Decompressive surgery

Kastrau et al. Stroke 2005 36(4) 825-829 Retrospective evaluation of aphasia in patients with hemicraniectomy for dominant sphere infarcts 14 patients with surgery evaluated with psychometric quantification twice over 470 days Evolution of aphasic symptoms 13/14 patients with improved scores and increased ability to communicate from baseline in 13 patients. Young age and early decompressive surgery were main... 

Rieke K, Schwab S, Krieger D, von Kutnmer R, Aschoff A, Schuchardt V, Hacke W. Decompressive surgery in space-occupying hemispheric infarction results of an open, prospective trial. Crit Care Med 1995 23(9) 1576-1587. 

PCRA is typically accomplished by inserting a small catheter into the affected site, and then attaching the catheter to some type of pump that enables the patient to self-administer small amounts of medication as needed. For example, a PCA system has been used to deliver local anesthetics such as bupivacaine and ropivacaine into the subacromial space following acromial decompression surgery.3,27 Likewise, PCRA can be used to deliver a local anesthetic to the area around a peripheral nerve (sciatic, popliteal, and so forth), and... 

If the patient fails to respond to weight loss and medical intervention and if there is a loss of visual function, then surgical maneuvers may be attempted. A shunt between the lumbar spinal cord and the peritoneal cavity (lumboperitoneal shunt) may be tried. As an alternative, fenestration of the optic nerve sheath allows for decompression, which relieves symptoms, reduces papilledema, and improves visual acuity. Mitomycin-C has been shown to increase the success rate of the decompression surgery. 

No medical or snrgical treatment is effective for NAION. Optic nerve sheath decompression surgery has been shown to be ineffective and may be harmful in the treatment of NAION. Up to 43% of NAION patients experience spontaneons recovery of vision by three or more lines of Snellen acnity at 6 months. 

The Ischemic Optic Neuropathy Decompression Trial Research Group. Optic nerve decompression surgery for non-arteritic arteriole ischemic optic neuropathy (AION) is not effective and may be harmful. JAMA 1995 273 625-632. 

Recent advances inclnde the nse of a fornical incision, which is considered a technical advance in decompression surgery because it allows good views of the medial and lateral walls of the orbit. Additionally, a transcaruncu-lar approach to the medial wall allows easy removal of the ethmoid bones. 

The acute ischemic stroke patient may not be competent to make medical decisions. Because emergency treatments (i.e., decompressive surgery, hemorrhage evacuation, thrombolytic drug administration, intraarterial clot removal, emergency endarterectomy) carry... 

Abla, A.A., Link, T., Fusco, D., Wilson, D.A., Sonntag, V.K., 2010. Comparison of dural grafts in Chiari decompression surgery review of the literature. J. Craniovertebr. Junction Spine 1, 29-37. 

Decompressive surgery of the posterior interosseous nerve is indicated if there is continuous worsening or no recovery of function with a few months. 

Fig. 8.61a-d. Postoperative patient with recurrence of symptoms after decompressive surgery of the ulnar nerve at the cubital tunnel for a ganglion cyst. a,b Transverse 12-5 MHz US images obtained a at the cubital tunnel level and b at the proximal forearm with c,d Tlw SB MR imaging correlation show a relapsed cyst (asterisks) which constricts the transposed ulnar nerve (arrow). The patient underwent surgery again and the postoperative course was finally uneventful. ME, medial epicon-dyle... 

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