Abstract:
OBJECTIVES:For patients with medically unresponsive trigeminal neuralgia (TN), surgical options include micro vascular decompression (MVD), radiofrequency rhizotomy (RF), and stereotactic radio surgery (SRS). Multiple sclerosis (MS) is a demyelinating condition that can be associated with TN, but is not amenable to treatment with MVD. We sought to identify the outcome differences of patients with TN in MS undergoing SRS or RFR in an attempt to identify factors that may influence outcomes. We also evaluated cost outcomes, both initially and over time, based on the index procedure. We performed a retrospective review of our experience with 17 cases. PATIENTS AND METHODS:A single institution retrospective chart review was performed. Since 1997, 17 patients with TN and MS have been treated at our institution. All patients underwent a preoperative MRI to rule out a compressive lesion. Patients either underwent SRS (n=7) or RFR (n=10) as their index procedure and were evaluated as a group based on this first procedure. Outcome measures included preoperative Expand Disability Status Score (EDSS) scores, pre- and postoperative facial pain and medication use, post-intervention facial numbness, need for subsequent procedures, and duration of follow-up. Charges for the index procedure, subsequent interventions, and total costs were tabulated and analyzed in 2017 US dollars, adjusting for inflation. RESULTS:The median age of patients at first operation in each group was 58.5±10.9 and 63.5±7.5 for SRS and RFR respectively. There were no significant differences in basic demographics. Overall, 71% of these patients had an excellent or good initial pain outcome. Over time, 60% of RFR and 29% of SRS patients required additional procedures to obtain satisfactory pain relief. The patients who underwent RFR as their index procedure required a significantly higher number of procedures to achieve adequate pain relief (RFR=2.7 vs SRS=2.0 [p=0.04]). The average index procedure costs in US dollars were significantly different (SRS=53,300±5257 vs RFR=12,315±3387). The average subsequent costs (costs incurred following the initial intervention) (SRS=8320±17,842, RFR=36,002±46,767) and total costs (SRS=61,620±16,087, RFR=48,317±48,475) were not statistically significantly different. CONCLUSION:TN in the setting of MS is highly difficult to treat medically with SRS and RFR being offered as options for these patients. Both can provide good initial pain relief. For patients who have RFR as their initial procedure, a larger number of procedures are required for relief compared to patients who initially underwent SRS. While there is a significant difference in the cost of the initial procedure, over time, with the cost of required subsequent interventions, there is no significant difference in total costs between the two groups.
journal_name
Clin Neurol Neurosurgjournal_title
Clinical neurology and neurosurgeryauthors
Holland MT,Teferi N,Noeller J,Swenson A,Smith M,Buatti J,Hitchon PWdoi
10.1016/j.clineuro.2017.09.004subject
Has Abstractpub_date
2017-11-01 00:00:00pages
80-84eissn
0303-8467issn
1872-6968pii
S0303-8467(17)30242-1journal_volume
162pub_type
杂志文章abstract:OBJECTIVES:Although stroke incidence is inversely associated with socioeconomic status, whether similar disparities exist with moyamoya disease (MMD) is unknown. Determining the socioeconomic and demographic factors involved in MMD will provide better direction in elucidating the etiology or addressing healthcare inequ...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2020.105719
更新日期:2020-05-01 00:00:00
abstract::No specific treatment exists for patients with multiple sclerosis (MS) who fail to respond to conventional immunosuppressive and immunomodulating modalities. Furthermore, no method is available for regeneration of existing defect in the central nervous system (CNS). The ultimate goals of MS treatment, similarly to oth...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/j.clineuro.2008.01.014
更新日期:2008-11-01 00:00:00
abstract:OBJECTIVE:Spinal cord stimulation has been proven highly effective in the treatment of Complex Regional Pain Syndrome (CRPS). The definitive implantation of a neurostimulator is usually preceded by a therapeutic test (trial), which has the purpose of identifying whether the patient would respond positively to neuromodu...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2018.06.014
更新日期:2018-08-01 00:00:00
abstract:OBJECTIVES:The significance of conventional neuroimaging features for predicting molecular diagnosis and patient survival based on the updated World Health Organization (WHO) classification remains uncertain. We assessed the relevance of neuroimaging features (ring enhancement [RE], non-ring enhancement [non-RE], overa...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2019.105556
更新日期:2019-12-01 00:00:00
abstract::Are there any differences between probable Moyamoya disease and unilateral Moyamoya disease? What kinds of differences exist between definite and probable Moyamoya disease? Furthermore, according to the diagnostic criteria of Moyamoya disease, patients with systemic disorders and angiographic features similar to those...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/s0303-8467(97)00052-8
更新日期:1997-10-01 00:00:00
abstract:OBJECTIVE:To assess the assumed advantages of pure endoscopic and endoscope-assisted methods for the supraorbital keyhole approach. The aim is to demonstrate visibility and accessibility of the pure endoscope approach as a possible standard approach for the supraorbital keyhole approach. PATIENTS AND METHODS:We perfor...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2019.105623
更新日期:2020-02-01 00:00:00
abstract:OBJECTIVE:To report on a case of post-denervation muscle hypertrophy in an unusual distribution. CASE REPORT:A 52-year-old patient with severe flaccid paraparesis after polio developed unilateral C-6 radiculopathy that resolved with conservative treatment. Within 2 years marked hypertrophy, stiffness and pain in the m...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2004.09.019
更新日期:2005-08-01 00:00:00
abstract::A rare case of meningioma of the fourth ventricle is reported. A review of the literature revealed only 24 reported cases of this type of tumor. ...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/0303-8467(92)90080-m
更新日期:1992-01-01 00:00:00
abstract::The objective of this study was to summarize the available literature describing the presentation, diagnostic evaluation, and management for adults with Type 1 and Type 2 split spinal cord malformations. A review of the literature was performed using the CINAHL, PubMed, Embase, and Web of Science database, alongside a...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/j.clineuro.2020.105733
更新日期:2020-06-01 00:00:00
abstract::A 70-year-old man developed urinary retention in the early stages of herpes simplex virus (HSV) type-1 encephalitis. A nerve conduction study suggested latent myeloradiculitis. This is the first report of human herpes simplex virus-1 encephalitis followed by urinary retention at early stage from the onset like the Els...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2017.03.011
更新日期:2017-06-01 00:00:00
abstract:OBJECTIVE:Early brain injury after aneurysmal subarachnoid hemorrhage (aSAH) comprises a pronounced neuroinflammatory reaction. Nevertheless, its relevance for functional outcome and its role as outcome predictor remains uncertain. We evaluated the relationship of various early inflammatory parameters regarding functio...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2015.08.030
更新日期:2015-11-01 00:00:00
abstract:BACKGROUND:Pituitary tumor transforming gene (PTTG) is an oncogene and has been detected in several tumors of unrelated histological origin. However, its role in meningiomas is unknown so far. We aim to investigate PTTG expression in intracranial meningiomas, and clarify the relationship between PTTG and the histopatho...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2014.04.028
更新日期:2014-07-01 00:00:00
abstract::Nineteen homocystinuric patients--13 children and 6 adults--were identified in the course of a selective screening for homocystinuria due to cystathionine synthase deficiency. Treatment with high doses (300-1200 mg/day) of pyridoxine was carried out in 17 patients, of whom 15 were completely responsive. In 10 patients...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/0303-8467(83)90046-x
更新日期:1983-01-01 00:00:00
abstract:OBJECTIVE:We evaluated long-term outcomes of posterior fossa decompression (PFD) without duroplasty in consecutive patients with newly diagnosed Chiari-1 malformation. METHODS:We searched the institutional database for all adult patients who underwent Chiari decompression between 1995 and 2007. PFD was offered to all ...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2013.12.016
更新日期:2014-03-01 00:00:00
abstract::A 21-year-old man was admitted to hospital because of recent anosmia and liquorrhoea. He also complained of moderate headache and concentration problems in the past few years. On CT scan and MRI scans a big subfrontal process was seen, partially solid and partially cystic. Neurosurgical and histological findings prove...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/0303-8467(94)00068-h
更新日期:1995-05-01 00:00:00
abstract::Extraneural metastasis (ENM) of primary central nervous system (CNS) tumors is an uncommon occurrence. Case reports and case series describe ENM after shunting, but this phenomenon has not been well characterized. In this review we aim to better understand the risk factors and clinical implications of ENM associated w...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章,meta分析
doi:10.1016/j.clineuro.2018.09.038
更新日期:2018-11-01 00:00:00
abstract:OBJECTIVE:The Medicaid patient population and health care costs for spine surgeries among these patients have increased since 2010. Hospital length of stay (LOS) contributes appreciably to hospital costs for patients undergoing primary lumbar spine surgery (PLSS). The aim of this study was to identify independent risk ...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2019.105570
更新日期:2020-01-01 00:00:00
abstract:OBJECTIVE:Gliosarcoma (GSM) is a rare subtype of glioblastoma (GBM) that accounts for approximately four percent of high-grade gliomas. There is scarce epidemiological data on patients with GSM as a distinct subgroup of GBM. METHODS:A systematic literature review was performed of peer-reviewed databases using the Pref...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2020.106054
更新日期:2020-08-01 00:00:00
abstract:OBJECTIVE:Posterior fossa tumor surgery in children poses a significant morbidity and mortality. Large multi-institutional datasets characterizing the epidemiology and morbidity of children undergoing posterior fossa tumor surgery are lacking. The objective of this study is to describe the epidemiology and short term s...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2018.02.038
更新日期:2018-05-01 00:00:00
abstract:AIM:To assess health-related quality of life (HRQoL) in patients with DM1, to identify muscular, multisystemic, central and social factors that may affect QoL and to define a DM1 patient in risk of poor QoL. PATIENTS AND METHOD:This cross-sectional study comprised 120 DM1 consecutive patients. The following scales wer...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2012.05.015
更新日期:2013-03-01 00:00:00
abstract:OBJECTIVE:In this study, we aimed to evaluate sexual dysfunction (SD) between two different regions of Turkey in patients with Parkinson's Disease (PD). PATIENTS AND METHODS:Forty-three PD patients in Ordu and 71 patients in Istanbul were included. The Unified PD Rating Scale and Hoehn and Yahr Stage (HYS) scale were ...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2017.08.014
更新日期:2017-10-01 00:00:00
abstract:BACKGROUND:The annual hemorrhage rate of intracranial cavernous malformation (CM) is reported to range from 0.23% to 1.1%. Because of the low hemorrhage rate, operating on a deep symptomatic lesion with or without hemorrhage is considered controversial. For the prevention of hemorrhage, radiosurgery is an alternative m...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2006.04.001
更新日期:2006-12-01 00:00:00
abstract::Recurrent aseptic meningitis in a 35-year-old caucasian woman is described. She had many attacks over a period of 9 years. The first attack occurred after travel in the tropics. In spite of extensive examinations no cause could be found for the recurrent attacks. Both the clinical presentation and characteristics of t...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/s0303-8467(00)00074-3
更新日期:2000-06-01 00:00:00
abstract::True and false positive rates of auditory and visual evoked potentials, as well as multi-modal evoked potentials, were assessed in groups of 30 multiple sclerosis patients and 19 healthy age-matched subjects. Sensitivity (true positive rate) generally proved to be high confirming published reports. False positive rate...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/0303-8467(92)90058-b
更新日期:1992-01-01 00:00:00
abstract::Localizing the semiology of ictal fear and seizure onset in epilepsy patients is commonly challenging due to limited value of routine electroencephalography (EEG) and very few surgical attempts. Here we reported a case of refractory epilepsy characterized by aura of extreme fear and hypermotor seizures, in which the l...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2017.10.025
更新日期:2017-12-01 00:00:00
abstract::Two patients presenting a relapsing form of sporadic brachial plexus neuropathy, the so-called Parsonage Turner syndrome, are reported. The diagnosis is based on clinical and electromyographic features. Recurrent attacks, although infrequently encountered, have been well described in the past. Sporadic cases of this s...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/s0303-8467(88)80014-3
更新日期:1988-01-01 00:00:00
abstract:BACKGROUND/OBJECT:Ligation and division of anterior third (AT) of superior sagittal sinus (SSS) is presumed to be safe and is commonly used for approaching anterior skull base tumors and distal anterior cerebral artery aneurysms (DACA). Contrary to this belief we found complications secondary to this procedure more oft...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2013.06.003
更新日期:2013-10-01 00:00:00
abstract:PURPOSE:Presacral schwannomas are rare tumors. Due to their benign nature and slow growth, these tumors are often giant and become difficult to treat. Their removal is a surgical challenge with different strategies reported in the literature. This study presents the consecutives cases of presacral schwannomas operated ...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2020.106409
更新日期:2021-01-01 00:00:00
abstract::Tardive dyskinesia (TD) is a hyperkinetic movement disorder induced by dopamine receptor blocking drugs (DRBDs). TD typically presents with stereotypy or dystonia, but may also cause akathisia, myoclonus, or tremor. However, no detailed reports of gait abnormalities have been documented. We report three patients expos...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2007.09.013
更新日期:2008-02-01 00:00:00
abstract:OBJECTIVE:Cerebral microbleeds (CMB) on gradient-echo T2*-weighted magnetic resonance image (MRI) are frequently seen in patients with cerebral diseases. In this observational study we assessed whether CMB are a predictive factor for first-ever cerebrovascular events. PATIENTS AND METHODS:This study consisted of 698 s...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2009.08.011
更新日期:2009-12-01 00:00:00