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PubMed1999

Surgical decompression of the first part of vertebral artery for ischemic brainstem dysfunction.

BACKGROUND: Ischemic brainstem dysfunction can be caused by extrinsic compression or kinking of the proximal vertebral artery. This is a retrospective survey of operated patients comparing neurologic examinations done postoperatively with preoperative neurologic evaluation. No patient with arteriosclerotic obstruction of the proximal vertebral artery treated by endarterectomy is included in this series. METHODS: Over a 5 year period, 104 patients presented preoperatively with signs and symptoms of brainstem dysfunction, with negative computerized tomographic scans of the brain, and angiography which demonstrated radiographic findings compatible with impediment to and compromise of blood flow into the first part of the vertebral artery. All patients had surgical exploration of the proximal vertebral artery in the lower neck mainly under local infiltrative anesthesia. Extrinsic compression or kinking of the proximal vertebral artery was found in all patients and relieved by surgical decompression and arteriolysis. Thirty-eight (36%) of the 104 patients had staged bilateral vertebral artery decompression and arteriolysis. RESULTS: There was no operative mortality and only minimal morbidity in this series. Twenty four patients had postoperative aortic arch angiography which showed absence of any radiographic abnormalities seen preoperatively, and which further showed a more directly aligned flow path of the proximal vertebral artery with the subclavian artery. The one year postoperative results in the 104 patients were as follows: 71 (68%) had sustained partial restoration of lost neurologic function, 23 (22%) had no change in neurologic status, and 10 (10%) became worse in neurologic status. In the group of 71 patients who had sustained partial restoration of lost neurologic function for 1 year postoperatively, 19 patients were neurologically evaluated for from 16 to 20 years postoperatively and continued to exhibit sustained partial restoration of lost neurologic function over that time. CONCLUSIONS: A safe, effective surgical procedure that can be performed under local anesthesia, namely decompression and arteriolysis of the proximal vertebral artery, is available for the treatment of ischemic brainstem dysfunction caused by extrinsic compression or kinking of the proximal vertebral artery.

Adolescent↗
PubMed1997

[Drilling decompression of the proximal tibia for osteoarthritis of the knee].

OBJECTIVE: To investigate the effect of drilling decompression of the proximal tibia for the Osteoarthritis of the Knee. METHOD: The drilling decompression of the proximal tibia were performed in 21 patients (38 knees) of osteoarthritis with 99mTc-MDP scintingraphy and the intraosseous phlebography made pre-postoperatively. Knee function scores and scales were evaluated. RESULT: During 6-12 months follow-up, the preoperative score of the knee function was 18-48 (average 30.78) and the postoperative score was 61-96 (average 87.95); the rates of fair and good of knee scales rose from 5% preoperatively to 86.84% postoperatively. CONCLUSION: Drilling decompression of the proximal tibia is a simple, safe, less traumatic and effective method to relieve the pain and improve the function for the early osteroarthritis of knee, For late cases it is a method to relieve pain. 99mTc-MDP scintingraphy can be used as a method to diagnose the early stage of the osteoarthritis.

Adult↗
PubMed1999

[Cerebral blood flow (CBF) before and after cranioplasty performed during the chronic stage after decompressive craniectomy evaluated by xenon-enhanced computerized tomography (Xe-CT) CBF scanning].

Patients who undergo decompressive craniectomy for the purpose of prevention of cerebral herniation sometimes improve neurologically or increase activity of daily life after cranioplasty during the chronic stage. We studied the effect which cranioplasty at the chronic stage had on intracranial environment by means of xenon-enhanced computerized tomography (Xe-CT) CBF scanning. Eight patients underwent decompressive craniectomy at the acute stage and cranioplasty at the chronic stage was reviewed. Xe-CT CBF scanning was performed before and after cranioplasty. On the slice of the basal ganglia. CBF of the symptomatic hemisphere increased in five patients and CBF of the other hemisphere increased in three patients after cranioplasty. On the slice 20 mm above the basal ganglia, CBF of the symptomatic hemisphere increased in five patients and CBF of the other hemisphere increased in four patients after cranioplasty. Cranioplasty after decompressive craniectomy may increase CBF of not only the symptomatic hemisphere but also the other hemisphere.

Aged↗
PubMed1999

New techniques for surgical decompression of thyroid-related orbitopathy.

Certain cases of thyroid-related orbitopathy may require surgical decompression of the orbit. The purpose of this paper is to highlight new techniques of orbital decompression in thyroid-related orbitopathy. We present two illustrative cases selected from our recent surgical experience. The techniques of combined-approach decompression, transcaruncular approach to the medial orbital wall, drilling reduction of the greater wing of sphenoid and lateral wall lag-screw fixation after lateralization by greenstick fracture are presented. The relative utility of each technique is examined. These techniques expand the surgical repertoire for this condition and allow individualization of treatment for a specific patient's needs.

Adult↗
PubMed1999

Interlaminar decompression in lumbar canal stenosis.

Opinion is still divided over a standard surgical procedure to decompress lumbar canal stenosis. Both, laminectomy with or without facetectomy and foraminotomy and interlaminar fenestration have been advocated. In the present communication interlaminar decompression in lumbar canal stenosis has been discussed. Sixteen consecutive patients (7 males and 9 females) with clinical, neurological and radiological features of lumbar canal stenosis were treated by interlaminar (fenestration) decompression. The age of onset of symptoms ranged between 22-57 years. Adjoining lamina around interlaminar space of involved segment along with ligamentum flavum and part of facet joint (undercutting facetectomy), extending laterally (foraminotomy) were removed at single or multiple levels. Follow-up response (93.7%) over a period of two and half years showed the results as good in 73.3% and fair in 26.7% of cases, with uniformly uneventful post-operative period.

Adult↗
PubMed2000

[Electrophysiological mapping of the trigeminal nerve root during microvascular decompression for trigeminal neuralgia].

A method for intraoperative electrophysiological mapping of the intracranial root of the trigeminal nerve was studied in five patients with trigeminal neuralgia. During surgery, the trigeminal nerve root was stimulated centrally with a bipolar electrode, and antidromic responses were recorded peripherally from three branches of the trigeminal nerve in the face. In all patients, the fibers of the individual subdivisions of the trigeminal nerve root were successfully localized based on the peripheral sites of antidromic response. This neural mapping was used during microvascular decompression in four patients and during a rhizotomy procedure in one patient. As a result of mapping, the fibers of the trigeminal division subserving the pain were clearly confirmed to be compressed by the artery in all four patients who were undergoing microvascular decompression. Likewise, the antidromic responses precisely identified the first division of the trigeminal nerve, which should be preserved to avoid postoperative corneal ulcers in patients undergoing rhizotomy. Based on these findings, it was concluded that this technique enables surgeons to precisely identify which fibers of the trigeminal nerve root should be decompressed or divided during surgery for trigeminal neuralgia.

Aged↗
PubMed1999

[Decompression craniectomy--life-saving treatment in acute cerebral infarction].

Massive cerebral infarction is often accompanied by early death secondary to transtentorial herniation. Decompressive hemicraniectomy has been suggested as a lifesaving procedure. We report the case of a 61 year old man who had an acute infarction in the distribution area of the right middle cerebral artery. Initially, he was awake and suffered from total left-sided hemiparalysis. Over the next two days, his level of consciousness deteriorated to a Glasgow Coma Scale score of 5. Intracranial pressure (ICP) monitoring was then established. Three days later, the ICP increased from 20 to 40 mm Hg. We performed a right-sided decompressive hemicraniectomy, and the ICP was normalized immediately. Ten months after surgery the patient was at home and functioning with minimal assistance. He had moderate paresis of the left leg and was able to walk, but his left arm was paralytic. The presented case confirms that decompressive hemicraniectomy may prevent death and allow survival without severe disability in patients with massive cerebral infarction.

Acute Disease↗
PubMed2000

Effects of heterogeneous structure and diffusion permeability of body tissues on decompression gas bubble dynamics.

To gain insight into the special nature of gas bubbles that may form in astronauts, aviators and divers, we developed a mathematical model which describes the following: 1) the dynamics of extravascular bubbles formed in intercellular cavities of a hypothetical tissue undergoing decompression; and 2) the dynamics of nitrogen tension in a thin layer of intercellular fluid and in a thick layer of cells surrounding the bubbles. This model is based on the assumption that, due to limited cellular membrane permeability for gas, a value of effective nitrogen diffusivity in the massive layer of cells in the radial direction is essentially lower compared to conventionally accepted values of nitrogen diffusivity in water and body tissues. Due to rather high nitrogen diffusivity in intercellular fluid, a bubble formed just at completion of fast one-stage reduction of ambient pressure almost instantly grows to the size determined by the initial volume of the intercellular cavity, surface tension of the fluid, the initial nitrogen tension in the tissue, and the level of final pressure. The rate of further bubble growth and maximum bubble size depend on comparatively low effective nitrogen diffusivity in the cell layer, the tissue perfusion rate, the initial nitrogen tension in the tissue, and the final ambient pressure. The tissue deformation pressure performs its conservative action on bubble dynamics only in a limited volume of tissue (at a high density of formed bubbles). Our model is completely consistent with the available data concerning the random latency times to the onset of decompression sickness (DCS) symptoms associated with hypobaric decompressions simulating extravehicular activity. We believe that this model could be used as a theoretical basis for development of more adequate methods for the DCS risk prediction.

Atmospheric Pressure↗
PubMed2000

[Dynamic magnetic resonance tomography (MRI): a follow-up study after femur core decompression and instillation of recombinant human bone morphogenetic protein-2 (rhBMP-2) in avascular femur head necrosis].

OBJECT: The aim of the study was to test the use of dynamic magnetic resonance imaging study with Gd-DTPA-application and the dynamic changes of signal intensity at patients with avascular femoral head necrosis after having installed rhBMP-2 and/or decompressed the core. MATERIAL AND METHODS: Six patients with avascular necrosis of the femoral head ARCO-stage I- or II-lesions were treated surgically by femoral head core decompression. Three of these patients were additionally treated with rhBMP-2-instillation. The progression or regression could be confirmed by T1- and T2-weighted spinecho-sequences (zero, four, ten, sixteen weeks and 24 months follow up). RESULTS: Corresponding ARCO-classification with partly more sensitive measurement of vitality signs in comparison to the optical x-ray classification. The objective, quantitative measurement of signal intensity post contrast medium reduces the influence of experience and level of education. The dynamic sequences results are reproducible. CONCLUSION: The dynamic magnetic resonance imaging study after Gd-DTPA-application and the dynamic changes of signal intensity after Gd-DTPA enhancement in the necrotic areas of the femoral head were the important subject of our study and it seems, that these sequencies and the ascertainment of signal intensity changes will be an efficient method for judgement of vitality, vascularisation and perfusion after therapeutical intervention. Combination of femoral head core decompression and rhBMP-2-instillation for the purpose of osseous regeneration seems to stabilize the affection.

Adult↗
PubMed1999

[Severe decompression sickness in divers].

The term "decompression illness (DCI)" is a disorder which arises from the presence of ectopic gas bubbles following decompression. Scuba diving poses the risk of two typically clinical syndromes: decompression sickness (DCS) and arterial gas embolism (AGE). DCS results from the formation of gas bubbles in the tissues of the body and in the blood due to rapid reduction of the environmental pressure. AGE is caused by pulmonary overinflation if the breathing gas cannot be exhaled adequately during the ascent. Although the pathophysiological mechanisms of these two disorders are quite different, both of them lead to the same result: inert gas bubbles that may cause impairment of vital functions due to hypoxia. Recognizing the signs and symptoms of DCI is the first step of the therapy. The emergency treatment contains: basic life support, advanced life support--if necessary, horizontal positioning of the victim, administration of 100% normobaric oxygen via face mask or endotracheal tube, rehydration, rapid transportation to the nearest emergency department/hyperbaric facility for definitive treatment in order to prevent serious neurological sequelae.

Barotrauma↗
PubMed2000

Management of decompression sickness in Jordan.

This study, conducted at Princes Haya Hussein Hospital Hyperbaric Department, examined 23 cases (22 males, 1 female), diagnosed with decompression sickness (types I and II) and treated with hyperbaric therapy. The results showed 61% of dive accidents were decompression sickness type II; 26% of treated patients had residual symptoms after the first session of recompression treatment and 74% made a full recovery. There were no deaths and no complications were observed. The study concludes that decompression sickness type II is the most common type, found mainly in sports divers. Early recognition of symptoms and commencement of treatment lead to a much better outcome.

Adolescent↗
PubMed2001

The effect of exposure to 35,000 ft on incidence of altitude decompression sickness.

INTRODUCTION: Exposure to 35,000 ft without preoxygenation (breathing 100% oxygen prior to decompression) can result in severe decompression sickness (DCS). Exercise while decompressed increases the incidence and severity of symptoms. Clarification of the level of activity vs. time to symptom onset is needed to refine recommendations for current operations requiring 35,000-ft exposures. Currently, the U.S. Air Force limits these operations to 30 min following 75 min of preoxygenation. The objective of this study was to determine the effect of exercise intensity on DCS incidence and severity at 35,000 ft. METHODS: Following 75 or 90 min of ground-level preoxygenation, 54 male and 38 female subjects were exposed to 35,000 ft for 3 h while performing strenuous exercise, mild exercise, or seated rest. The subjects were monitored for venous gas emboli (VGE) with an echo-imaging system and observed for signs and symptoms of DCS. RESULTS: Exposures involving strenuous and mild exercise resulted in higher incidence (p < 0.05) and earlier onset of symptoms (p < 0.05) of DCS than exposure at rest. Mild and strenuous exercise during exposure did not differ in incidence or rate of onset. Incidence at 30 min of exposure was 8% at rest and 23% while exercising. CONCLUSION: The results showed that current guidelines for 35,000-ft exposures keep DCS risk below 10% at rest. Exercise, even at mild levels, greatly increases the incidence and rate of onset of DCS.

Aerospace Medicine↗
PubMedDate not supplied

[Follow up results and pathogenetic substantiation of the effect of decompression surgery on the optic nerve in glaucomatous optic neuropathy].

Retrospective analysis of the efficiency of optic nerve decompression in progressive glaucomatous optic neuropathy in patients with normalized intraocular pressure showed widening and/or stabilization of the visual field in remote periods (6-11 years) in 83.3% patients. Study of the hemodynamics after optic nerve decompression showed a significant improvement of the hemodynamic parameters in the orbital artery-central retinal artery system: increased bloodflow velocity in the central retinal artery, increase of ophthalmic blood pressure and perfusion pressure, dilatation of the arteries, and constriction of veins, which indicates improvement of hemoperfusion in the initial portion of the optic nerve and retina after decompression surgery on the optic nerve. Extension and stabilization of visual field correlated with positive changes in circulation.

Decompression, Surgical↗
PubMed2001

Facial nerve paralysis in temporal bone fractures: outcomes after late decompression surgery.

The aim of this paper was to address some of the unanswered questions regarding management of facial nerve paralysis in temporal bone fractures (TBF), such as the outcomes after late facial nerve decompression surgery. The study design was a retrospective review of a consecutive clinical series. Thirteen patients who underwent late decompression surgery for facial nerve paralysis due to TBF involving the perigeniculate ganglion region were analyzed. Patients were operated on 27-90 days after trauma. A transmastoid extralabyrinthine approach was used in all cases. Facial nerve-sheath slitting was performed routinely. Normal or subnormal facial nerve function (HB 1 or HB 2) was achieved in 7/9 cases (78%) evaluated at > or = 1 year after surgery. Good functional results were also obtained in two patients operated on 3 months after trauma. Bases on the outcomes observed in the present series, in patients unable to be operated on early, presenting 1 to 3 months with >95% denervation on EnoG, facial nerve decompression may have a beneficial effect.

Decompression, Surgical↗
PubMed2002

Rectus extraocular muscle paths and decompression surgery for Graves orbitopathy: mechanism of motility disturbances.

PURPOSE: To study possible causes of motility disturbances that may result from orbital decompression surgery in patients with Graves orbitopathy and especially the role of rectus extraocular muscle paths. METHODS: Sixteen patients with Graves orbitopathy were studied before and 3 to 6 months after translid (6 patients) and coronal (10 patients) orbital decompression surgery for disfiguring proptosis. Ocular motility changes were measured by comparing maximum ductions and severity of diplopia, and the positions and the displacements of the anterior rectus muscle paths were objectively measured using cine magnetic resonance imaging (MRI). RESULTS: Averaged preoperative rectus muscle path positions were not different from those in normal subjects. Averaged postoperative muscle path positions were generally the same as preoperative paths. The only significant exceptions were centrifugal (outward from the orbital axis) displacements of the inferior rectus (IR) muscle path after translid surgery, and of the medial rectus (MR) muscle path after coronal surgery. The amount of IR path displacement with translid surgery was directly correlated with range of depression and with severity of vertical diplopia. The amount of MR path displacement with coronal surgery was inversely correlated with range of abduction and directly correlated with severity of horizontal diplopia. CONCLUSIONS: The anterior orbital connective tissue seems to form a "functional skeleton" that is usually (except as noted for IR and MR) capable of keeping the rectus muscle paths aligned after decompression surgery and preserving the normal functions of rectus muscle pulleys. The centrifugal displacement of the IR and MR may increase the elastic component of the muscle force, leading to the specific patterns of motility disturbance that may occur in some patients after translid and coronal surgery. These findings suggest that standard surgical management of Graves orbitopathy should be supplemented.

Adolescent↗
PubMed2000

[Craniovertebral decompression and posterior fossa reconstruction treatment of Chiari syringomyelia complex].

OBJECTIVE: To study the results of Chiari malformation/syringomyelia (CM-SM) complex treated by craniovertebral decompression and posterior fossa reconstruction (PFR). METHODS: 37 patients of CM-SM complex were treated surgically from 1994 to 1999. All patients underwent craniovertebral decompression and posterior fossa reconstruction. The procedure consisted of suboccipital craniectomy and laminectomy of C1 (when necessary C2), exploration and plugging of the obex, and resection of arachnoid adherence. A wide dural graft was used to reconstruct the cisterna magna artificially. Syrinx shunt was not performed. RESULTS: Follow-up for 0.5 to 4.5 years showed that 31 patients (83.8%) had their symptoms improved, 5 (13.5%) stabilized, but 1 (2.7%) deteriorated. Magnetic resonance was used to evaluate the morphological results. The shrinkage of the syrinx, upward migration of the hindbrain, the formation of an artificial cisterna magna were observed. CONCLUSIONS: Craniovertebral decompression and posterior fossa reconstruction in restoring the craniovertebral junction are recommended in the treatment of CM-SM complex.

Adolescent↗
PubMed1998

[Microvascular decompression of pons for idiopathic hemifacial spasm and exploration of its mechanism].

OBJECTIVE: To further explore the cause, mechanism and surgical treatment of idiopathic hemifacial spasm (IHFS). METHODS: Routine sagittal and coronal cryoslices of 8 (16 sides) pons were made. The sections were stained with Luxol fast blue and Nissl stains. The location of the facial nucleus and pathway of facial neurofibers in the pons were observed. Twenty-five patients with IHFS whose facial nerve root exit zone(REZ) was not compressed by vessels underwent microvascular decompression of pons. RESULTS: The distances from the facial nucleus to the ventral surface of pons, the median line, and the ventroexterior surface were 12.0-12.5 mm, 6.0 mm, and 7.5-9.0 mm respectively. The distance from the facial neurofibers in the pons to the surface of the pons was 1.0 to 2.0 mm, with an average of 1.65 mm. The vascular compression was at the surface of pons, within 4 mm anterosuperior to the REZ in 25 IHFS patients. The compressing vessels were the anterior inferior cerebellar arteries and their branches. The results of decompression in 25 patients with IHFS were as follows: spasm immediately disappeared in 8 patients, and within one week in 17 patients. No recurrence was found during a follow-up period from 6 months to 5 years. CONCLUSION: The main cause of IHFS was vascular compression, but the position of compression is not necessarily always at the REZ. The "short-circuiting" theory can only explain the cases with vascular compression at the REZ. But in cases who do not have vascular compression at the REZ, there might be dysfunction of the facial nucleus. In the present cases, vascular compression was at the surface of the brain stem anterosuperior to the REZ, pons microvascular decompression is an effective treatment.

Adult↗
PubMed2002

[Acute carpal tunnel syndrome after distal radius fractures--long term results of surgical treatment with decompression and external fixator application].

Acute Carpal Tunnel Syndrome (ACTS) is a relatively rare sequel of distal fractures of the radius. This paper is an analysis of the causes of ACTS and of long-term results of treatment by surgical decompression combined with use of external fixators. Out of 128 patients with distal radius fractures treated in our department 11 cases required surgical treatment because of ACTS. Fractures were classified according to the AO classification as C2 and C3. CTSA was diagnosed basing on typical clinical signs: pain numbness over the radial three and a half fingers. All patients were treated surgically by reduction of the fracture, external fixation and decompression of the median nerve, all performed simultaneously. The results were assessed within 11 months (on average) postoperatively. It was found that ACTS depends on the severity of the fracture (comminuted, dislocated) and on method of treatment (local anaesthesia, multiple reductions, Cotton-Loder position). Long term results: pain was absent the two-point discrimination test was within norm, light sensation was within norm in 9 cases and slightly decreased in 2 cases. There were no positive Phalen tests and no Tinel signs. Grip strength raged from 17 to 120 kg (mean: 38 kg). According to Gartland-werley classification 5 excellent, 3 good, and 3 acceptable results were obtained. This indicates that early recognition and prompt treatment by surgical decompression and external fixation results in significant improvement of symptoms and prevents persistence of symptoms.

Acute Disease↗