Abstract:
:OBJECTIVE Chronic neuropathic pain after peripheral nerve injury is a major clinical problem. Its management is difficult, and therapeutic approaches vary and include oral medication, neurostimulation, and surgery. The aim of this study was to assess the adequacy of surgical nerve revision in a large series of patients with long-term follow-up. METHODS The authors reviewed the charts of 231 patients (335 nerve injuries) who experienced neuropathic pain after peripheral nerve injury and underwent surgery for nerve revision at the authors' institution between 1997 and 2012. The following parameters were recorded for each patient: history, location, duration, and severity of the pain and details of nerve revision surgery. In addition, patients were invited to participate in a follow-up consultation and were asked to score their pain at that time. Current medications and examination findings were also documented. RESULTS Elective surgery was the source of nerve injury for 55.4% of the patients. The lower extremity was the most commonly involved anatomical region (54.3%), followed by the lower abdomen (16.4%) and the thoracic region (13%). The mean time between the onset of injury and revision surgery was 48 months. On average, 1.3 injured nerves per patient were explored, and surgery was performed 1.2 times per patient. Each nerve underwent revision 1.1 times on average. Neuromas-in-continuity and scar-tethered nerves were observed in 205 nerves (61%) and terminal neuromas were observed in 130 nerves (39%). The authors performed 186 (56%) neurolyses and 149 (44%) neuroma resections and translocations. The mean follow-up of the 127 (55%) patients who agreed to come back for a consultation was 68 months. These patients indicated an average pain decrease of 4 points in the visual analog scale (VAS) score. Pain relief greater than a 2-point decrease on the VAS, a criterion for a successful treatment according to the European Federation of Neurological Societies guidelines, was encountered in 80% of patients. Pain relief did not vary in a statistically significant way with regard to surgical technique, age and sex of the patient, affected nerve, or time between trauma and surgery. Before surgery, 76% of the patients were on a regimen of paracetamol and/or NSAIDs and 44% received opiates, while after nerve revision only 37% still required simple analgesia and 14% needed opiates. CONCLUSIONS Bearing in mind that medication achieves satisfying pain relief in only 30%-40% of patients with neuropathic pain, surgery must be considered as an effective alternative therapy. No objective criteria were shown to be factors of poor prognosis. Systematic preoperative clinical mapping of the injured nerves and diagnostic nerve blocks could improve the primary success rate of the surgery.
journal_name
J Neurosurgjournal_title
Journal of neurosurgeryauthors
Decrouy-Duruz V,Christen T,Raffoul Wdoi
10.3171/2017.1.JNS161778subject
Has Abstractpub_date
2018-04-01 00:00:00pages
1235-1240issue
4eissn
0022-3085issn
1933-0693pii
2017.1.JNS161778journal_volume
128pub_type
杂志文章abstract:OBJECT:The factors that contribute to periprocedural complications following cranioplasty, including patient-specific and surgery-specific factors, need to be thoroughly assessed. The aim of this study was to evaluate risk factors that predispose patients to an increased risk of cranioplasty complications and death. M...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2014.9.JNS14405
更新日期:2015-07-01 00:00:00
abstract::The mechanisms that give rise to ischemic brain damage have not been definitively determined, but considerable evidence exists that three major factors are involved: increases in the intercellular cytosolic calcium concentration (Ca++i), acidosis, and production of free radicals. A nonphysiological rise in Ca++i due t...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3171/jns.1992.77.3.0337
更新日期:1992-09-01 00:00:00
abstract::The relationship between neuropsychological deficit and emotional disturbance was examined in a sample of 124 patients who sustained work-related head injuries. Most injuries met criteria for minor head injury. Since all patients were receiving compensation, the relationship between emotional disturbance and neuro-beh...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1989.70.4.0509
更新日期:1989-04-01 00:00:00
abstract::Twenty-two patients with closed myelomeningoceles, shunted hydrocephalus, and symptomatic Arnold-Chiari malformations were studied retrospectively. Seventeen of the 22 patients were aged 6 months or younger; five patients were aged 3 to 23 years. Patients in the younger group presented with stridor, apnea, and/or feed...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1987.66.6.0812
更新日期:1987-06-01 00:00:00
abstract:OBJECT:In this retrospective study conducted at Atkinson Morley's Hospital and Middlesbrough General Hospital, the authors analyzed 100 matched patients who had suffered subarachnoid hemorrhage (SAH) to determine whether the technical procedure by which aneurysms are treated affects the development of chronic hydroceph...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2000.92.6.0991
更新日期:2000-06-01 00:00:00
abstract::Intratumoral hemorrhage as the presenting symptom of spinal tumors is rare. The authors describe a patient who presented with rapidly progressing paraplegia 24 hours after sustaining a minor traumatic injury of the thoracic spine. Radiological evaluation demonstrated a low-thoracic intradural tumor that was resected a...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/spi.2000.93.2.0327
更新日期:2000-10-01 00:00:00
abstract::The search for the origin of the commonly held principle in current neurosurgery regarding the resectability of the anterior one third of the superior sagittal sinus unravels the many fascinating developments that occurred in neurosurgery during the early 20th century. All these occurrences can be traced back to, and ...
journal_title:Journal of neurosurgery
pub_type: 传,历史文章,杂志文章
doi:10.3171/jns.2003.99.4.0787
更新日期:2003-10-01 00:00:00
abstract:OBJECT:Neurointensivists are specialists trained to manage all aspects of the intensive care unit (ICU) stay of neurologically ill patients. No study to date has examined the role of neurointensivists specifically in subarachnoid hemorrhage (SAH) management. This study examined the use of a team-based neurointensivist ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2009.8.JNS09441
更新日期:2010-03-01 00:00:00
abstract::The history of medicine is replete with innovations in neurosurgery that have spurred further developments across the medical spectrum. Surgeons treating pathologies in the head and spine have broken ground with new approaches, techniques, and technologies since ancient times. Neurosurgeons occupy a vital nexus in pat...
journal_title:Journal of neurosurgery
pub_type: 历史文章,杂志文章
doi:10.3171/2014.8.JNS141791
更新日期:2014-12-01 00:00:00
abstract::Somatosensory evoked response from the cervical skin surface over the spine (the cervical SER) was recorded, and compared with the cord dorsum potential (CDP) simultaneously recorded from the posterior epidural space at the same segment. The cervical SER evoked by segmental nerve stimulation consisted of an initially ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1978.48.6.0980
更新日期:1978-06-01 00:00:00
abstract::The effect of concentrated conditioned medium from each of eight human malignant glioma cell lines on the growth of indicator cells (normal rat kidney fibroblasts (NRK), clone 14) was determined in monolayer and in soft agar assay systems. The conditioned medium from all cell lines was mitogenic in the monolayer assay...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1989.71.6.0875
更新日期:1989-12-01 00:00:00
abstract::OBJECTIVE Different surgical routes have been used over the years to achieve adequate decompression of the optic nerve in its canal including, more recently, endoscopic approaches performed either through the endonasal corridor or the transorbital one. The present study aimed to detail and quantify the amount of bone ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2016.8.JNS16566
更新日期:2017-07-01 00:00:00
abstract::Between 1975 and 1989, 25 children treated with myelomeningocele closure and shunting for hydrocephalus at the Children's Hospital of Pittsburgh developed progressive lower brain-stem dysfunction from their Chiari malformation. Retrospective univariate and multivariate analyses of these cases were undertaken to assess...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1992.77.6.0881
更新日期:1992-12-01 00:00:00
abstract::Giant paraclinoidal carotid artery aneurysms frequently require temporary interruption of local circulation to facilitate safe occlusion. Due to brisk retrograde flow through the ophthalmic artery and cavernous branches, simple trapping of the aneurysm by cervical internal carotid artery clamping and intracranial dist...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1990.73.2.0305
更新日期:1990-08-01 00:00:00
abstract:OBJECT:The authors performed a retrospective analysis of a consecutive series of craniopharyngiomas and their recurrences, which were managed with surgery alone. METHODS:In the past 20 years, 37 consecutive patients with craniopharyngiomas underwent surgery without adjuvant radiotherapy. During that period there was a...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2005.103.2.0224
更新日期:2005-08-01 00:00:00
abstract:OBJECT:The aim of this study was to acquire intraoperative images during neurosurgical procedures for later reconstruction into a stereoscopic image system (QuickTime Virtual Reality [QTVR]) that would improve visualization of complex neurosurgical procedures. METHODS:A robotic microscope and digital cameras were used...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3171/jns.2004.100.4.0591
更新日期:2004-04-01 00:00:00
abstract:OBJECT:Experience with intraarterial abciximab for the treatment of thromboembolism during endovascular coil embolization is limited. The authors report the outcome of intraarterial abciximab use, with an emphasis on fatal hemorrhagic complications. METHODS:Between March 2003 and May 2006, the authors treated 606 aneu...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/JNS/2008/108/3/0450
更新日期:2008-03-01 00:00:00
abstract::The authors describe the case of a 32-year-old woman known to have Russell-Silver syndrome who presented with repeated aneurysmal subarachnoid hemorrhage. Multiple intracranial aneurysms and advanced peripheral vascular disease were demonstrated. The authors postulate a link between these vascular features and the pat...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2014.11.JNS1410
更新日期:2015-08-01 00:00:00
abstract::A 12-year operative experience with 171 consecutive patients with severe brachial plexus lesions who had at least 1 1/2 years of follow-up review is analyzed. Selection for and timing of operation was helped by categorization of each individual plexus element as "completely" or "incompletely" injured and as "in contin...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1983.58.5.0631
更新日期:1983-05-01 00:00:00
abstract::The effect of suppression of postischemic reactive hyperemia on the blood-brain barrier (BBB) and ischemic brain edema after temporary focal cerebral ischemia was studied in cats under ketamine and alpha-chloralose anesthesia. Regional cerebral blood flow (rCBF) was measured by a thermal diffusion method and a hydroge...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1989.70.1.0073
更新日期:1989-01-01 00:00:00
abstract::Intraventricular rupture of a colloid cyst is a rare phenomenon and has been proposed as a mechanism for sudden death in patients with colloid cysts. Imaging of a colloid cyst during rupture has been described in only one other instance. The authors report a highly unusual case of a 53-year-old man who presented with ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2016.5.JNS153015
更新日期:2017-06-01 00:00:00
abstract::Metrizamide computerized tomographic cisternography (MCTC) has proved 100% successful in documenting the precise anatomic location of the dural osseous defect in three patients with sphenoethmoidal rhinorrhea. In each patient, direct surgical approach to the site indicated by MCTC terminated the leakage in a single pr...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1980.53.2.0222
更新日期:1980-08-01 00:00:00
abstract::The authors present a surgical technique for resection of dumbbell tumors of the spine. The transparaspinal exposure combines laminectomy and sectioning of the paraspinal muscles through a transverse incision. The procedure allows total tumor resection by means of a single posterior approach in selected patients, thus...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1998.88.1.0106
更新日期:1998-01-01 00:00:00
abstract::Clinical results of an extra-intracranial arterial bypass (EIAB) procedure for cerebral ischemia are assessed in 65 patients. The 5-year-study suggests that the EIAB procedure has a protective effect against further clinically significant cerebrovascular accidents in properly selected patients. Correlation with angiog...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1976.44.3.0313
更新日期:1976-03-01 00:00:00
abstract::A 63-year-old woman with a 10-year history of intermittent cerebrospinal fluid (CSF) rhinorrhea was found to have a transclival meningocele. After pluridirectional tomography demonstrated a bone defect in the clivus, the diagnosis was established by means of computerized tomography (CT) by comparing the absorption coe...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1980.53.4.0553
更新日期:1980-10-01 00:00:00
abstract::Neural foundations underlying visual agnosia are poorly understood. The authors present the case of a patient who underwent awake surgery for a right basal temporooccipital low-grade glioma in which direct electrostimulation was used both at the cortical and subcortical level. Brain mapping over the inferior longitudi...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2012.10.JNS12527
更新日期:2013-01-01 00:00:00
abstract:OBJECT:Diffuse axonal injury (DAI) is a major complication of traumatic brain injury (TBI) that leads to functional and psychological deficits. Although DAI is frequently underdiagnosed by conventional imaging modalities, it can be demonstrated using diffusion tensor imaging. The aim of this study was to assess the pre...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2005.103.2.0298
更新日期:2005-08-01 00:00:00
abstract::The authors report a series of 34 meningiomas of the sphenoid ridge. Eight tumors were totally removed uneventfully: two from the middle sphenoid ridge and six from the pterion or Sylvian point. Five tumors were not operated on because of their extensions or the patient's age. Twenty-one tumors raised serious surgical...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1980.53.5.0587
更新日期:1980-11-01 00:00:00
abstract::The mortality rate has recently been reduced to only a small percentage of patients selected for early aneurysm surgery. Despite recovery without neurological deficits, however, a diffuse encephalopathy may remain, with emotional and psychological sequelae that will interfere with rehabilitation and social reintegrati...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1985.62.5.0673
更新日期:1985-05-01 00:00:00
abstract::The authors present the oldest historical case of a so-called beaten-copper cranium. The typical pattern was identified on a skull from a child, probably a boy, who died at approximately 6 years of age and was buried in a provisional cemetery used during the siege of Hanau, Germany, in 1635 and 1636. Morphological and...
journal_title:Journal of neurosurgery
pub_type: 历史文章,杂志文章
doi:10.3171/ped.2007.106.1.71
更新日期:2007-01-01 00:00:00