Microvascular Decompression versus Radiofrequency Ablation in Trigeminal Neuralgia of the Maxillary and Mandibular Divisions.

Background Although medical treatment is the mainstay of therapy, in trigeminal neuralgia (TN), patients failing to respond to it make them candidates to ablative or nonablative procedures. Objective The aim of this study was to compare the outcome of Microvascular decompression (MVD) and radiofrequency (RF) thermocoagulation in the management of TN affecting the mandibular and maxillary divisions. Materials and Methods Retrospective analysis of the data of 40 patients suffering from intractable classical TN affecting the maxillary or mandibular divisions or both was carried out. Twenty patients were operated upon by MVD of the trigeminal nerve; and 20 had RF ablation of the maxillary or mandibular divisions of the trigeminal nerve or both. Results In MVD the overall successful outcome was achieved in 16 patients (80%), while the failure was in 4 patients (20%) of which 3 had a fair outcome and 1 patient had a poor outcome. Whereas in RF the overall successful outcome was achieved in 17 patients (85%), while the failure was in 3 patients (15%) of which 2 had a fair outcome and 1 patient had a poor outcome. Outcome was insignificantly different between both groups ( p -value 0.806). Conclusion MVD and RF ablation represent safe and efficacious surgical choices for addressing TN that encompasses both the mandibular and maxillary divisions. Long-term follow-up studies demonstrate that MVD consistently yields favorable outcomes, establishing it as the preferred primary surgical technique, unless contraindicated by the patient's general health and specific needs.

Ventriculoperitoneal Shunt Surgery in Pediatrics: Does Preoperative Skin Antisepsis with Chlorhexidine/Alcohol Reduce Postoperative Shunt Infection Rate?

BACKGROUND: In pediatrics, shunt infection is considered the most common complication of ventriculoperitoneal (VP) shunt insertion and the main cause of shunt failure. Careful surgical technique and hygienic skin preparations are highly important for prevention of shunt infections. Our objective was to assess the significance of using preoperative chlorhexidine/alcohol as a skin antiseptic in reducing the infection rate in pediatric VP shunts surgery. METHODS: We conducted a retrospective, case control study of 80 pediatric patients with active hydrocephalus. The control group (a single step of preoperative skin antisepsis using povidone-iodine and isopropyl alcohol) comprised 40 patients who underwent a shunt surgery between January 2019 and June 2020 and the study group (two steps of preoperative skin antisepsis using 2% chlorhexidine gluconate in 70% isopropyl alcohol as a first step followed by povidone-iodine as a second step) comprised 40 patients who underwent a shunt surgery between July 2020 and January 2022. RESULTS: Shunt infection was encountered in 11 (13.7%) patients. It was significantly higher in preterm babies (p = 0.010), patients with a previous shunt revision (p < 0.001), and those with a previous shunt infection (p < 0.001). The incidence of infection was 22.5% in the control group and 5% in study group, with a statistically significant difference (p = 0.023). CONCLUSIONS: Two steps of preoperative skin antisepsis, first using chlorhexidine/alcohol and then povidone-iodine scrub solution, may significantly reduce the infection rate in pediatric VP shunt surgeries.

Percutaneous Selective Vertebroplasty: State of the Art Management in Well-Confined Metastatic Vertebral Lesions.

STUDY DESIGN: Prospective cohort study. PURPOSE: To evaluate the clinical and radiological results of percutaneous selective vertebroplasty (PSV) as first-line treatment options in the setting of well-confined spinal metastases. OVERVIEW OF LITERATURE: Recent technological advances combined with innovative interventional techniques enable an alternative less invasive treatment option for many patients with malignant vertebral body infiltration. Percutaneous vertebral augmentation procedures offer less invasive but effective pain relief to many patients with symptomatic spinal metastatic disease. METHODS: Eleven patients with 21 well-confined metastatic vertebral lesions that had been treated with PSV were included. Pain was evaluated one week, one month, 3 months and 6 months post-procedure using a 10-point visual analogue scale (VAS). A statistical analysis including repeated measures analysis of variance test was used to collectively indicate the presence of any significant differences between different time sequences. Medication usage and range of mobility were also evaluated. RESULTS: The 11 patients had an average age of 42 years and 54.5% were male. Highly significant improvements in VAS scores at rest and with activity (p<0.001) were evident. There was a significant decrease in rate of medication consumption post-procedure (p<0.05). CONCLUSIONS: PSV can be used successfully as the first-line treatment for well-confined metastatic vertebral lesions. It is also an effective method to decrease pain, increase mobility, and decrease narcotic administration in such patients.

Influence of Vertebral Bone Marrow Edema on Outcome in Non-Acute Osteoporotic Patients Treated with Percutaneous Vertebroplasty.

STUDY DESIGN: Prospective cohort study. PURPOSE: To prospectively investigate the influence of presence of bone marrow edema (BME) in non acute osteoporotic verterbral compression fractures on postoperative clinical outcome in patients treated by percutaneous vertebroplasty (PV). OVERVIEW OF LITERATURE: Although PV is widely used to treat osteoporotic collapsed vertebral compression fractures (VCF); little is known about the influence of BME in osteoporotic VCF or about its relation with relief of pain. METHODS: Sixty seven patients with non acute osteoporotic verterbral compression fractures treated with PV. They were divided into edema group (56 patients with apparent vertebral BME in their magnetic resonance [MR] images), and non edema group (11 patients with no vertebral BME detected in their MR images). Pain was evaluated one week, one month, six months, and one year post procedure using visual analogue scale. Statistical analysis including a 2-tailed t test comparing postoperative data with preoperative values was done. RESULTS: A good clinical response to PV procedure was seen in all patients. Significant difference was seen between two groups in one week, and one month follow up periods. Regarding pain relief in the other periods of follow up, no significant difference was seen between two groups. CONCLUSIONS: PV resulted in significantly clinical improvement in patients with BME pattern than in those without in one week and one month follow up periods. But the absence of vertebral BME did not influence pain relief in patients with osteoporotic VCFs in six months, and one year post procedure.

Retraction: Sensitivity of Pyramidal Signs in Patients with Cervical Spondylotic Myelopathy.

[This retracts the article on p. 65 in vol. 10, PMID: 26949460.].

Sensitivity of Pyramidal Signs in Patients with Cervical Spondylotic Myelopathy.

STUDY DESIGN: This was a retrospective study. PURPOSE: The purpose of this study was to study the relationship between prevalence of pyramidal signs and the severity of cervical myelopathy. The study is focused on patients having increased signal intensity in T2-weighted magnetic resonance imaging. OVERVIEW OF LITERATURE: Cervical spondylotic myelopathy is the most common cause of spinal cord dysfunction in elderly population. It is the consequence of spondylotic changes leading to cervical cord injury with resulting clinical deficits. Diagnosis in such patients is made based on clinical and radiographic features. A patient must have both symptoms and signs consistent with cervical cord injury as well as radiographic evidence of damage to spondylotic cord. METHODS: Forty-six patients with complaint of cervical spondylotic myelopathy with increased signal intensity in T2-weighted magnetic resonance imaging were included in the study. The neurological finding of the patients was reviewed for the presence of pyramidal signs. The prevalence of each pyramidal sign was calculated and correlated to severity of cervical myelopathy. The motor function scores of the upper and lower extremities for cervical myelopathy set by the Japanese Orthopedic Association (motor Japanese Orthopaedic Association score, m-JOA) scores were used to assess severity of myelopathy. RESULTS: The most prevalent signs were hyperreflexia (89.1%), Hoffmann reflex (80.4%), Babiniski sign (56.5%), and ankle clonus (39.1%). Babiniski sign, ankle clonus, and Hoffmann reflex showed significant association with the lower m-JOA score. CONCLUSIONS: In patients with cervical myelopathy, hyperreflexia exhibited highest sensitivity whereas ankle clonus demonstrated lowest sensitivity. The prevalence of the pyramidal signs is correlated with increasing severity of myelopathy.

Percutaneous Vertebroplasty: A New Serial Injection Technique to Minimize Cement Leak.

STUDY DESIGN: This is a prospective cohort study. PURPOSE: This study discusses a new technique for injecting cement in the affected vertebrae. OVERVIEW OF LITERATURE: Since introduction of vertebroplasty to clinical practice, the cement leak is considered the most frequent and hazardous complication. In literature, the cement extravasation occurred in 26%-97% of the cases. METHODS: A hundred and twenty-three patients underwent vertebroplasty using the serial injection technique. The package of the cement powder and the solvent was divided into five equal parts. Each part of the powder and the solvent was mixed as a single dose and injected to the affected vertebra. The duration between subsequent injections was 10 minutes. Each injection consisted of 1-1.5 mL of cement. RESULTS: This new technique gives the surgeon enough time to make multiple separate injections using the same package. The time interval between injections hardens the cement just enough so that it does not get displaced by the next cement injection. This technique gives time to the preceding injected cement to seal off the cracks and cavities in the vertebra, and subsequently leads to a significant decrease in cement leak (p<0.001), as compared to literature. CONCLUSIONS: This study demonstrates a previously unreported technique for vertebroplasty that adds more safety to the procedure by significantly decreasing cement leak. It also makes the surgeon more relaxed due to time intervals, giving him more self-confidence whilst performing the procedure.

Percutaneous vertebroplasty: a first line treatment in traumatic non-osteoporotic vertebral compression fractures.

STUDY DESIGN: This was a prospective cohort study. PURPOSE: The purpose of this study was to document and evaluate the clinical and radiological results of percutaneous vertebroplasty (PV) as a first line treatment in traumatic non-osteoporotic vertebral compression fractures (TNVCFs). OVERVIEW OF LITERATURE: PV is commonly used for osteoporotic and neoplastic compression fractures, however its use in traumatic non-osteoporotic compression fractures is uncertain. METHODS: We included 23 patients with traumatic non-osteoporotic TNVCFs and normal bone mineral densitometry scores who were treated with PV. Pain was evaluated at 2 hours, 1 week, 1 month, 6 months, 1 year, and 2 years post procedure using the 10-point visual analogue scale (VAS). Ronald-Morris disability Questionnaire (RDQ) scores were also collected. Statistical analysis included a 2-tailed t test comparing postoperative data with preoperative values. Range of mobility was also evaluated. RESULTS: The 23 patients had an average age of 36 years, and 69.5% were female. There was a significant improvement in VAS scores of pain at rest and in motionand in RDQ scores (p<0.05). CONCLUSIONS: The results of this study proved that PV can be used successfully as a first line treatment in patients with non-osteoporotic compression fractures. It is also, an effective method to decrease pain, increase mobility, and decrease narcotic administration.