No abstract

Percutaneous epidural stimulation of the low thoracic spinal cord was carried out in 41 patients with pain from peripheral arterial disease of the lower limbs. Results are reported relating to pain, claudication distance, peripheral blood flow, and trophic lesion changes. Following a trial period of stimulation, 37 patients had stimulators permanently implanted. After a mean poststimulation follow-up period of 25 months, substantial pain relief (75% to 100%) was obtained in 29 cases; claudication distance significantly increased in 15 cases; Doppler ultrasound recordings of lower-limb distal arteries showed a tendency toward normalization of pulse-wave morphology, with increase of amplitude in 12 of the 23 patients studied; a rise in skin temperature was also detected by thermography. Distal arterial blood pressure remained unchanged with stimulation. Ischemic cutaneous trophic lesions of less than 3 sq cm healed, but gangrenous conditions were not benefited. A placebo effect or the natural history of the disease can be excluded as the reason for these improvements. It is concluded that spinal cord stimulation is a valid alternative treatment for moderate peripheral arterial disorders when direct arterial surgery is not possible or has been unsuccessful.

Sixty laminectomies were performed in dogs to investigate the prevention of the laminectomy membrane and its side effects. These operations were distributed in six groups of 10, one was a control group, and in the others the bone defect was protected with different materials (Oxicel, Silastic, Dacron, methyl methacrylate, and Kiel bone graft). After a survival of 2 months, suboccipital myelography was performed, immediately after which the animals were sacrificed and the operated spinal slice obtained. The different radiographic densities of the tissues of each slice were calculated and the diverse histological nature identified by hematoxylin and eosin, periodic acid Schiff, Masson's trichrome, and Gomori's reticulin strains. Only the acrylic plastic and the Kiel bone graft prevented expansion of the scar tissue inside the spinal canal and adhesions between the dura and the cicatrical overlying muscles. Therefore, the authors suggest that a solid barrier is necessary to effectively prevent the so-called "laminectomy membrane."

25 patients with low-flow carotid-cavernous fistula (CCF) underwent radiosurgery between 1977 and 1992. 22 had spontaneous low flow fistulae and 3 traumatic high flow fistulae which had been previously treated with internal carotid trapping. The mean preoperative symptomatic period was 12.2 months (4–24 months). Fistulae were classified according to Barrow''s classification. Type T was added for traumatic, high-flow fistulae with flow reduction after internal carotid trapping. 11 cases were of type B, 4 of type C, 7 of type D and 3 of type T. The target point for radiosurgry was calculated from selective internal or external carotid angiograms. Stereotaffi;lradiosurgery was performed with a cobalt source, with 5- to 10-mm collimators. A total dose of 30–40 Gy was delivered in all cases, except 1 posttraumatic case in which the dose was 20 Gy. The follow-up period ranged between 14 years and 15 months (mean: 49.76 months). 20 of the 22 low flow fistulae (90.9%) completely closed in a mean period of 7.5 months (range: 2–20 months) after radiosurgery. Improvement of the symptoms began at a mean period of 2.37 months (range: 0.5–14 months). There were no recurrences, the follow-up period ranging between 14 years and 15 months. 100% of type B CCF closed after a mean period of 5.9 months, 75% of type C closed after a mean period of 12.66 months, and 85.7% of cases of type D closed after a mean period of 8.16 months. Only one of the three traumatic fistulae (type T) was cured 6 months after radiosurgery, while there was no significant change in the other two cases of type T fistulae. There was no untoward effect attributable to irradiation in the whole series. The authors conclude that because of its relative safety and efficacy this technique makes it the treatment of choice for low-flow CCF, while intravascular embolization maintains its indications for the high-flow ones.