Background: Postoperative skull bone defects are one of the urgent problems of neurorehabilitation. Skull bone defect limits the scope of rehabilitation measures, complicates patient care, and leads to secondary complications. Significant risks of postop complications demands making a decision about surgery individually. Surgery timing varies widely and remains controversal. Aims: to formulate the features of skull bone defects reconstruction in patients at various stages of rehabilitation based on the analysis of the frequency and structure of postoperative surgical complications. Materials and methods: the retrospective analysis of cranioplasty results was performed in the 129 patients treated in FRCC ICMR from 2018 to 2022 at various stages of rehabilitation (intensive care, inpatient, outpatient). The features of surgery, frequency and structure of surgical complications dependent on rehabilitation stage were analyzed. Results: A total of 129 patients were included in the study (84 men (65%) and 45 women (35%)). The average age of the patients was 43.2 13.9 years. The average timing of cranioplasty surgery was 79 days [60;133]. Seventy two patients (56%) were operated on at the intensive care stage of rehabilitation, forty (31%) and seventeen (13%) patients were operated on at the inpatient and outpatient stages, respectively. In total, complications occurred in 16 patients (12%). Intensive care patients required careful preoperative preparation, correction of homeostasis and metabolism disorders. In our series, postoperative complications were observed in 12 patients on intensive care stage (17%); all cases of hydrocephalus occurred only in intensive care patients. In patients operated on at the inpatient stage of rehabilitation, complications occurred in 4 cases (10%), while there was no statistically significant difference in the incidence of complications in patients from the intensive care and inpatient subgroups (p=0.334). Complications in patients at the outpatient stage of rehabilitation were not observed in our series. Conclusions: Cranioplasty surgery is possible even in somatically burdened patients at the intensive care stage of rehabilitation. It allows to expand the scope of rehabilitation measures and facilitate medical care. When planning surgical intervention in the early stages after the cranioplasty surgery, it is important to take into account the increased risk of hydrocephalus manifestation.
Objective: Spinal cord stimulation (SCS) is one approach to the potential improvement of patients with post-stroke or post-traumatic spasticity. However, little is known about whether and how such interventions alter supraspinal neural systems involved in the pathogenesis of spasticity. This pilot study investigated whether epidural spinal cord stimulation at the level of the C3–C5 cervical segments, aimed at reducing spasticity, alters the patterns of functional connectivity of the brain. Methods: Eight patients with spasticity in the right limbs as a result of left cerebral hemisphere damage (due to hemorrhagic and ischemic stroke or traumatic and anoxic brain injury) were assessed with fMRI immediately before and immediately after short-term (1 to 6 days) test cervical epidural SCS therapy. Eight demographically and clinically comparable patients with spasticity in the right extremities due to a left hemisphere ischemic stroke and brain injury who received conventional therapy were examined as a control group. All patients also had paresis of one or two limbs and hyperreflexia. Results: After the SCS therapy, there were three main findings: (1) higher functional connectivity of the brainstem to the right premotor cortex and changes in functional connectivity between cortical motor areas, (2) increased functional connectivity between the right and left lateral nodes of the sensorimotor network, and (3) a positive correlation between decreased spasticity in the right leg and increased functional connectivity within the right hemisphere sensorimotor cortex. All these changes in functional connectivity occurred with a statistically significant decrease in spasticity, as assessed using the modified Ashworth scale. The control group showed no decrease in spasticity or increase in functional connectivity in any of the seeds of interest. On the contrary, a decrease in functional connectivity of the brainstem and right postcentral gyrus was observed in this group during the observation period. Conclusions: We were thus able to detect intrinsic brain connectivity rearrangements that occurred during spasticity mitigation following short epidural SCS therapy. Significance: The clinical results obtained confirmed the efficacy of short-term anti-spastic SCS therapy. The obtained data on functional rearrangements of the central motor system may shed light on the mechanism of antispastic action of this procedure.
BACKGROUND: Pain in cancer patients, often poorly treated, cause severe distress for patients and their caregivers, and significantly reduces quality of life. Modern guides for the medical treatment of chronic pain in cancer patients are not effective in all cases, especially when chronic neuropathic pain syndrome occurs. In this regard, there is a need for a multidisciplinary personalized approach to the tactics of chronic pain management in favor of surgical methods at earlier stages of this condition. Nowadays neuromodulation is widely used for the treatment of neuropathic chronic pain syndrome in patients with various pathologies, whereas it is not used routinely in cancer patients. CLINICAL CASE DESCRIPTION: We introduce a case report of successfully applied neuromodulation in patient with severe chronic pain syndrome due to rectal cancer. Epidural spinal cord stimulation at Th10Th12 levels allowed to stop the systemic use of opioids and achieve long-term remission. Spinal cord stimulation has shown itself to be very promising and significantly improved patients quality of life. CONCLUSIONS: Our case report evidently shows that current chronic pain management guides and treatment recommendations needs a revision and neuromodulation usage in category of cancer patients should be considered.
The paper analyzes the experience of using epidural spinal cord stimulation in tonic and burst stimulation modes in 71 patients with the consequences of damage to the central nervous system, who underwent treatment and rehabilitation at the Research Institute of Rehabilitology named after professor I.V. Pryanikov, FSCC RR, from 2020 to 2021. The efficacy of epidural stimulation in the indicated modes for clinical manifestations of pyramidal syndrome in the extremities, chronic disorders of consciousness, neuropathic pain, and paresis of the extremities without spasticity has been studied. The use of invasive spinal cord stimulation in the burst mode in patients with spasticity and chronic disorders of consciousness is described for the first time. The impact of various factors on the effectiveness of stimulation has also been analyzed. The average age of patients in the study group was 47 ± 17 years, the average duration of test epidural stimulation was 4.3 ± 1.6 days. Twenty-eight patients (39.5%) were stimulated in the tonic mode, twenty-two patients (31%) were stimulated in the burst mode, and the remaining patients were stimulated in the combined mode. Results: positive dynamics after the use of epidural stimulation was observed in 39 patients (54.9%). The spasticity regressed in 32 patients (52.5%); in addition, an increase in the active range of motion was observed in 23 patients (37.7%) from this subgroup. The decrease in the severity of spasticity in the extremities ranged from 0.33 ± 0.1 to 0.63 ± 0.13 points (p<0.005). The signs of an increase in the level of consciousness as a result of the stimulation were noted in 8 patients (38.1%); the neuropathic pain syndrome regressed in 8 patients (72.7%). When applying this technique in patients with paresis without spasticity, the stimulation did not have an effect in any patients of this subgroup. There was no statistically significant influence of etiology, age of patients or duration of stimulation on its effect. The patients with spasticity, who were stimulated in the tonic mode, more often demonstrated the effectiveness of stimulation compared with the patients from the combined mode subgroup (p<0.013). Higher effectiveness of the burst mode stimulation compared to the combined mode stimulation in patients with spasticity was on the borderline of statistical significance (p=0.065). Thus, the use of epidural stimulation in patients with chronic neuropathic pain and spasticity showed the best results; the effect of epidural stimulation on the level of consciousness in chronic disorders requires additional studies and changes in their design.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.