World Neurosurg
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Randomized Controlled Trial
Applying cerebral hypothermia and brain oxygen monitoring in treating severe traumatic brain injury.
Severe traumatic brain injury (TBI) was to be one of the major health problems encountered in modern medicine and had an incalculable socioeconomic impact. The initial cerebral damage after acute brain injury is often exacerbated by postischemic hyperthermia and worsens the outcome. Hypothermia is one of the current therapies designed to combat this deleterious effect. The brain tissue oxygen (P(ti)o(2))-guided cerebral perfusion pressure (CPP) management was successfully reduced because of cerebral hypoxic episodes following TBI. ⋯ Therapeutic mild hypothermia combined with P(ti)o(2)-guided CPP/ICP management allows reducing elevated ICP before 24 hours after injury, and daily variations of ICP were shown to be significantly different among the three treatment groups after the third posttraumatic day. It means that the hypothermia groups may reduce the ICP earlier and inhibit the elicitation of acute inflammation after cerebral contusion. Our data also provided evidence that early treatment that lowers P(ti)o(2) may improve the outcome and seems the best medical treatment method in these three groups. We concluded that therapeutic mild hypothermia combined with P(ti)o(2)-guided CPP/ICP management provides beneficial effects when treating TBI, and a multicenter randomized trial needs to be undertaken.
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Comparative Study
Comparison of endoscopic transnasal and transoral approaches to the craniovertebral junction.
The study compared the endoscopic anatomy of the transnasal and transoral approaches to the craniovertebral junction (CVJ). ⋯ The endoscopic transoral and transnasal approaches to the CVJ should be viewed as complementary routes as opposed to strict alternatives.
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Case Reports
Abnormal white matter changes after cerebral aneurysm treatment with polyglycolic-polylactic acid coils.
Polyglycolic-polylactic acid (PGLA) coils induce inflammation within a cerebral aneurysm, which in turn is hypothesized to decrease aneurysm recurrence. We present 2 patients, who after aneurysm coiling with PGLA coils, developed mild symptoms and extensive magnetic resonance imaging (MRI) white matter changes. ⋯ Conclusions: After extensive evaluation for alternate causes of disease, we hypothesize that the patients' symptoms and MRI findings, which were not all within the territory supplied by the coiled vessel, were due to an overexuberant inflammatory response related to the PGLA coils. These cases highlight the importance of heightened clinical suspicion of neurologic complaints in the subacute period after aneurysm coiling. We recommend a low threshold for neuroimaging of these patients.
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Case Reports Clinical Trial
Placement of percutaneous thoracic pedicle screws using neuronavigation.
Percutaneous thoracic pedicle screw fixation is challenging because of the complexity of the spinal anatomy and obscuration of normal surgical landmarks by soft tissue. We report a novel percutaneous technique in which intraoperative Iso-C C-arm navigation was used to treat complex thoracic spinal fractures. ⋯ Percutaneous thoracic pedicle screw fixation with intraoperative neuronavigation for the stabilization of complex spinal fractures is feasible and associated with acceptable rates of accuracy and morbidity.