Cases reported "Neuralgia"

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11/22. nerve crush--a possible treatment of peripheral neuralgia.

    Twenty-three patients with neuralgic pain (mean duration 3 years) were treated with crushing instead of sectioning the peripheral nerve. There was immediate relief of pain in 19 patients (83%). With the return of skin sensation the pain recurred after 3-4 months in 4 patients and within 2.5 years in another 3 patients. Twelve (52%) of the patients felt no pain at follow-up after 3-6 years. Eight of the 12 patients (67%) who were free of pain at follow-up were still anaesthetic in the area; pain had returned in 6 of the 10 patients (60%) with normal skin sensation. There were no cases of postoperative deafferentation pain, and those 4 patients who did not experience any relief after nerve crush all had a restitutio ad integrum.
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12/22. Selective rhizotomies for spinal root pain and neuralgia of the inguinal region.

    Our recent experience stimulated a review of selective rhizotomies for the alleviation of localized pain. Three patients with postoperative neuralgia in the inguinal region and two with neoplastic root compression were treated. Results were good and long-lasting in two cases, moderate in two and poor in one case. The relief appeared to better, the more clearly the pain was localized. In lesions distal to the spinal root it is necessary to undertake selective paravertebral root blocks with local anaesthetics. Experimental data are discussed that help in an understanding of pain recurrence after rhizotomy.
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13/22. Percutaneous glossopharyngeal thermocoagulation complicated by syncope and seizures.

    We describe the case of a patient who, during the percutaneous thermocoagulation of the petrous ganglion of Andersch, suffered a serious vagal response resulting in cardiac arrest, collapse, and generalized convulsions. Notwithstanding such major symptoms, the postoperative examination revealed no lesions of the vagus nerve and the glossopharyngeal lesion was shown to be isolated and selective.
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14/22. Spontaneous saphenous neuralgia.

    Six patients representing seven cases of spontaneous (nontraumatic) saphenous neuralgia secondary to entrapment of the nerve in the subsartorial canal are presented. All patients complained of medial knee and leg pain. Clinical findings included tenderness over the subsartorial canal and sensory changes in the cutaneous distribution of one or both terminal branches of the saphenous nerve. The diagnosis was confirmed by saphenous nerve block in all cases. All patients were treated operatively, which resulted in symptomatic improvement. All six patients initially underwent external neurolysis; however, three patients required saphenous neurectomy for recurrent symptoms. Saphenous neuralgia should be considered in the differential diagnosis of medial lower extremity pain.
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15/22. Proposed operation for occipital neuralgia: C-2 and C-3 root decompression. Case report.

    The common association of occipital neuralgia with post-traumatic cervical arthritis raises the question of whether some cases of occipital neuralgia are due to delayed C-2 or C-3 root entrapment. This hypothesis led to surgical exploration of the C-3 and C-2 roots in a young patient with post-traumatic arthritic occipital neuralgia. The abnormal operative findings and resolution of the neuralgia after C-3 foraminal and C-2 fascial root decompression lead to the tentative proposal that some cases of occipital neuralgia represent a root entrapment syndrome amenable to neurosurgical decompression.
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16/22. Selective percutaneous thermocoagulation rhizotomy in essential glossopharyngeal neuralgia.

    Percutaneous radiofrequency (rf) thermocoagulation of the inferior petrous ganglion of Andersch at the jugular foramen has been used to treat three patients with essential glossopharyngeal neuralgia. Two of these patients needed a second rf thermocoagulation, one within 1 week due to an incomplete result, and the other 8 months after the first procedure for recurrence of some neuralgic pain. Thus, a total of five rf thermocoagulations of the ganglion of Andersch have been performed. The patients are now pain-free and without significant side-effects. deglutition and phonation have remained intact after each rf thermocoagulation. Glossopharyngeal selectivity was obtained by avoiding the risk of injury to the other nerves at the jugular foramen. The surgical technique involves precise x-ray control and constant monitoring of the blood pressure and electrocardiogram findings. Electrode misplacement of any spreading of current to the vagus nerve will be readily detected by bradycardia and hypotension during the physiological testing before a definite rf lesion takes place. This operative technique is described.
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17/22. Polymorphonuclear function in patients with skin and joint symptoms after small-intestinal shunt operations.

    Previous studies have shown that the small-bowel shunt operation for morbid obesity may be followed by signs of enhanced cell-mediated immunity and polymorphonuclear (PMN) granulocyte bactericidal capacity. In the present study seven patients, operated 4 months--4.5 years previously and exhibiting postoperative arthralgias, arthritis, and/or skin rashes, were investigated with regard to their PMN adherence and bactericidal capacity and plasma levels of complement factors 3 and 4 (C3 and C4). There patients showed a decreased PMN bactericidal capacity compared both with 10 other shunt-operated patients without skin and joint symptoms and with healthy controls, whereas PMN adherence was lower than for the non-symptomatic patients but similar to that of the controls. Two patients had C3 levels above the reference value; all had normal C4 values. Thus, a small-bowel shunt operation for obesity, complicated by skin and joint symptoms, might be associated with decreased PMN bactericidal capacity.
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18/22. Intraoperative monitoring of spinal cord SEPs during microsurgical DREZotomy (MDT) for pain, spasticity and hyperactive bladder.

    Since 1972, MDT has been performed in 234 patients with chronic pain, 140 with hyperspasticity and 12 with hyperactive neurogenic bladder. In the last 64 patients, the evoked electrospinogram has been recorded intraoperatively from the surface of the spinal cord, to monitor the electrophysiological effects produced by the surgical lesioning, not only on the conduction of lemniscal fibers when entering the dorsal column, but also on the postsynaptic responses of the dorsal horn cells. The decrease in amplitude of the latter responses (N13 or N22) was well correlated with (1) the depth and the width of the DREZ lesion, and (2) the number of spinal segments operated on. In most cases, amplitude was reduced in the order of 2/3, which was considered the best value.
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ranking = 5
keywords = operative
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19/22. Intraoperative monitoring of the vagus nerve during intracranial glossopharyngeal and upper vagal rhizotomy: technical note.

    Intracranial section of the glossopharyngeal and upper vagal rootlets for the treatment of vagoglossopharyngeal neuralgia may cause dysphagia or vocal cord paralysis from injury to the motor vagal rootlets in 10% to 20% of cases. To minimize this complication, we recently applied a technique of intraoperative monitoring of the vagus nerve (previously described by Lipton and McCaffery to monitor the recurrent laryngeal nerve during thyroid surgery) in a patient undergoing intracranial rhizotomy for vagoglossopharyngeal neuralgia. By inserting an electrode in the ipsilateral false vocal cord and stimulating the rostral vagal rootlets intraoperatively under general anesthesia, we could differentiate the rostral vagal motor rootlets from the sensory rootlets. In this patient, the technique allowed us to preserve a rostral vagal rootlet, which if sectioned, could have caused dysphagia or vocal cord paralysis. We conclude that intraoperative monitoring of the rostral vagal rootlets is an important technique to minimize complications of upper vagal rhizotomy.
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ranking = 7
keywords = operative
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20/22. Glossopharyngeal neuralgia associated with vascular compression and choroid plexus papilloma.

    We report two cases of presumed idiopathic glossopharyngeal neuralgia that were discovered intraoperatively to be associated with compression by choroid plexus papillomas, and by a variable degree of vascular compression at the root entry zones of cranial nerves IX and X. The combination of the two entities in glossopharyngeal neuralgia has not previously been reported.
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