This case report presents the therapeutic effect of restorative neurostimulation (ReActiv8®) on chronic low back pain (CLBP) in a 44-year-old male, where the primary etiology was not lumbar disc herniation (LDH). Despite presenting with LDH at L4-L5, clinical evaluations suggested lumbar microinstability and multifidus muscle dysfunction as the main contributors to his pain, without radicular symptoms. The patient had a 12-year history of CLBP, resistant to conventional treatments like physiotherapy, medications, and epidural injections. Opting for a minimally invasive approach, he underwent implantation of ReActiv8®, focusing on rehabilitating the impaired multifidus muscle. Over a 12-month therapy period, significant improvements were noted in pain levels, functionality, and quality of life, leading to a full return to work. Interestingly, follow-up imaging showed not only a substantial reduction in pain but also an unexpected resolution of the LDH at L4-L5, enhanced lumbar lordosis, and improved disc hydration, despite minor progressing Modic changes. This case underlines the potential of restorative neurostimulation in CLBP management, especially when the pain origin is non-discogenic. It emphasizes the importance of accurate pain source identification in CLBP treatment and suggests further research into the efficacy and applicability of neurostimulation in similar clinical scenarios.
A chronic subdural hematoma (CSDH) is one of the most common neurosurgery operations. This study aimed to evaluate the effect of topical corticosteroids combined with surgery in patients with CSDH.
The present study is a clinical trial study on patients referred to hospitals associated with Ahvaz University of Medical Sciences with chronic subdural hematoma in 2019. Patients requiring surgical drainage of chronic subdural hematoma who met the inclusion criteria underwent open craniotomy surgery on the side of the hematoma. A drain was placed in the open craniotomy site. On the third day after the operation, before removing the drain, 40 mg of methylprednisolone sodium succinate was injected through the drain into the subdural space, after which the drain was pulled entirely. Patients were evaluated with the Markwalder Grading Scale (MGS) on the third day, third month, and sixth month after surgery for improved or worsened neurological symptoms. Also, in the third and sixth months after surgery, the patients underwent Computerized Tomography Scan imaging and were checked for recurrence.
32 patients with CSDH entered the study, including 28 men and four women, with a mean age of 71.62 ± 9.85 years. Moreover, 87.5 % had a unilateral chronic subdural hematoma (uCSDH), and 12.5 % had a bilateral chronic subdural hematoma (bCSDH). Left and right uCSDHs had the same frequency (43. 8 %). After surgery, 26 patients had no postoperative complications, and six patients experienced pneumocephalus.
Topical dexamethasone injection through the potential CSDH cavity can result in desirable outcomes.
To assess the influence of clinical and imaging characteristics on the outcome of microsurgery treatment for cerebellopontine angle (CPA) epidermoid cyst (EC) presenting only with trigeminal neuralgia (TN).
A retrospective observational study describing 42 cases of CPA epidermoid cyst presenting only with TN n CPA for 10 years from 2011 to 2021 with the mean follow-up period was 37 months (range, 6–60 months). This study is the largest research with a long follow-up period reported so far worldwide for ECs with only TN symptom. We analyzed the clinical-radiological records of all the patients who met the rigorous requirements to find the distinct features of these tumors.
The mean age was 40.1 ± 4.7 years. The time from symptom onset to surgery was 8.6 ± 3.9 months. Symptoms of multiple branches of the 5th nerve appeared in 71.4 %, the most common was V2V3 accounting for 42.9 %. Most of the tumors were located limited in the CPA, accounting for 66.7 %. Total resection reached 90.5 %. The effectiveness of pain relief of microsurgery reached 97.6 %, Barrow Neurological Institute (BNI) score I reached 73.8 % and pain relief was 23.8 %. The postoperative neurologic deficit was 14.3 %.
CPA epidermoid cysts presenting with TN as the sole symptom have favorable characteristics for total removing the tumor compared with other tumors in the remaining group. Total removing the tumor with the support of continuous intraoperative electromyography monitoring and decompressing the 5th nerve was ideal; it will not only increase the symptom improvement but also have a low rate of postoperative complications.