Pain-free survival after vagoglossopharyngeal complex sectioning with or without microvascular decompression in glossopharyngeal neuralgia

2020 ◽  
Vol 132 (1) ◽  
pp. 232-238 ◽  
Author(s):  
Zoe E. Teton ◽  
Katherine G. Holste ◽  
Fran A. Hardaway ◽  
Kim J. Burchiel ◽  
Ahmed M. Raslan
Keyword(s):  
Quality Of Life ◽  
Pain Relief ◽  
Microvascular Decompression ◽  
Glossopharyngeal Neuralgia ◽  
Long Term Outcome ◽  
Free Survival ◽  
Throat Pain

OBJECTIVEGlossopharyngeal neuralgia (GN) is a rare pain condition in which patients experience paroxysmal, lancinating throat pain. Multiple surgical approaches have been used to treat this condition, including microvascular decompression (MVD), and sectioning of cranial nerve (CN) IX and the upper rootlets of CN X, or a combination of the two. The aim of this study was to examine the long-term quality of life and pain-free survival after MVD and sectioning of the CN X/IX complex.METHODSA combined retrospective chart review and a quality-of-life telephone survey were performed to collect demographic and long-term outcome data. Quality of life was assessed by means of a questionnaire based on a combination of the Barrow Neurological Institute pain intensity scoring criteria and the Brief Pain Inventory–Facial. Kaplan-Meier analysis was performed to determine pain-free survival.RESULTSOf 18 patients with GN, 17 underwent sectioning of the CN IX/X complex alone or sectioning and MVD depending on the presence of a compressing vessel. Eleven of 17 patients had compression of CN IX/X by the posterior inferior cerebellar artery, 1 had compression by a vertebral artery, and 5 had no compression. One patient (6%) experienced no immediate pain relief. Fifteen (88%) of 17 patients were pain free at the last follow-up (mean 9.33 years, range 5.16–13 years). One patient (6%) experienced throat pain relapse at 3 months. The median pain-free survival was 7.5 years ± 10.6 months. Nine of 18 patients were contacted by telephone. Of the 17 patients who underwent sectioning of the CN IX/X complex, 13 (77%) patients had short-term complaints: dysphagia (n = 4), hoarseness (n = 4), ipsilateral hearing loss (n = 4), ipsilateral taste loss (n = 2), and dizziness (n = 2) at 2 weeks. Nine patients had persistent side effects at latest follow-up. Eight of 9 telephone respondents reported that they would have the surgery over again.CONCLUSIONSSectioning of the CN IX/X complex with or without MVD of the glossopharyngeal nerve is a safe and effective surgical therapy for GN with initial pain freedom in 94% of patients and an excellent long-term pain relief (mean 7.5 years).

130 Pain Free Survival After Microvascular Decompression and Sectioning of the Vagoglossopharyngeal Nerve Complex in Glossopharyngeal Neuralgia

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 229-230
Author(s):  
Katherine Holste ◽  
Ahmed M T Raslan ◽  
Kim J Burchiel
Keyword(s):  
Quality Of Life ◽  
Pain Relief ◽  
Microvascular Decompression ◽  
Glossopharyngeal Neuralgia ◽  
Pain Intensity Score ◽  
Free Survival ◽  
Throat Pain

Abstract INTRODUCTION Glossopharyngeal neuralgia (GN) is a rare pain condition in which patients experience paroxysmal, lancinating throat pain. There are multiple surgical approaches to this disorder including microvascular decompression (MVD), sectioning of cranial nerves IX and the upper rootlets of X, or a combination of the two. The aim of this study was to examine the long term quality of life and pain free survival after both MVD and sectioning of the X/IX complex. METHODS A combined retrospective chart review and a quality of life telephone survey were performed to collect demographic information and long-term outcomes. Quality of life was assessed by a modified Barrow Neurological Institute Pain Intensity Score and a Brief Pain Inventory - Facial scale questionnaires. Kaplan-Meier analysis was done for pain free survival. RESULTS >Seventeen patients had an MVD and/or sectioning of the IX/X complex. Eleven patients had compression of IX/X by the Posterior Inferior Cerebellar Artery, 1 by a vertebral artery and 5 had no compression. One patient (6%) experienced no immediate pain relief. Eight (47%) were pain free at the longest follow-up (mean 4.3 years, ranging 2 weeks to 13 years). One patient (6%) had their throat pain relapsed at 2 months. Pain free survival was 8 years and the time until therapy failure, defined as the time of pain return at equal or worse intensity from pre-operative level, was 10.4 years. Thirteen patients (77%) had short-term complaints: the most common being dysphagia, hoarseness, ipsilateral hearing loss, and loss of taste at two weeks. All recovered except three patients (18%) who had tolerable dizziness, loss of taste and jaw pain at longest follow up. CONCLUSION Glossopharyngeal MVD with IX/X complex sectioning is a safe and effective surgical therapy for glossopharyngeal neuralgia with an initial pain freedom in 94% of patients and an excellent long-term pain relief of 10 years.

scholarly journals Long-term outcome and quality of life after CNS cavernoma resection: eloquent vs. non-eloquent areas

2021 ◽  
Author(s):  
Loay Shoubash ◽  
Jörg Baldauf ◽  
Marc Matthes ◽  
Michael Kirsch ◽  
Matthias Rath ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Short Form ◽  
Preoperative Evaluation ◽  
Patient Counseling ◽  
Surgical Morbidity ◽  
Term Outcome ◽  
Long Term Outcome

AbstractThe aim of this study is to analyze the long-term quality of life after surgery of cavernoma. A monocentric retrospective study was conducted on 69 patients with cavernoma treated microsurgically between 2000 and 2016. The eloquence was adopted from Spetzler-Martin definition. A most recent follow-up was elicited between 2017 and 2019, in which the quality of life (QoL) was evaluated with the Short Form-12 questionnaire (SF12). Forty-one lesions were in eloquent group (EG), 22 in non-eloquent group (NEG), 3 in orbit, and 3 in the spinal cord. Postoperative worsening of the modified Rankin scale (mRS) occurred in 19.5% of cases in EG versus 4.5% in NEG. After a mean follow-up of 6.5 years (SD 4.6), the neurological status was better or unchanged compared to baseline in 85.4% of EG and 100% of NEG. Regarding QoL assessment of 44 patients (EG n = 27, NEG n = 14) attended the last follow-up. Patients after eloquent cavernoma resection reported a non-inferior QoL in most SF12 domains (except for physical role) compared to NEG. However, they reported general health perception inferior to norms, which was affected by the limited physical and emotional roles. At a late follow-up, the surgical morbidity was transient in the NEG and mostly recovered in the EG. The QoL comparison between eloquent and non-eloquent cavernomas created interesting and new data after prolonged follow-up. These results add value for decision-making as well as patient counseling for future encountered cases. Preoperative evaluation of QoL is recommended for future studies to assess QoL dynamics.

Spinal Cord Stimulation in Treatment of Chronic Benign Pain: Challenges in Treatment Planning and Present Status, a 22-Year Experience

Neurosurgery ◽  
2006 ◽  
Vol 58 (3) ◽  
pp. 481-496 ◽  
Author(s):  
Krishna Kumar ◽  
Gary Hunter ◽  
Denny Demeria
Keyword(s):  
Quality Of Life ◽  
Spinal Cord ◽  
Pain Relief ◽  
Success Rate ◽  
Spinal Cord Stimulation ◽  
Pain Clinic ◽  
Axial Component

Abstract OBJECTIVE: To present an in-depth analysis of clinical predictors of outcome including age, sex, etiology of pain, type of electrodes used, duration of pain, duration of treatment, development of tolerance, employment status, activities of daily living, psychological status, and quality of life. Suggestions for treatment of low back pain with a predominant axial component are addressed. We analyzed the complications and proposed remedial measures to improve the effectiveness of this modality. METHODS: Study group consists of 410 patients (252 men, 58 women) with a mean age of 54 years and a mean follow-up period of 97.6 months. All patients were gated through a multidisciplinary pain clinic. The study was conducted over 22 years. RESULTS: The early success rate was 80% (328 patients), whereas the long-term success rate of internalized patients was 74.1% (243 patients) after the mean follow-up period of 97.6 months. Hardware-related complications included displaced or fractured electrodes, infection, and hardware malfunction. Etiologies demonstrating efficacy included failed back syndrome, peripheral vascular disease, angina pain, complex regional pain syndrome I and II, peripheral neuropathy, lower limb pain caused by multiple sclerosis. Age, sex, laterality of pain or number of surgeries before implant did not play a role in predicting outcome. The percentage of pain relief was inversely related to the time interval between pain onset and time of implantation. Radicular pain with axial component responded better to dual Pisces electrode or Specify-Lead implantation. CONCLUSION: Spinal cord stimulation can provide significant long-term pain relief with improved quality of life and employment. Results of this study will be effective in better defining prognostic factors and reducing complications leading to higher success rates with spinal cord stimulation.

Neurosurgical Choice for Glossopharyngeal Neuralgia: A Benefit–Harm Assessment of Long-Term Quality of Life

Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. 131-139 ◽  
Author(s):  
Tao Du ◽  
Bing Ni ◽  
Wei Shu ◽  
Yongsheng Hu ◽  
Hongwei Zhu ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pain Relief ◽  
Brief Pain Inventory ◽  
Glossopharyngeal Neuralgia ◽  
Significant Difference ◽  
Patient Database ◽  
Global Impression Of Change ◽  
Satisfaction Rates

Abstract BACKGROUND Microvascular decompression (MVD) and vagoglossopharyngeal rhizotomy (VGR) are effective treatment for glossopharyngeal neuralgia (GN). However, surgical choice is controversial due to the need to maximize pain relief and reduce complications. OBJECTIVE To retrospectively compare safety, efficacy, long-term quality of life (QOL), and global impression of change following MVD and VGR for treatment of GN. METHODS Patient database reviews and telephone surveys were conducted to assess baseline characteristics and long-term outcomes. The effects of pain and complications on QOL were assessed using Brief Pain Inventory-Facial (BPI-Facial) questionnaire. Complication tolerance and surgery satisfaction were sorted using the global impression of change survey. RESULTS Of 87 patients with GN, 63 underwent MVD alone, 20 underwent VGR alone, and 4 underwent VGR following a failed MVD. The long-term rate of pain relief was slightly, but not significantly, lower following MVD than VGR (83.6% vs 91.7%, P = .528). However, long-term complications occurred much more frequently following VGR (3.0% vs 50.0%, P < .001). The BPI-Facial, which evaluates pain and complications, showed that MVD had better postoperative QOL than VGR (P < .001). However, 91.7% of patients who underwent VGR experienced no or mild complications. There was no significant difference in the overall satisfaction rates between the groups (83.3% vs 83.6%, P > .99). CONCLUSION Although VGR resulted in lower postoperative QOL due to a high complication rate, most of these complications were mild. The overall satisfaction rates for the 2 surgeries were similar.

Bortezomib Induction Followed by ASCT in Patients with Multiple Myeloma: Achievement of Response After Induction and Achieving CR Post-ASCT Are Both Important Prognostic Markers

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1866-1866
Author(s):  
Min Kyoung Kim ◽  
Chang-Ki Min ◽  
Myung Soo Hyun ◽  
Kihyun Kim ◽  
Sung-Soo Yoon ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Maintenance Therapy ◽  
Conflicts Of Interest ◽  
Induction Treatment ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Free Survival

Abstract Abstract 1866 Background: In multiple myeloma (MM), the association between the response to induction before autologous stem cell transplantation (ASCT) and long-term outcome is less clear but the situation may change with the introduction of novel agents. We therefore assessed the clinical relevance of response of bortezomib induction treatment or post-ASCT response for patients who received bortezomib-combined induction chemotherapy followed by ASCT. Methods: We retrospectively assessed 183 MM patients who received bortezomib-containing induction therapy (BTZ-IT) followed by ASCT in 24 institutions throughout Korea between 2003 and 2010. Records of these patients were reviewed using the Korean Myeloma Registry database (www.myeloma.or.kr). Each institution was requested to reconfirm the data using additional case report forms. Patients who had overt MM based on International Myeloma Working Group diagnostic criteria were selected. Results: One-hundred seventy eight patients were eligible. Their median age was 56 years (range, 28–69 years) and 96 (53.9%) were male. Forty nine (27.5%) received bortezomib as front-line therapy and 129 (72.5%) as second-line treatment. All patients underwent ASCT and 22 (12.4%) were treated with tandem ASCT. Ninety-seven (54.5%) patients were treated with maintenance therapy after ASCT. After BTZ-IT, the response rates in this selected series of patients were 37.6% CR, 12.4% VGPR, 41.0% PR, 7.3% SD and 1.7% PD (Figure 1A, 1B, 1C); the corresponding post-ASCT rates were 69.2% CR, 14.0% VGPR, 11.0% PR, 2.9% SD and 2.9% PD. At a median follow-up of 46.6 months, the 3-year overall survival (OS) and event-free survival (EFS) rates were 70.0% and 31.9%, respectively. Multivariate analysis showed that factors independently predictive of OS and EFS included achievement of BTZ-IT response °Ã PR (P=0.025 and P=0.014, respectively) and the treatment with maintenance therapy (P=0.048 and P=0.001, respectively). Post-ASCT CR vs. °Â VGPR was also an independent prognostic factor for OS and EFS (P=0.0001 and P=0.002, respectively). Conclusion: At least PR to BTZ-IT and CR after ASCT were predictive of survival. These findings suggest that patients who responded to BTZ-IT may benefit from ASCT due to an enhanced quality of response. Maintenance therapy can also affect patient outcomes. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Long-Term Results of Neurological Outcome, Quality of Life, and Cosmetic Outcome After Cranioplastic Surgery: A Single Center Study of 202 Patients

2021 ◽  
Vol 12 ◽  
Author(s):  
Henrik Giese ◽  
Jennifer Antritter ◽  
Andreas Unterberg ◽  
Christopher Beynon
Keyword(s):  
Quality Of Life ◽  
Regression Analysis ◽  
Neurological Outcome ◽  
Long Term Results ◽  
Complication Rates ◽  
Long Term Outcome ◽  
Sf 36

Objective: An increased interest in the surgical procedures of decompressive craniectomy (DC) and subsequent cranioplasty (CP) has emerged during the last decades with specific focus on mortality and complication rates. The aim of the present study was to evaluate long-term neurological and cosmetic outcomes as well as Quality of Life (QoL) after CP surgery.Methods: We retrospectively reviewed the medical records of CP patients treated at our institution between 2004 and 2014 and performed a follow-up examination, with evaluation of neurological outcome using the modified Rankin Scale (mRS) and the Glasgow outcome scale (GOS), QoL (SF-36 and EQ-5D-3L). Furthermore, the cosmetic results after CP were analyzed.Results: A total of 202 CP-patients were included in the present study. The main indications for DC and subsequent CP were space-occupying cerebral ischemia (32%), traumatic brain injury (TBI, 26%), intracerebral or subarachnoid hemorrhage (32%) and infection (10%). During a mean follow-up period of 91.9 months 46/42.6% of patients had a favorable neurological outcome (mRS ≤ 3/GOS ≥ 4). Patients with ischemia had a significant worse outcome (mRS 4.3 ± 1.5) compared with patients after TBI (3.1 ± 2.3) and infectious diseases requiring CP (2.4 ± 2.3). The QoL analysis showed that <1/3rd of patients (31.2%) had a good QoL (SF-36) with a mean EQ-5D-VAS of 59 ± 26. Statistical analysis confirmed a significant worse QoL of ischemia patients compared to other groups whereas multivariate regression analysis showed no other factors which may had an impact on the QoL. The majority (86.5%) of patients were satisfied with the cosmetic result after CP and regression analysis showed no significant factors associated with unfavorable outcomes.Conclusion: Long-term outcome and QoL after CP were significantly influenced by the medical condition requiring DC. Early detection and evaluation of QoL after CP may improve the patient's outcome due to an immediate initiation of targeted therapies (e.g., occupational- or physiotherapy).

Long-Term Outcome after Dynamic Graciloplasty for Treatment of Persistent Fecal Incontinence in Patients with Anorectal Malformations

2018 ◽  
Vol 29 (03) ◽  
pp. 276-281
Author(s):  
Johan Danielson ◽  
Urban Karlbom ◽  
Tomas Wester ◽  
Wilhelm Graf
Keyword(s):  
Quality Of Life ◽  
Fecal Incontinence ◽  
Short Form ◽  
Anorectal Malformations ◽  
Dynamic Graciloplasty ◽  
Term Outcome ◽  
Long Term Outcome

Purpose Dynamic graciloplasty (DGP) has been used to treat severe fecal incontinence since the 1980s. Previous studies have shown an inferior outcome in patients with anorectal malformations (ARMs). Our experience has been that DGP has been appreciated by ARM -patients. The objective of the study was to evaluate the long-term outcome of DGP in our patients with ARM compared with patients with other underlying conditions. Materials and Methods Twenty-three patients operated with DGP at our institution from 1996 to 2010 were sent validated bowel function and quality of life questionnaires. Eighteen of 23 responded. Seven had ARM and 11 had other etiologies of fecal incontinence. The mean follow-up time was 11.6 years (range, 5–17). Results Four of 7 of the patients with ARM and 8 of 11 of patients with other etiologies used their implants at follow-up. The Miller incontinence score was slightly higher for patients with ARMs, but they had less constipation and higher Fecal Incontinence Quality of Life (FIQL)- and 36-Item Short Form Health Survey (SF-36) scores. None of the differences were statistically significant. Conclusion This study cannot confirm earlier reports in which DGP has an inferior outcome in patients with ARM. We therefore believe that the procedure should remain a treatment option for selected patients.

Genetic and Clinical Spectrum of Osteopetrosis.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1087-1087
Author(s):  
Ansgar S Schulz ◽  
Despina Moshous ◽  
Klaus-Michael Debatin ◽  
Anna Villa
Keyword(s):  
Quality Of Life ◽  
Genetic Background ◽  
Clinical Presentation ◽  
Hematopoietic Stem ◽  
Long Term Outcome ◽  
Significant Difference ◽  
Unrelated Donors

Abstract Abstract 1087 Poster Board I-109 Background Osteopetrosis (OP) is a multi-systemic inborn disorder characterized by heterogeneous clinical presentations on the basis of a variety of mutated genes. We performed a retrospective analysis in patients with OP from 28 European centers on behalf of the ESID and the EBMT. Main objectives of this analysis were survival and quality of life with respect to genetic background, initial clinical presentation, and treatment modality. Methods A set of clinical parameters, genetic findings, transplant information and follow up data were collected using specific questionnaires. Questionnaires were sent at several time points to European centers treating patients with OP and the collected data were stored in a central OP database. DNA sequencing of candidate genes involved in human OP was done predominantly at laboratories in Milan, Paris and Ulm. Results Data of 173 patients and of 134 hematopoietic stem cell transplantations (HSCT) were obtained during a time frame between 1983 and 2008. In the whole cohort, mutations in the following genes were detected: 47% biallelic TCIRG1, 9% biallelic CLCN7, 6% monoallelic CLCN7, 5% OSTM1, 2% RANK, 1% RANKL; 30% of patients have no mutations in these genes or could not be tested completely. In 23% of patients HSCT was not considered because of severe neurological problems or other complications mostly in the context of OSTM1 or CLCN7 mutations, or because of less severe phenotypes mainly due to monoallelic CLCN7 mutations (autosomal dominant OP, ADO). Follow up data of 103 transplanted patients were available. With respect to donor type, the probability of survival at 2 years was 88% for matched family donors, 80% for matched unrelated donors, 68% for HLA-haploidentical donors and 54% for mismatched unrelated donors. There was no significant difference in survival of patients with different gene mutations but a trend to a worse long term outcome in CLCN7 patients. Most notably, several major sequelae were present in the majority of surviving patients. Visual impairment or dwarfism were found in about 2/3 of children showing no significant influence of the affected genes. About 10% of patients are suffering from significant persistent neurological problems after HSCT, which were found in patients with TCIRG and CLCN7 mutations. The quality of life were judged as normal by the parents in about 2/3 of surviving patients. Conclusion HSCT in infantile OP results in acceptable survival rates even after HLA-nonidentical transplants. However, outcome is influenced by a set of specific disease related problems and long term sequelae. The heterogeneity of OP necessitates an individualised therapeutic strategy respecting the genetic background, the clinical presentation and the type of the available donor. Disclosures No relevant conflicts of interest to declare.

P197 LONG-TERM HEALTH-RELATED QUALITY OF LIFE AFTER BENIGN ESOPHAGEAL PERFORATION

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
Knepper Laura ◽  
Brinkmann Sebastian ◽  
F Fuchs Hans ◽  
H Hoelscher Arnulf ◽  
Kuhr Kathrin ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Esophageal Perforation ◽  
Health Related Quality ◽  
Long Term Outcome ◽  
Related Quality ◽  
Long Term Follow Up ◽  
Health Related

Abstract Aim This study aims to evaluate long-term outcome and health related quality of life in patients with benign esophageal perforations. Background and Methods Esophageal perforation is associated with high morbidity and mortality. In addition to surgical treatment, endoscopic endoluminal stent placement and endoscopic vacuum therapy (EVT) are established methods in the management of this emergency condition. As health-related quality of life (HRQoL) is becoming a major issue in the evaluation of any therapeutic intervention not much is known about HRQoL, particular in the long-term follow-up of patients treated for benign esophageal perforation with different treatment strategies. Patients treated for benign esophageal perforation at the University Hospital Cologne from January 2003 to December 2014 were therefore investigated. Primary outcome and management of esophageal perforation were documented and long-term quality of life was assessed using the Gastrointestinal Quality of Life Index (GIQLI), the Health-Related Quality of Life Index (HRQL) for patients with gastroesophageal reflux disease (GERD) and the European Organization for Research and Treatment of Cancer (EORTC) questionnaires for general and esophageal cancer specific QoL (QLQ-C30 and QLQ-OES18). Results Patients were divided based on primary treatment into an endoscopic (46.5%), surgical (34.5%) and conservative treatment group (19%). Short- and long-term outcome, as well as quality of life were compared. HRQoL was measured after a median follow-up of 49 months. HRQoL was generally reduced in patients with benign esophageal perforation. Endoscopically treated patients showed the highest GIQLI overall score and highest EORTC general health status, followed by the conservative and the surgical group. Conclusion HRQoL in patients with benign esophageal perforation is reduced even in the long-term follow-up. Temporary stent or EVT is effective and provides a good alternative to surgery not only in the short-term but also in the long-term follow-up.

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