Osteochondral Lesion of the Talus: Prognostic Factors Affecting the Clinical Outcome After Arthroscopic Marrow Stimulation Technique

The treatment of symptomatic osteochondral lesions of the talus (OLT) has difficulties and limitations caused by the poor regeneration of articular cartilage and the limited access to the ankle joint. It is important that the surgeon understand the causes of failure as well as the factors influencing the results of arthroscopic treatment of OLTs. The presence of such a risk factor may encourage surgeons to find new treatment strategies as well as counsel patients differently.ope

Reoperation for persistent or recurrent hemifacial spasm after microvascular decompression

OBJECTIVE: The objective of this study was to investigate the outcome of reoperation for persistent or recurrent hemifacial spasm (HFS) after microvascular decompression (MVD). METHODS: Repeat MVD was performed on 13 patients with an HFS between June 1994 and May 2004. Patients who had compressing offending vessels identified on postoperative (prerevision) three-dimensional short-range magnetic resonance angiography were selected for repeat MVD. RESULTS: Six patients were found to have no improvement in HFS with the first MVD. All of these patients exhibited excellent improvement after the second MVD. In one patient who had mild improvement with the first MVD, but with more than 50% of remaining spasm, complete abolition of spasm occurred immediately after the second MVD. Six patients showed initial relief and subsequent aggravation of HFS after the first MVD. Of these patients, four had excellent results with the second MVD, one had a good result, and one had a fair outcome. Adverse effects after the second MVD were found in two patients (one patient with permanent mild facial weakness and one patient with hearing impairment). There was no serious morbidity associated with the second MVD. CONCLUSION: Our data suggest that repeat MVD of the facial nerve may be sufficient to resolve symptoms in selected patients with persistent or recurrent HFS. Additionally, three-dimensional short-range magnetic resonance angiography may help to identify the offending vessels and to select the patients with persistent or recurrent HFS.ope