Clinical Outcomes and Complications following Internal Neurolysis for the Treatment of Trigeminal Neuralgia: An Institutional Case Series

2020 ◽  
Author(s):  
Jacob Mazza ◽  
Victor Sabourin ◽  
Pascal Lavergne ◽  
Jeffery Head ◽  
Tomas Garzon ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Clinical Outcomes ◽  
Case Series ◽  
Internal Neurolysis

Internal Neurolysis with and without Microvascular Decompression for Trigeminal Neuralgia: Case Series

2020 ◽  
Vol 143 ◽  
pp. e70-e77
Author(s):  
Victor Sabourin ◽  
Jacob Mazza ◽  
Tomas Garzon ◽  
Jeffrey Head ◽  
Donald Ye ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Case Series ◽  
Internal Neurolysis

scholarly journals Internal Neurolysis With and Without Microvascular Decompression for Trigeminal Neuralgia

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Victor Sabourin ◽  
Jacob Mazza ◽  
Tomas Garzon-Muvdi ◽  
Donald Yandong Ye ◽  
Anthony Stefanelli ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Case Series ◽  
Treatment Modalities ◽  
Low Grade ◽  
Neurovascular Compression ◽  
Salvage Procedure ◽  
Internal Neurolysis ◽  
Significant Difference

Abstract INTRODUCTION Trigeminal Neuralgia (TN) is a pain syndrome often resulting in debilitating, paroxysmal lancinating facial pain in various distributions. Microvascular decompression (MVD) is the mainstay surgical treatment when an offending vessel is identified. However, internal neurolysis (IN) or nerve-combing (NC) have become increasingly utilized as an adjunct or stand-alone therapy when low grade or no neurovascular compression (NVC) is identified intraoperatively, or as a salvage procedure in patients with TN unresponsive to MVD or other treatment modalities. METHODS A retrospective case series review was performed for patients with TN treated with IN, with or without MVD. An MVD was performed with IN when an offending vessel causing low grade compression was seen. If no NVC was identified, IN alone was performed. Twenty-three patients were identified with an average follow-up of 14.5 mo. The Barrow Neurologic Institute (BNI) Pain Scale and Hypesthesia Scale were used to determine outcomes. Additionally, a systematic review of the literature was performed for patients with TN treated with IN/NC with or without MVD. RESULTS The overall success of treatment with an average follow-up of 14.5 mo was 87%. There was no significant difference (P = .235) between rates of successful treatment for patients who had an MVD/IN versus IN alone, however there was a trend toward improved outcomes when MVD/IN were simultaneously performed; 93% MVD/IN versus 75% IN alone. The most common complication with IN was postoperative hypesthesia, however most patients (96%) had either no or mild non-bothersome hypesthesia at last follow-up. CONCLUSION IN with or without MVD represents a reasonable option for TN when low grade or no NVC is identified or as a salvage procedure when other modalities of treatment have failed.

Punch Grafting for the Management of Hard-to-Heal Diabetic Foot Ulcers: A Prospective Case Series

2021 ◽  
pp. 153473462110310
Author(s):  
Marta García-Madrid ◽  
Irene Sanz-Corbalán ◽  
Aroa Tardáguila-García ◽  
Raúl J. Molines-Barroso ◽  
Mateo López-Moral ◽  
...  
Keyword(s):  
Wound Healing ◽  
Clinical Outcomes ◽  
Diabetic Foot ◽  
Donor Site ◽  
Case Series ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Wound Debridement ◽  
Prospective Case Series

Punch grafting is an alternative treatment to enhance wound healing which has been associated with promising clinical outcomes in various leg and foot wound types. We aimed to evaluate the clinical outcomes of punch grafting as a treatment for hard-to-heal diabetic foot ulcers (DFUs). Six patients with chronic neuropathic or neuroischemic DFUs with more than 6 months of evolution not responding to conventional treatment were included in a prospective case series between May 2017 and December 2020. All patients were previously debrided using an ultrasound-assisted wound debridement and then, grafted with 4 to 6 mm punch from the donor site that was in all cases the anterolateral aspect of the thigh. All patients were followed up weekly until wound healing. Four (66.7%) DFUs were located in the heel, 1 (16.7%) in the dorsal aspect of the foot and 1 (16.7%) in the Achilles tendon. The median evolution time was 172 (interquartile range [IQR], 25th-75th; 44-276) weeks with a median area of 5.9 (IQR; 1.87-37.12) cm2 before grafting. Complete epithelization was achieved in 3 (50%) patients at 12 weeks follow-up period with a mean time of 5.67 ± 2.88 weeks. Two of the remaining patients achieved wound healing at 32 and 24 weeks, respectively, and 1 patient showed punch graft unsuccessful in adhering. The median time of wound healing of all patients included in the study was 9.00 (IQR; 4.00-28.00) weeks. The wound area reduction (WAR) at 4 weeks was 38.66% and WAR at 12 weeks was 88.56%. No adverse effects related to the ulcer were registered through the follow-up period. Autologous punch graft is an easy procedure that promotes healing, achieving wound closure in chronic DFUs representing an alternative of treatment for hard-to-heal DFUs in which conservative treatment has been unsuccessful.

Clinical outcomes of the piggyback secondary implantation of a novel multifocal lens in the ciliary sulcus: A case series

2021 ◽  
pp. 112067212110294
Author(s):  
Gerardo Valvecchia ◽  
Guadalupe Cervantes-Coste ◽  
Oscar Asis ◽  
Federico Pereyra ◽  
Manuel Garza-León ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Case Series ◽  
Visual Outcome ◽  
Iol Implantation ◽  
Secondary Implantation ◽  
Intermediate Distance ◽  
Efficient Alternative ◽  
Monofocal Iol ◽  
Multifocal Lens ◽  
Prospective Case Series

Purpose: Evaluate the clinical outcomes of the secondary piggyback add-on IOL implantation in the ciliary sulcus for pseudophakic patients previously implanted with a monofocal IOL, who pursue a spectacle-free option after IOL surgery. Methods: A prospective case series including seven pseudophakic patients who underwent an in-the-bag monofocal IOL implantation. All eyes underwent a piggyback IOL implantation of the new sulcus designed A4 AddOn IOL in the ciliary sulcus as a secondary procedure for pseudophakic patients pursuing a spectacle-free option for near and intermediate distance after IOL surgery. Results: Seven eyes from six patients were included in this study, from which 4 (71.43%) were female, with a mean age of 58.33 ± 3.5 years (range 54–63; 95% CI 54.66, 62.01). The postoperative spherical equivalent at the 3-month visit was −0.10 m ± 0.82. Also, the UDVA was 0.11 ± 0.08 logMAR, the UIVA 0.01 ± 0.03, and the UNVA 0.01 ± 0.03 3 months after their surgical procedure. Conclusions: The A4 AddOn multifocal IOL’s secondary piggyback implant is an efficient alternative for monofocal pseudophakic patients seeking presbyopia solutions. This sulcus-designed IOL provides an optimal visual outcome for near and distance vision.

scholarly journals Impact of Pathological Stratification on the Clinical Outcomes of Advanced Well-Differentiated/Dedifferentiated Liposarcoma Treated with Trabectedin

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1453
Author(s):  
Chiara Fabbroni ◽  
Giovanni Fucà ◽  
Francesca Ligorio ◽  
Elena Fumagalli ◽  
Marta Barisella ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Proportional Hazards ◽  
Case Series ◽  
Progression Free Survival ◽  
Cox Proportional Hazards ◽  
Low Grade ◽  
High Grade ◽  
Retrospective Case ◽  
Well Differentiated ◽  
The Impact

Background. We previously showed that grading can prognosticate the outcome of retroperitoneal liposarcoma (LPS). In the present study, we aimed to explore the impact of pathological stratification using grading on the clinical outcomes of patients with advanced well-differentiated LPS (WDLPS) and dedifferentiated LPS (DDLPS) treated with trabectedin. Patients: We included patients with advanced WDLPS and DDLPS treated with trabectedin at the Fondazione IRCCS Istituto Nazionale dei Tumori between April 2003 and November 2019. Tumors were categorized in WDLPS, low-grade DDLPS, and high-grade DDLPS according to the 2020 WHO classification. Patients were divided in two cohorts: Low-grade (WDLPS/low-grade DDLPS) and high-grade (high-grade DDLPS). Results: A total of 49 patients were included: 17 (35%) in the low-grade cohort and 32 (65%) in the high-grade cohort. Response rate was 47% in the low-grade cohort versus 9.4% in the high-grade cohort (logistic regression p = 0.006). Median progression-free survival (PFS) was 13.7 months in the low-grade cohort and 3.2 months in the high-grade cohort. Grading was confirmed as an independent predictor of PFS in the Cox proportional-hazards regression multivariable model (adjusted hazard ratio low-grade vs. high-grade: 0.45, 95% confidence interval: 0.22–0.94; adjusted p = 0.035). Conclusions: In this retrospective case series, sensitivity to trabectedin was higher in WDLPS/low-grade DDLPS than in high-grade DDLPS. If confirmed in larger series, grading could represent an effective tool to personalize the treatment with trabectedin in patients with advanced LPS.

Efficacy of Internal Neurolysis for Trigeminal Neuralgia without Vascular Compression

2021 ◽  
Author(s):  
Ming-Wu Li ◽  
Xiao-feng Jiang ◽  
Chaoshi Niu
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Chart Review ◽  
Vascular Compression ◽  
Internal Neurolysis ◽  
Facial Numbness ◽  
Relief Rate

Abstract Background and Objective Trigeminal neuralgia is a common neurologic disease that seriously impacts a patient's quality of life. We retrospectively investigated the efficacy and safety of internal neurolysis (nerve combing) for trigeminal neuralgia without vascular compression. Patients and Methods This study was a retrospective review of all patients with trigeminal neuralgia who were admitted between January 2014 and February 2019. A subgroup of 36 patients had no vascular compression at surgery and underwent internal neurolysis. Chart review and postoperative follow-up were performed to assess the overall outcomes of internal neurolysis. Results Thirty-six patients were identified, with a mean age of 44.89 ± 7.90 (rang: 31–65) years and a disease duration of 5.19 ± 2.61 years. The immediate postoperative pain relief (Barrow Neurological Institute [BNI] pain score of I or II) rate was 100%. The medium- to long-term pain relief rate was 91.7%. Three patients experienced recurrence. Facial numbness was the primary postoperative complication. Four patients with a score of III on the BNI numbness scale immediately after surgery had marked improvement at 6 months. No serious complications occurred. Conclusion Internal neurolysis is a safe and effective treatment for trigeminal neuralgia without vascular compression or clear responsible vessels.

scholarly journals Clinical outcomes and kinetics of propanil following acute self-poisoning: a prospective case series

2009 ◽  
Vol 9 (1) ◽  
Author(s):  
Darren M Roberts ◽  
Renate Heilmair ◽  
Nick A Buckley ◽  
Andrew H Dawson ◽  
Mohamed Fahim ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Case Series ◽  
Prospective Case Series ◽  
Kinetics Of
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