Microvascular decompression of the trigeminal nerve is an accepted and effective means of treating patients with trigeminal neuralgia in whom compression of the nerve by a vascular structure is implicated in the pathogenesis of the disease. The current standard technique uses the binocular operating microscope for all intra-operative visualization. Posterior fossa endoscopy has demonstrated that the endoscope provides more comprehensive views of the anatomy of the cerebellopontine angle than does the operating microscope. To date, endoscopy has only been used to supplement microscopy in cranial nerve decompression surgery. In this report, we describe our completely endoscopic surgical technique as we present the case of a patient with trigeminal neuralgia who underwent successful vascular decompression by this approach. Using this technique the offending vessel was separated from the nerve with minimal brain retraction or dissection of surrounding structures. This report represents the first documented case where the endoscope was used as the exclusive imaging modality for decompression of the trigeminal nerve. From our experience we conclude that the endoscope's superior visualization more accurately identifies neurovascular conflicts, and provides a comprehensive evaluation of the completeness of the decompression. Additionally, this new method minimizes the risks of brain retraction and extensive dissection often required for microscopic exposure. From this study we conclude that completely endoscopic vascular decompression represents the next step forward in the safe and effective surgical treatment of trigeminal neuralgia.
Background: A fistulectomy involves complete excision of the fistulous tract, thereby eliminating the risk of missing secondary tracts and providing complete tissue for histopathological examination. By studying with comparing the LIFT with fistulectomy withits outcome being advantages and disadvantages in terms of hospital stay, postoperativebleeding, postoperative pain, recurrences, incontinence patient can be benefitted with early outcome with less complications associated, so this study being done to evaluate the standard procedure in terms of with less complication associated. Objectives of the study: To compare the LIFT with fistulectomy in term of operative time, postoperative, bleeding, hospital stay, wound healing, postoperative pain, recurrence, incontinence Methods: Patients satisfying inclusion criteria are enrolled within 24 hours of admission after informed consent. All the patients with Trans sphincteric fistula in ano will be evaluated with thorough clinical examination, radiological and laboratory investigations. Those who require surgery will be admitted and appropriate surgery will be performed .and analyzed for in term of operative time, postoperative bleeding, hospital stay, postoperative pain, recurrence, incontinence. Results: Majority of patients belonged to the age group of 30 -40 years. M:F is 4:1, Duration of hospital stay is significantly low in LIFT group with P<0.417, Post-operative pain is less in LIFT group with P<0.002, Post-operative woundHealing time are less with LIFT group . Incontinence is less with LIFT group when compared to Fistulectomy with P<0.0452, recurrence is noted in either group but more in LIFT group. Success rate in our study is 90% in LIFT group. Interpretation and conclusion: LIFT is associated with less postoperative pain, shorter duration of hospital stay and a quicker recovery, shorter duration of surgery, earlier return to work as compared with fistulectomy. LIFT procedure is not associated with major post-operative complications. There is no incontinence in the follow up period of six months.
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