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PubMedDate not supplied

Isolated caruncular approach for orbital decompression.

PURPOSE: To evaluate the effectiveness of the isolated caruncular approach to orbital decompression of thyroid ophthalmopathy. METHODS: In a retrospective, noncomparative, interventional case series, we reviewed the records of 29 patients (48 orbits) who had thyroid ophthalmopathy and had undergone orbital decompression using the caruncular approach. The medial wall was decompressed in two patients (three orbits), and the medial and inferior walls were decompressed in 27 patients (45 orbits). RESULTS: The mean retrodisplacement achieved was 2.7 mm of decompression of the medial wall, and 4.2 mm of decompression of the medial and inferior walls. Diplopia arose in the primary position in 4 of 17 previously asymptomatic patients. Persistent postdecompression strabismus was managed successfully with adjustable strabismus surgery. Other complications were minimal, including a hypertrophic scar in one eye and a pyogenic granuloma in another. CONCLUSIONS: Orbital decompression using the isolated caruncular approach offers rapid access to the medial and inferior orbital walls and makes graded decompression possible in each case. It is a useful approach for patients wishing surgery for cosmetic purposes and for those with compressive optic neuropathy as well.

Adolescent↗
PubMed2004

Decompressive percutaneous endoscopic gastrostomy in nonmalignant disease.

BACKGROUND: Percutaneous endoscopic gastrostomy is the standard for long-term enteral access. It can provide enteral nutrition or gastrointestinal decompression. Utilization of the gastrostomy for decompression has traditionally been reported in the setting of malignant obstruction. However, decompressive gastrostomy can play a role in the treatment of nonmalignant bowel dysfunction as well. METHODS: Over a 2-year period, 20 of 121 percutaneous endoscopic gastrostomies attempted by this surgical endoscopist were for gastrointestinal decompression. RESULTS: Eleven of 18 gastrostomies successfully placed for decompression were for benign conditions. In 5 patients with fistulous disease, the purpose of decompression was to divert the gastrointestinal tract until operative repair. Four of these patients have since undergone definitive surgery. CONCLUSIONS: This series presents the successful use of the percutaneous endoscopic gastrostomy for decompression of nonmalignant conditions. In such scenarios, the drainage gastrostomy can be employed as a bridge to future surgery, or as a means of long-term decompression for bowel dysfunction.

Adult↗
PubMed2004

Trigeminal neuralgia: what are the important factors for good operative outcomes with microvascular decompression.

BACKGROUND: Microvascular decompression has been widely used as the first choice in treating trigeminal neuralgia, but in a few patients, facial pain cannot be effectively controlled by microvascular decompression. We sought to clarify the important factors for good operative outcomes. METHODS: We reviewed 62 patients with trigeminal neuralgia treated by microvascular decompression during the period 2000 through 2002, including clinical presentation, operative findings, techniques, and outcomes. Neurovascular conflicts were divided into single contact, contact and indentation, single adhesion, adhesion and indentation, and trigeminal nerve atrophy. Operative outcomes were graded into immediate postoperative complete pain relief (excellent), delayed postoperative complete pain relief (better), significant pain relief (good), and no response to microvascular decompression (poor). RESULTS: All patients' presentations were typical at the time of pain onset, but the symptom in 17 patients changed to atypical before surgery. During operation, single contact and single adhesion was found in 14 patients and 15 patients, respectively; contact or adhesion in combination with indentation was found in 7 patients and 18 patients, respectively; atrophy occurred in 8 patients. Postoperatively, immediate and delayed complete pain relief was achieved in 32 (51.6%) patients and 17 (27.4%) patients, respectively; 11(17.7%) patients got significant pain relief; and 2 patients showed no response. The overall rate of complete pain relief in patients with shorter duration, typical presentation, artery compression and complete decompression was higher than that in patients with longer duration, atypical presentation, venous compression, and incomplete decompression. CONCLUSIONS: Shorter duration, typical presentation, single artery compression, and complete decompression are the positive factors for better operative outcomes with microvascular decompression. Worse outcomes are usually related to venous compression, longer duration, and atypical presentation.

Adult↗
PubMed2001

Spinal cord decompression: an endoscopically assisted approach for metastatic tumors.

STUDY DESIGN: The paper describes a technique for complete vertebrectomy and spinal cord decompression, followed by a formal anterior column reconstruction, using endoscopic instruments. This procedure is indicated for patients with radioresistant metastasis of the thoracic spine, particularly those involving the upper thoracic segments where a thoracotomy is difficult and carries a high morbidity, and for patients with pulmonary disease who cannot tolerate a standard thoracotomy. Results in nine consecutive cases are reported. OBJECTIVES: To demonstrate the feasibility and benefits of endoscopically assisted decompression and stabilization through a single, extrapleural, posterolateral approach. SETTING: The Cleveland Clinic, Cleveland, Ohio, USA. METHODS: Posterolateral decompression of the thoracic spinal cord offers potential advantages over traditional combined procedures (anterior thoracotomy and posterior instrumentation), including reduced operative time, decreased morbidity, and reduced hospital stay. Previous studies have not demonstrated the same neurological benefit for posterolateral decompression as for anterior vertebrectomy and decompression, however, Surgical indications, rationale and technique for an improved posterolateral approach, augmented by endoscopic methods, are provided, and initial clinical results are described. RESULTS: Drawbacks to the traditional posterolateral decompressions have included poor visualization of the spinal cord and anterior tumor, poor access to tumor on the side contralateral to the approach, and the need to manipulate the spinal cord to completely remove both adjacent tumor and tumor adherent to the dura. Transpedicular decompression using endoscopy is described in nine patients. The mean operative time for the combined procedure was 6.0 h, with a mean blood loss of 1677 cc. Neurological recovery and maintenance were excellent. Inpatient days averaged 6.5, and ICU days averaged 1.4. Two patients died of disease eight and 14 months post-op, and seven were living, with disease, 3-36 months after surgery. CONCLUSIONS: Endoscopically assisted decompression can reduce morbidity, hospitalization, and treatment costs while matching the efficacy of traditional combined procedures. Endoscopy provides a readily available and easily applied tool that dramatically improves the surgeon's vision, providing light, magnification, and a direct view of remote structures.

Decompression, Surgical↗
PubMed2002

Decompression of the spinal subarachnoid space as a solution for syringomyelia without Chiari malformation.

STUDY DESIGN: Review and analysis of seven cases of syringomyelia treated surgically. OBJECTIVE: To demonstrate the beneficial role of decompressive surgery for the altered cerebrospinal fluid (CSF) flow dynamics in syringomyelia not associated with Chiari I malformation. A comparison between the pre- and post-operative syrinx size and CSF flow in the subarachnoid space was made using cine-mode magnetic resonance imaging (cine-MRI) and then correlated with clinical improvement. SETTING: University Hospital, Seoul, Korea. METHODS: Conventional spinal MRI and cine-MRI were performed in the region of CSF flow obstruction preoperatively in seven patients with syringomyelia not associated with Chiari I malformation. The group consisted of one case of syrinx with post-traumatic compression fracture, one case of post-traumatic arachnoiditis, two cases of holocord syrinx associated with hydrocephalus without Chiari malformation, one case of syrinx with post-traumatic pseudomeningeal cyst, one case of post-laminectomy kyphosis-associated syringomyelia and one case of post-tuberculous arachnoiditis syringomyelia. Based on the preoperative cine-MRI, the types of surgery appropriate to correct the CSF flow obstruction were chosen: decompressive laminectomy-adhesiolysis and augmentation duraplasty in arachnoiditis cases, ventriculoperitoneal shunt for hydrocephalus, cyst extirpation in pseudomeningeal cyst and both anterior and posterior decompression-fusion in the case of post-laminectomy kyphosis. A syrinx-draining shunt operation was performed in three cases; where the syringomyelia was associated with post-traumatic compression fracture refractory to a previous decompression, where hydrocephalus was present in which the decompression by ventriculoperitoneal shunt was insufficient and where post-traumatic arachnoiditis was present in which the decompression was impossible due to diffuse adhesion. Change in syrinx size was evaluated with post-operative MRI in all seven cases and restoration of flow dynamics was evaluated with cine-MRI in three of the cases, two patients with clinical improvement and one patient with no change of clinical status, respectively. RESULTS: Four out of seven patients showed symptomatic improvement after each decompressive operation. In the remaining three cases, reconstruction of the spinal subarachnoid space was not possible due to diffuse adhesion or was not the main problem as in the patient with syrinx associated with hydrocephalus who had to undergo a shunt operation. One of these three patients showed clinical improvement after undergoing syringosubarachnoid shunt. A decrease of syrinx size was observed in only two out of the five patients who showed clinical improvement after treatment. Of these five patients, two patients underwent post-operative cine-MRI and the restoration of normal CSF flow dynamics was noted in both patients. Of the remaining two patients, one underwent post-operative cine-MRI and there was no change in the CSF flow dynamics evident. CONCLUSION: These results suggest that the restoration of CSF flow dynamics between the syrinx and the subarachnoid space by decompressive operation is more effective than simple drainage of the syrinx cavity itself in the treatment of syringomyelia without Chiari malformation.

Adolescent↗
PubMed2002

Ulnar nerve strains at the elbow: the effect of in situ decompression and medial epicondylectomy.

Strains were measured in the ulnar nerve at the elbow in 10 unembalmed, intact cadavers by using a microstrain gauge. In each cadaver, strains in the ulnar nerve behind the medial epicondyle, occurring between 60 degrees and 140 degrees flexion, were calculated for the following 3 conditions: (1) initial strain before in situ decompression, (2) strain after in situ decompression, and (3) strain after in situ decompression plus medial epicondylectomy. The average strain for each group was compared by using the paired Students t-test with multiple comparisons. The average initial percent strain was not significantly reduced by in situ decompression alone (5.3% to 4.3%). However, the average percent strain after medial epicondylectomy and in situ decompression was -0.54%, which was a significant reduction from the initial percent strain and after decompression alone. In situ decompression of the ulnar nerve at the elbow alone does not relieve the tensile strains at the elbow, which may contribute to cubital tunnel syndrome. Medial epicondylectomy after in situ decompression eliminates ulnar nerve strains with elbow flexion.

Cadaver↗
PubMed2003

Decompressive craniectomy in severe brain injury.

OBJECT: The goal of this study was to evaluate the therapeutic role of decompressive craniectomy in severe brain injury. METHODS AND RESULTS: Between 1996 and 1998 we treated 87 patients with severe brain injury (GCS 3-8) in our department. In 70 cases follow up data could be obtained. Mean age was 49 years (range 1-79). Initial CT scans of all patients demonstrated diffuse brain injury with generalised brain swelling and/or mass lesion. In 51 of these patients uni (n=40)- or bilateral (n=11) decompressive craniectomy was performed initially or secondarily after failure of standard treatment. In a retrospective analysis we performed statistical tests of the follow-up group. The mortality rate did not show a significant difference between the two treatment groups (p=0.802) with a slight advantage for the decompression. The log-rank-test demonstrated a non-significant improvement of the survival time for decompressed patients (p=0.632). Secondary decompression showed a significantly better survival rate and time compared to primary decompression. In all 7 pediatric cases (1-16 yrs) we performed craniectomy. 2 of them died immediately post emergency operation, 5 survived with good outcome (1 LOF). CONCLUSIONS: A slight, but non-significant benefit could be demonstrated after decompressive craniectomy in the whole patient population. In young patients decompression seems to have a more positive influence on outcome and survival.

Adolescent↗
PubMed2003

Strabismus following endoscopic orbital decompression for thyroid eye disease.

Endoscopic orbital decompression may be used to treat disfiguring proptosis or sight threatening optic nerve compression in patients with thyroid eye disease. Strabismus is common in thyroid eye disease and frequently follows decompression surgery. We retrospectively reviewed patients undergoing endoscopic decompression for thyroid eye disease, by a single surgeon, from 1994 to 2000. Twenty-three patients (21 female, 2 male) were identified with a mean age of 47.5 years. At presentation, 21 patients had proptosis, 8 optic nerve compression (2 without proptosis) and 11 strabismus (9 complained of diplopia) with a mean BSV score of 24.5 before decompression. Forty orbits were decompressed with a mean decrease in proptosis of 3.3 mm. Following decompression, the mean BSV score was 25, and 17 patients had manifest strabismus in primary gaze (3 at near only) of whom 10 had pre-existing strabismus. Five patients had new diplopia (22%). Eleven patients ultimately required strabismus surgery of whom 8 had manifest strabismus before decompression. Following strabismus surgery, the mean BSV score was 37. The final BSV score for those not requiring strabismus surgery was 29. Mean follow-up was 28 months. Endoscopic orbital decompression can effectively treat disfiguring proptosis. Diplopia is a common complication, but pre-existing diplopia may improve.

Adult↗
PubMed1999

Analysis of dural configuration for evaluation of posterior decompression in cervical myelopathy.

OBJECTIVE: The goal of this study was to establish the criteria for sufficient decompression of the cervical spinal cord in laminoplastic surgery. METHODS: Radiological examinations and neurological evaluations were conducted for 63 patients with cervical spondylotic myelopathy (CSM) and 31 patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine who underwent suspension laminotomy. RESULTS: The dural configuration in computed tomographic myelograms was evaluated in comparison with the critical value for the dural configuration established from 36 control subjects. Seventy-six of 94 patients were judged to have achieved full decompression. The neurological improvement of patients with full decompression was significantly better than that of patients with insufficient decompression (P<0.01). The postoperative sagittal diameter of the spinal canal was more than 14 mm in most of the sufficiently decompressed cases of CSM and more than 17 mm in OPLL cases. The laminotomy width was more than 70% of the transverse diameter of the spinal canal in both CSM and OPLL cases. There were four OPLL cases with insufficiently decompressed dura mater in the well-enlarged spinal canal after surgery. In these cases, the ossified posterior longitudinal ligament continuously occupied more than 25% of the preoperative spinal canal area over three or more segments. CONCLUSION: The following conditions were considered critical for sufficient decompression of the spinal cord in laminoplastic operations: postoperative sagittal diameter of the spinal canal of more than 14 mm in CSM cases and more than 17 mm in OPLL cases and laminotomy width of more than 70% of the transverse diameter of the spinal canal in both CSM and OPLL cases. However, in cases of extensive OPLL, sufficient decompression could not be obtained through posterior enlargement of the spinal canal.

Adult↗
PubMed2000

Management of severe traumatic brain injury by decompressive craniectomy.

OBJECTIVE: The beneficial effect of decompressive craniectomy in the treatment of head trauma patients is controversial. The aim of our study was to assess the value of unilateral decompressive craniectomy in patients with severe traumatic brain injury. METHODS: We retrospectively investigated 49 patients who underwent decompressive craniectomy. Intracranial pressure, cerebral perfusion pressure, therapy intensity level, and cranial computed tomographic scan features (midline shift, visibility of ventricles, gyral pattern, and mesencephalic cisterns) were evaluated before and after craniectomy. The gain of intracranial space was calculated from cranial computed tomographic scans. Patient outcome was graded using the Glasgow Outcome Scale. RESULTS: Thirty-one patients (63.3%) underwent rapid surgical decompression within 4.5 +/- 3.8 hours after trauma; in 18 patients (36.7%), delayed surgical decompression was performed 56.2 +/- 57.0 hours after injury. Patients younger than 50 years or patients who underwent rapid surgical decompression had a significantly better outcome than older patients or patients who underwent delayed surgical decompression. Craniectomy significantly decreased midline shift and improved visibility of the mesencephalic cisterns. The state of the mesencephalic cisterns correlated with the distance of the lower border of the craniectomy to the temporal cranial base. Alterations in intracranial pressure, cerebral perfusion pressure, and therapy intensity level were not significant. The overall mortality of the patients corresponded to the reports of the Traumatic Coma Data Bank (1991). CONCLUSION: Although there was a significant decrease in midline shift after craniectomy, this did not translate into decompressive craniectomy demonstrating a beneficial effect on patient outcome.

Adolescent↗
PubMed1998

Endoscopically assisted decompression for metastatic thoracic neoplasms.

STUDY DESIGN: The author describes a technique for complete vertebrectomy and anterior decompression followed by a formal anterior column reconstruction, using readily available endoscopic instruments. This procedure is indicated in patients with radioresistant metastasis of the thoracic spine, particularly those involving the upper thoracic segments where a thoracotomy is difficult and causes a high rate of morbidity. This is also a suitable technique for patients with pulmonary disease who cannot tolerate a standard thoracotomy. OBJECTIVES: To demonstrate the feasibility and potential benefits of endoscopically controlled decompression through an extrapleural, posterolateral approach. SUMMARY OF BACKGROUND DATA: Posterolateral decompression of the thoracic spine offers potential advantages in comparison with traditional anterior-posterior procedures combining thoracotomy and posterior instrumentation, including decreased operative time, decreased morbidity, and reduced hospital stay. Results of previous studies have not demonstrated the same benefit for posterolateral decompression as for anterior vertebrectomy and decompression. Drawbacks to the traditional posterolateral decompressions have included poor visualization of the spinal cord and anterior tumor, poor access to tumor on the side contralateral to the approach, and the need to manipulate the spinal cord to completely remove adjacent tumor and tumor adherent to the dura. METHODS: Surgical indications, rationale, and technique are provided, and initial clinical results are described. RESULTS: Transpedicular decompression using endoscopy is described in five patients. The mean operative time for the combined procedure was 7.25 hours, with a mean blood loss of 1800 mL. Neurologic recovery and maintenance were excellent. Inpatient days averaged 7.5, and intensive care days averaged 2. One patient died of disease 8 months after surgery, and four were living, with disease, 3-24 months after surgery. CONCLUSIONS: Endoscopically assisted decompression can reduce morbidity, hospital stay, and treatment costs while matching the efficacy of traditional combined procedures. Endoscopy provides a readily available and easily applied tool that dramatically improves the surgeon's vision, providing light, magnification, and a direct view of remote structures.

Bone Nails↗
PubMed2001

Staged spinal cord decompression through posterior approach for thoracic myelopathy caused by ossification of posterior longitudinal ligament.

STUDY DESIGN: Prospective clinical study of the effect of staged elimination of anatomic factors inhibiting posterior shift of the thoracic spinal cord on the degree of posterior shift of the thoracic spinal cord and its significance in augmenting the safety of ossification of posterior longitudinal ligament (OPLL) manipulation in thoracic OPLL myelopathy. OBJECTIVES: To develop a comprehensive method that enables safe and sufficient decompression of the spinal cord for thoracic OPLL myelopathy. SUMMARY OF BACKGROUND DATA: Decompression of the spinal cord by direct manipulations of thoracic OPLLs, via either anterior or posterior approach, caused some iatrogenic catastrophic spinal cord injuries, and methods to prevent such injuries during surgery have not yet been developed. METHODS: Procedures of elimination of anatomic factors inhibiting posterior shift of the thoracic spinal cord were performed in stages at intervals of between 1 month and 11 years depending on patients' neurologic status. The first stage operation consisted of extensive cervicothoracic laminoplastic decompression with or without posterior longitudinal durotomy, and if the decompression were insufficient, measures for OPLL-spinal cord separation with or without OPLL manipulation were added. RESULTS: All 17 patients with thoracic OPLL myelopathy showed improvements of neurology comparable with those with successful anterior approaches after decompression. The mean follow-up period was 42 months (range 6-101 months). Neurologic improvements persisted for the entire follow-up period in all patients except one patient who developed arachnoid cyst compressing the dorsum of the once-decompressed spinal cord 30 months after surgery. CONCLUSIONS: Staged posterior decompression to eliminate anatomic factors inhibiting posterior shift of the thoracic spinal cord is the safest and the most reliable method of spinal cord decompression to treat thoracic OPLL myelopathy, so far. However, long-term results are required before the methods can be established.

Adult↗
PubMed2004

Decompressive laparotomy to treat intractable intracranial hypertension after traumatic brain injury.

INTRODUCTION: Increases in intra-abdominal pressure (IAP) can cause increases in intracranial pressure (ICP). Recently, we noticed that abdominal fascial release could be useful in treating intracranial hypertension (ICH) after traumatic brain injury (TBI). We added this as an option in our treatment of TBI. METHODS: In our institution, ICH is treated with an algorithm using osmolar therapy, CSF drainage and barbiturates. Patients with refractory ICH have routine measurement of IAP. If elevated, consideration is given to decompressive laparotomy. We retrospectively reviewed all patients admitted from January 2000 through July 2003 who had abdominal decompression to treat refractory ICH. RESULTS: From 1/00 to 7/03, 17 patients underwent decompressive laparotomy for intractable ICH. Thirteen male and 4 females all sustained blunt injury. All had failed maximal therapy including 14 who had had decompressive craniectomy. Mean ICP was 30 +/- 8.1 mmHg (range 20-40 mmHg) before decompression. No patients had evidence of abdominal compartment syndrome (ACS). Before decompression mean IAP was 27.5 (+/- 5.2) mmHg (range 21-35 mmHg). After abdominal decompression ICP dropped precipitously by at least 10 mmHg to a mean of 17.5 (+/- 3.2) mmHg (range 10-25 mmHg). In 6 patients the decrease in ICP was transient. All died. The remaining 11 had sustained decreases in ICP. All survived, made neurologic recovery and were discharged to a rehabilitation facility. CONCLUSION: Decompressive laparotomy can be a useful adjunct in the treatment of ICH failing maximal therapy following TBI. More work will need to be done to precise the exact indications for this therapy.

Adolescent↗
PubMed1975

Blood flow during 2-Torr exposures at different decompression rates.

Central and peripheral blood flow of denitrogenated dogs, measured in the femoral artery and aorta, declined rapidly and ceased within mean times of 28, 35, 70, or 90 s after 1-, 10-, 30-, or 60-s decompressions from 258 Torr to 2 Torr, respectively. Neither arterial nor venous hypoxemia was seen after 1-s decompressions since the hypoxic blood did not reach the aorta. In contrast, arterial and venous O2 saturation levels dropped as low as 12 or 6% following 10- to 60-s decompressions since circulation continued. A severe and transient decerebratelike rigidity and subsequent temporary flaccid paralysis of the hind legs was seen during recovery from decompressions slower than 1 s, whereas only a mild temporary flaccid paralysis was frequently present after 1-s decompression. The more severe responses following 10- to 60-s decompressions are associated with the greater hypoxemia after slow decompressions, indicating tissue hypoxia is more severe when decompression rate is slow.

Animals↗
PubMed1987

Consumption of platelets in decompression sickness of rabbits.

Platelet behavior was studied in rabbit decompression sickness which was brought about by the exposure to 6 ATA for 40 min (bottom time) followed by rapid decompression. Platelet counts significantly decreased after the decompression. Kinetic studies with 111In-oxine-labeled platelets revealed shortened survivals of circulating platelets, and audioradiograms indicated the accumulation of radioactivity in the lungs after the decompression. Although there was no change in the mode volume of platelets after the decompression, the transient appearance of circulating smaller or fragmented platelets suggested a random overdestruction of platelets. Whole and releasable adenine nucleotide contents of platelets were decreased significantly after the decompression. There were no significant changes in cytoplasmic adenine nucleotide contents. Therefore, in decompression sickness, the circulating platelets behaved similarly to those in acquired storage pool disease. Platelet thrombi were found in the pulmonary arteries, compatible with the accumulation of 111In-oxine-labeled platelets. These findings suggest that circulating air bubbles interact with platelets, causing the platelet release reaction, and these activated platelets participate in the formation of thrombi in experimental decompression sickness.

Adenine Nucleotides↗
PubMed1998

Effect of oxygen tension and rate of pressure reduction during decompression on central gas bubbles.

Reduction in ascent speed and an increase in the O2 tension in the inspired air have been used to reduce the risk for decompression sickness. It has previously been reported that decompression speed and O2 partial pressure are linearly related for human decompressions from saturation hyperbaric exposures. The constant of proportionality K (K = rate/partial pressure of inspired O2) indicates the incidence of decompression sickness. The present study investigated the relationship among decompression rate, partial pressure of inspired O2, and the number of central gas bubbles after a 3-h dive to 500 kPa while breathing nitrox with an O2 content of 35 kPa. We used transesophageal ultrasonic scanning to determine the number of bubbles in the pulmonary artery of pigs. The results show that, for a given level of decompression stress, decompression rate and O2 tension in the inspired air can be traded off against each other by using pulmonary artery bubbles as an end point. The results also seem to confirm that decompressions that have a high K value are more stressful.

Animals↗
PubMed1998

Recovery of nerve conduction following microvascular decompression for trigeminal neuralgia.

OBJECTIVE: To assess the function of trigeminal nerve before and after microvascular decompression for trigeminal neuralgia. BACKGROUND: To date there is no direct evidence that microvascular decompression of the trigeminal root restores normal conduction in the nerve. METHODS: The authors examined 10 patients with trigeminal neuralgia in whom preoperative MRI and MR angiography demonstrated neurovascular contact. During microvascular decompression, the trigeminal nerve was monitored by recording early scalp trigeminal evoked potentials immediately before, during, and after decompression. Direct recordings from the root entry zone were also performed. RESULTS: In all patients preoperative scalp evoked potentials showed impaired conduction of the trigeminal root. Microvascular decompression was associated with immediate recovery of conduction in seven patients, demonstrated by both scalp evoked potentials and direct root recordings. All 10 patients were pain free postoperatively. CONCLUSIONS: Improvement in trigeminal neuralgia following microvascular decompression is often associated with normalization of neurophysiologic data, suggesting recovery of nerve function. Rapid electrophysiologic recovery and pain relief following microvascular decompression argue that neither phenomenon is linked to remyelination. It is possible that the trigeminal evoked potentials might predict an effective microvascular decompression.

Decompression, Surgical↗
PubMed2002

The effect of limited interlaminar decompression versus complete laminectomy on intrathecal volume in degenerative lumbar spinal stenosis.

INTRODUCTION: There is a controversial discussion about the adequate surgical procedure for degenerative lumbar spinal stenosis. Due to the observation that the degenerative lumbar spinal stenosis takes place predominantly at the interlaminar region on the level of the disc involving facets and bulging of the ligamentum flavum, resection of the whole lamina might not be necessary. A biomechanical study was designed to assess the effect of different decompression techniques using cadaver lumbar spine models. METHODS: Twelve cadaver spines with CT verified degenerative lumbar spinal stenosis were dissected in order to measure the volume of the dural sac at different flexion and extension angles. Each segment (L3/4, L4/5) was decompressed first by limited interlaminar decompression and second by complete laminectomy. Intrathecal volume measurements were taken initially, after limited interlaminar decompression and after complete laminectomy. RESULTS: Before surgical procedure, the cadaver spines showed an increase of the intrathecal volume in flexion and decrease in extension. After limited interlaminar decompression, there was a significant reduction of volume loss in extension. There was no significant additional reduction of volume loss in extension after complete laminectomy in comparison to limited interlaminar decompression. CONCLUSION: The results allow to conclude that limited interlaminar decompression is efficient for decompression in degenerative lumbar spinal stenosis.

Aged↗