Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2013
COSBID-M3: a platform for multimodal monitoring, data collection, and research in neurocritical care.
Neuromonitoring in patients with severe brain trauma and stroke is often limited to intracranial pressure (ICP); advanced neuroscience intensive care units may also monitor brain oxygenation (partial pressure of brain tissue oxygen, P(bt)O(2)), electroencephalogram (EEG), cerebral blood flow (CBF), or neurochemistry. For example, cortical spreading depolarizations (CSDs) recorded by electrocorticography (ECoG) are associated with delayed cerebral ischemia after subarachnoid hemorrhage and are an attractive target for novel therapeutic approaches. However, to better understand pathophysiologic relations and realize the potential of multimodal monitoring, a common platform for data collection and integration is needed. ⋯ Selected events identified in raw (e.g., ICP) or processed (e.g., CSD) measures are displayed graphically, can trigger alarms, or can be sent to researchers or clinicians via text message. For instance, algorithms for automated detection of CSD have been incorporated, and processed ECoG signals are projected onto three-dimensional (3D) brain models based on patient magnetic resonance imaging (MRI) and computed tomographic (CT) scans, allowing real-time correlation of pathoanatomy and cortical function. This platform will provide clinicians and researchers with an advanced tool to investigate pathophysiologic relationships and novel measures of cerebral status, as well as implement treatment algorithms based on such multimodal measures.
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Acta Neurochir. Suppl. · Jan 2013
Active stimulation site of nucleus accumbens deep brain stimulation in obsessive-compulsive disorder is localized in the ventral internal capsule.
Obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder characterized by persistent thoughts and repetitive ritualistic behaviours. Despite optimal cognitive-behavioral and pharmacological therapy, approximately 10 % of patients remain treatment-resistant. Deep brain stimulation (DBS) is being investigated as experimental therapy for treatment-refractory OCD. ⋯ Our nine patients receiving bilateral vALIC DBS improved on average 73 % on their Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores, whereas the six patients with their centers of stimulation located otherwise improved on average only 42 %. We therefore propose bilateral vALIC as a promising new DBS target for patients with treatment-refractory OCD. Future studies employing a direct vALIC targeting approach in larger patient numbers are needed to test whether this proposal holds true.
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Acta Neurochir. Suppl. · Jan 2013
Metabolomic analysis of cerebral spinal fluid from patients with severe brain injury.
Proton nuclear magnetic resonance (H-NMR) spectroscopic analysis of cerebral spinal fluid provides a quick, non-invasive modality for evaluating the metabolic activity of brain-injured patients. In a prospective study, we compared the CSF of 44 TBI patients and 13 non-injured control subjects. CSF was screened for ten parameters: β-glucose (Glu), lactate (Lac), propylene glycol (PG), glutamine (Gln), alanine (Ala), α-glucose (A-Glu), pyruvate (PYR), creatine (Cr), creatinine (Crt), and acetate (Ace). ⋯ For TBI patients, the strongest significant correlations were between lactate and α-glucose (r = 0.54), lactate and alanine (r = 0.53), and α-glucose and alanine (r = 0.48). The GLM and multimodel inference indicated that the combined metabolites of PG, glutamine, α-glucose, and creatinine were the strongest predictors for CMRO2, ICP, and GOSe. By analyzing the CSF of patients with TBI, our goal was to create a metabolomic fingerprint for brain injury.
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Acta Neurochir. Suppl. · Jan 2013
Computed tomography after decompressive craniectomy for head injury.
New findings (NF) on postoperative CTs are -occasionally found in patients who undergo surgery for traumatic brain injury (TBI). We conducted a retrospective -registry-based review of the care of 102 patients who underwent decompressive craniectomy (DC) for TBI to investigate the prognostic factors of new findings on CT early after -surgery. Of the 102 patients, the mean age was 50 years and 69.6 % were male. ⋯ The univariate analysis showed that a GCS score ≤8 (P = 0.012) and the absence of a basal cistern (P = 0.012) were significantly associated with NF on postoperative CT. The logistic regression analysis demonstrated that the GCS score ≤8 (P = 0.041; OR, 3.0; 95 % CI, 1.048-8.517) was the only significant factor. TBI patients with a low GCS score who underwent DC should undergo additional CT evaluations immediately after surgery.
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Acta Neurochir. Suppl. · Jan 2013
Removal of clots in subarachnoid space could reduce the vasospasm after subarachnoid hemorrhage.
Cerebral vasospasm after subarachnoid hemorrhage (SAH) is a major cause of morbidity and mortality. We studied the effects of clot removal on multiple outcome variables following the clipping of ruptured anterior communicating aneurysms. ⋯ Fenestration of the lamina terminalis and removal of cisternal clots significantly decreased the incidence of post-SAH hydrocephalus and was associated with better outcomes in our series.