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[PMID]:28885083
[Au] Autor:Ravindra VM; Christensen MT; Onwuzulike K; Smith JT; Halvorson K; Brockmeyer DL; Walker ML; Bollo RJ
[Ad] Endereço:Division of Pediatric Neurosurgery, Department of Neurosurgery; and.
[Ti] Título:Risk factors for progressive neuromuscular scoliosis requiring posterior spinal fusion after selective dorsal rhizotomy.
[So] Source:J Neurosurg Pediatr;20(5):456-463, 2017 Nov.
[Is] ISSN:1933-0715
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE Selective dorsal rhizotomy (SDR) via limited laminectomy is an effective treatment of lower-extremity spasticity in the pediatric population. Children with spasticity are also at risk for neuromuscular scoliosis; however, specific risk factors for progressive spinal deformity requiring posterior spinal fusion (PSF) after SDR are unknown. The authors' goal was to identify potential risk factors. METHODS The authors performed a retrospective cohort study of patients who underwent SDR via limited laminectomy between 2003 and 2014 and who had at least 1 year of follow-up. They analyzed demographic, clinical, and radiographic variables to elucidate risk factors for progressive neuromuscular scoliosis. The primary outcome was need for PSF. RESULTS One hundred thirty-four patients underwent SDR and had at least 12 months of follow-up (mean 65 months); 48 patients (36%) had detailed pre- and postoperative radiographic data available. The mean age at surgery was 10 years (SD 5.1 years). Eighty-four patients (63%) were ambulatory before SDR, 109 (82%) underwent a single-level laminectomy, and a mean of 53% of the dorsal rootlets from L-1 to S-1 were sectioned. Fifteen patients (11.2%) subsequently required PSF for progressive deformity. Nonambulatory status (p < 0.001) and a preoperative Cobb angle > 30° (p = 0.003) were significantly associated with PSF on univariate analysis, but no statistically significant correlation was found with any clinical or radiographic variable and PSF after SDR on multivariate regression analysis. CONCLUSIONS Patients with preoperative nonambulatory status and Cobb angle > 30° may be at risk for progressive spinal deformity requiring PSF after SDR. These are well-known risk factors for progressive deformity in children with spasticity in general. Although our analysis suggests SDR via limited laminectomy may not significantly accelerate the development of neuromuscular scoliosis, further case-control studies are critical to elucidate the impact of SDR on spinal deformity.
[Mh] Termos MeSH primário: Espasticidade Muscular/cirurgia
Complicações Pós-Operatórias/etiologia
Complicações Pós-Operatórias/cirurgia
Rizotomia
Escoliose/etiologia
Fusão Vertebral
[Mh] Termos MeSH secundário: Criança
Progressão da Doença
Feminino
Seguimentos
Seres Humanos
Laminectomia
Região Lombossacral
Masculino
Análise Multivariada
Complicações Pós-Operatórias/diagnóstico por imagem
Estudos Retrospectivos
Fatores de Risco
Escoliose/diagnóstico por imagem
Escoliose/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170909
[St] Status:MEDLINE
[do] DOI:10.3171/2017.5.PEDS16630


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[PMID]:28786493
[Au] Autor:Munger ME; Aldahondo N; Krach LE; Novacheck TF; Schwartz MH
[Ad] Endereço:Center for Gait and Motion Analysis, Gillette Children's Specialty Healthcare, Saint Paul, MN, USA.
[Ti] Título:Long-term outcomes after selective dorsal rhizotomy: a retrospective matched cohort study.
[So] Source:Dev Med Child Neurol;59(11):1196-1203, 2017 Nov.
[Is] ISSN:1469-8749
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIM: To examine long-term outcomes of selective dorsal rhizotomy (SDR) 10 to 17 years after surgery. METHOD: Participants who underwent SDR had spastic diplegic cerebral palsy (CP), completed baseline gait analysis, and were 16 to 25 years old at follow-up. Non-SDR participants (i.e. controls) were matched on important clinical parameters at baseline but did not undergo SDR. All study participants completed six surveys assessing pain, quality of life, participation, function, and mobility. Treatment history for lower extremity surgery and antispasticity injections was tabulated. A subset of each study group returned for three-dimensional gait analysis, including kinematics, metabolic energy cost, and physical examination. Gait Deviation Index (GDI) was calculated to measure gait quality. RESULTS: The study cohort had 24 participants with SDR and 11 without SDR. Of these, 13 patients with SDR (five males, eight females; median [IQR] age 17y 2mo [16y 8mo-17y 9mo]) and eight without SDR (three males, five females; median [IQR] age 19y 2mo [17y 3mo-21y 11mo]) completed baseline and follow-up gait analysis. Spasticity significantly decreased in those with SDR (p<0.05). Gait Deviation Index improved more in participants without SDR than those with SDR (Δ =12.8 vs Δ =9.1; p=0.01). Compared with the SDR group, participants without SDR underwent significantly more subsequent interventions (p<0.05). INTERPRETATION: Patients in both the SDR and non-SDR groups showed improved gait quality more than 10 years after surgery. Participants without SDR had a larger improvement in gait pathology but underwent significantly more intervention. There were no differences between groups in survey measures. These results suggest differing treatment courses provide similar outcomes into early adulthood. WHAT THIS PAPER ADDS: Selective dorsal rhizotomy (SDR) and non-SDR groups had significant improvement in gait pathology over time. The non-SDR group had significantly better gait compared with the SDR group at follow-up. The groups had similar levels of energy cost, pain, and quality of life. Non-SDR participants underwent significantly more orthopaedic surgery and antispasticity injections than SDR participants. Use of a clinically similar control group highlights that different treatment courses may result in similar outcomes into young adulthood.
[Mh] Termos MeSH primário: Paralisia Cerebral/cirurgia
Rizotomia/métodos
Raízes Nervosas Espinhais/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Estudos de Casos e Controles
Paralisia Cerebral/psicologia
Criança
Estudos de Coortes
Feminino
Marcha/fisiologia
Seres Humanos
Masculino
Qualidade de Vida/psicologia
Amplitude de Movimento Articular/fisiologia
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170809
[St] Status:MEDLINE
[do] DOI:10.1111/dmcn.13500


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[PMID]:28617943
[Au] Autor:Daunter AK; Kratz AL; Hurvitz EA
[Ad] Endereço:Department of Physical Medicine & Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA.
[Ti] Título:Long-term impact of childhood selective dorsal rhizotomy on pain, fatigue, and function: a case-control study.
[So] Source:Dev Med Child Neurol;59(10):1089-1095, 2017 Oct.
[Is] ISSN:1469-8749
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIM: Selective dorsal rhizotomy (SDR) is a surgical treatment for spasticity in children with cerebral palsy (CP). Studies suggest long-lasting effects of SDR on spasticity; long-term effects on symptoms and function are not clear. This study tested whether adults with CP (average 22y after SDR) report less pain, fatigue, and functional decline than a retrospectively assessed non-surgical comparison group. METHOD: This was a case-control study. Eighty-eight adults with CP (mean age 27y; SDR=38 male/female/missing=20/16/2; non-surgical [comparison]=50, male/female=19/31) recruited from a tertiary care center and the community completed a battery of self-reported outcome measures. Regression models were used to test whether SDR status predicted pain, fatigue, functional change, and hours of assistance (controlling for Gross Motor Function Classification System level). RESULTS: SDR status did not significantly predict pain interference (p=0.965), pain intensity (p=0.512), or fatigue (p=0.404). SDR related to lower decline in gross motor functioning (p=0.010) and approximately 6 fewer hours of daily assistance than for those in the comparison group (p=0.001). INTERPRETATION: Adults with CP who had SDR in childhood reported less gross motor decline and fewer daily assistance needs than non-surgically treated peers, suggesting the functional impact of SDR persists long after surgery.
[Mh] Termos MeSH primário: Paralisia Cerebral/cirurgia
Fadiga
Espasticidade Muscular/cirurgia
Dor
Rizotomia
[Mh] Termos MeSH secundário: Atividades Cotidianas
Adulto
Estudos de Casos e Controles
Paralisia Cerebral/complicações
Paralisia Cerebral/fisiopatologia
Proteínas de Drosophila
Fadiga/etiologia
Fadiga/fisiopatologia
Fadiga/cirurgia
Feminino
Seres Humanos
Masculino
Atividade Motora
Espasticidade Muscular/etiologia
Espasticidade Muscular/fisiopatologia
Dor/etiologia
Dor/fisiopatologia
Dor/cirurgia
Medição da Dor
Medidas de Resultados Relatados pelo Paciente
Autorrelato
Centros de Atenção Terciária
Fatores de Transcrição
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Dip3 protein, Drosophila); 0 (Drosophila Proteins); 0 (Transcription Factors)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170929
[Lr] Data última revisão:
170929
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170616
[St] Status:MEDLINE
[do] DOI:10.1111/dmcn.13481


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[PMID]:28574172
[Au] Autor:Miller SD; Juricic M; Hesketh K; Mclean L; Magnuson S; Gasior S; Schaeffer E; O'donnell M; Mulpuri K
[Ad] Endereço:BC Children's Hospital, Vancouver, BC, Canada.
[Ti] Título:Prevention of hip displacement in children with cerebral palsy: a systematic review.
[So] Source:Dev Med Child Neurol;59(11):1130-1138, 2017 Nov.
[Is] ISSN:1469-8749
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIM: To conduct a systematic review and evaluate the quality of evidence for interventions to prevent hip displacement in children with cerebral palsy (CP). METHOD: A systematic review was performed using American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Searches were completed in seven electronic databases. Studies were included if participants had CP and the effectiveness of the intervention was reported using a radiological measure. Results of orthopaedic surgical interventions were excluded. RESULTS: Twenty-four studies fulfilled the inclusion criteria (4 botulinum neurotoxin A; 2 botulinum neurotoxin A and bracing; 1 complementary and alternative medicine; 1 intrathecal baclofen; 1 obturator nerve block; 8 positioning; 7 selective dorsal rhizotomy). There was significant variability in treatment dosages, participant characteristics, and duration of follow-up among the studies. Overall, the level of evidence was low. No intervention in this review demonstrated a large treatment effect on hip displacement. INTERPRETATION: The level and quality of evidence for all interventions aimed at slowing or preventing hip displacement is low. There is currently insufficient evidence to support or refute the use of the identified interventions to prevent hip displacement or dislocation in children and young people with CP. WHAT THIS PAPER ADDS: High-quality evidence on prevention of hip displacement is lacking. No recommendations can be made for preventing hip displacement in children with cerebral palsy because of poor-quality evidence. High-quality, prospective, longitudinal studies investigating the impact of interventions on hip displacement are required.
[Mh] Termos MeSH primário: Paralisia Cerebral/complicações
Luxação do Quadril/etiologia
Luxação do Quadril/prevenção & controle
[Mh] Termos MeSH secundário: Toxinas Botulínicas Tipo A/uso terapêutico
Braquetes
Criança
Terapias Complementares
Bases de Dados Factuais/estatística & dados numéricos
Seres Humanos
Bloqueio Nervoso
Fármacos Neuromusculares/uso terapêutico
Avaliação de Resultados (Cuidados de Saúde)
Rizotomia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Neuromuscular Agents); EC 3.4.24.69 (Botulinum Toxins, Type A)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171030
[Lr] Data última revisão:
171030
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170603
[St] Status:MEDLINE
[do] DOI:10.1111/dmcn.13480


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[PMID]:28377244
[Au] Autor:Spina A; Mortini P; Alemanno F; Houdayer E; Iannaccone S
[Ad] Endereço:Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy. Electronic address: spina.alfio@hsr.it.
[Ti] Título:Trigeminal Neuralgia: Toward a Multimodal Approach.
[So] Source:World Neurosurg;103:220-230, 2017 Jul.
[Is] ISSN:1878-8769
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Trigeminal neuralgia (TN) is the most common cranial neuralgia in adults, with a slight prevalence in women. Antiepileptic drugs represent the mainstay of the medical treatment, whereas microvascular decompression is the best option in case of neurovascular conflict. Although these treatments showed a good rate of efficacy, they can be contraindicated in some patients and >50% of patients undergoing these treatments will present recurrence of pain in the following months. In this majority of patients, pain becomes chronic and can severely affect their quality of life and cause cognitive disturbances, such as anxiety and depression. METHODS: The purpose of this study was to review the efficacy and safety of current treatment modalities for TN, as well as to propose a multimodal approach for those patients presenting with a chronic form of TN. RESULTS: Current treatment modalities have been reviewed. Actual pain evaluation systems and the neuropsychologic features of TN have been analyzed in order to propose an alternative treatment algorithm. DISCUSSION: Chronic pain can also lead to the misperception of patients' own selves leading to enhanced pain perception and altering therapeutic outcomes. Thus, there is the need to define a personalized multimodal approach of treatment, taking into account other available TN therapies and the neuropsychologic aspect of chronic pain.
[Mh] Termos MeSH primário: Anticonvulsivantes/uso terapêutico
Terapia por Estimulação Elétrica/métodos
Cirurgia de Descompressão Microvascular/métodos
Radiocirurgia/métodos
Rizotomia/métodos
Neuralgia do Trigêmeo/terapia
[Mh] Termos MeSH secundário: Ansiedade/psicologia
Toxinas Botulínicas Tipo A/uso terapêutico
Terapia Combinada
Estimulação Encefálica Profunda/métodos
Depressão/psicologia
Seres Humanos
Fármacos Neuromusculares/uso terapêutico
Procedimentos Neurocirúrgicos
Qualidade de Vida
Estimulação Magnética Transcraniana/métodos
Neuralgia do Trigêmeo/psicologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Anticonvulsants); 0 (Neuromuscular Agents); EC 3.4.24.69 (Botulinum Toxins, Type A)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170406
[St] Status:MEDLINE


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[PMID]:28027234
[Au] Autor:Poppler LH; Schellhardt LM; Hunter DA; Yan Y; Mackinnon SE; Wood MD; Moore AM
[Ad] Endereço:St. Louis, Mo. From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine.
[Ti] Título:Selective Nerve Root Transection in the Rat Produces Permanent, Partial Nerve Injury Models with Variable Levels of Functional Deficit.
[So] Source:Plast Reconstr Surg;139(1):94-103, 2017 Jan.
[Is] ISSN:1529-4242
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The goal of this study was to develop a partial, nonregenerative nerve injury model in a rat that results in permanently reduced motoneuron numbers and function. This model could serve as a platform for the study of therapeutics, such as a reverse end-to-side nerve transfer (i.e., supercharge). The authors hypothesized that transection of one or more of the L4 to L6 nerve roots supplying the sciatic nerve would cause a permanent reduction in muscle force. METHODS: Rats were randomized into five groups that underwent variations of nerve root transections or sham injury. The L4 to L6 nerve roots were selectively transected and capped to prevent regeneration. Tibial and common peroneal nerves were harvested for quantitative histology and retrograde-labeled to assess the number of motoneurons projecting axons. Muscle force and relative muscle mass were assessed as metrics of postinjury motor function. RESULTS: At 6 months, the number of motoneurons projecting axons and myelinated axon counts were reduced in both the tibial and common peroneal nerves after injury in all groups. Transecting both L4 and L5 or both L4 and L6 reduced motoneuron numbers sufficiently below sham numbers to reduce muscle force and mass in major muscles of the hindlimb innervated by both nerves. Transecting L4 reduced muscle force and mass in common peroneal-innervated muscles, whereas transecting L5 reduced muscle force and mass in tibial-innervated muscles. These findings were stable over time. CONCLUSION: Transection of nerve roots produces stable (time-independent) partial nerve injury models with a selective decrease in motor function.
[Mh] Termos MeSH primário: Modelos Animais
Traumatismos dos Nervos Periféricos/fisiopatologia
Ratos Endogâmicos Lew/cirurgia
Rizotomia
Raízes Nervosas Espinhais/lesões
[Mh] Termos MeSH secundário: Animais
Axônios/patologia
Masculino
Neurônios Motores/patologia
Força Muscular
Músculo Esquelético/inervação
Músculo Esquelético/fisiopatologia
Traumatismos dos Nervos Periféricos/patologia
Nervo Fibular/patologia
Distribuição Aleatória
Ratos
Ratos Endogâmicos Lew/fisiologia
Nervo Isquiático
Raízes Nervosas Espinhais/cirurgia
Nervo Tibial/patologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161228
[St] Status:MEDLINE
[do] DOI:10.1097/PRS.0000000000002874


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[PMID]:27908676
[Au] Autor:Buizer AI; van Schie PE; Bolster EA; van Ouwerkerk WJ; Strijers RL; van de Pol LA; Stadhouder A; Becher JG; Vermeulen RJ
[Ad] Endereço:Department of Rehabilitation Medicine, Research Institute MOVE, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. Electronic address: ai.buizer@vumc.nl.
[Ti] Título:Effect of selective dorsal rhizotomy on daily care and comfort in non-walking children and adolescents with severe spasticity.
[So] Source:Eur J Paediatr Neurol;21(2):350-357, 2017 Mar.
[Is] ISSN:1532-2130
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In non-walking children with severe spasticity, daily care can be difficult and many patients suffer from pain. Selective dorsal rhizotomy (SDR) reduces spasticity in the legs, and therefore has the potential to improve daily care and comfort. AIM: To examine effects of SDR on daily care and comfort in non-walking children with severe spasticity due to different underlying neurological conditions. METHODS: Medical history, changes in daily care and comfort and satisfaction with outcome were assessed retrospectively in non-walking children who underwent SDR in our center, with a mean follow-up of 1y 7m (range 11m-4y 3m). All eligible patients (n = 24, years 2009-2014) were included. RESULTS: Mean age at SDR was 12y 4m (SD 4y 3m, range 2y 8m-19y 3m). Associated orthopaedic problems were frequent. Seven patients underwent scoliosis correction in the same session. Most improvements were reported in dressing (n = 16), washing (n = 12) and comfort (n = 10). Median score for satisfaction was 7 on a scale of 10 (range 1-9). SDR resulted in reduction of spasticity in leg muscles. In nine patients dystonia was recorded post-operatively, mainly in children with congenital malformations and syndromes. INTERPRETATION: SDR is a single event intervention that can improve daily care and comfort in non-walking children with severe spasticity, and can safely be combined with scoliosis correction. Despite the improvements, satisfaction is variable. Careful attention is necessary for risk factors for dystonia, which may be unmasked after SDR.
[Mh] Termos MeSH primário: Espasticidade Muscular/cirurgia
Assistência ao Paciente
Conforto do Paciente
Rizotomia
[Mh] Termos MeSH secundário: Adolescente
Criança
Pré-Escolar
Distonia/complicações
Feminino
Seguimentos
Seres Humanos
Masculino
Procedimentos Ortopédicos
Satisfação do Paciente
Complicações Pós-Operatórias
Estudos Retrospectivos
Rizotomia/efeitos adversos
Rizotomia/métodos
Escoliose/cirurgia
Resultado do Tratamento
Caminhada
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170411
[Lr] Data última revisão:
170411
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161203
[St] Status:MEDLINE


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[PMID]:27349397
[Au] Autor:Kanpolat Y; Al-Beyati E; Yakupoglu H
[Ad] Endereço:Ankara University, School of Medicine, Department of Neurosurgery, Ankara, Turkey.
[Ti] Título:Staged Bilateral Nucleus Caudalis DREZ Lesioning for Persistent Idiopathic Facial Pain: Exceptional Case Report.
[So] Source:Turk Neurosurg;27(2):316-320, 2017.
[Is] ISSN:1019-5149
[Cp] País de publicação:Turkey
[La] Idioma:eng
[Ab] Resumo:Persistent idiopathic facial pain (PIFP) is a rare but challenging type of facial pain. How to manipulate such a problem becomes more contentious in cases with bilateral complaints. In situations when conventional treatments fail to reduce the pain, some treatment options like nucleus caudalis dorsal root entry zone (DREZ) lesioning shine as valuable means of managing such intractable problems. Herein, we report an individual with bilateral PIFP in which the patient suffered from intractable pain and was the first to undergo bilateral nucleus caudalis DREZ operation for PIFP. The patient was followed up and the procedure resulted in immediate and complete pain relief.
[Mh] Termos MeSH primário: Dor Facial/cirurgia
Dor Intratável/cirurgia
Rizotomia/métodos
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1704
[Cu] Atualização por classe:170428
[Lr] Data última revisão:
170428
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160629
[St] Status:MEDLINE
[do] DOI:10.5137/1019-5149.JTN.12940-14.1


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[PMID]:27997548
[Au] Autor:Chen ST; Yang JT; Yeh MY; Weng HH; Chen CF; Tsai YH
[Ad] Endereço:Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan.
[Ti] Título:Using Diffusion Tensor Imaging to Evaluate Microstructural Changes and Outcomes after Radiofrequency Rhizotomy of Trigeminal Nerves in Patients with Trigeminal Neuralgia.
[So] Source:PLoS One;11(12):e0167584, 2016.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Trigeminal neuralgia is characterized by facial pain that may be sudden, intense, and recurrent. Our aim was to investigate microstructural tissue changes of the trigeminal nerve in patients with trigeminal neuralgia resulting from neurovascular compression by diffusion tensor imaging, and to test the predictive value of diffusion tensor imaging for determining outcomes after radiofrequency rhizotomy. Forty-three patients with trigeminal neuralgia were recruited, and diffusion tensor imaging was performed before radiofrequency rhizotomy. By selecting the cisternal segment of the trigeminal nerve manually, we measured the volume of trigeminal nerve, fractional anisotropy, apparent diffusion coefficient, axial diffusivity, and radial diffusivity. The apparent diffusion coefficient and mean value of fractional anisotropy, axial diffusivity, and radial diffusivity were compared between the affected and normal side in the same patient, and were correlated with pre-rhizotomy and post-rhizotomy visual analogue scale pain scores. The results showed the affected side had significantly decreased fractional anisotropy, increased apparent diffusion coefficient and radial diffusivity, and no significant change of axial diffusivity. The volume of the trigeminal nerve on affected side was also significantly smaller. There was a trend of fractional anisotropy reduction and visual analogue scale pain score reduction (P = 0.072). The results suggest that demyelination without axonal injury, and decreased size of the trigeminal nerve, are the microstructural abnormalities of the trigeminal nerve in patients with trigeminal neuralgia caused by neurovascular compression. The application of diffusion tensor imaging in understanding the pathophysiology of trigeminal neuralgia, and predicting the treatment effect has potential and warrants further study.
[Mh] Termos MeSH primário: Imagem de Tensor de Difusão/métodos
Rizotomia
Nervo Trigêmeo
Neuralgia do Trigêmeo
[Mh] Termos MeSH secundário: Idoso
Feminino
Seres Humanos
Masculino
Meia-Idade
Nervo Trigêmeo/diagnóstico por imagem
Nervo Trigêmeo/fisiopatologia
Nervo Trigêmeo/cirurgia
Neuralgia do Trigêmeo/diagnóstico
Neuralgia do Trigêmeo/fisiopatologia
Neuralgia do Trigêmeo/cirurgia
[Pt] Tipo de publicação:CLINICAL TRIAL; JOURNAL ARTICLE
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170630
[Lr] Data última revisão:
170630
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161221
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0167584


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[PMID]:27556293
[Au] Autor:Hitchon PW; Holland M; Noeller J; Smith MC; Moritani T; Jerath N; He W
[Ad] Endereço:Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, United States. Electronic address: patrick-hitchon@uiowa.edu.
[Ti] Título:Options in treating trigeminal neuralgia: Experience with 195 patients.
[So] Source:Clin Neurol Neurosurg;149:166-70, 2016 Oct.
[Is] ISSN:1872-6968
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: For patients with medically unresponsive trigeminal neuralgia (TN), surgical options include microvascular decompression (MVD), radiofrequency rhizotomy (RF), and stereotactic radiosurgery (SRS). In an attempt to identify the risks and benefits and cost inherent with each of the three modalities, we performed a retrospective review of our experience with 195 cases of TN treated over the past 15 years. METHODS: Since 2001, 195 patients with previously untreated TN were managed: with MVD in 79, RF in 36, and SRS in 80. All patients reported herein underwent preoperative MRI. Women outnumbered men 122/73 (p=0.045). Follow-up after surgery was 32±46months. RESULTS: The patients qualifying for MVD were generally healthier and younger, with a mean age±SD of 57±14, compared to those undergoing RF (75±15) or SRS (73±13, p<0.0001). In case of relapse, medical treatment was always tried and failed prior to consideration of surgical intervention. A second surgical procedure was necessary in 2, 23, and 18 patients initially treated with MVD, RF, and SRS respectively (p<0.0001). In the patients treated with MVD, RF, and SRS, the average number of procedures per patient necessary to achieve pain control was 1.1, 2.0, and 1.3 respectively (p=0.001). There were 7 complications in the patients treated with MVD but no deaths. Numbness was present in 13, 18, and 29 patients treated with MVD, RF, and SRS respectively (p=0.008). CONCLUSION: MVD for TN is the treatment least likely to fail or require additional treatment. Patients who underwent MVD were younger than those undergoing RF or SRS. The highest rate of recurrence of TN was encountered in patients undergoing RF (64%). Facial numbness was least likely to occur with MVD (16%) compared to RF and SRS (50% and 36% respectively).
[Mh] Termos MeSH primário: Cirurgia de Descompressão Microvascular/estatística & dados numéricos
Avaliação de Resultados (Cuidados de Saúde)/estatística & dados numéricos
Complicações Pós-Operatórias/epidemiologia
Reoperação/estatística & dados numéricos
Rizotomia/estatística & dados numéricos
Neuralgia do Trigêmeo/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Seguimentos
Seres Humanos
Masculino
Cirurgia de Descompressão Microvascular/efeitos adversos
Meia-Idade
Estudos Retrospectivos
Rizotomia/efeitos adversos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170817
[Lr] Data última revisão:
170817
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160825
[St] Status:MEDLINE



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