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Jianbo Shi - One of the best experts on this subject based on the ideXlab platform.
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a modified surgical procedure for endoscopic optic Nerve Decompression for the treatment of traumatic optic neuropathy
North American Journal of Medical Sciences, 2014Co-Authors: Fenghong Chen, Kejun Zuo, Shaoyan Feng, Jiebo Guo, Yunping Fan, Jianbo ShiAbstract:Background: Although the endoscopic anterior-to-posterior technique offers many advantages, the long-term effects of the iatrogenic trauma (removal of the uncinate process and anterior ethmoidal sinus) resulting from the complete ethmoidectomy procedure used to gain full access to the optic Nerve canal is unknown, and sequelae such as nasal synechia and sinusitis should not be ignored. Aims: The aim of our study is to develop a less invasive procedure for endoscopic optic Nerve Decompression. Materials and Methods: We proposed a modified trans-sphenoidal surgical procedure for endoscopic optic Nerve Decompression in five patients with traumatic optic neuropathy (TON), all with high sphenoidal pneumatisation and without Onodi cellulae. Results: After performing a direct sphenoidotomy through the natural ostium of the sphenoid sinus rather than a complete ethmo-sphnoidectomy, we found that the modified approach provided adequate access to the optic Nerve canal and the apex using a 45 o angled endoscope. Successful Decompression of the canal optic Nerve was performed trans-sphenoidally in all five TON patients using an angled endoscope. No surgical complications occurred, and none of the patients suffered from anterior ethmoidal sinus or skull base damage. Conclusions: The modified trans-sphenoidal approach is a feasible, safe, effective, and minimally invasive approach for TON patients with high sphenoidal pneumatisation and without supersphenoid-ethmoid cellulae.
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treatment of traumatic optic neuropathy our experience of endoscopic optic Nerve Decompression
Journal of Laryngology and Otology, 2008Co-Authors: Bing Zhou, Jianbo Shi, Lei Cheng, Wanqing WenAbstract:Objective: Traumatic optic neuropathy can be treated by various methods including steroids and surgical Decompression. Endoscopic optic Nerve Decompression has been suggested to be effective in treating this condition. The aim of this study was to assess the outcome of treating traumatic optic neuropathy with steroids and endoscopic surgical Decompression. Methods: Two hundred and thirty-seven patients with traumatic optic neuropathy were treated with steroids; 176 also consented to endoscopic optic Nerve Decompression. Results: The total vision improvement rate was 55 per cent in the 176 patients treated with both steroids and endoscopic optic Nerve Decompression, compared with 51 per cent in the 61 patients treated with steroids alone; this difference was not statistically significant ( p > 0.05). Treatment with steroids plus endoscopic optic Nerve Decompression resulted in a significantly greater vision improvement in patients with gradual vision loss, compared with those with immediate blindness (68 vs 42 per cent, respectively). Early surgery (within one week) was an important prognostic factor for vision recovery, compared with more delayed surgical treatment (associated vision improvement rates were 60 and 31 per cent, respectively). Conclusions: Endoscopic optic Nerve Decompression is a minimally invasive, safe and efficient treatment for traumatic optic neuropathy. Used in combination with steroids, it provides effective rescue for some patients suffering visual loss. It should be undertaken as soon as possible.
Rami Burstein - One of the best experts on this subject based on the ideXlab platform.
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tracking patients with chronic occipital headache after occipital Nerve Decompression surgery a case series
Cephalalgia, 2019Co-Authors: Pamela Blake, Ronyreuven Nir, Carlton Perry, Rami BursteinAbstract:BackgroundThe therapeutic benefit of Nerve Decompression surgeries for chronic headache/migraine are controversial.AimTo provide clinical characteristics of headache type and treatment outcome of o...
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reduction in chronic migraine following occipital Nerve Decompression surgery further implications for extracranial origin of headache p2 170
Neurology, 2017Co-Authors: Pamela Blake, Carlton Perry, Rami BursteinAbstract:Objective: We aimed to determine if Nerve Decompression Surgery (NDS) of the bilateral lesser and greater occipital Nerves (bLON/GON) would reduce the burden of chronic migraine (CM). Background: CM affects nearly 5% of the 36 million American with migraine. Some of these patients experience chronic occipital headaches with chronic tenderness of neck muscles. Recently a subset of these patients who underwent NDS for alleviation of their daily headaches had biopsies taken from the occipital periosteum; these were marked by upregulation of proinflammatory genes. As animal studies have demonstrated that compression of peripheral Nerves can cause local inflammatory changes, we hypothesized that compression of bLON/GON may be the cause of inflammation and that NDS may reduce inflammation and associated CM. Design/Methods: Eighteen patients with CM and predominantly occipital pain underwent NDS of bLON/GON. Twenty-three patients who were referred for surgery but unable to undergo the procedure served as a control group. Log recordings of headache frequency and intensity were obtained for 3 months prior to surgery and at least 6 months post-operatively. NDS included removal of compressive portions of trapezius and semispinalis capitis muscle, fascial attachments, and perineural inflammatory tissue. Results: No adverse events were associated with the surgery. At study entry, the number of predominantly occipital CM days per month was 30 for subjects assigned to the control group and 28.9 for subjects in the surgical group. In follow-up at mean of 46 months following study entry, the number of occipital CM days per month was 30 for the control group and 7.28 for the surgical group (P 50% reduction in headache days. Conclusions: Decompression of bLON/GON reduces headache burden in some patients with CM, most likely by reducing inflammation. Study Supported by: Not applicable Disclosure: Dr. Blake, MD has nothing to disclose. Dr. Perry, MD has nothing to disclose. Dr. Burstein has received personal compensation for activities with Allergan, GSK, and Merck as a consultant or member of the scientific advisory board.
Marc-elie Nader - One of the best experts on this subject based on the ideXlab platform.
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Delayed facial Nerve Decompression for severe refractory cases of Bell’s palsy: a 25-year experience
Journal of Otolaryngology - Head & Neck Surgery, 2018Co-Authors: Ilyes Berania, Mohamed Awad, Issam Saliba, Jean-jacques Dufour, Marc-elie NaderAbstract:Background This study aims to assess the effectiveness of delayed facial Nerve Decompression for Bell’s palsy (BP). Methods We performed a retrospective case review of all patients having undergone facial Nerve Decompression for severe refractory BP between 1984 and 2009 at our tertiary referral center. Demographics, timing between onset of symptoms and surgical Decompression, degree of facial Nerve dysfunction pre- and post-operatively, follow-up length after surgery and postoperative complications were recorded. Facial Nerve dysfunction was assessed using the House-Brackmann (HB) scale. Electroneuronography, electromyography and imaging results were assessed when available. Results Eighteen patients had surgery between 21 and 60 days after onset of BP (group I), and 18 patients had surgery more than 60 days after onset of symptoms (group II). In group II, 11 patients had surgery between 61 and 89 days and 7 patients after 90 days. Groups I and II showed similar functional gain and rates of improvement to HB 3 or better (11/18 vs. 11/18, p > 0.05). In group II, patients operated 60 to 89 days after onset of BP showed a significantly higher rate of improvement to HB 3 or better (9/11 vs. 2/6, p = 0.049) with higher functional gain compared to those operated after 90 days ( p = 0.0293). Conclusions When indicated, facial Nerve Decompression for BP is usually recommended within the first 2 weeks of onset of facial paralysis. Nonetheless, our results suggest that patients with severe BP could benefit from Decompression surgery within 90 days after onset of symptoms in the absence of an opportunity to proceed earlier to surgery. Further investigation is still required to confirm our findings. Trial registration Retrospective registered. IRB# 2016–6154, CE 15.154 – CA
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delayed facial Nerve Decompression for severe refractory cases of bell s palsy a 25 year experience
Journal of Otolaryngology-head & Neck Surgery, 2018Co-Authors: Ilyes Berania, Mohamed Awad, Issam Saliba, Jean-jacques Dufour, Marc-elie NaderAbstract:This study aims to assess the effectiveness of delayed facial Nerve Decompression for Bell’s palsy (BP). We performed a retrospective case review of all patients having undergone facial Nerve Decompression for severe refractory BP between 1984 and 2009 at our tertiary referral center. Demographics, timing between onset of symptoms and surgical Decompression, degree of facial Nerve dysfunction pre- and post-operatively, follow-up length after surgery and postoperative complications were recorded. Facial Nerve dysfunction was assessed using the House-Brackmann (HB) scale. Electroneuronography, electromyography and imaging results were assessed when available. Eighteen patients had surgery between 21 and 60 days after onset of BP (group I), and 18 patients had surgery more than 60 days after onset of symptoms (group II). In group II, 11 patients had surgery between 61 and 89 days and 7 patients after 90 days. Groups I and II showed similar functional gain and rates of improvement to HB 3 or better (11/18 vs. 11/18, p > 0.05). In group II, patients operated 60 to 89 days after onset of BP showed a significantly higher rate of improvement to HB 3 or better (9/11 vs. 2/6, p = 0.049) with higher functional gain compared to those operated after 90 days (p = 0.0293). When indicated, facial Nerve Decompression for BP is usually recommended within the first 2 weeks of onset of facial paralysis. Nonetheless, our results suggest that patients with severe BP could benefit from Decompression surgery within 90 days after onset of symptoms in the absence of an opportunity to proceed earlier to surgery. Further investigation is still required to confirm our findings. Retrospective registered. IRB# 2016–6154, CE 15.154 – CA
Gerhard Moser - One of the best experts on this subject based on the ideXlab platform.
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the effect of steroids in combination with optic Nerve Decompression surgery in traumatic optic neuropathy
Laryngoscope, 2013Co-Authors: Thorsten Ropposch, Bernhard Steger, Cem Meco, Martin Emesz, Herbert A Reitsamer, G Rasp, Gerhard MoserAbstract:Objectives/Hypothesis Traumatic optic neuropathy (TON) is an important cause of severe visual impairment following blunt or penetrating head trauma. Treatment options include steroids, Decompression, or both. Studies have failed to show a clear benefit for either steroids or surgery or a combined therapy. This study describes the visual outcome in surgically managed patients with or without steroid treatment. Study Design Retrospective analysis. Methods In a retrospective chart review we included patients (n = 42) with TON who were managed with optic Nerve Decompression surgery with or without steroids. Comparison of initial and final visual acuity was the primary outcome parameter. Results In 42 consecutive patients, steroids were used in 21 cases (50%). Ten patients received a high-dose systemic regimen of more than 500 mg methylprednisolone initial dose, and 11 patients were treated with a lower dose. The overall visual improvement rate was 33%, no change was noted in 50%, and no outcome data were available in 17%. The visual improvement rate of patients treated with Decompression surgery and steroids was lower (29%, 6 of 21) than those treated with surgery alone (53%, 8 of 15). Comparing both groups, additional steroids had no beneficial effect on the visual outcome (P = .97). There was no case with a deterioration of visual function due to therapy. Conclusions In patients with traumatic optic neuropathy who were treated with optic Nerve Decompression surgery, steroids had no beneficial effect on the visual outcome. Level of Evidence 2c.
Cem Meco - One of the best experts on this subject based on the ideXlab platform.
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the effect of steroids in combination with optic Nerve Decompression surgery in traumatic optic neuropathy
Laryngoscope, 2013Co-Authors: Thorsten Ropposch, Bernhard Steger, Cem Meco, Martin Emesz, Herbert A Reitsamer, G Rasp, Gerhard MoserAbstract:Objectives/Hypothesis Traumatic optic neuropathy (TON) is an important cause of severe visual impairment following blunt or penetrating head trauma. Treatment options include steroids, Decompression, or both. Studies have failed to show a clear benefit for either steroids or surgery or a combined therapy. This study describes the visual outcome in surgically managed patients with or without steroid treatment. Study Design Retrospective analysis. Methods In a retrospective chart review we included patients (n = 42) with TON who were managed with optic Nerve Decompression surgery with or without steroids. Comparison of initial and final visual acuity was the primary outcome parameter. Results In 42 consecutive patients, steroids were used in 21 cases (50%). Ten patients received a high-dose systemic regimen of more than 500 mg methylprednisolone initial dose, and 11 patients were treated with a lower dose. The overall visual improvement rate was 33%, no change was noted in 50%, and no outcome data were available in 17%. The visual improvement rate of patients treated with Decompression surgery and steroids was lower (29%, 6 of 21) than those treated with surgery alone (53%, 8 of 15). Comparing both groups, additional steroids had no beneficial effect on the visual outcome (P = .97). There was no case with a deterioration of visual function due to therapy. Conclusions In patients with traumatic optic neuropathy who were treated with optic Nerve Decompression surgery, steroids had no beneficial effect on the visual outcome. Level of Evidence 2c.