ABSTRACT
The treatment of spasticity in severely paralyzed patients undergoing rehabilitation constitutes a significant neurosurgical challenge that requires comprehensive management. In this study, 118 patients were treated with invasive modalities when medical therapy failed. The results of percutaneous radiofrequency foraminal rhizotomy were initially successful in 95% of the 77 patients who underwent this procedure; the rate of minor complications was 5%. This procedure was satisfactorily supplemented with percutaneous radiofrequency sciatic neurectomy in 32 of these 77 patients. Four myelotomies were performed with complete success and no major complications in patients in whom percutaneous techniques had proven inadequate. In 35 instances of focal spasticity and incomplete paralysis, intramuscular neurolysis by phenol injection was used. The success rate was 89%. In 9 patients with persistent recurrent spasticity of the lower limb, open tenotomies and peripheral neurectomies were done. Success was complete and without complications. Multiple modalities must be available for the comprehensive management of patients with paralytic spasticity.
Subject(s)
Muscle Spasticity/surgery , Spinal Nerve Roots/surgery , Humans , Muscle Spasticity/physiopathology , Retrospective Studies , Spinal Nerve Roots/physiopathologyABSTRACT
The usual surgical approach to the sella turcica is via a labial sulcus incision over the nasal spine with continuation backward to the nasal septum and sphenoid sinus. In our series of 25 transsphenoidal hypophysectomies, a primary transseptal approach was used, avoiding the oral incision. The operating time was reduced, and the visualization was adequate. The morbidity associated with the labial sulcus incision was also avoided. The surgical approach and results are discussed.
Subject(s)
Hypophysectomy/methods , Humans , Hypophysectomy/instrumentation , Pituitary Neoplasms/surgeryABSTRACT
A case of an acoustic neurinoma presenting as a subarachnoid hemorrhage is described. This is the second such case in the literature.
Subject(s)
Cranial Nerve Neoplasms/diagnosis , Neuroma, Acoustic/diagnosis , Subarachnoid Hemorrhage/diagnosis , Vestibulocochlear Nerve , Cranial Nerve Neoplasms/complications , Diagnosis, Differential , Female , Humans , Middle Aged , Neuroma, Acoustic/complications , Subarachnoid Hemorrhage/complicationsABSTRACT
A woman had cervical C-1 to C-2 subluxation with dysphagia. Initial improvement with halo cast and posterior fusion was followed by recurrence of symptoms, but transpharyngeal resection of the odontoid process had continued to alleviate symptoms at 18-month follow-up examination. The importance of vertical C-1 to C-2 subluxation in rheumatoid cervical arthritis is emphasized.
