Effects of Microvascular Decompression Plus Longitudinal Nerve Sectioning on Recurrent Trigeminal Neuralgia and Investigations of Postoperative Recurrence Causes.

AIM: To investigate the causes of recurrent trigeminal neuralgia (RTN) and to evaluate the efficacy of microvascular decompression (MVD) plus longitudinal nerve sectioning (LNS) or LNS only for RTN patients who have undergone multiple procedures. MATERIAL AND METHODS: Twenty one patients underwent MVD plus LNS or LNS only at our institute from June 2008 to December 2014. The patients were retrospectively reviewed and analyzed. The following data were collected: age, sex , treatment before surgery, pain severity and distribution, findings during surgery, immediate postoperative BNI (Barrow Neurological Institute score system), final follow-up BNI, complications and associated comorbidities. RESULTS: Vascular compression, arachnoid adhesion and Teflon granulomas were the primary causes of RTN. After MVD plus LNS or LNS only treatments, almost all patients (19/21, 90.5%) reported pain relief after 36.1 months. Of these patients, 15 patients (71.4%) reported being pain-free (BNI score I) and 4 patients (19.1%) reported pain relief (BNI II-III). Two patients reported a pain level of BNI IV. However, almost all patients were left with some degree of numbness. CONCLUSION: This study certified that vascular compression, arachnoid adhesion and Teflon granulomas were the reasons for RTN. MVD plus LNS or LNS only were both feasible therapeutic options, with good probabilities of success, especially after multiple neurodestructive procedures.

Wide optic nerve canal decompression for the treatment of blindness resulting from an indirect optic nerve injury.

OBJECTIVE: The objective of this study was to investigate the efficacy of wide decompression of the optic canal for treating blindness resulting from an indirect optic nerve injury. METHODS: Forty-three patients with blindness resulting from an indirect optic nerve injury were retrospectively reviewed for preoperative vision, preoperative image, operative video, postoperative visual acuity, complications, and follow-up results. RESULTS: The 43 patients included 37 men and 6 women with an age range from 15 to 41 years (average, 31.8 years). On preoperative examination, all patients presented blindness in the involved eye. Six patients had an optic canal fracture. During the operation, a compression of the optic canal from a bony fragment was found in 1 patient, and an optic nerve sheath hematoma was found in another patient. After the operation, 6 patients developed cerebrospinal fluid rhinorrhea but recovered with conservative therapy. At the 6-month follow-up, visual acuity was improved to 3/60 in 3 patients, 5 patients could count fingers, 3 patients could see hand motions, and 3 patients retained light perception in the afflicted eye. The vision in other patients remained nonperceptive to light. CONCLUSIONS: Although the prognosis for blindness resulting from an indirect optic injury is poor, some patients have a chance to recover with enough decompression on the traumatized optic nerve. Poor results of this procedure may be related to the severity of the primary optic nerve injury.

The management of severe vascular injuries caused by stripping of great saphenous vein varicosis / 中华普通外科杂志

Objective To summarize our experience on the treatment for severe vascular injuries in the operation of great saphenous varicose vein. Methods The clinical data of 4 cases (5 lower limbs) from December 2004 to April 2009 of severe vascular injuries were retrospectively analyzed. For the lower limbs in which from the end of femoral artery to the upper part of posterior tibial artery were stripped, reconstruction operation using blood vessel prothesis was performed, above knee amputation was performed because of limb gangrene. For three limbs in which 10 cm to 15 cm superficial femoral artery were stripped, reconstruction operation using autologous saphenous vein were performed, above knee amputation was performed for one limb 5 days after the operation. For the limb in which 2 cm superficial femoral vein were cut, reconstruction operation using autologous saphenous vein were performed. Results No cases died perioperatively,for four limbs of injuried artery, ampution were performed for two limbs(50% ) ;two limbs (50%) were saved. The patient of injuried superficial femoral vein recovered. Conclusions Severe vascular injuries can be prevented and its incidence reduced by improving the awareness for iatrogenic vascular injuries,accurate operation; once the vascular injury occurred, prompt and rational measures must be adopted.