We present the long-term clinical and angiographic follow-up results of 100 consecutive intracranial aneurysms treated with Onyx liquid embolic system (MTI, Irvine, Calif.), either alone or combined with an adjunctive stent, in a single center. A total of 100 aneurysms in 94 patients were treated with endosaccular Onyx packing. Intracranial stenting was used adjunctively in 25 aneurysms including 19 during initial treatment and 6 during retreatment. All aneurysms except two were located in the internal carotid artery. Of the 100 aneurysms, 35 were giant or large/wide-necked, and 65 were small. Follow-up angiography was performed in all 91 surviving patients (96 aneurysms) at 3 and/or 6 months. Follow-up angiography was performed at 1, 2, 3, 4 and 5 years in 90, 41, 26, 6 and 2 patients, respectively. Overall, aneurysm recanalization was observed in 12 of 96 aneurysms with follow-up angiography (12.5%). All 12 were large or giant aneurysms, resulting in a 36% recanalization rate in the large and giant aneurysm group. One aneurysm out of 25 treated with the combination of a stent and Onyx showed recanalization. There was also no recanalization in the follow-up of small internal carotid artery aneurysms treated with balloon assistance only. At final follow-up, procedure- or device-related permanent neurological morbidity was present in eight patients (8.3%). There were two procedure-related and one disease-related (subarachnoid hemorrhage) deaths (mortality 3.2%). Delayed spontaneous asymptomatic occlusion of the parent vessel occurred in two patients, detected on routine follow-up. Onyx provides durable aneurysm occlusion with parent artery reconstruction resulting in perfectly stable 1-year to 5-year follow-up angiography both in small aneurysms treated with balloon assistance only (0% recanalization rate) and large or giant aneurysms treated with stent and Onyx combination (4% recanalization rate). Endosaccular Onyx packing with balloon assistance may not be adequate for stable long-term results in those with a large or giant aneurysm. However, the recanalization rate of 36% in these aneurysms is better than the reported results with other techniques, i.e., coils with or without adjunctive bare stents.

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Many patients may suffer from neuropathic pain in the early post-surgical period after lumbar discectomy. Gabapentin and pregabalin are anticonvulsant agents that may decrease perioperative central sensitization and early post-surgical neuropathic pain. Gabapentin and pregabalin effectively relieved neuropathic pain and prevented the conversion of acute pain to chronic pain at the 1-year follow-up after lumbar discectomy.

ABSTRACTimaging (USI). The use of these imaging methods increases the rate of success and decreases complications. Ultrasound is a good alternative to fluoroscopy, which has proven side effects (particularly radiation emission), is expensive and requires an additional technical team. Furthermore, in recent years, USI has been widely used in chronic pain cases as an effective and reliable imaging method (16).In the present study, we compared the results of ultrasoundand fluoroscopy-guided caudal epidural steroid injections in lumbar postlaminectomy patients in terms of efficacy, ease of administration, patient satisfaction, and complications. █ mATERIAl and mEThODSThis study was a prospective, randomized, and controlled single-blinded study. The study protocol was approved by █ INTRODUCTION L ow back pain (lumbago) is an important clinical problem in post-laminectomy patients. Unless treated early, it can attain a chronic neuropathic course, which requires a more complex therapy. For years, various epidural interventions (interlaminary, transforaminal, caudal) have been used for pain therapy in post-lumbar laminectomy (7). Caudal epidural blockade procures successful results in acute pain (in pediatric and adult inguinal and pelvic operations) as well as in chronic pain conditions (particularly in low back pain, pelvic pain, etc.) (13). For many years, caudal blockade had been administered utilizing the landmark technique. Since this technique does not provide adequate anesthesia and also causes some complications (dural perforation, hemorrhage, intraosseous injection, etc.), caudal blockade is currently performed under the guidance of fluoroscopy and ultrasound AIm:To compare the results of ultrasound and fluoroscopy guided caudal epidural steroid injections in postlaminectomy patients. mATERIAl and mEThODS: Thirty postlaminectomy patients were randomly divided into two groups, Group I (n=15) received ultrasound-guided and Group II (n=15) received fluoroscopy-guided caudal epidural local anesthetic and steroid injection. Time of block for each patient was recorded. The patients' visual analogue scale (VAS), Oswestry Disability Index (ODI), and satisfaction with the therapy during the 3-month follow-up were evaluated. RESUlTS:The caudal block performed with both methods resulted in similar improvement in low back pain and functions. Time of block was shorter in Group I than in Group II (6.06 ±0.88 minutes versus 11.2±1.14 minutes). CONClUSION:Caudal epidural steroid injection is an effective analgesic method for postlaminectomy patients. Ultrasound-guided caudal block can be as effective as fluoroscopy-guided block and even more comfortable.

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