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PubMed2002

[Acute low back pain with progressive sensorimotor paralysis. Differential diagnosis and therapy of acute decompression disease].

HISTORY AND CLINICAL FINDINGS: A 38-year-old man presented with acute low back pain and paraesthesia in dermatome S1. 4 hours before onset of symptoms he had finished the last of three scuba dives with a maximum depth of 30 m and a total diving time of 3 hours. No alcoholic beverages were taken during or before diving. The patient was complaining of local pain in the thoracic and lumbar spine and showed a 3/5 weakness of the big toe and impaired sensitivity in the S1 dermatome. 90 minutes later the patient developed a hemiparesis of the right side including hypaesthesia and additional meningism (stiff neck). INVESTIGATIONS: The X-rays of the thoracic and lumbar spine in two standard planes, cerebrospinal fluid examination, a cranial spiral-computer tomographie (CCT) and laboratory investigations showed no pathologic values. DIAGNOSIS: Acute decompression sickness (DCS) type II. TREATMENT AND COURSE: The patient received an intravenous infusion, antiinflammatory prophylaxis with dexamethasone and an immediate submission to hyperbaric oxygenation therapy. Complete recovery of neurological symptoms appeared after 4 decompression sessions in a hyperbaric chamber. CONCLUSIONS: In patients presenting low back pain as common symptoms the differential diagnosis needs to be worked out and DCS should be included especially if progressive neurologic deficits are present. Only emergency hyperbaric oxygen therapy can compromise a sufficient therapy of these patients.

Acute Disease↗
PubMed2004

[Unilateral decompressive craniectomy in left transverse and sigmoid sinus thrombosis].

Cerebral venous and dural sinus thrombosis is a rare cause of stroke. We explore the controversial issue of anticoagulation therapy and indication for decompressive craniectomy in association with severe sinus thrombosis. The 62-year-old female patient was admitted to hospital, because of first generalized seizure. A computed tomographic (CT) scan of the brain revealed a left occipital hemorrhage. Digital subtraction angiogram showing thrombosis of the left transverse and sigmoid sinus. An intravenously administered regimen of heparin was begun, because of a protein S deficiency. On the 6th day the patients level of consciousness deteriorated, necessitating intubation, hyperventilation, and mannitol. Repeat CT scan revealed increasing edema with midline shift and obliteration of the basal cisterns, although the hemorrhagic lesion was unchanged. The patient developed signs of diencephalic dysfunction. A large left temporoparietooccipital craniectomy was performed and the dura was opened. The multiloculated intraparenchymatous hemorrhage portion of the brain was not removed. In addition, the patient was treated postoperatively with heparin therapy for three months, than a regimen of phenprocoumon was begun. Twelve months later the hemianopsia had not improved and she had an incomplete Wernicke's dysphasia. When, despite adequate anticoagulation therapy and intensive care, neurological deterioration occurs in sigmoideus and/or transversus dural sinus thrombosis with unilateral edema, a decompressive craniectomy should be considered especially in young patients.

Anticoagulants↗
PubMed1998

Decompression induced venous gas emboli in sport diving: detection with 2D echocardiography and pulsed Doppler.

The aim of this study was to determine the utility of pulsed Doppler and 2D echocardiography for the detection and the quantification of circulating bubbles after decompression. Twenty-three sport divers performed 60 SCUBA dives (mean 32 msw). An evaluation of circulating bubbles was performed using 2D images one hour after diving. Circulating bubbles were also detected with pulsed Doppler. The sample volume was placed in the outflow area of the right ventricle 1-2 cm below the pulmonary valve. 2D echocardiography showed circulating bubbles in right cavities of the heart in 32 cases. Short axis parasternal view and right cavities long axis view were the best incidences. Pulsed Doppler confirmed the results in these 32 cases and detected circulating bubbles in seven other cases. Isometric contraction of muscle limb must be performed to increase the sensitivity of detection. The count of the bubbles may be evaluated when using a combination of Spencer's and Powell's grading. We conclude that 2D echocardiography is less accurate than pulsed Doppler in the detection of circulating bubbles after decompression. Further studies are needed to compare pulsed Doppler guided by 2D echocardiography to continuous Doppler for the detection of circulating bubbles.

Adult↗
PubMed1996

[Specific risks of active compression-decompression in cardiopulmonary resuscitation: a case report].

Circulatory effects of cardiopulmonary resuscitation with active compression-decompression (CPR-ACD) are superior to the conventional technique. Decompression, thoracic expansion and a corresponding suction effect obviously improves cardiac preload. Due to significant or unphysiological thoracic expansion, thorax, diaphragma, and epigastrium are exposed to considerable traction powers. In a patient with fulminant pulmonary embolism, conventional cardiac massage and ACD were maintained during 65 minutes with simultaneous systemic thrombolytic therapy. After CPR, the patient developed a massive haemorrhagic shock. During emergency laparotomy, significant adhesions of upper abdominal organs with serious injuries of spleen and liver were found. Traction powers during CPR-ACD in combination with abdominal adhesions are considered responsible. Until improved outcome of CPR-ACD is demonstrated in larger clinical investigations, at least initially conventional cardiac massage should be preferred before the ACD-technique is used. Special attention to patients with a history of upper abdominal operations or chronic inflammatory lung diseases is mandatory.

Cardiopulmonary Resuscitation↗
PubMed1999

Microvascular decompression as treatment of trigeminal neuralgia in the elderly patient.

Elderly patients with idiopathic trigeminal neuralgia are commonly referred to percutaneous treatment if medical therapy has failed. Due to elaborated microsurgical techniques and perioperative care, minimal invasive neurosurgical operations like microvascular decompression (MVD) can be offered increasingly to elderly patients. We operated upon 8 elderly patients (median 70.5 years) suffering from trigeminal neuralgia using MVD in a one-year period (1995). Seven patients were free of pain at release. At a two year follow-up, 2 patients reported of slight dull pain in the trigeminal area, one of these had been pretreated with retrogasserian glycerol rhizolysis and an initial MVD procedure four years before this decompression. All patients were still off medication (analgetics and anticonvulsants), indicating that all patients experienced an excellent (6/8) or a good (2/8) result two years after MVD. One CSF fistula requiring reoperation was the only complication. After failure of medical therapy for symptomatic trigeminal neuralgia, we encourage elderly patients to undergo MVD if the general medical condition is stable and complete pain relief without medication is the requested aim of treatment.

Aged↗
PubMed1992

[Decompression sickness as differential diagnosis in internal medicine emergency admissions].

Two men (aged 37 years--patient 1, and 26 years--patient 2), both in good health, had dived as a sport to a depth of 40 and 45 m, respectively, reportedly keeping to the prescribed decompression times on their ascent. Patient 1 immediately developed shortness of breath and pain in the chest, later neurological deficits in both legs, as well as faecal and urinary incontinence. Examination 60 h later revealed paraparesis, increased leg proprioceptor reflexes and paraesthesia below the 10th thoracic vertebra, with abnormal posterior column function. After recompression (hyperbaric oxygenation, 6 treatment sessions of 4 h each over 8 days, as prescribed in US Navy Table No. 6) the signs improved and two months later there were no deficits. Patient 2 developed 30 min after a similar dive painful, doughy swellings and redness over the upper ventral half of the thorax and both upper arms. All signs and symptoms disappeared after recompression treatment (hyperbaric oxygenation for 3 h), begun 28 h after the dive. Previously elevated levels for haemoglobin (18.5 g/dl), haematocrit (0.56) and red blood corpuscles (5.98 x 10(6)/microliters) returned to normal. The described neurological abnormalities are typical for type II, redness and joint pains for type I decompression sickness.

Adult↗
PubMed1980

[Central nervous system damage after decompression accidents (author's transl)].

An increasing number of decompression accidents can be observed due to increasing popularity of diving and due to ignorance of its dangers. Permanent neurological damage is a frequent consequence of insufficient availability of treatment at the site of the accident. A 39-year-old man with a decompression accident showed the broad neurological symptomatology caused by multitopic lesions of the central nervous system. Apart from well known spinal symptoms manifold cerebral manifestations occurred. Mental and in particular neuropsychological defects could be observed beyond the purely neurological symptomatology.

Brain Diseases↗
PubMed2003

Open versus arthroscopic subacromial decompression: a prospective, randomized study of 34 patients followed for 8 years.

In a randomized prospective study, we selected 15 patients for arthroscopic subacromial decompression (ASD) and 19 patients for open subacromial decompression (OSD). All had impingement syndrome (Neer grade II), and had been unsuccessfully treated without surgery for more than 6 months. The UCLA Shoulder Rating Scale, Visual Analogue Scales for pain and satisfaction, isokinetic dynamometer recordings and physical testing were assessed preoperatively and at 1 (except isokinetic testing), 3, 6, and 12 months, and, finally, 8 years after surgery. We found essentially no differences in the clinical tests between the groups during this period. The use of ASD or OSD seems to be a matter of cosmesis and personal preference.

Acromion↗
PubMed1999

Technical aspects of the percutaneous cervical and lumbar laser-disc-decompression and -nucleotomy.

To achieve optimal results during percutaneous cervical and lumbar laser-disc-decompression, technical aspects have to be taken into consideration for this minimally invasive operation. The selection of the laser system is thus most significant. A Neodym-YAG-Laser is applied with a wavelength of 1064 nm which, compared to vaporization, has the prerequisites for shrinking from the experimental viewpoint. Selection of parameters for the application of energy depends on size and position of the cervical and lumbar discs. A needle with a mandrin having an outer cross section of up to 2 mm is used to puncture the disc. An ultrasharp needle tip is important. The approach depends on the section of the vertebral column involved. The insertion of the needle in the cervical discs is from the right side ventral and dorsolateral in thoracic and lumbar regions. In difficult cases of spondylophytes the insertion is helped by the so-called punctual laserosteotomy through the spondylophytes, which does not require any additional equipment at the operating table. The C-bow is sufficient for X-ray equipment and has to be adjusted according to the disc position. This minimal invasive procedure shows a technical failure rate of only 1.5/1000 in 2535 percutaneous laser disc decompressions and nucleotomies. There are two malfunctions of the laser machine and one of the X-ray technique. The PLDN using Nd-YAG 1064 nm is a technically perfect method with a very high standard of safety.

Cervical Vertebrae↗
PubMed2000

Neuroendoscopy in microvascular decompression for trigeminal neuralgia and hemifacial spasm: technical note.

Miocrovascular decompression is an effective treatment for trigeminal neuralgia (TN) and hemifacial spasm (HFS). A complete cure cannot be obtained, and additional adjuncts for extended use of endoscopy are needed. The use of an endoscope combined with the operating microscope can enhance the surgeon's ability to view deep structures during operation. We study the application of combined microsurgical and endoscopic techniques in 21 cases of HFS and 12 cases of TN. With these techniques the surgeon can explore the ventral aspect of the brainstem and cranial nerves without further retraction, can see the groove caused by compression of the offending artery, and can confirm the proper position of the prosthesis after attachment to the dura by fibrin glue. In HFS the most common offending vessels in 75% of cases were the posterior inferior cerebellar artery (PICA) and anterior inferior cerebellar artery (AICA) and in 25% of cases the vertebral artery (VA). In trigeminal neuralgia the offending vessel in 60% of cases was the superior cerebellar artery (SCA), and in 40% of cases the AICA. The overall success rate was 97% with minimal morbidity 3% (facial palsy) and no mortality. The aim of this work is to study advantages and disadvantages of using endoscopy during microvascular decompression for TN and HFS.

Brain Stem↗
PubMed2006

Fronto-ethmoidal mucocele after coronal orbital decompression.

A patient who underwent coronal orbital decompression for Graves' orbitopathy eight years earlier presented with left-sided proptosis without signs of periorbital inflammation. Computed tomography imaging showed a fronto-ethmoidal mucocele. It is suggested that this mucocele may be a late complication of decompression surgery.

Decompression, Surgical↗
PubMed2006

Radiological classification of anterior skull base anatomy prior to performing medial orbital wall decompression.

PURPOSE: To study a radiological classification, originally described by Keros in 1965, which provides an objective assessment of anterior skull base anatomy relevant in patients undergoing external medial orbital decompression. MATERIALS AND METHODS: The classification is based on anatomical landmarks measured via coronal CT-scan. The patients are divided into 3 Keros categories based on their olfactory fossa depth; Keros 1 (1-3 mm), Keros 2 (4-7 mm) and Keros 3 (8-16 mm). A cross-sectional group of 32 consecutive patients on the hospital radiology database with coronal CT scans were classified according to the Keros system. RESULTS: All the patients fell into one of the three Keros categories. Anatomical associations of the Keros classification suggest that Keros 1 patients have the least risk of intracranial entry whilst Keros 3 patients carry the greatest risk. CONCLUSION: Keros classification provides an objective assessment of anterior skull base anatomy and can therefore guide the surgeon on the superior extent of medial wall bone removal during orbital decompression. This may help improve the safety profile of the procedure.

Decompression, Surgical↗
PubMed2000

A simple technique for neurovascular decompression of the cranial nerves.

Various synthetic materials and plastic adhesives are used for neurovascular decompression, but they may have some adverse effects on nervous tissue. We used fibrin glue alone for neurovascular decompression and obtained excellent results without complications or recurrence, compared with the previous technique with a prosthesis or plastic adhesive.

Cerebellum↗
PubMed2001

Intraoperative monitoring of facial EMG responses during microvascular decompression for hemifacial spasm. Prognostic value for long-term outcome: a study in a 33-patient series.

Lateral spread responses (LSR), an electrophysiological characteristic of hemifacial spasm (HFS), can be recorded during surgery. This work aims at evaluating the prognostic value of the persistence or suppression of the LSR at the end of the microvascular decompression (MVD) procedure of the facial nerve. Thirty-three patients with HFS, which had been evolving for 5.5 years, underwent MVD with intraoperative EMG. Monitoring required the placement of a needle in the frontalis and mentalis muscles. Responses were recorded after stimulation of inferior or superior branches of the facial nerve to search for abnormal ephaptic LSR. Preoperative abnormal LSRs were present in all patients. In 23 patients, LSR disappeared with vascular decompression and was not present upon closure. Among those patients, 20 were considered clinically cured and three still presented with mild/moderate spasm at 3-month follow-up. At late follow-up, 22 patients were free of spasm. One patient had recurrence of spasm at month 10. On the contrary, 10 patients had persistent abnormal LSR upon closure. Among those, seven were cured at early follow-up (3 months on average), whereas spasm disappeared at late follow-up (12 to 36 months) in the other three patients. The prognostic value of LSR monitoring is questionable; a good clinical result may be obtained in patients who presented with persistent LSR at the end of MVD. Delayed cure strongly supports the hypothesis that HFS is not only due to the mechanical pulsations of the elongated artery against the root exit zone of the facial nerve, but also to demyelination of the nerve and/or hyperactivity of the facial motornucleus generated by the neurovascular compression.

Adult↗
PubMed1996

Symptomatic subdural hygroma as a complication of foramen magnum decompression for hindbrain herniation (Arnold-Chiari deformity).

Pseudomeningocele is a well known complication of foramen magnum decompression. Symptomatic subdural hygroma has not previously been described. We discuss a case of Arnold Chiari malformation type 1 in a 55-year-old Caucasian woman who underwent foramen magnum and upper cervical decompression and who developed a symptomatic subdural hygroma 2 weeks following surgery. This complication was most likely due to a technical error during surgery. It responded favourably to conservative therapy.

Arachnoid↗
PubMed1997

Fatal tumoural haemorrhage following decompressive craniectomy: a report of three cases.

Three cases of large and deep seated anaplastic cerebral glioma were treated by bone and dural decompression. The patients worsened suddenly within 12 h of surgery and later died. Postmortem examination revealed a large intratumoural clot in each case. The effects of decompression and the probable causes of fatal bleeding are analysed in this report.

Adolescent↗
PubMed2006

Anterior decompression for cervicothoracic pathology: A study of 14 patients.

INTRODUCTION: Various anterior approaches to the cervicothoracic junction have been described. This study reports our experience with 14 patients who had cervical anterior approaches to the cervicothoracic junction (C6-T2). This technique was evaluated with regard to the extent of exposure, ease of technique, and postoperative morbidity. We have chosen the low cervical approach to obtain exposure up to T2. For T3-T4 pathology, we use the transthoracic, periscapular approach. We do not practice bone-splitting approaches because of the morbidity associated with these approaches. METHODS: Fourteen patients with C6-T2 pathology who required anterior decompression and fusion were studied for a period of 2 years. In all cases, the low cervical anterior approach was used. RESULTS: This approach is simple, requires less operative time, and provides excellent exposure up to the level of T2. There was no long-term morbidity attributed to the approach and procedure. CONCLUSION: The low cervical anterior approach is an excellent approach that provides adequate exposure for spinal pathology to T2 that requires anterior decompression and fusion.

Adolescent↗
PubMedDate not supplied

Interfacility transport of patients with decompression illness: literature review and consensus statement.

OBJECTIVE: Decompression illness (DCI) is a potentially lethal complication of diving and may occur far from hyperbaric facilities. The need for prompt transport to a hyperbaric facility often involves air medical transport, but this may exacerbate DCI. The authors reviewed available literature to establish evidence-based transport strategies utilizing safe altitudes for patients, with DCI. METHODS: MEDLINE, EMBASE, and materials from organizations with expertise in diving medicine were searched for the following terms: decompression sickness, caisson disease, hyperbaric oxygenation, depth intoxication, or diving. Two reviewers independently selected relevant citations involving patients with DCI and air medical transport for review and consensus statement development by an expert working group. RESULTS: A total of 341 citations were identified, and 53 unique citations were reviewed. Nine relevant citations were selected for consensus statement development. There were no clinical trials or prospective cohort studies. Only two retrospective case series, including nine patients, specifically examined the effect of altitude on patients with DCI during transport. No symptom recurrence occurred when the cabin altitude remained within 500 feet of ground level. Seven citations were either letters or statements of expert opinion, recommending a maximum cabin altitude of 500-1000 feet (152-305 meters). CONCLUSIONS: The working group identified the paucity of clinical studies and evidence-based recommendations for air medical transport of patients with DCI. Transport selection should be based on minimizing total transport time and, when transporting by air, ensuring that a cabin altitude of the transporting vehicle does not exceed 500 feet (152 meters) above the departure point.

Air Ambulances↗