jannaschii appeared to rupture upon rapid decompression (ca. 1 s) from 260 atm of hyperbaric pressure. When decompression from 260 atm was performed over 5 min, the proportion of ruptured cells decreased significantly. In contrast to the effect produced by decompression from hyperbaric pressure, decompression from a hydrostatic pressure of 260 atm did not induce cell lysis.

Bacteriolysis↗
PubMed1993

Colonic pseudo-obstruction: decompression with a tricomponent coaxial system under fluoroscopic guidance.

A tricomponent coaxial system (TAS) suitable for colonic decompression with fluoroscopic guidance is described. The TAS was successfully used in four of four patients, two with acute pseudo-obstruction, one with sigmoid volvulus, and one with recurrent colonic pseudo-obstruction. All patients had acute abdominal distention with cecal diameter of at least 12 cm, and nonsurgical management was unsuccessful. Complete colonic decompression was observed in all four patients, with no recurrence in three of three patients after removal of the decompression catheter. The decompression catheter was left in place in one patient for her comfort until she died of hepatic failure 4 days later. There was no associated colonic bleeding or perforation in any of the four cases. The procedure lasted approximately 20-90 minutes. The TAS promises to be a useful and inexpensive tool with which to perform colonic decompression in selected patients.

Adolescent↗
PubMed1994

Probabilistic model of altitude decompression sickness based on mechanistic premises.

To develop a predictive equation and to test ideas about the mechanisms involved in hypobaric decompression sickness, we performed statistical analyses on published results of 7,023 exercising O2-breathing men subjected to one-step decompressions in altitude chambers. The dependent variable was signs or symptoms so severe that the person's trial was terminated (forced descent). The three independent variables were 1) duration of 100% O2 breathing at ground level (prebreathing), 2) atmospheric pressure after ascent, and 3) exposure duration. The best model, chosen from trial-and-error combinations of premises about bubble behavior, indicates that decompression sickness outcome depends on 1) prebreathing time, but with an unexpectedly long washout half time for N2; 2) time at altitude, as if bubbles grow; and 3) the estimated difference, raised to the fifth power, between the partial pressure of N2 in tissue before and that in bubbles after decompression, perhaps an index of the number of bubbles generated. We expect the model to provide accurate predictions for decompressions matching those of the bulk of the data; the mechanistic cues should be considered hypotheses for further investigation.

Altitude Sickness↗
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↗
PubMedDate not supplied

Esophagogastric decompression and enteral feeding following cholecystectomy: a controlled, randomized prospective trial.

One hundred fourteen patients scheduled to undergo elective cholecystectomy were prospectively randomized into one of four treatment groups to study the potential benefits of esophagogastric decompression with and without immediate postoperative enteral nutrition. Group I was the control, and patients received only iv fluids and were allowed to eat as tolerated. Group II patients received iv fluids and esophagogastric decompression. Group III patients received esophagogastric decompression and enteral sterile water through the duodenal feeding lumen. Group IV patients received esophagogastric decompression and infusion of an elemental diet through the feeding lumen. The surgical techniques were standardized for all patients. The results of the study indicated no statistically or clinically significant differences among any of the treatment groups regarding; (1) need for parenteral analgesics or antiemetics, (2) tolerance of regular diet, (3) postoperative day of discharge, and (4) postoperative day that other discharge criteria were met. It is concluded that there is no objective benefit to the routine use of esophagogastric decompression with or without enteral nutrition in elective cholecystectomy patients.

Cholecystectomy↗
PubMedDate not supplied

Decompression of the facial nerve in Bell's palsy: a historical review.

This year, 1981, is the 50th anniversary of facial nerve decompression for Bell's palsy. The procedure was first suggested in 1923 but not performed until 1931. From the start, facial nerve decompression has generated disagreement regarding the indication and timing for surgical treatment and the anatomic extent of decompression. In each decade as the postonset time within which to perform surgical intervention has decreased, the anatomic extent of decompression has increased. Otologists continue to disagree, and we need to reevaluate our past and analyze how the difference may be resolved in the future. This critical review, in chronologic order, of the history and present status of facial nerve decompression is the necessary first step in resolving some of the persistent problems in surgical management of patients with Bell's palsy.

Facial Nerve↗
PubMed1989

Total facial nerve decompression for recurrent facial paralysis: an update.

Recurrent facial paralysis (RFP) is a rare disorder that in some individuals may lead to worsening sequelae. Melkersson-Rosenthal syndrome is a variant of RFP that is associated with recurrent facial edema. In the past, decompression of the mastoid segment of the facial nerve has not been successful in preventing recurrences. In 1981 we began performing total facial nerve decompression for RFP and in 1986 reported its efficacy in one patient with Melkersson-Rosenthal syndrome and in another in whom both nerves were decompressed for alternating bilateral paralysis. An additional four cases with 3 to 8 years of followup demonstrate no recurrences in any patient. Total facial nerve decompression for RFP in selected patients appears efficacious in preventing recurrences. Decompression will remain investigational until further followup is obtained. Furthermore, its salutary effect should not be extrapolated to Bell's palsy without further study.

Adolescent↗
PubMed2003

Early decompressive craniectomy and duraplasty for refractory intracranial hypertension in children: results of a pilot study.

INTRODUCTION: Severe traumatic brain injury (TBI) in childhood is associated with a high mortality and morbidity. Decompressive craniectomy has regained therapeutic interest during past years; however, treatment guidelines consider it a last resort treatment strategy for use only after failure of conservative therapy. PATIENTS: We report on the clinical course of six children treated with decompressive craniectomy after TBI at a pediatric intensive care unit. The standard protocol of intensive care treatment included continuous intracranial pressure (ICP) monitoring, sedation and muscle relaxation, normothermia, mild hyperventilation and catecholamines to maintain an adequate cerebral perfusion pressure. Decompressive craniectomy including dura opening was initiated in cases of a sustained increase in ICP > 20 mmHg for > 30 min despite maximally intensified conservative therapy (optimized sedation and ventilation, barbiturates or mannitol). RESULTS: In all cases, the ICP normalized immediately after craniectomy. At discharge, three children were without disability, two children had a mild arm-focused hemiparesis (one with a verbal impairment), and one child had a spastic hemiparesis and verbal impairment. This spastic hemiparesis improved within 6 months follow-up (no motor deficit, increased muscle tone), and all others remained unchanged. CONCLUSION: These observational pilot data indicate feasibility and efficacy of decompressive craniectomy in malignant ICP rise secondary to TBI. Further controlled trials are necessary to evaluate the indication and standardization of early decompressive craniectomy as a 'second tier' standard therapy in pediatric severe head injury.

Brain Injuries↗
PubMed1979

Enhancement of experimental cerebral edema after decompressive craniectomy: implications for the management of severe head injuries.

Decompressive craniectomy has been advocated as a treatment for the cerebral edema associated with massive head injury. Although craniectomy has been successful in lowering intracranial pressure after head injury, a comparison of computerized tomographic scans of comparable patients with traumatic brain edema treated by medical means or decompressive craniectomy showed that bony decompression resulted in apparent exacerbation of edema. To investigate the possibility of enhancement of brain edema by craniectomy, we produced standardized cold lesions in the brains of 10 dogs. Five animals served as controls. In the other 5 animals we performed large decompressive craniectomies after lesioning. Physiological parameters were comparable in both groups. The dogs were killed 8 hours after lesioning. After fixation, their brains were cut into 1-mm-thick slices. We used an image analysis facility built around a PDP 11/105 computer to measure the volume of edema as outlined by Evans blue staining. The mean volume of the brain edema in the control animals was 0.27 +/- 0.19 ml. Mean edema volume was over 7 times greater in craniectomized animals (1.96 +/- 1.89 ml). This difference is statistically significant (p less than 0.05). The driving force for the formation of edema fluid is the difference between intravascular and interstitial presssure. Decompression of the brain by bone removal probably results in a reduction of interstitial fluid pressure and edema enhancement. The clinical literature contains no evidence that craniectomy decreases the morbidity or mortality of human head injury. In view of our experimental findings, this is not surprising. Indeed, pathological evidence indicates that severe edema (such as that accentuated by craniectomy) may produce permanent changes in the neuropil.

Animals↗
PubMed1982

Simple decompression and occasional microsurgical epineurolysis under local anesthesia as treatment for ulnar neuropathy at the elbow.

Decompression of the ulnar nerve in the cubital tunnel will reverse ulnar neuropathy at the elbow in most patients. We believe that operating under local anesthesia has allowed us to identify those few patients who will not respond to simple decompressive surgery. Among the 20 cases of ulnar neuropathy managed in this fashion, intraoperative motor-sensory improvement occurred after simple decompressive surgery in 16. Four patients who failed to improve after cubital tunnel decompression underwent microsurgical epineurolysis immediately thereafter, under the same local anesthetic, with prompt improvement. Local anesthesia and microsurgical epineurolysis seem to be useful adjuncts to simple decompressive surgery for ulnar neuropathy.

Female↗
PubMed1988

Role of subtemporal decompression in severe closed head injury.

There is general agreement that aggressive management and monitoring of the patient with closed head injury with control of intracranial pressure (ICP) will improve patient survival and eventual outcome. Conversely, there is little agreement on the value of surgical craniectomy for increasing intracranial volume and subsequently decreasing ICP in these same patients. This study examines 115 patients with severe closed head injuries (Glasgow Coma Score 8 or less) seen at the North Carolina Baptist Hospital between July 1, 1983, and April 1, 1987. All 115 patients were started on a regimen of head elevation, fluid restriction, chemoparalysis, and hyperventilation at PCO2 25-30 torr. Fifty-seven patients failed to respond to that therapy and were given mannitol. Twenty-seven of these still failed to respond; 24 were placed in a pentobarbital coma therapy group and 3 underwent subtemporal decompression. Of the 24 patients in pentobarbital coma, 17 failed to respond, 7 of whom underwent subtemporal decompression and 10 of whom were not operated on. Of all 10 patients undergoing subtemporal decompression, 7 (70%) responded with an average reduction in ICP of 34% (+/- 19.5% SD). Of the 10, 4 died (40%), in contrast with a mortality of 82.4% among patients in pentobarbital coma without subtemporal decompression. These data strongly suggest that subtemporal decompression can be beneficial in patients with medically intractable elevations of ICP.

Adolescent↗
PubMed1994

Repeat operations in failed microvascular decompression for trigeminal neuralgia.

For the study of pathogenesis and treatment of recurrent trigeminal neuralgia, we performed 31 repeat operations from among 400 patients with trigeminal neuralgia in the past 10 years. Initially, of these 400 patients, 376 underwent microvascular decompression only, and 24 underwent partial sensory rhizotomy with or without microvascular decompression. Fifty-three patients (14%) had recurrences after microvascular decompression, of which 31 patients underwent repeat operations. Among the repeat operations, there was negative exploration in 16 patients (52%), arterial loop compression in 7 (22%), venous compression in 4 (13%), and Teflon compression or adhesion in 4 (13%). Twenty-one patients had early recurrences within 1 year, and 10 patients had late recurrences. Negative exploration and arterial compression were more likely in early recurrence (P = 0.01). Continuing demyelination might occur in patients with negative exploration, even when adequate decompression had been initially performed. Seventy percent of the patients had no recurring pain by way of partial sensory rhizotomy for negative explorations, redecompression of arterial loops, division of offending veins, or lysis and reposition of Teflon. About half of the patients had positive findings that were amenable without rhizotomy in the repeat operations. A repeat operation for failed microvascular decompression is a good choice if the condition of the patient is tolerant.

Arteries↗
PubMed1990

Optic nerve decompression via the lateral facial approach.

Two cases of visual loss after lateral orbital wall fracture are presented: one with retrobulbar hematoma and evidence of optic nerve compression who failed to respond to lateral canthotomy and high-dose corticosteroid administration, and the second with immediate, total blindness associated with fracture of the bony optic canal. In both, extradural decompression of the orbit and optic nerve was achieved through the lateral facial approach with partial return of visual acuity and without surgical complications. The role of orbital and optic nerve decompression in the management of patients with blindness following orbital trauma is controversial. Orbital decompression may be of value for cases of post-traumatic visual loss unresponsive to medical management. If optic nerve injury is suspected as the cause, the additional step of decompression of the optic nerve is a logical but unproven procedure. The indications for optic nerve decompression are not established and should be considered only within the context of the specific needs of the individual patient.

Adult↗
PubMed1993

Use of the holmium: yttrium aluminum garnet (Ho:YAG) laser for cranial nerve decompression: an in vivo study using the rabbit model.

A study was designed to evaluate the utility and safety of the holmium:yttrium aluminum garnet (Ho:YAG) laser for precise bony decompression of neural canals. In vivo rabbit studies were performed to measure temperature changes and nerve degeneration which occurred when the facial canal was decompressed with the laser as compared to the diamond burr. Marked temperature elevations were noted with the laser (n = 4), but not with the burr (n = 4). Seven of nine nerves decompressed with the laser revealed moderate to severe degeneration, whereas two control nerves decompressed with the drill demonstrated only minimal degeneration. It is concluded that this laser should not be used for nerve decompression unless better control of temperature elevation can be achieved.

Animals↗