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PubMed1992

Myokymic discharges: prompt cessation following nerve root decompression during spine surgery.

In surgical cases during which spine nerve roots are at risk, we have found it useful to monitor EMG from the muscles supplied by those roots. Mechanical irritation of a root results in muscle activity, whose amplified signals can be broadcast over a loudspeaker, providing immediate feedback to the surgeon that the root is being irritated. We report here on a patient undergoing spinal canal decompression and fusion following a burst fracture of the L5 vertebral body sustained five days previously. EMG was continuously monitored from the tibialis anterior (TA) and medial gastrocnemius (MG) muscle groups bilaterally. During the period leading up to decompression, myokymic discharges from the left TA muscle were observed, whereas the other 3 muscles monitored did not show such activity. These semi-rhythmic and repetitive discharges from the left TA ceased immediately following surgical removal of a bone fragment compressing the left L5 nerve root. This indicates that the site of axonal irritation was the nerve root, and that myokymic discharges secondary to acute axonal compression can cease immediately upon nerve root decompression.

Action Potentials↗
PubMed1992

Visual improvement after transethmoid-sphenoid decompression in optic nerve injuries.

Transethmoid-sphenoid decompression has been performed on 11 patients with indirect optic nerve injury. Visual improvement occurred in 8 patients, including 4 patients with initial total blindness. Optic neuropathy improved even when there was a long interval, up to 92 days, between trauma and decompression. There is still controversy about the treatment of traumatic optic neuropathy. Our results suggest that surgery can be helpful in the management of this condition. Transethmoid-sphenoid optic nerve decompression is a minimally invasive procedure that gave, in this series, satisfactory results with low morbidity.

Adolescent↗
PubMed1992

Prospective comparison of partial versus total portal decompression for bleeding esophageal varices.

Eighty-six patients underwent portacaval shunt (PCS) to treat bleeding esophagogastric varices during a period of four years. Twenty-eight patients (group 1) underwent emergency total portal decompression, while 58 patients (group 2) underwent elective partial PCS. Age, gender, preshunt and postshunt alcohol consumption and modified Child-Pugh classification at the time of operation, and at latest follow-up evaluation, did not differ significantly between the two groups. Early mortality was higher after emergency shunts than after elective operation (p < 0.01). However, partial portal decompression, when compared with total shunt, resulted in a significantly lower likelihood of late mortality (13 versus 39 percent) (p < 0.05), as well as portasystemic encephalopathy (8 versus 56 percent) (p < 0.0005). All shunts remained patent postoperatively and no patient had variceal rebleeding during follow-up evaluation averaging 2.2 years. Duplex sonography demonstrated hepatofugal portal flow in all patients in both groups. The results of the current study suggest that partial portal decompression is technically feasible, prevents further variceal hemorrhage and confers significant protection against late mortality and the development of postshunt neuropsychologic dysfunction.

Adult↗
PubMed1992

Movement study following anterior cervical decompression without fusion.

Movement studies of the neck have shown that certain patients with cervical spondylotic myelopathy (CSM) demonstrate instability in the vertebral joint immediately above the posterior osteophytic bar. While Cloward's anterior cervical decompression with fusion eliminates the cord or root compressive element, it adds to the hypermobility of the adjoining vertebral segment. In an attempt to reduce the hypermobility or subluxation, anterior cervical decompression without fusion was carried out on a selected group of twenty-three patients with spondylotic cervical myelopathy in whom the cord compression was mainly at a single level. Follow-up cineradiographic studies of these cases demonstrated the continued preservation of the range of movement of the adjoining vertebral segments and in 30%, a return of normal functional mobility to the affected cervical intervertebral joint. The findings and results of anterior cervical decompression surgery to a single level are reported.

Adult↗
PubMed1992

[Intraoperative monitoring of facial electromyographic responses during neurovascular decompressive surgery for hemifacial spasm].

UNLABELLED: In this paper, we reported our experience of intraoperative facial electromyographic recordings obtained during microvascular decompression for hemifacial spasm. MATERIALS AND METHODS: Intraoperative electromyographic recordings from the mentalis muscle during stimulation of the temporal branch of the facial nerve has been attempted in 31 patients. No muscle relaxants were used except for those before intubation. Of 31 patients, 22 were female and 9 were male. The age on admission ranged from 31 to 60 years with a mean of 54 years. RESULTS: 1. Abnormal response appeared with a latency of about 10 msec after stimulation. This response disappeared in 30 out of 31 patients at the end of operation. In 4 patients, the abnormal response disappeared prior to decompression of the nerve. 2. 30 patients in whom the abnormal response disappeared were free of spasm immediately after surgery. Hemifacial spasm has been relieved in 28 patients with a follow up period of 6 months to 2 years and 7 months. The remaining two patients had mild spasm. The one patient in whom the abnormal response did not disappear had persistent hemifacial spasm. CONCLUSION: The authors think that intraoperative facial electromyographic recording is useful to identify the blood vessel that is causing the spasm and to ensure that decompression of the nerve has been accomplished.

Adult↗
PubMedDate not supplied

[The microsurgical decompression of the accessory nerve in spasmodic torticollis].

Microsurgical decompression of the accessory nerve was conducted in 10 patients with spasmodic torticollis (tonic and tonic-clonic forms). Compression of the roots of the accessory nerve of the posterior inferior cerebellar and the vertebral arteries was discovered. Decompression was accomplished by division of the arachnoid adhesions, anastomosis with sensory roots of C1 and C2, and placing a layer of muscular tissue between the nerve and the vessel. The results of treatment of spasmodic torticollis are analysed and the efficacy of neurovascular decompression is emphasized.

Accessory Nerve↗
PubMed2004

Role of percutaneous disc decompression using coblation in managing chronic discogenic low back pain: a prospective, observational study.

BACKGROUND: Percutaneous disc decompression using Coblation (Nucleoplasty trade mark) implements the principle of volumetric reduction to achieve disc decompression and reduce intradiscal pressure. Previous analyses have shown that Nucleoplasty achieves reduction in volume and intradiscal pressure with minimal damage to surrounding tissue in the treated disc. OBJECTIVE: To determine effectiveness of nucleoplasty in patients with discogenic back pain. STUDY DESIGN: A prospective, non-randomized, observational study. METHODS: Forty-seven patients presenting with predominant back pain undergoing treatment with the Nucleoplasty procedure using Coblation technology were included in this analysis. Patients were followed at 1 month, 3 months, 6 months, and 12 months after the procedure. A numeric pain scale of 0 to 10, percent pain relief, and improvement in functional status as determined on the basis of their ability to sit, stand, and walk. RESULTS: The proportion of patients who reported 50% or more pain relief was 80%, 74%, 63% and 53% at the 1, 3, 6 and 12 months follow-up time periods, respectively. Functional improvements were reported by 46% of patients for sitting ability, 41% for standing ability, and 49% for walking ability at 12 months. There were no complications observed due to the Nucleoplasty procedure. CONCLUSION: Nucleoplasty for disc decompression is one of the least-invasive techniques in the minimally invasive category, thus far exhibiting a very low incidence of complications. Although no long-term data are available, these preliminary results indicate that the Nucleoplasty procedure is a safe and moderately effective procedure for reducing pain in patients presenting with predominant discogenic low back pain associated with contained disc herniation.

Journal Article↗
PubMed1991

[Stapes decompression].

Footplate decompression, which has been described in Lyon in 1965, can be easily performed under local anesthesia. The surgical procedure consists of a 8/10 mm diameter stapedotomy followed by an obturation with spongel, gelfoam or a piece of thin fascia. The operation is not a labyrinthectomy or a sacculotomy but aims to decompress endolymphatic hydrops in Ménière's disease. It must be realised only in case of typical unilateral Ménière's disease with disabling vertigo and very poor residual hearing. More than two hundred cases have been operated on. Vertigo has been relieved in 90% of the operated cases, tinnitus less severe in 50% of cases and hearing sometimes worse but often unchanged. In patients suffering from a unilateral Ménière's disease with disabling vertigo and poor residual hearing, footplate decompression appears to be one of the most simple safe and effective surgical procedures.

Humans↗
PubMed1991

[Endonasal, endoscopic-microscopic control of the decompression of the optic nerve. An anatomic endoscopic presentation of the operation].

The indication for decompression of the optic nerve after indirect trauma is made both by the ophthalmologist and the ENT-surgeon. The ENT-surgeon usually reaches and decompresses the optic canal by a transethmoidal-transsphenoidal route. The majority of authors prefer the transfacial approach to the ethmoid including resection of the crossing plane comprising the frontal process of the maxilla, the ethmoid, the lacrimal and the frontal bone. Hitherto we have knowledge of only one author utilising an endonasal approach to decompress the optic nerve. At the university hospital of Göttingen, the ENT-surgeons gathered experience with the endonasal, endoscopically and microscopically controlled operation method, which is less traumatic to the patient and avoids postoperative mucoceles of the frontal sinus. This surgical procedure is described by surgical-anatomical specimens.

Endoscopes↗
PubMed1990

Does optic nerve injury require decompression?

Forty patients with indirect optic nerve injury were prospectively analysed. Ultimate outcome on conservative management were correlated to their visual evoked potential (VEP) finding and the need for optic nerve decompression was questioned. An associated indirect optic nerve injury was observed in 2% of all head injuries. Ethmoid fracture was recorded in 2 patients and optic canal fracture was recorded in one patient. CT scanning for optic canal and for the orbit revealed abnormality in none of these patients. All the patients were managed conservatively and received intravenous dexamethasone for 48 hours followed by oral prednisolone therapy. Optic nerve decompression was not undertaken. VEPs were present in 18 patients of whom 4 had normal VEPs. Twenty patients had visual improvement. Amongst the patients with positive VEPs 89% had visual improvement. It is concluded that VEP study may help in avoiding unnecessary decompression of the optic nerve.

Adolescent↗
PubMed1990

[Monitoring of auditory brainstem response (ABR) during microvascular decompression (MVD): results in 400 cases].

In recent years, microvascular decompression (MVD) has been well established as a definitive surgical procedure in the management of hemifacial spasm (HFS) and trigeminal neuralgia (TN). With careful microsurgical technique, MVD can be performed accurately without significant morbidity. However, some incidence of postoperative hearing disturbance has been reported as one the annoying complications. In order to avoid complications of the 8th nerve, we have been using intraoperative monitoring of auditory brainstem response (ABR) for the past 5 years. This report presents the results of ABR monitoring in our personal series of 400 MVD cases. Our clinical results consist of 225 HFS and 175 TN, who underwent recording of ABR before, during and after MVD, including audiometry before and after the operation. There are 107 males and 293 females with the age ranging between 22 and 79, averaging 55 years old. Under routine general endotracheal anesthesia, the patient was placed in a lateral position and a small retromastoid opening was made. Pieces of teflon tape and fibrin glue was used to transpose, reposition and fixate the offending vessels. We used CADWELL 5200 and recorded ABR with needle electrode and click sound averaging 1500 times. ABR recordings were performed on admission, at the beginning of the operation, during nerve decompression and wound closure and at the time of discharge. The interpeak latency of waves I-V and the wave V amplitude during nerve decompression or wound closure were compared with those on admission.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Clinical experiences with early colonoscopic decompression in acute pseudo-obstruction of the colon].

The prognosis of an acute colonic pseudoobstruction has improved significantly since the introduction of colonoscopic decompression. Our experience confirms this technique as a safe and effective therapy even for critically ill patients. In most of our cases several endoscopic decompressions were necessary before a lasting improvement of the clinical symptoms could be achieved. The additional use of new procinetic substances and the endoscopic placement of thick decompression tubes may reduce the number of endoscopic procedures necessary for each patient.

Acute Disease↗
PubMedDate not supplied

One-stage decompression and stabilization in the treatment of spinal tumors.

Nowadays, extradural vertebral neoplasms which compress the spinal cord are being diagnosed earlier and therefore laminectomy for decompression relieves many patients of their neurological deficits before permanent cord damage has set in. In addition, radiotherapy and oncological treatment have prolonged life expectancy as well as the quality of life in these patients. As the indications for surgery have grown, the problem of spinal instability resulting from direct involvement of the supporting structures of the spine or due to the surgical procedure per se, must be considered. Many of these patients would rapidly return to leading their normal activities if not confined to bed rest or uncomfortable orthopedic devices. The Authors present 9 patients with extradural vertebral lesions: 4 plasmacytomas, 3 metastatic carcinomas, 1 malignant lymphoma and 1 aggressive osteoblastoma treated by simultaneous decompression and stabilization of the spine. All patients showed remarkable improvement of neurological symptoms except in one case where massive pulmonary embolism caused death a few hours after surgery. This surgical treatment offers the advantages of performing wider and better decompressive maneuvers and, at the same time, assuring fast mobilization of the patient after surgery who is often in poor general conditions, thus reducing post-operative complications due to delayed physical therapy and bed confinement.

Adult↗
PubMedDate not supplied

[Decompression operations on the optic nerve in glaucoma].

The authors give theoretical grounds and experimental validation for surgery on the optic nerve to eliminate its atrophic changes in glaucoma. They suggest a technique of the direct intervention at the site of the optic disk, approaching it from the side of the eye cavity. A method for the optic nerve decompression at the site of its stem portion via an extraocular approach is suggested. Experimental studies have demonstrated the possibility of enlarging the volume of the optic nerve scleral canal by discission of its narrowest section, the scleral ring; this operation essentially decreases twisting and deformation of the nerve fibers and main vessels of the retina. Clinical results of decompression surgery in 32 patients with far-progressed glaucoma are analyzed. Improvement of the visual function and stabilization of the glaucomatous process were observed in all the patients both in the immediate and late postoperative periods. The retinal and optic nerve blood microcirculation were found to improve after the suggested decompression surgery.

Aged↗
PubMed1989

[Experimental study on the interruption of hepatic blood flow in obstructive jaundice, with special reference to the causes of death and prolonged jaundice after biliary decompression].

The purpose of this investigation was to elucidate the influence of interruption of the hepatic blood flow on survival and on prolonged jaundice after biliary decompression in dogs with obstructive jaundice. There were three experimental groups. Two or three weeks after inducing obstructive jaundice by ligation of the common bile duct with cholecystectomy, the hepatic artery (group A), portal vein (group B) or both (group C) were interrupted for various intervals, with antibiotics administration. Biliary decompression was simultaneously performed with choledochoduodenostomy. The one week survival rate after the interruption of hepatic blood flow was more than 60% at 2 and 1 hours in group A, 20 and 10 minutes in group B, 10 and 5 minutes in group C at two and three weeks after biliary obstruction, respectively. Necrosis more than 50% of the liver was observed in early death cases. Edema and stasis in the bile canaliculi were markedly observed histologically in survivors in groups A and C, accompanied with significant elevations of serum T. Bil and GPT. The changes were greater in cases with longer periods of jaundice. In obstructive jaundice, hepatic artery occlusion causes hepatic necrosis, in spite of antibiotics administration, and may induce prolonged jaundice after biliary decompression. As an indicator of the prognosis, the serum total bile acid value was useful.

Animals↗
PubMed1989

[Outcome of decompression operations in the treatment of Legg-Perthes disease].

The authors evaluate the results of 90 decompression operations in 68 patients with Perthes' disease at stages I-IV; the mean age of the children was 8.3 +/- 1.2 years and the follow-up period after the surgery was from 6 months to 10 years. Decompression operations made in the clinic have been protected by author's certificates No. 942712 and No. 1050672. The results were excellent and good in 87.8% and satisfactory in 12.2%. Decompression operations are substantiated from the pathogenetic viewpoint. They interrupt the pathologic process in the epiphysis, contribute to a rapid restoration of the femoral head, are characterized by low traumatism and may be performed simultaneously on both sides which precipitate the children's rehabilitation. The best results have been observed in the children aged 5 to 7 years and at stages I and II of the disease. The surgical treatment has allowed to reduce the terms of the treatment of the children 3 to 4-fold as compared with the conservative method.

Adolescent↗
PubMed1989

The significance of residual stenosis after decompression for lumbar spinal stenosis.

Thirty-one patients with degenerative or combined degenerative and developmental lumbar spinal stenosis diagnosed by myelography and at subsequent surgery were thoroughly examined by computed tomography (CT) to reveal the completeness of the decompression and its correlation with the outcome. Complete elimination of the stenosis was achieved in 10 cases (32%) of whom 9 (90%) showed improvement. Various combinations of residual stenosis (some type of stenosis of the lateral part of vertebral canal at the laminectomy sites and also central stenosis outside the laminectomy field) were observed in 21 cases (68%). Of these, 14 (67%) had nearly complete, subtotal decompression with minimal or some residual stenosis, 7 (33%) had only minor decompression of the most constricted part of the spinal canal with a considerable amount of residual stenosis. The latter groups showed improvement in 8 cases (57%) and 6 cases (86%), respectively. Three patients (10%) with increased postoperative symptoms had only minimal or some residual stenosis. The significance of these findings is discussed.

Female↗
PubMed1989

Surgical decompression for thoracic outlet syndrome.

Fifty consecutive surgical decompression operations for thoracic outlet syndrome (TOS) were performed in 43 patients over a 7-year period. Of these, 54% presented with neurological symptoms alone; the others complained of symptoms of vascular or combined origin. Operations for decompression consisted of excisions of 14 cervical ribs, 22 first ribs, and 14 soft tissue or fibrous bands. In six limbs, cervical sympathectomy was also performed for patients who had secondary Raynaud's phenomenon. Surgery resulted in complete relief of symptoms in 37 limbs (74%) and an improvement was achieved in another 10 (20%). In three limbs (6%) surgery gave no benefit. There was no mortality. Thoracic outlet decompression via the supraclavicular approach gave good results in 94% of the patients.

Female↗