Acta neurochirurgica. Supplement
-
Acta Neurochir. Suppl. · Jan 2010
Prognosis for severe traumatic brain injury patients treated with bilateral decompressive craniectomy.
Decompressive craniectomy for traumatic brain injury patients has been shown to reduce intracranial hypertension, while it often results in increased brain edema and/or contralateral space-occupied hematoma. The purpose of this study was to determine the prognosis of bilateral decompressive craniectomy in severe head injury patients with the development of either bilateral or contralateral lesions after ipsilateral decompressive craniectomy. ⋯ Head injury patients with either bilateral or contralateral lesions have poor prognosis. However, bilateral decompressive craniectomy may be a favorable treatment in certain younger patients with reactive pupils, whose ICP and CPP values are stabilized 24 h post-surgery.
-
Acta Neurochir. Suppl. · Jan 2010
The effects of selective brain hypothermia and decompressive craniectomy on brain edema after closed head injury in mice.
Intractable brain edema remains one of the main causes of death after traumatic brain injury (TBI). Brain hypothermia and decompressive craniectomy have been considered as potential therapies. The goal of our experimental study was to determine if selective hypothermia in combination with craniectomy could modify the development of posttraumatic brain edema. ⋯ Brain edema was significantly increased ipsilaterally in the trauma + craniectomy group (82.11 +/- 0.6%, p < 0.05), but not in the trauma + craniectomy + hypothermia group (81.52 +/- 1.1%, p > 0.05) as compared to the sham group (79.31 +/- 0.7%). These data suggest that decompressive craniectomy leads to an increase in brain water content after CHI. Additional focal hypothermia may be an effective approach in the treatment of posttraumatic brain edema.
-
Acta Neurochir. Suppl. · Jan 2010
Treatment of ruptured cerebral aneurysms - clip and coil, not clip versus coil.
Recent advances in neurosurgery and interventional neuroradiology have brought us a new aspect in the treatment of cerebral aneurysms. The present single-surgeon series provides a balanced overview of the treatment of ruptured aneurysms in surgical clipping and coil embolization. ⋯ A combined microsurgical-endovascular approach can achieve the best outcomes for patients with ruptured cerebral aneurysms. Our findings support the policy of "Clip and Coil, not Clip versus Coil."
-
Acta Neurochir. Suppl. · Jan 2010
Minocycline attenuates brain edema, brain atrophy and neurological deficits after intracerebral hemorrhage.
Evidence suggests that microglia activation contributes to brain injury after intracerebral hemorrhage (ICH). The present study aimed to determine if minocycline, an inhibitor of microglia activation, can reduce brain edema, brain atrophy and neurological deficits after ICH. Male Sprague-Dawley rats received an infusion of 100-microL autologous whole blood into the right basal ganglia. ⋯ Minocycline also improved functional outcome. In addition, minocycline reduced brain tissue loss in the ipsilateral caudate (p < 0.01) and ventricular enlargement (p < 0.05). In conclusion, minocycline attenuates ICH-induced brain edema formation, neurological deficits and brain atrophy in rats suggesting an important role of microglia in ICH-related brain injury.
-
Acta Neurochir. Suppl. · Jan 2010
Nanowired-drug delivery enhances neuroprotective efficacy of compounds and reduces spinal cord edema formation and improves functional outcome following spinal cord injury in the rat.
The possibility that drugs attached to nanowires enhance their therapeutic efficacy was examined in a rat model of spinal cord injury (SCI). Three Acure compounds AP-173, AP-713 and AP-364 were tagged with TiO(2)-based nanowires (50-60 nm) and applied over the traumatized cord either 5 or 60 min after SCI in rats produced by a longitudinal incision into the right dorsal horn of the T10-11 segments under equithesin anaesthesia. Normal compounds were used for comparison. ⋯ Whereas normal compounds applied at 5 min after injury (but not after 60 min) had some significant but less beneficial effects compared to their nanowired combinations. On the other hand, nanowires alone did not influence spinal cord pathology or motor function after SCI. Taken together, our results indicate that the nanowired-drug-delivery enhances the neuroprotective efficacy of drugs in SCI and reduces functional outcome compared to normal compounds even applied at a later stage following trauma, not reported earlier.