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Najmedden Attabib and Anthony M. Kaufmann

✓The standard techniques of microvascular decompression (MVD) surgery in which implant materials such as shredded Teflon felt are used may be inadequate in some complex cases. The authors evaluated the use of fenestrated aneurysm clips to maintain transposition of culprit vessels in patients with trigeminal neuralgia (TN) and hemifacial spasm (HFS).

The authors conducted a retrospective review of MVD operations in which the culprit vessel was transposed and then maintained in position with a fenestrated aneurysm clip secured in position by suturing it to the dura mater.

Among a consecutive series of more than 450 MVD surgeries, the fenestrated aneurysm clip sling was used in eight of the last 100 cases: six for HFS and two for TN. The follow-up period ranged from 1 to 13 months, and complete symptom resolution was noted in seven of the eight patients. No patient exhibited evidence of any surgical complications.

This approach can be safely performed in complicated MVD cases such as reoperations and transpositions of long ectatic arteries. To the best of the authors' knowledge this is the first report in which the use of fenestrated aneurysm clips in MVD surgery is described.

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R. Andrew Glennie, Mayilee Canizares, Anthony V. Perruccio, Edward Abraham, Fred Nicholls, Andrew Nataraj, Philippe Phan, Najmedden Attabib, Michael G. Johnson, Eden Richardson, Greg McIntosh, Henry Ahn, Charles G. Fisher, Neil Manson, Kenneth Thomas, and Y. Raja Rampersaud

OBJECTIVE

Patients undergoing spine surgery generally have high expectations for improvement postoperatively. Little is known about how these expectations are affected by the diagnosis. The purpose of this study was to examine whether preoperative expectations differ based on diagnostic pathoanatomical patterns in elective spine surgery patients.

METHODS

Patients with common degenerative cervical/lumbar pathology (lumbar/cervical stenosis, lumbar spondylolisthesis, and cervical/lumbar disc herniation) who had given their consent for surgery were analyzed using the Canadian Spine Outcomes and Research Network (CSORN). Patients reported the changes they expected to experience postoperatively in relation to 7 separate items using a modified version of the North American Spine Society spine questionnaire. Patients were also asked about the most important item that would make them consider the surgery a success. Sociodemographic, lifestyle, and clinical variables were also collected.

RESULTS

There were 3868 eligible patients identified within the network for analysis. Patients with lumbar disc herniation had higher expectations for relief of leg pain compared with stenosis and lumbar degenerative spondylolisthesis cohorts within the univariate analysis. Cervical stenosis (myelopathy) patients were more likely to rank general physical capacity as their most important expectation from spine surgery. The multinomial regression analysis showed that cervical myelopathy patients have lower expectations for relief of arm or neck pain from surgery (OR 0.54, 0.34–0.88; p < 0.05). Patient factors, including age, symptoms (pain, disability, depression), work status, and lifestyle factors, were significantly associated with expectation, whereas the diagnoses were not.

CONCLUSIONS

Patients with degenerative spinal conditions consenting for spine surgery have high expectations for improvement in all realms of their daily lives. With the exception of patients with cervical myelopathy, patient symptoms rather than diagnoses had a more substantial impact on the dimensions in which patients expected to improve or their most important expected change. Determination of patient expectation should be individualized and not biased by pathoanatomical diagnosis.