Results of Sacral Neuromodulation
To date, effectiveness has been assessed by objective and subjective measures. In evaluating the effectiveness of sacral nerve stimulation, results are frequently discussed according to urge incontinence chronic urinary retention, and chronic pelvic pain. However, subjective measures are difficult to implement because the definition tends to vary from what actual improvement occurs in patients. In a multicenter randomized controlled trial, Schmidt et al. 131 observed at six months after sacral...
Causes and Symptoms of Smell Disorders
Since olfactory disorders or even total olfactory loss are far less of a handicap than blindness or deafness for the person concerned, there have not been many attempts to estimate the percentage of people with olfactory problems. Initial surveys were done with questionnaires and rapid smell tests. They revealed that approximately 1-3 of the population has an olfactory problem 117, 118 . Since most of the decrease in olfactory function, like any other sensory function, is due to aging 119 ,...
The Overactive Bladder
Until the most recent definition of the International Continence Society ICS , the term of bladder overactivity referred to urodynamic status. The bladder was considered as overactive when objectively shown to contract, spontaneously or on stimulation, during the filling phase of a cystometro-gram while the patient is attempting to inhibit micturition 2 . Furthermore, in the first standardization report, the threshold of 15cmH20 was necessary to conclude that an uninhibited bladder was related...
Pain
Fig. 5. WHO guidelines for pain therapy should be the prime consideration in analgesic selection, the approach advocates three basic steps Patients with mild to moderate post-operative-related pain should be treated with a non-opioid analgesic, which should becombined with an adjuvant drug if a specific indication exists. For example, a patient with mild to moderate arm pain caused by fracture may benefit when a tricyclic antidepressant is added to acetaminophen. Patients who are relatively...
Historical Evolution of Functional Surgery in Lower Urinary Tract Dysfunction
It was Budge who in 1858 opened up the concept of ''micturition reflex'' by stimulating the nervous system. Thanks to technical improvements made by Oersted in 1820 and especially Faraday in 1821, he was able to activate bladder contractions using an electrical stimulation in the sacral part of the spinal cord 130 . Over a century later in 1972, Friedman 64 performed selective bladder stimulation in animal models by implanting bipolar electrodes in the spinal cord. The preganglionic...
Clinical Application of Sacral Neuromodulation
Neuromodulation of the sacral nerves is a therapeutic option for voiding dysfunction in patients who do not respond to the common non-invasive therapies and in whom disturbance in reflex coordination between the bladder, sphincter and pelvic floor is suspected. The rationale for using electrical stimulation techniques for the treatment of such voiding dysfunction is that this stimulation turns the neurological control mechanism back towards a more functional status. The main indications are...
Magnetic Functional Source Imaging of the Sensorimotor Strip
The central sulcus is an important anatomical reference in order to localize the sensorimotor cortical strip. It is important to identify precisely the functional anatomy of these cortical areas with the aim of performing surgical resections in and around these areas without harming the eloquent cortex. In particular space-occupying lesions, as tumours and vascular malformations may deform the cortical anatomy such that pre-operative MRI scans may not be appropriate for the identification of...
Treatment of Venous Sinus Obstruction
In most cases of PTS spontaneous resolution of the condition will occur. In these cases, removal of any offending agent such as tetracyclines, conventional medical therapy including acetazolamide and or steroids, and intermittent lumbar punctures will enable sufficient control of the condition until spontaneous resolution occurs. However, consideration should be considered to more aggressive intervention when the condition is refractory to medical therapy, it does not undergo spontaneous...
Methods and Techniques for Sacral Nerve Stimulation
The sacrum is normally composed of five modified vertebrae which are fused together. It is a triangular bone mass extending from the inferior vertebral column and containing the sacral and coccygeal nerves. The skin in the sacral region is usually thick, and the subcutaneous tissue varies in thickness according to the habitus of the individual. It tends to be thinner than that found in the adjacent gluteal and lumbar regions. Situated deep below the superficial fascia are two layers of fibrous...
References Fua
1. Alexander M, Rajaratanam S, Singh S, Korah IP, Gnanamuthu C, Seshadri MS 1999 Acquired dural fistulae in benign intracranial hypertension a short case report. Acta Neurol Scand 99 318-321 Amaral JF, Tsiaris W, Morgan T, Thompson WR 1987 Reversal of benign intracranial hypertension by surgically induced weight loss. Arch Surg 122 946-949 Angeli SI, Sato Y, Gantz BJ 1994 Glomus jugulare tumors masquerading as benign intracranial hypertension. Arch Otolaryngol Head Neck Surg 120 1277-1280...
Venous Sinus Obstruction in Pseudotumor Cerebri Syndrome Cause or Effect
Whether venous sinus obstruction in PTS is cause or effect remains unresolved. The experimental and clinical evidence discussed above indicates that there is potential for primary venous sinus pathology to cause PTS and there is also potential for secondary venous sinus obstruction due to raised intracranial pressure. We discuss below the available evidence and also present a unifying theory based on the establishment of a disordered positive feedback cycle. The discussion will centre on the...
Complications of Sacral Neuromodulation
Complications of Peripheral Nerve Evaluation PNE Siegel et al. 143 noted 18.2 of adverse effects in 914 test stimulation procedures. The most common adverse events are lead migration from 11.8 143 to 18.6 143 , technical problems 2.6 and pain 2.1 . One surgical intervention 0.1 was required to remove a test lead electrode that became dislodged during lead removal. Local infection and subcutaneous hematoma are rare 143 . Complications of Sacral Nerve Neuromodulation For chronic sacral...
Contents
List of Depolarisation Phenomena in Traumatic and Ischaemic Brain Injury. A. J. Strong and R. Dardis, Section of Neurosurgery, Department of Clinical Neurosciences, King's College, London, UK Abbreviation History, Definitions and Cortical Spreading The Onset Phase of Initiation of The DC Potential Mass Neuronal Activity Grafstein - Changes in Extracellular Ion Concentrations K e, Na e, Cl e, Changes in Membrane Potential and Conductance During CSD 10 Redistribution of Water Tissue Mode of...