Journal of neurotrauma
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Journal of neurotrauma · Jan 2013
Bone flap resorption: risk factors for the development of a long-term complication following cranioplasty after decompressive craniectomy.
Aseptic bone flap resorption (BFR) is a known long-term complication after cranioplasty (CP). We analyzed our institutional data in order to identify risk factors for BFR. From October 1999 to April 2012, 254 patients underwent CP after decompressive craniectomy (DC) at our institution, and had a long-term follow-up period of >1 year after CP (range 12-146 months). ⋯ Furthermore, BFR developed significantly more often in patients who underwent cranioplasty ≤2 months after DC (p=0.008), as well as in patients with wound healing disturbance or abscess as an early complication after the CP procedure (p=0.01). The multivariate analysis of the present data identified the presence of multiple fractures within the bone flap (p=0.002, OR 10.3, 95% CI 2.4-43.8), wound infection after CP (p=0.003, OR 12.3, 95% CI 2.3-65.3), and cranioplasty performed ≤2 months after DC (p=0.01, OR 6.3, 95% CI 1.5-26.3) as independent risk factors for the development of BFR after CP in a large series with long-term follow-up. This might influence future surgical decision making, especially in patients fulfilling high risk criteria for developing BFR.
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Journal of neurotrauma · Jan 2013
Trends in outcomes and hospitalization costs for traumatic brain injury in adult patients in the United States.
Several new therapeutic strategies have been introduced for the management of adult traumatic brain injury (TBI) over the last decade, such as the development of management pathways and specialized TBI units and improved treatment of cerebral perfusion. The purpose of this study is to compare TBI-related hospitalization outcomes in the United States between two time periods, 1993-1994 and 2006-2007. We determined the rates of occurrence, in-hospital outcomes, and mean hospital charges for patients hospitalized with adult TBI in 1993-1994 using the nationally representative all-payer Nationwide Inpatient Survey (NIS) database, and compared these outcomes with homologous data from 2006-2007. ⋯ There was a significant increase in average hospitalization charges and death rates in all TBI severity subgroups in 2006-2007 compared with 1993-1994. The decline in rate of hospitalization between the two time periods was predominantly related to the decline in the number of admissions of patients with mild TBI. Although the number of TBI admissions was reduced, a significant increase in average hospitalization charges and in-hospital mortality rate was observed in 2006-2007 compared with 1993-1994.
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Journal of neurotrauma · Jan 2013
Midbrain raphe stimulation improves behavioral and anatomical recovery from fluid-percussion brain injury.
The midbrain median raphe (MR) and dorsal raphe (DR) nuclei were tested for their capacity to regulate recovery from traumatic brain injury (TBI). An implanted, wireless self-powered stimulator delivered intermittent 8-Hz pulse trains for 7 days to the rat's MR or DR, beginning 4-6 h after a moderate parasagittal (right) fluid-percussion injury. MR stimulation was also examined with a higher frequency (24 Hz) or a delayed start (7 days after injury). ⋯ This procedure reversed injury-induced declines of cAMP levels in both cortex and hippocampus. In conclusion, midbrain raphe nuclei can enduringly enhance recovery from early disseminated TBI, possibly in part through increased signaling by cAMP in efferent targets. A neurosurgical treatment for TBI using interim electrical stimulation in raphe repair centers is suggested.
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Journal of neurotrauma · Jan 2013
Cognitive recovery and development after traumatic brain injury in childhood: a person-oriented, longitudinal study.
Influence of childhood traumatic brain injury (TBI) on cognitive recovery and subsequent development is poorly understood. In this longitudinal study we used cluster analysis to explore acute stage individual profiles of injury age and cognition in 118 children with traumatic brain injury. Repeated measures of cognitive function were conducted at 30 months, indicating recovery, and 10 years post-injury, indicating development. ⋯ This suggests that developmental change after TBI in childhood takes place on a continuum, with both chance of long-term catching up, and risk of poor development. An acute profile of higher FFD and lower PS seemed to reflect injury consequences and were followed by developmental gains. These results challenge previous findings, and warrant further investigation.
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Journal of neurotrauma · Jan 2013
A multiscale computational approach to estimating axonal damage under inertial loading of the head.
A computational modeling framework is developed to estimate the location and degree of diffuse axonal injury (DAI) under inertial loading of the head. DAI is one of the most common pathological features of traumatic brain injury and is characterized by damage to the neural axons in the white matter regions of the brain. We incorporate the microstructure of the white matter (i.e., the fiber orientations and fiber dispersion) through the use of diffusion tensor imaging (DTI), and model the white matter with an anisotropic, hyper-viscoelastic constitutive model. ⋯ Acceleration loading curves from accident reconstruction data were then applied to the FE models. The rotational (rather than translational) accelerations were shown to dominate the injury response, which is consistent with previous studies. Through this accident reconstruction, we demonstrate a conceptual framework to estimate the degree of axonal injury in the fiber tracts of the human brain, enabling the future development of relationships between computational simulation and neurocognitive impairment.