Percutaneous Trigeminal Stimulation for Intractable Facial Pain: A Case Series

Neurosurgery ◽  
2020 ◽  
Vol 87 (3) ◽  
pp. 547-554 ◽  
Author(s):  
Pavlos Texakalidis ◽  
Muhibullah S Tora ◽  
J Tanner McMahon ◽  
Alexander Greven ◽  
Casey L Anthony ◽  
...  
Keyword(s):  
Head Trauma ◽  
Facial Pain ◽  
Rating Scale ◽  
Oral Surgery ◽  
Treatment Options ◽  
Case Series ◽  
Lead Contamination ◽  
Complication Rates ◽  
Trial Period ◽  
Trigeminal Stimulation

Abstract BACKGROUND Facial pain syndromes can be refractory to medical management and often need neurosurgical interventions. Neuromodulation techniques, including percutaneous trigeminal ganglion (TG) stimulation, are reversible and have emerged as alternative treatment options for intractable facial pain. OBJECTIVE To report the complication rates and analgesic effects associated with TG stimulation and identify potential predictors for these outcomes. METHODS A retrospective chart review of 59 patients with refractory facial pain who underwent TG stimulation was conducted. Outcomes following trial period and permanent stimulation were analyzed. Patients with >50% pain relief during trial stimulation received permanent implantation of the stimulation system. RESULTS Successful trial stimulation was endorsed by 71.2% of patients. During the trial period, 1 TG lead erosion was identified. History of trauma (facial/head trauma and oral surgery) was the only predictor of a failed trial compared to pain of idiopathic etiology (odds ratio: 0.15; 95% CI: 0.03-0.66). Following permanent implantation, approximately 29.6% and 26.5% of patients were diagnosed with lead erosion and infection of the hardware, respectively. TG lead migrations occurred in 11.7% of the patients. The numeric rating scale score showed a statistically significant reduction of 2.49 (95% CI: 1.37-3.61; P = .0001) at an average of 10.8 mo following permanent implantation. CONCLUSION TG stimulation is a feasible neuromodulatory approach for the treatment of intractable facial pain. Facial/head trauma and oral surgery may predict a nonsuccessful trial stimulation. Future development of specifically designed electrodes for stimulation of the TG, and solutions to reduce lead contamination are needed to mitigate the relatively high complication rate.

Need for standard outcome reporting systems in craniosynostosis

2011 ◽  
Vol 31 (2) ◽  
pp. E1 ◽  
Author(s):  
Caroline Szpalski ◽  
Katie Weichman ◽  
Fabio Sagebin ◽  
Stephen M. Warren
Keyword(s):  
Health Care Professionals ◽  
Treatment Options ◽  
Case Series ◽  
Functional Results ◽  
Series Data ◽  
Quality Level ◽  
Complication Rates ◽  
Outcome Reporting ◽  
Radiographic Measurements ◽  
Patient Reported

Craniosynostosis is the premature fusion of one or more cranial sutures. When a cranial suture fuses prematurely, skull growth is altered and the head takes on a characteristic pathological shape determined by the suture(s) that fuses. Numerous treatment options have been proposed, but until recently there were no parameters or guidelines of care. Establishing such parameters was an important step forward in the treatment of patients with craniosynostosis, but results are still assessed using radiographic measurements, complication rates, and ad hoc reporting scales. Therefore, clinical outcome reporting in the treatment of craniosynostosis is inconsistent and lacks methodological rigor. Today, most reported evidence in the treatment of craniosynostosis is level 5 (expert opinion) or level 4 (case series) data. Challenges in obtaining higher quality level 1 or level 2 data include randomizing patients in a clinical trial as well as selecting the appropriate outcome measure for the trial. Therefore, determining core outcome sets that are important to both patients and health care professionals is an essential step in the evolution of caring for patients with craniosynostosis. Traditional clinical outcomes will remain important, but patient-reported outcomes, such as satisfaction, body image, functional results, and aesthetic outcomes, must also be incorporated if the selected outcomes are to be valuable to patients and families making decisions about treatment. In this article, the authors review the most commonly used tools to assess craniosynostosis outcomes and propose a list of longitudinal parameters of care that should be considered in the evaluation, diagnosis, and treatment evaluation of a patient with craniosynostosis.

Laser Interstitial Thermal Therapy for Metastatic Melanoma After Failed Radiation Therapy: A Case Series

2020 ◽  
Vol 19 (2) ◽  
pp. 126-133
Author(s):  
Ali H Palejwala ◽  
Kyle P O’Connor ◽  
Camille K Milton ◽  
Panayiotis E Pelargos ◽  
Chad A Glenn ◽  
...  
Keyword(s):  
Metastatic Melanoma ◽  
Chart Review ◽  
Radiation Treatment ◽  
Treatment Options ◽  
Case Series ◽  
Retrospective Chart Review ◽  
Thermal Therapy ◽  
Complication Rates ◽  
Laser Interstitial Thermal Therapy ◽  
Hospital Stays

Abstract BACKGROUND Laser interstitial thermal therapy (LITT) is a growing technology to treat a variety of brain lesions. It offers an alternative to treatment options, such as open craniotomy and stereotactic radiosurgery. OBJECTIVE To analyze our experience using LITT for metastatic melanoma. METHODS This is a retrospective chart review of the patients from our institution. Our case series involves 5 patients who had previously failed radiation treatment. RESULTS Our patients have low complication rates and short hospital stays. Both are considerably lower when compared to the literature for metastatic melanoma. CONCLUSION LITT is a safe therapy, with few complications and short hospital stays.

Coronal Correction Using Kickstand Rods for Adult Thoracolumbar/Lumbar Scoliosis: Case Series With Analysis of Early Outcomes and Complications

2020 ◽  
Vol 19 (4) ◽  
pp. 403-413 ◽  
Author(s):  
Thomas J Buell ◽  
Peter A Christiansen ◽  
James H Nguyen ◽  
Ching-Jen Chen ◽  
Chun-Po Yen ◽  
...  
Keyword(s):  
Rating Scale ◽  
Numerical Rating Scale ◽  
Adult Spinal Deformity ◽  
Case Series ◽  
Wound Dehiscence ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Leg Pain ◽  
Complication Rates ◽  
Iliac Screw ◽  
Coronal Correction

Abstract BACKGROUND The “kickstand rod technique” has been recently described for achieving and maintaining coronal correction in adult spinal deformity (ASD). Kickstand rods span scoliotic lumbar spine from the thoracolumbar junction proximally to a “kickstand iliac screw” distally. Using the iliac wing as a base, kickstand distraction produces powerful corrective forces. Limited literature exists for this technique, and its associated outcomes and complications are unknown. OBJECTIVE To assess alignment changes, early outcomes, and complications associated with kickstand rod distraction for ASD. METHODS Consecutive ASD patients treated with kickstand distraction at our institution were retrospectively analyzed. RESULTS The cohort comprised 19 patients (mean age: 67 yr; 79% women; 63% prior fusion) with mean follow-up 21 wk (range: 2-72 wk). All patients had posterior-only approach surgery with tri-iliac fixation (third iliac screw for the kickstand) for mean fusion length 12 levels. Three-column osteotomy and lumbar transforaminal lumbar interbody fusion were performed in 5 (26%) and 15 (79%) patients, respectively. Postoperative alignment improved significantly (coronal balance: 8 to 1 cm [P < .001]; major curve: 37° to 12° [P < .001]; fractional curve: 20° to 10° [P < .001]; sagittal balance: 11 to 4 cm [P < .001]; pelvic incidence to lumbar lordosis mismatch: 38° to 9° [P < .001]). Pain Numerical Rating Scale scores improved significantly (back: 7.2 to 4.2 [P = .001]; leg: 5.9 to 1.7 [P = .001]). No instrumentation complications occurred. Motor weakness persisted in 1 patient. There were 3 reoperations (1-PJK, 1-wound dehiscence, and 1-overcorrection). CONCLUSION Among 19 ASD patients treated with kickstand rod distraction, alignment, and back/leg pain improved significantly following surgery. Complication rates were reasonable.

scholarly journals Current endovascular treatment options for central retinal arterial occlusion: a review

2014 ◽  
Vol 36 (1) ◽  
pp. E7 ◽  
Author(s):  
Nitin Agarwal ◽  
Nihar B. Gala ◽  
Reza J. Karimi ◽  
Roger E. Turbin ◽  
Chirag D. Gandhi ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Treatment Options ◽  
Central Retinal Artery Occlusion ◽  
Case Series ◽  
Arterial Occlusion ◽  
Retinal Artery Occlusion ◽  
Artery Occlusion ◽  
Central Retinal Artery ◽  
Complication Rates ◽  
Retinal Artery

Central retinal artery occlusion, although relatively rare, is an ophthalmological emergency. If left untreated, complete blindness will ensue. Conventional therapies have not significantly improved outcomes compared with the natural history of the disease. Several case series of more recent endovascular approaches, such as intraarterial fibrinolysis, report successful outcomes. Still other studies regarding intraarterial fibrinolysis do not demonstrate any significantly better outcomes, with some even indicating increased complication rates. Therefore, the authors present a review of the current endovascular treatment options for central retinal artery occlusion.

Functional Results and Outcomes After Repair of Partial Proximal Hamstring Avulsions at Midterm Follow-up

2019 ◽  
Vol 47 (14) ◽  
pp. 3436-3443 ◽  
Author(s):  
Justin W. Arner ◽  
Halle Freiman ◽  
Craig S. Mauro ◽  
James P. Bradley
Keyword(s):  
Rating Scale ◽  
Case Series ◽  
High Rate ◽  
Functional Score ◽  
Complication Rates ◽  
Patient Reported ◽  
Surgical Fixation ◽  
The Mean ◽  
Proximal Hamstring

Background: Partial avulsions of the proximal hamstring origin remain a challenging problem with nonoperative treatments frequently providing limited success. The literature is limited regarding the outcomes of operative management in the active and athletic population. Hypothesis: Surgical fixation of proximal hamstring ruptures will have favorable outcomes at midterm follow-up. Study design: Case series; Level of evidence, 4. Methods: A total of 64 patients with partial avulsions of the proximal hamstring origin treated with surgical fixation by a single surgeon were reviewed at a 2-year minimum follow-up. All patients had initially undergone failed nonoperative treatment. Patient-reported outcome scores on the Lower Extremity Functional Score (LEFS), Marx Activity Rating Scale, custom LEFS and Marx scales, and total proximal hamstring score were evaluated. Data on patient-perceived strength, return to sport, and satisfaction were also collected. Results: The cohort included 27 male and 37 female (N = 64) patients with a mean age of 47.3 years (range, 16-65 years), and all were reviewed at a mean 6.5-year (range, 2-12.5 years) follow-up. The average postoperative LEFS was 96% (range, 68%-100%), with the custom LEFS being 90% (range, 39%-100%). The mean Marx score was 12.4 (range, 4-16). The Marx custom score demonstrated no disability with activities of daily living. The mean total proximal hamstring score was 94% (range, 69%-100%). No differences in any outcome measures were seen when comparing acute versus chronic repairs. Three patients underwent further hamstring surgery. No patients reported symptoms of numbness in the operative extremity at rest, while 3 patients had a superficial stitch abscess treated with antibiotics alone. The most commonly reported difficulty was with prolonged sitting. Ninety-seven percent were satisfied with surgery, 92% reported they could participate in strenuous activity, and 97% estimated their strength to be >75%, while 64% estimated it to be 100% of their contralateral side. Patients returned to sport at an average of 11.1 months, and all that returned were satisfied with their performance. Conclusion: Both early and delayed anatomic surgical repair of partial proximal hamstring avulsions leads to successful functional outcomes, a high rate of return to athletic activity, and low complication rates at the 6.5-year follow-up. Nonoperative treatments should first be attempted.

Outcomes of scleral buckle technique performed by trainee doctors in retinal detachment

2021 ◽  
Vol 2 (3) ◽  
pp. 159-163
Author(s):  
Aalok Kumar ◽  
◽  
Sanjiv Kumar Gupta ◽  
Keyword(s):  
Retinal Detachment ◽  
Success Rate ◽  
Care Center ◽  
Treatment Options ◽  
Tertiary Care ◽  
Case Series ◽  
Complication Rates ◽  
Scleral Buckle ◽  
Retrospective Case ◽  
Anatomical Success

AIM: To evaluate the outcomes of patients operated for retinal detachment by scleral buckle technique done by trainee doctors pursuing postgraduate course in ophthalmology. METHODS: This study was a non-comparative retrospective case series to evaluate the demography, clinical features and outcomes of patients underwent rhegmatogenous retinal detachment (RRD) repaired by scleral buckle technique from July 2017 to February 2018 at a tertiary care center in India. Records of all these patients were screened. Statistical analyses were performed and using Fisher's exact test, Mann-Whitney test and Nominal Logistic regression. RESULTS: Totally of 41 patients were included out of which, 32 (78.04%) were males and 9 (21.95%) were females. In our study primary anatomical success rate was 95.12%, with significant visual gain. Postoperative complications were raised intraocular pressure (n=2), new breaks (n=2) and re-detachment in 2 patients which was successfully managed by pars plana vitrectomy (PPV) with internal tamponade and laser. CONCLUSION: The study showed that scleral buckle surgeries done by trainee doctors under supervision can achieve a high success rate in patients of RRD both in terms of postoperative anatomical success, visual acuity and complication rates. Thus, scleral buckle surgery can be an acceptable primary procedure for trainee doctors for management of RRD in selected cases despite the various treatment options now available.

Percutaneous Trigeminal Stimulation for Intractable Facial Pain: A Case Series

Neurosurgery ◽  
2021 ◽  
Vol 89 (Supplement_2) ◽  
pp. S10-S10
Author(s):  
Pavlos Texakalidis ◽  
Muhibullah S Tora ◽  
J Tanner McMahon ◽  
Alexander Greven ◽  
Casey L Anthony ◽  
...  
Keyword(s):  
Facial Pain ◽  
Case Series ◽  
Trigeminal Stimulation

In-block lateralization as a new technique for mobilization of the inferior alveolar nerve: a technique case series

2020 ◽  
Author(s):  
Marcos Augusto Tomazi ◽  
Alexandre da Silveira Gerzson ◽  
Angelo Menuci Neto ◽  
André Luciano Pasinato da Costa
Keyword(s):  
Treatment Options ◽  
Inferior Alveolar Nerve ◽  
Case Series ◽  
New Technique ◽  
Autogenous Bone ◽  
Minimal Risk ◽  
Short Implants ◽  
Bone Atrophy ◽  
A New Technique ◽  
Number Of Treatment

The edentulous atrophic posterior mandible is often a great challenge for implant rehabilitation. Although a number of treatment options have been proposed, including the use of short implants and surgical grafting techniques, in cases of severe bone atrophy, techniques for mobilization of the inferior alveolar nerve (IAN) have been shown to be efficient, with good results. Four female patients underwent IAN lateralization for prosthetic rehabilitation of the posterior mandible from 2013 to 2019, with 1 year to 5 years and 4 months of follow-up. This case series describes a new technique for mobilization of the IAN, named in-block lateralization, to facilitate access to the IAN and to reduce nerve manipulation. The implant is immediately installed (allowing nerve lateralization in unitary spaces) and the original mandibular anatomy is restored with autogenous bone from the original bed during the same surgical procedure. When well indicated and well performed, this new approach provides better and easier visualization of the IAN as well as safer manipulation aiming to achieve good results for implant stability and minimal risk of neurosensory disturbances, allowing rehabilitation even in unitary spaces.

scholarly journals Complications and Revisions After Spine Surgery in Patients With Skeletal Dysplasia: Have We Improved?

2021 ◽  
pp. 219256822199478
Author(s):  
Karim Shafi ◽  
Francis Lovecchio ◽  
Maria Sava ◽  
Michael Steinhaus ◽  
Andre Samuel ◽  
...  
Keyword(s):  
Spine Surgery ◽  
Skeletal Dysplasia ◽  
Spinal Surgery ◽  
Cardiovascular Health ◽  
Surgical Complication ◽  
Case Series ◽  
Neurologic Complication ◽  
Complication Rates ◽  
Retrospective Case ◽  
Average Patient

Study Design: Retrospective case series. Objective: To report contemporary rates of complications and subsequent surgery after spinal surgery in patients with skeletal dysplasia. Methods: A case series of 25 consecutive patients who underwent spinal surgery between 2007 and 2017 were identified from a single institution’s skeletal dysplasia registry. Patient demographics, medical history, surgical indication, complications, and subsequent surgeries (revisions, extension to adjacent levels, or for pathology at a non-contiguous level) were collected. Charlson comorbidity indices were calculated as a composite measure of overall health. Results: Achondroplasia was the most common skeletal dysplasia (76%) followed by spondyloepiphyseal dysplasia (20%); 1 patient had diastrophic dysplasia (4%). Average patient age was 53.2 ± 14.7 years and most patients were in excellent cardiovascular health (88% Charlson Comorbidity Index 0-4). Mean follow up after the index procedure was 57.4 ± 39.2 months (range). Indications for surgery were mostly for neurologic symptoms. The most commonly performed surgery was a multilevel thoracolumbar decompression without fusion (57%). Complications included durotomy (36%), neurologic complication (12%), and infection requiring irrigation and debridement (8%). Nine patients (36%) underwent a subsequent surgery. Three patients (12%) underwent a procedure at a non-contiguous anatomic zone, 3 (12%) underwent a revision of the previous surgery, and another 3 (12%) required extension of their previous decompression or fusion. Conclusions: Surgical complication rates remain high after spine surgery in patients with skeletal dysplasia, likely attributable to inherent characteristics of the disease. Patients should be counseled on their risk for complication and subsequent surgery.

Sign in / Sign up

Export Citation Format

Share Document