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PubMed1977

Compression neuritis of the ulnar nerve treated with simple decompression.

The purpose of this investigation was to test the hypothesis submitted by Osborne (1957), which proposed that the symptoms of compression ulnar neuritis, in most cases, result from compression on the ulnar nerve at the proximal border of the aponeurosis of the flexor carpi ulnaris muscle. Thirty-two simple decompression operations were performed on 31 patients, diagnosed as suffering from compression neuritis of the ulnar nerve. They were subsequently examined over a period of 5 years. Relief from symptoms was achieved in 28 cases, whilst four patients derived no improvement from the operation. Three of the four unsuccessful cases were judged to have been incorrectly diagnosed and were not suffering from compression of the ulnar nerve in the elbow. A second operation was required in two patients, in one a second decompression and in the other anteposition. No surgical or post-surgical complications occurred.

Adolescent↗
PubMed2000

Decompressive craniectomy for space-occupying supratentorial infarction: rationale, indications, and outcome.

A subset of patients with ischemic cerebrovascular stroke suffer a progressive deterioration secondary to massive cerebral ischemia, edema, and increased intracranial pressure (ICP). The evolution is often fatal. In these patients, a decompressive craniectomy converts the closed, rigid cranial vault into an "open box." The result is a dramatic decrease in ICP and a reversal of the clinical and radiological signs of herniation. For these reasons, decompressive craniectomy has been increasingly proposed as a life-saving measure in patients with large, space-occupying hemispheric infarction. The authors review the rationale, indications, and clinical experience with this procedure, which has been performed in patients who have had supratentorial ischemic stroke.

Cerebral Infarction↗
PubMed2001

Outcome analysis of anterior decompressive surgery and fusion for cervical ossification of the posterior longitudinal ligament: report of 107 cases and review of the literature.

OBJECT: This study was designed to determine the surgical technique and surgery-related outcome, fusion rate, and complication of anterior decompression and fusion (with various graft materials) performed in patients with ossification of the posterior longitudinal ligament (OPLL) of the cervical spine. METHODS: Between 1980 and 1998, 107 patients with radiologically proven OPLL underwent surgery via the anterior approach for direct removal of the ossified mass. Graft materials included iliac crest in 45 cases, vertebral body (VB) in 37 cases; and interbody fusion cages in 25 cases. In four patients with three-level VB grafts and one with a two-level VB graft, anterior plates were placed. Surgery-related outcome was excellent or good in 89% and fair in 11%. This clinical improvement correlated well with the severity of preoperative myelopathy. Only one patient with severe myelopathy due to extensive mixed-type OPLL developed a segmental weakness of the bilateral upper extremities. The overall fusion rate was 97%. Three patients with obvious spinal instability due to pseudarthrosis required reoperation. Of the graft materials used in this series, VB grafts were the most fragile. CONCLUSIONS: The anterior approach is an effective route for decompressing the cervical cord with OPLL. Slight asymptomatic kyphotic deformity may be encountered. Of the graft materials used in our series, VB graft was considered most fragile, and thus least optimal.

Adult↗
PubMed1998

Microvascular decompression for superior oblique myokymia: first experience. Case report.

Superior oblique myokymia (SOM) is a rare eye movement disorder presenting as uniocular rotatory microtremor due to intermittent contractions of the superior oblique muscle. Medical treatment usually fails to provide long-term benefit for the patient and has considerable side effects. Surgical alternatives including tenotomy or partial tenectomy of the superior oblique tendon often result in incomplete resolution of the visual symptoms. The authors report a patient who experienced immediate cessation of disabling SOM following microvascular decompression of the fourth nerve at the root exit zone. Temporary double vision at downgaze resolved 5 months after surgery. There was no recurrence of oscillopsia during a follow-up of 22 months to date. From this single observation it appears likely that vascular compression of the trochlear nerve could be a significant pathophysiological factor contributing to SOM. In the hands of an experienced surgeon, microvascular decompression at the brainstem exit zone of this nerve may evolve as the method of choice for selected cases of disabling SOM.

Decompression↗
PubMed2000

Microvascular decompression for trigeminal neuralgia in Charcot-Marie-Tooth disease.

The authors report on three patients suffering from coexistent trigeminal neuralgia (TGN) and Charcot-Marie-Tooth disease who, based on preoperative magnetic resonance tomographic angiography findings, underwent microvascular decompression. All patients had demonstrable neural compression and all experienced immediate postoperative pain relief. Symptoms recurred in one patient and required a second procedure in the form of a neurotomy. Two patients suffered from bilateral TGN. When a patient with TGN suffers coexistent neurological disease and experiences bilateral symptoms, preoperative imaging and subsequent decompressive surgery may avoid the unacceptable risk of morbidity associated with bilateral ablative procedures.

Adult↗
PubMed2005

Resolution of neurogenic arterial hypertension after suboccipital decompression for Chiari malformation. Case report.

A Chiari malformation Type I may remain asymptomatic until the patient has reached adulthood and acute presentation of symptoms occurs. In several clinical and experimental studies it has been shown that essential hypertension is associated with vascular compression of the brainstem, particularly of the rostral ventrolateral medulla oblongata. Nevertheless, two cases of Chiari malformation and neurogenic arterial hypertension have been reported. In this article the authors describe a patient with Chiari malformation Type I and neurogenic arterial hypertension. A simple suboccipital decompression not only provided neurological improvement, but also led to resolution of the hypertension. In cases of Chiari malformation and concomitant neurogenic arterial hypertension, careful preoperative clinical and neuroimaging assessments may reveal the cause of the arterial hypertension. Resolution of neurogenic arterial hypertension may be expected even in a case of simple suboccipital decompression.

Acute Disease↗
PubMed2006

Contrast ultrasonographic assessment of cerebral perfusion in patients undergoing decompressive craniectomy for traumatic brain injury.

OBJECT: The aims of this study were to determine whether contrast-enhanced ultrasonography (CEU) could be used for noninvasive evaluation of cerebral perfusion in patients with traumatic brain injury (TBI) and to assess the effect of decompressive surgery on cerebral perfusion as measured by CEU. METHODS: Contrast-enhanced ultrasonography with intravenous administration of a microbubble contrast agent was performed in six patients with TBI undergoing decompressive craniectomy. Contrast-enhanced ultrasonography was performed through a bur hole before craniectomy and through the calvarial defect immediately after craniectomy and on postoperative Days 1 and 2. For the latter two studies, patients were placed in the recumbent position and at a 35 degrees incline to investigate changes in perfusion produced by modulation of intracranial pressure (ICP). Cerebral microvascular blood flow increased by almost threefold immediately after craniectomy, from a mean of 7.5 +/- 6.9 (standard deviation [SD]) to 20.9 +/- 11.6 (p < 0.05), and further improved on postoperative Day 1 (mean 37.1 +/- 13.9 [SD], p < 0.05, compared with postcraniectomy microvascular blood flow) without subsequent change on Day 2. The change in microvascular perfusion correlated inversely with the initial ICP (p < 0.01), indicating less recovery of flow when preoperative ICP was markedly elevated. On postoperative Days 1 and 2, head-of-bed elevation produced an increase in microvascular perfusion on CEU (mean 37 +/- 11 compared with 51 +/- 20, p < 0.05) and a small decrease in ICP (mean 16 +/- 5 mm Hg compared with 12 +/- 4 mm Hg, p < 0.05). In patients with parenchymal hematoma, CEU provided spatial information on perfusion abnormalities in the hemorrhagic core and surrounding tissues. CONCLUSIONS: Contrast-enhanced ultrasonography has potential for the intraoperative and bedside assessment of cerebral perfusion in patients with TBI. The technique may be appropriate for evaluating responses to therapies aimed at preventing secondary ischemia and for assessing regional perfusion abnormalities.

Adolescent↗
PubMed2006

Decompression of cavernous sinus meningioma for preservation and improvement of cranial nerve function. Technical note.

Meningiomas are the most common tumors affecting the cavernous sinus (CS). Despite advances in microsurgery and radiosurgery, treatment of CS meningiomas remains difficult and controversial. As in cases of other meningiomas, the goal of treatment for CS meningioma is long-term growth control and preservation of neural function. Gross-total resection, the ideal treatment for meningioma, is not always possible to obtain in patients with CS meningiomas with an acceptable level of morbidity. Therefore, microsurgery and radiosurgery have recently been advocated as a combined therapy to achieve good control of tumor growth and favorable functional outcome. The authors describe a technique in which tumor volume can be reduced to a minimal residual amount, while preserving cranial nerve function. This enables the smallest field to be treated radiosurgically. The optic nerve is decompressed, and the tumor mass is reduced to provide at least a 5-mm interpositional distance between the optic nerve and the residual lesion. Direct decompression of the CS, with opening of the lateral and superior sinus walls, and piecemeal removal of the tumor in "safe" locations are performed to facilitate an improvement in cranial nerve function. The authors describe the use of this technique in a series of patients and demonstrate improvement of cranial nerve function in a subset of these patients.

Adult↗
PubMed2004

Subtemporal decompression for slit-ventricle syndrome: successful outcome after dramatic change in intracranial pressure wave morphology. Report of two cases.

Subtemporal decompression is recognized as an effective treatment for slit-ventricle syndrome; however, the effects of this procedure have not been demonstrated using both pre- and postsurgical intracranial pressure (ICP) monitoring. The authors report two cases in which slit-ventricle syndrome and elevated ICP had been diagnosed. Each patient underwent ICP monitoring before and after subtemporal decompression; the dramatic changes in the ICP measurements are presented along with findings from 1-year follow-up examinations.

Adolescent↗
PubMed1999

One-stage posterior decompression and reconstruction of the cervical spine by using pedicle screw fixation systems.

OBJECT: This retrospective study was conducted to analyze the results of one-stage posterior decompression and reconstruction of the cervical spine by using pedicle screw fixation systems in 46 patients. METHODS: Causes of cervical myelopathy in these 46 patients included spondylosis or ossification of the posterior longitudinal ligament, rheumatoid arthritis, metastatic or primary vertebral tumors, cervical spinal injuries, and spinal cord tumor. Thirty-three patients underwent this one-stage procedure as primary surgery. In the remaining 13 patients who had previously undergone laminectomies, the one-stage procedure was performed as salvage surgery. Cervical pedicle screws were inserted into the pedicles after probing and tapping. Graft bone was placed on the bilateral lateral masses, and pedicle screws were interconnected longitudinally by either plates or rods. Postoperatively, 26 patients showed improved neurological status (at least one grade improvement on Frankel's functional classification). There were no cases of neurological deterioration postoperatively. Solid bony fusion was obtained in all patients, except in seven patients with metastatic tumor who did not receive bone grafts. Correction of kyphosis was satisfactory. Postoperative radiological evaluation revealed that 10 (5.3%) of 190 screws inserted into the cervical vertebrae had perforated the cortex of the pedicles; however, no neurovascular complications were caused by the perforations. CONCLUSIONS: The pedicle screw fixation procedure, which does not require the lamina to be used as a stabilizing anchor, has proven to be valuable when performing one-stage posterior decompressive and reconstructive surgery in the cervical spine. The risk to neurovascular structures in this procedure, however, cannot be completely eliminated. Thorough knowledge of local anatomy and application of established surgical techniques are essential for this procedure.

Adult↗
PubMed2000

Anatomical projection of the cervical uncinate process in ventral, ventrolateral, and posterior decompressive surgery.

OBJECT: The cervical uncinate processes (UPs), their variations, and the relationships between the neurovascular structures and surrounding bone were investigated in this anatomical study. The object of this study was to highlight the important surgery-related considerations associated with ventral, ventrolateral, and posterior decompressive surgery. METHODS: Forty-nine adult C3-7 dry bone samples were used, and 10 measurements were obtained for each vertebra. The anterior measurements involved the cervical uncinate process (UP): height, width, length, distance between its tip and vertebral foramina, interuncinate process distance, sagittal angle with the superior margin of the vertebral body (VB), VB anteroposterior diameter, and VB width. Posterior measurements involved the vertical distance between the superior border of the lamina at the lamina-facet joint and the tip of the UP, as well as the horizontal distance between the medial-most border of the superior facet and the tip of the UP. All symmetrical structures were measured bilaterally. There were no statistically significant differences between right- and left-sided measurements in this series. The height of the UP increased gradually at each segmental level between C-3 and C-7. The width of the UP did not change with segmental level (5.0 mm at C-3 compared with 5.3 mm at C-7). On average, the length of the UP was relatively constant. The distance from the tip of the UP to vertebral foramina averaged 1 mm at the C2-3 level and 1.5 mm at the C5-6 level. Interuncinate distance and VB width gradually increased and were highly variable, which appeared to be related with osteophyte formation. There was a slight gradual increase from C-3 to lower segments, and it paralleled with the midline anteroposterior diameter of the same VB. The angle between the UP and the superior margin of the VB exhibited great variety. The posterior measurements decreased gradually from C-3 to C-7. CONCLUSIONS: Based on the data obtained in this study, a surgeon is provided with a three-dimensional orientation as well as anatomical knowledge. This knowledge also allows for a more effective neurovascular decompression by minimizing the surgery-related complications.

Adult↗
PubMed2001

Intraoperative computerized tomography scanning to assess the adequacy of decompression in anterior cervical spine surgery.

OBJECT: The purpose of this study was to improve the accuracy of bone removal during anterior spinal surgery. Intraoperative computerized tomography (CT) scanning was used to assess the success of bone resection and permit immediate correction in the event of inadequate bone removal. METHODS: The Phillips Tomoscan M was used to obtain preoperative cervical scans before and after cervical bone resection was complete. The completeness of bone removal was assessed by the operating neurosurgeon by reviewing the postresection CT scan. If the bone removal was deemed inadequate, additional bone was removed using a high-speed drill. A CT scan was obtained after each subsequent decompression until adequate bone removal was achieved. In 31 patients undergoing anterior cervical decompression intraoperative CT scanning was performed. Nineteen patients underwent corpectomy and 12 discectomy. Of the 31 patients, assessment of intraoperative CT scans obtained in 17 indicated further bone removal was required. CONCLUSIONS: Intraoperative CT scanning to monitor bone removal during anterior cervical surgery is a valuable tool to ensure the adequacy of surgery.

Adult↗
PubMed2001

Results of degenerative spondylolisthesis treated with posterior decompression alone via a new surgical approach.

OBJECT: The purpose of this study was to assess radiologically demonstrated results and clinical outcomes in patients with degenerative spondylolisthesis who underwent posterior decompressive surgery via a new (unilateral) approach. This approach allows surgeons to perform central and bilateral decompression while only stripping the muscles unilaterally, thus preserving the posterior osteoligamentous complexes. METHODS: The authors evaluated 51 consecutive patients in whom surgery was performed between 1987 and 1996. The mean follow-up period was 4.7 years. There was no statistically significant difference between the pre- and postoperative measurements in percentage of vertebral slippage. Postoperative dynamic angulation statistically decreased compared with its preoperative value (p < 0.05). Improvement of an average of 67% was shown on the Japanese Orthopaedic Association scale, and in 78% of these patients, good to excellent results were demonstrated. Secondary fusion was required in only three patients (5.9%). CONCLUSIONS: This new surgical technique offers a potential alternative for the treatment of degenerative spondylolisthesis in a minimally invasive manner, avoiding the risk of causing or aggravating postoperative spinal instability.

Adult↗
PubMed2002

Long-term outcome of anterior decompression and spinal fixation after placement of the Wellesley Wedge for thoracic and lumbar spinal metastasis.

OBJECT: The authors assessed the long-term results of anterior decompressive and vertebral body reconstructive surgery in which the Wellesley Wedge was applied in patients with metastatic spinal lesions over the life span of these individuals. METHODS: The authors performed a retrospective review of the outcome of 27 consecutively treated patients who underwent surgery for thoracic or lumbar spine metastases. Decompressive surgery was performed via an anterior thoracotomy and/or retroperitoneal approach depending on the level of the lesion. The spine was reconstructed using a U-shaped plate with an interposed methylmethacrylate strut known as the Wellesley Wedge. RESULTS: Thirty percent of patients suffered medical complications whereas 22% experienced postoperative improvement, as reflected by an improved Frankel grade. Used in patients with a variety of primary tumor types, a spectrum of ages and neurological status, and extensive preoperative osseous spinal involvement and deformity, the Wellesley Wedge resulted in spinal stability for the duration of patients' lives in 92%. CONCLUSIONS: In this series the patient selection process for surgery was a challenge yet to be solved; however, considering the durability of the Wellesley Wedge itself, the authors will continue to use it in selected patients.

Adult↗
PubMed2004

Suspended laminoplasty for wide posterior cervical decompression and intradural access: results, advantages, and complications.

OBJECT: Cervical laminoplasty is a recognized technique commonly used for multilevel posterior cervical decompression, and it is favored over laminectomy for maintaining spinal stability. Traditional hinge techniques, however, limit lateral exposure on one side and can limit dural exposure. The authors present their experience with a modified laminoplasty technique incorporating complete laminectomy and placement of titanium miniplate instrumentation. This method allows wide bilateral posterior decompression and unobscured dural access. METHODS: Twenty-eight patients (mean age 57 years) underwent cervical laminoplasty during a 4-year period. Twenty-seven patients presented with progressive cervical myelopathy. Seventeen patients (61%) had degenerative spondylotic stenosis; nine (32%) underwent resection of an intradural neoplasm. A mean of 3.5 levels were exposed and reconstructed. The follow-up period ranged from 4 months to 4 years (mean 15 months). The mean angular extension-flexion displacement measured between C-1 and C-7 was unchanged postoperatively, with preserved mobility across laminoplasty-treated segments in all patients. The anteroposterior diameter of the spinal canal increased 3.6 mm (27.2%) postoperatively (p = 0.004). In one patient an asymptomatic postoperative kyphosis developed. There were five cases of postoperative infection. One superficial infection resolved after intravenous antibiotic therapy alone, and four deep infections required surgical reexploration. CONCLUSIONS: The advantages of this technique over other laminoplasty methods include wide lateral spinal canal and intradural access, as well as preserved motion with partial restoration of the posterior tension band.

Adolescent↗
PubMed2004

Anterior atlas fracture following suboccipital decompression for Chiari I malformation. Report of two cases.

Chiari I malformation, a congenital disorder involving downward displacement of the cerebellar tonsils through the foramen magnum, is often treated surgically by performing suboccipital craniectomy and C-1 laminectomy. The authors report two cases in which fracture of the anterior atlantal arch occurred during the postoperative period following Chiari I decompression and C-1 laminectomy causing significant neck pain. The findings indicate that interruption of the integrity of the posterior arch of C-1, iatrogenically or otherwise, confers increased risk of anterior arch fracture. A C-1 fracture should therefore be considered in the differential diagnosis of posterior cervical pain in patients who have previously undergone decompression for Chiari I malformation.

Adolescent↗
PubMed2004

Thoracic paraplegia due to missed thoracic compressive lesions after lumbar spinal decompression surgery. Report of three cases.

The authors discuss the cases of three patients in whom thoracic paraplegia developed after lumbar spinal decompressive surgery for slight lumbar spinal canal stenosis. Careful computerized tomography myelography and magnetic resonance imaging examination of the thoracic spine revealed another compressive lesion (spinal cord tumor, disc herniation, osteophyte of vertebral body, and ossification of the ligamentum flavum). Additional thoracic decompressive surgery provided partial amelioration of each patient's neurological condition. The authors suggest that to avoid such a complication physical and radiographic examination of the thoracic spine should be performed preoperatively if the lumbar imaging is inconclusive.

Aged↗
PubMed1997

Arthroscopic decompression for subacromial impingement syndrome.

Arthroscopic decompression and cuff debridement was performed on 47 cases in 45 consecutive patients with either stage II or stage III impingement syndrome: 19 with no actual tear of the cuff (stage II); 13 with a partial thickness tear (stage IIIa); 10 with complete tear less than 3 cm long (stage IIIb); and 5 with complete tear longer than 3 cm (stage IIIc). Patients were classified into impingement syndrome without tear (Group I), impingement syndrome with partial thickness tear (Group II), and impingement syndrome with full thickness tear (Group III). Group I had 19 cases, group II had 13 cases, and group III had 15 cases. Patients were followed up for an average of 39.3 months (24 approximately 62 months). In group I, postoperative UCLA ratings improved in 18 cases (95%) to satisfactory result rate. In group II, 11 patients (85%) had improvement to satisfactory result rate. In group III, 12 cases (80%) had improvement to satisfactory result rate. The arthroscopic subacromial decompression and rotator cuff debridement was effective in the treatment of subacromial impingement syndrome.

Adolescent↗