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PubMed2001

[Extended indications for decompression of the optic nerve: a differentiating analysis of restriction of the visual function, also in comatose patients].

BACKGROUND: The care of indirect traumatic optic neuropathy is still treated differently. Special diagnostic and therapeutic difficulties exist in comatose patients without definable visual acuity and in patients with complex failure of the visual field with central visual acuity still receiving sufficiently. METHOD: The total collective of optic nerve decompressions within the period between January 1992 and August 2000 was comprised of 66 patients. 18 of these 66 patients (average age: 40.5 years) were comatose and required critical care. 3 of the 48 consciousness-clear patients showed post-traumatically different defects of the visual field with a visual acuity of 0.3, 0.4 and 1.0. The indication for surgical decompression in both groups was based on the ophthalmological findings and the CT-finding of traumatization of the optic nerve, or the orbit apex respectively. RESULTS: During the subsequent postoperative examinations (on average 12.3 months postoperatively) five patients within the group of the unconscious patients showed a normal visual acuity (0.9-1.0), 3 patients a visual acuity of 0.7, 0.4 and 0.3 and one a visual acuity of 0.1. Six patients remained amaurotic. Three patients died from the general consequences of injury. Improvement of visual field and correction of stereoscopic function occurred in all patients, operated on primarily because of the described visual defects. CONCLUSIONS: Due to these results the indication for the decompression of the optic nerve should find special consideration in comatose patients and in cases of severe restriction of the visual field.

Accidental Falls↗
PubMed2002

Optic nerve decompression for orbitofrontal fibrous dysplasia.

Orbitofrontal fibrous dysplasia often involves the bony orbit and the optic canal. Although fibrous dysplasia reportedly produces compression of the optic nerve leading to visual distrubances, optic nerve decompression in patients without clinical signs of optic neuropathy is still controversial. We describe two patients with orbitofrontal fibrous dysplasia without signs of visual disturbance and one patient with McCune-Albright syndrome and progressive visual impairment. Optic nerve decompression was performed prophylactically for two patients and therapeutically for one patient through the transcranial extradural route. Dystopias and craniofacial deformities induced by fibrous dysplasia also were corrected. The micropressure suction-irrigation system was especially effective for decreasing heat transfer and thereby preventing thermal injury of the optic nerve. The orbitofrontal area was reconstructed from cranial bone, iliac bone, and ribs. Postoperative follow-up revealed no disturbances in visual function and no evidence of cerebrospinal fluid leakage. These findings suggest that optic nerve decompression may be effective in preventing visual disturbances with minimal risk of other neurological sequelae. Subsequent orbital reconstruction yielded satisfactory cosmetic results.

Case Reports↗
PubMed2004

Transcranial contrast imaging of cerebral perfusion in stroke patients following decompressive craniectomy.

AIM: Contrast-enhanced transcranial triggered B-mode technology can be used to examine cerebral perfusion. However, this technique is still faced with methodological problems, especially the difficulty of overcoming the temporal bone window. The aim of the present study is to evaluate a deficit in cerebral perfusion after administration of the contrast agent SonoVue (TM) in acute stroke patients following decompressive craniectomy. METHODS: Ten stroke patients (aged 39 to 59 years, mean age 57 years), in whom a decompressive craniectomy due to a malignant space-occupying infarction or intracerebral haemorrhage was performed, were examined with transcranial duplex sonography after application of the contrast agent SonoVue (TM). The transcranial examination was performed using transient response harmonic grey scale imaging with bolus kinetics based on a contrast harmonic imaging software with single-pulse transmission technology. The mechanical index was set at 1.0 to 1.1. Triggered images with pulsing intervals of 1000 ms were used for the evaluation of time intensity curves in several regions of interest. The sonographically imaged areas of hypoperfusion were compared with CT or MRI findings. RESULTS: After injection of the contrast agent, the perfusion deficit could be detected ipsilaterally according to the affected vascular territory in the area of the MCA in 5 patients, in the area of ACA and MCA in 2 patients, in the area of the MCA, ACA and PCA in one patient and in the area of intracranial haemorrhage in 2 patients. The calculated average peak images corresponded precisely with the superimposed CT or MRI images in shape and size in all patients. Additionally, it was possible to observe several interesting contrast-induced phenomena in the cerebral parenchyma, as well as specific transit-time curve characteristics in the perfusion deficit area. CONCLUSIONS: Using contrast-enhanced transcranial duplex sonography with transient response harmonic imaging, it is possible to depict the perfusion deficit in cerebral microcirculation in patients following decompressive craniectomy and to obtain new insights into the pathophysiology of the hypoperfusion areas. Further studies should be done in stroke patients through the intact skull to standardise this method for early diagnosis of acute deficit in cerebral perfusion.

Adult↗
PubMed1995

Percutaneous endoscopic gastrostomy as a decompressive technique in bowel obstruction due to abdominal carcinomatosis.

BACKGROUND AND STUDY AIMS: Percutaneous endoscopic gastrostomy (PEG) is a simple method of achieving nonsurgical gastric decompression in patients suffering from metastatic abdominal tumors and upper gastrointestinal tract obstruction. The aim of this prospective study was both to evaluate the efficacy of PEG for intestinal decompression in patients with disseminated abdominal cancer and to compare two catheters with different diameters. PATIENTS AND METHODS: Over a one-year period, 22 consecutive female patients (mean age 53.7, range 29-73) were referred to us and a PEG was successfully placed in 21. In four patients with unsatisfactory endoscopic trans-illumination of the anterior abdominal wall, an ultrasound unit was used to identify an adequate site for PEG placement. RESULTS: All patients experienced substantial symptomatic relief after a few days: vomiting and nausea completely resolved, and abdominal pain persisted in one patient only. No gastrostomy-related additional morbidity was noticed. We randomly inserted a 15-French or a 20-French tube: no statistically significant difference was noticed between the two in the symptomatic relief provided. CONCLUSIONS: Our data support the hypothesis that PEG is an effective, safe, and well-tolerated method of achieving gastric decompression in cancer patients; ultrasound guidance was an interesting option in positioning a tube in difficult situations; a standard nutritional tube, namely 15 or 20 French in diameter, may be large enough to obtain excellent clinical results.

Abdominal Neoplasms↗
PubMed1987

Rectoscopic decompression of acute recto-sigmoid obstruction.

Effective non-operative decompression of a low obstruction of the colon can sometimes be accomplished by inserting a tube into the rectum and threading the tip up to a point proximal to the obstruction (1). Failure of this non-surgical decompression would require emergency surgery--either a diverting colostomy or a two-stage resection. A new non-surgical treatment performed on a patient with an obstructive tumor of the recto-sigmoid is described. Decompression of the obstructed bowel was achieved with a rectal tube introduced over a flexible guide wire proximal to the obstruction with the aid of a rectoscope, following which a one-stage procedure--an anterior resection was performed in one patient, while the other was referred for oncological treatment.

Acute Disease↗
PubMed1991

[Endoscopically-controlled endonasal orbital decompression in malignant exophthalmos].

In 6 patients with endocrine ophthalmopathy, indications, surgical technique and results of the endoscopic controlled endonasal orbital decompression are described in comparison to the common surgical procedures. When medical and radiation therapy fail, indications for decompression are a) loss of visual acuity or visual field defects, b) increasing strabismus, c) severe keratopathy due to eyelid retraction. The endoscopic-controlled endonasal surgical decompression technique is proceeded in three steps. First, an endonasal ethmoidectomy with resection of the middle turbinate is performed and the medial wall of the maxillary sinus is widely opened. Second, the medial and inferior wall of the orbital walls are removed, preserving the infraorbital nerve. In the last step, the periorbital area is incised and the orbital fat herniates. The advantages of this procedure consist in the absence of exterior scars and the known morbidity of a Caldwell-Luc antrotomy. The results were documented by computed tomographic scans (CT), magnetic resonance imaging (MRI), Hertel measurements, evaluation of ocular motility and ophthalmoscopy. An average of 3-4 mm improvement in Hertel-measurements could be reached. All patients had a postoperative improvement of visual acuity. 2 patients developed more significant diplopia postoperatively, whereas in all other patients ocular motility either improved or rested unaffected. Therefore, the endoscopic controlled endonasal procedure allows to obtain comparable results to the common extranasal and transantral procedures without the disadvantages of the latter.

Aged↗
PubMedDate not supplied

[Significance of dorsal decompression and instrumentation in the treatment of spinal malignancies].

From 1986 to 1990 50 patients with increasing spinal instability due to pathologic fractures of one or more vertebrae were operated in the Orthopedic Department of Mainz University Hospital. In the course of 57 operations anterior decompression and stabilization were performed 3 times, whereas dorsal spondylodesis was done with Cotrel-Dubousset's instrumentation (CDI) 32 times, with Luque's 7 times and with Harrington's 1 time; a combination of CDI and Luque was chosen in 2 cases, a combination of Harrington and Luque in 1 case. 3 times a single-stage combination and 4 times a two-stage combination of ventral and dorsal stabilization was used. The application of the CDI required no postoperative external support. 35 patients suffered from major neurologic deficits preoperatively--among them 11 from a complete and 6 from an incomplete paraparesis--which made spinal cord decompression necessary in advance of the dorsal stabilization. Of these, 16 improved significantly; however, deterioration of the neurologic status occurred in 4 cases with a paraparesis in 3 of them. Survival time postoperatively was approximately 13 months in 27 patients. 9 of these died within half a year after the operative intervention. Failure of fixation as a result of tumor lesion was found in 2 cases of CDI procedure and in 1 case of the Harrington instrumentation. All required a revisional operation. 3 patients developed a radiologic lysis of methylmethacrylate implants fixed by an anterior procedure. Posterior decompression and stabilization render possible resolution of spine pain as well as restoration of mobility until a few days before exitus letalis without restricting adjuvant radio- or chemotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1990

[Primary optic nerve decompression in mid-face fractures].

In severe craniofacial-frontobasal injuries the optic nerve is quite often damaged. We report the findings and the visual outcome in 21 patients with severe mid-face fractures, who underwent primary optic nerve decompression after showing an afferent pupillary defect. During the subcranial exploration and the optic nerve decompression, fractures of the optic canal were found in 13 cases; a dislocated bone fragment could be removed in 6 patients. 9 eyes remained blind, but another 9 eyes regained good final visual acuity between 0.5 and 1.0. We conclude that fractures of the optic canal and dislocated bone fragments are often causes of optic nerve damage in mid-face injuries. The primary subcranial decompression of the optic nerve is a safe method to prevent secondary damage.

Adolescent↗
PubMed1991

Value of intraoperative brainstem auditory evoked potential monitoring in reducing the auditory morbidity associated with microvascular decompression of cranial nerves.

The present study was performed to determine whether the intraoperative monitoring of brainstem auditory evoked potentials (BAEPs) during microvascular decompression operations is effective in preventing profound hearing loss or deafness in the ipsilateral ear. The authors retrospectively compared the auditory morbidity of posterior fossa microvascular decompression surgery for the treatment of tic douloureux and hemifacial spasm before and after the introduction of routine intraoperative BAEP monitoring in 1984. Each patient underwent a similar procedure performed by the same surgeon. The two patient groups were comparable with regard to age, sex, and indications for surgery, Auditory morbidity did not decline with the increasing experience of the surgeon prior to 1984; 10 (6.6%) of 152 primary operations (151 patients) in which monitoring was not performed were followed by a profound ipsilateral hearing loss or deafness. In the monitored group, none of 109 operations (104 patients) caused profound hearing loss or deafness. This significant decline in auditory morbidity is attributed by the authors to the use of intraoperative BAEP monitoring, which allows the surgeon to alter the operation in response to degradations in the wave patterns. Based on our experience and that of others, we believe that intraoperative BAEP monitoring is of value in reducing the auditory morbidity of posterior fossa microvascular decompression surgery.

Journal Article↗
PubMed2006

Spontaneous bony orbital auto-decompression in thyroid ophthalmopathy.

Orbital 'auto-decompression' in TED (thyroid eye disease) is a well recognised phenomenon in older patients where lax orbital septa allow proptosis to decompress the orbit. Bony 'auto-decompression' in TED is a different entity which to the best of our knowledge has not been previously reported. We describe such a case which presented spontaneously, in the absence of trauma or bony pathology, and discuss possible causes.

Female↗
PubMed1997

Spinal cord decompression and stabilization in malignant lesions of the spine.

20 patients with neurologic deficit and pain from malignant spinal tumors (7 primary) underwent 28 decompression and stabilization procedures. Their mean age was 57 (30-74) years and 11 were women. Indications for stabilization were pathological spine fractures or a previous spinal decompression procedure. An anterior procedure was used in 2 patients with disease limited to 1 or 2 levels. A posterior procedure was used in 10 patients with widespread disease and unsatisfactory condition. Anteroposterior procedures in 1 or 2 stages were performed on 8 patients in satisfactory general condition with a malignant lesion at 1 or 2 levels and an unstable spine. Patients were submitted to radio- and/or chemotherapy postoperatively. Survival of patients treated for primary malignant tumors averaged 30 months and was 11 months for metastatic disease. 16 of the patients, especially those with nonmetastatic disease, had substantial relief of pain. Neurologic recovery was achieved in all of the anterior and combined anterior-posterior procedures and in 60% of the posterior decompressions. Complications included failure of the instrumentation in 2 cases, skin breakdown in another 2 and dislodgment of the autograft in 1.

Adult↗
PubMed2000

The effect of compression and decompression speed on the mechanical strength of compacts.

The purpose of this work was to investigate the effect of punch speed on the compaction properties of pharmaceutical powders; in particular, to separate out differences between the effect of the compression and decompression events. Tablets were prepared using an integrated compaction research system. Various "sawtooth" punch profiles were followed to compare the effects of different punch speeds on the crushing strength of the resulting tablets. The loading and unloading speeds were varied independently of one another. In general, when the compression speed was equal to the decompression speed, the tablet crushing strength was observed to decrease as the punch velocity increased. When the compression speed was greater than or less than the decompression speed, the results varied, depending on the material undergoing compaction. Reduction of the unloading speed from 300 to 10 mm/sec for pregelatinized starch and microcrystalline cellulose produced a significant increase in crushing strength, whereas no significant increase in crushing strength was observed until the loading speed was reduced to 10 mm/sec. Reduction of the unloading speed had a similar effect on the direct compression (DC) ibuprofen, however, even greater improvement in the crushing strength was observed when the loading speed was reduced. No improvement in the DC acetaminophen tablets was observed when the unloading speed was reduced, however, a significant increase in crushing strength was produced when the rate of loading was reduced. This work showed that the strength of tablets can be improved and some tableting problems such as capping can be minimized or prevented by modifying the rates of loading/unloading.

Powders↗
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↗
PubMed2001

Effect of preoperative biliary decompression on pancreaticoduodenectomy-associated morbidity in 300 consecutive patients.

OBJECTIVE: To examine the relationship between preoperative biliary drainage and the morbidity and mortality associated with pancreaticoduodenectomy. SUMMARY BACKGROUND DATA: Recent reports have suggested that preoperative biliary drainage increases the perioperative morbidity and mortality rates of pancreaticoduodenectomy. METHODS: Peri-operative morbidity and mortality were evaluated in 300 consecutive patients who underwent pancreaticoduodenectomy. Univariate and multivariate logistic regression analyses were done to evaluate the relationship between preoperative biliary decompression and the following end points: any complication, any major complication, infectious complications, intraabdominal abscess, pancreaticojejunal anastomotic leak, wound infection, and postoperative death. RESULTS: Preoperative prosthetic biliary drainage was performed in 172 patients (57%) (stent group), 35 patients (12%) underwent surgical biliary bypass performed during prereferral laparotomy, and the remaining 93 patients (31%) (no-stent group) did not undergo any form of preoperative biliary decompression. The overall surgical death rate was 1% (four patients); the number of deaths was too small for multivariate analysis. By multivariate logistic regression, no differences were found between the stent and no-stent groups in the incidence of all complications, major complications, infectious complications, intraabdominal abscess, or pancreaticojejunal anastomotic leak. Wound infections were more common in the stent group than the no-stent group. CONCLUSIONS: Preoperative biliary decompression increases the risk for postoperative wound infections after pancreaticoduodenectomy. However, there was no increase in the risk of major postoperative complications or death associated with preoperative stent placement. Patients with extrahepatic biliary obstruction do not necessarily require immediate laparotomy to undergo pancreaticoduodenectomy with acceptable morbidity and mortality rates; such patients can be treated by endoscopic biliary drainage without concern for increased major complications and death associated with subsequent pancreaticoduodenectomy.

Adolescent↗
PubMed1995

Optic nerve decompression in cranial base fibrous dysplasia.

Fibrous dysplasia of the anterior cranial base involves the bony orbit and optic canal. Although fibrous dysplasia is benign, it may produce a mass effect along the course of the optic nerve, inducing visual disturbances. Optic canal decompression in patients without clinical signs of optic neuropathy is controversial. We describe five patients with extensive fibrous dysplasia of the anterior cranial base involving the orbit and optic canal. These patients underwent transcranial optic canal decompression before signs of severe visual loss during correction of dystopias and craniofacial deformity induced by fibrous dysplasia. Cranial orbital reconstruction was performed by means of split rib and cranial bone grafts. Postoperative follow-up did not reveal disturbances in visual function, extraocular motility, or evidence of cerebrospinal fluid fistulas. This suggests that early, radical resection of orbital fibrous dysplasia with optic canal decompression may be effective in preventing visual loss with minimal risk of other neurological sequelae. Subsequent orbital reconstruction involving split-thickness rib and cranial bone grafting yields satisfactory cosmetic results.

Adolescent↗
PubMed1988

Medial entropion following orbital decompression for dysthyroid ophthalmopathy.

We found medial entropion of the lower eyelid to be common following orbital decompression for dysthyroid opthalmopathy. In our series significant postoperative medial entropion was noted in 14 of 69 patients, an incidence of 20%. Only four of these patients had entropion severe enough to require surgery (6%). Before orbital decompression, only one patient was found to have significant medial entropion (1.4%). Analysis of associated factors disclosed a positive relation between the amount of operative proptosis reduction and the degree of postoperative medial entropion. A strong correlation was also observed with the type of approach; transantral surgery was much more likely to be associated with significant postoperative medial entropion than was transconjunctival surgery. We suggest that the inferomedial displacement of the muscle cone that follows orbital decompression results in a force vector, transmitted through the lower eyelid retractors and capsulopalpebral ligament, that intorts the medial lower eyelid. Medial entropion in this setting often coexists with lower eyelid retraction, and if a "spacer" of sclera or ear cartilage is to be inserted into the lower eyelid, it should be carried into the medialmost portion of the eyelid to recess the posterior lamellae, including the medial retractors, and allow the eyelid margin to return to its normal anatomic position.

Entropion↗
PubMed1996

Core decompression for osteonecrosis of the femoral head.

A retrospective++ review of core decompression of the femoral head for treatment of osteonecrosis was done. Cause of osteonecrosis, radiographic stage and progression, complications, and clinical results were evaluated. The study was based on 54 hips in 45 patients (98.2% followup rate). All patients reported pain preoperatively. Thirty-five hips (30 patients) were considered to have failed. Of these, 26 hips (23 patients) underwent total hip arthroplasty. The remaining 9 hips (7 patients) had little or no relief of pain and no improvement in function, but had not undergone total hip arthroplasty at last followup. The average time to failure was 11.1 months (2-34 months). Nineteen hips (16 patients) were considered successful. Fifteen hips (12 patients) were graded good to excellent and 4 hips (4 patients) were graded fair in terms of clinical results with an average followup of 47.5 months (12.4-95.7 months). The mean preoperative Hospital for Special Surgery hip score improved from 24.6 points (range, 18-38 points) to 34.2 points (range, 20-40 points). There were 2 intertrochanteric femur fractures in this group (5 and 6 weeks postoperatively). The overall success rate of core decompression in this series was 35.2% (19 of 54 hips, 45 patients). The results of core decompression in this study were poor in general and had an unpredictable effect on disease progression.

Adolescent↗
PubMed1998

Radiographic predictors of outcome of core decompression for hips with osteonecrosis stage III.

Various investigators have studied the prognostic influence of various demographic, laboratory, and radiographic parameters on outcome for different treatment methods for osteonecrosis of the femoral head. A cross sectional study was done of 52 patients (68 hips) who had a core decompression for Ficat and Arlet Stage III osteonecrosis of the femoral head. The purpose of this study was to evaluate the prognostic significance of various radiographic factors for risk of disease progression after treatment with core decompression. Radiographic parameters included Steinberg stages (III or IV), Ohzono stage (central or lateral location), amount of head depression, extent of crescent sign arc, and extent of lesion by Kerboul combined necrotic angle measurements. Patient outcome assessment was at a followup mean of 12 years (range, 4-18 years) after core decompression. Overall, 20 of the 68 hips (29%) had satisfactory outcomes. Of the 44 hips with Steinberg Stage III disease, 18 (41%) underwent total hip arthroplasty. In comparison, in the Steinberg Stage IV hips, 22 of 24 hips (92%) underwent arthroplasty. Ohzono Stage B lesions had 50% survival (eight of 16 hips) compared with 23% survival (12 of 52 hips) for Ohzono Stage C. Hips with combined necrotic angles greater than 250 degrees had 16% survival (seven of 45) which can be compared with 57% survival (13 of 23) for hips with angles less than 250 degrees. The best multiple regression model for a satisfactory outcome was a Steinberg Stage III hip (no head depression), a central lesion (Ohzono Stage B), and a small lesion (< 250 degrees combined necrotic angle). With this combination, there were 89% satisfactory outcomes (8 of 9 hips). Conversely, the best generalized linear model for unsatisfactory outcomes (0 hips surviving of 14) was Steinberg Stage IV disease (head depression), lateral location (Ohzono Stage C lesion), and a large extent of the lesion (> 250 degrees combined necrotic angle).

Adult↗