Introduction
Neuromonitoring represents a cornerstone in the comprehensive management of patients with traumatic brain injury (TBI), allowing for early detection of complications such as increased ...intracranial pressure (ICP) 1. This has led to a search for noninvasive modalities that are reliable and deployable at bedside. Among these, ultrasonographic optic nerve sheath diameter (ONSD) measurement is a strong contender, estimating ICP by quantifying the distension of the optic nerve at higher ICP values. Thus, this scoping review seeks to describe the existing evidence for the use of ONSD in estimating ICP in adult TBI patients as compared to gold-standard invasive methods.
Materials and Methods
This review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews, with a main search of PubMed and EMBASE. The search was limited to studies of adult patients with TBI published in any language between 2012 and 2022. Sixteen studies were included for analysis, with all studies conducted in high-income countries.
Results
All of the studies reviewed measured ONSD using the same probe frequency. In most studies, the marker position for ONSD measurement was initially 3 mm behind the globe, retina, or papilla. A few studies utilized additional parameters such as the ONSD/ETD (eyeball transverse diameter) ratio or ODE (optic disc elevation), which also exhibit high sensitivity and reliability.
Conclusion
Overall, ONSD exhibits great test accuracy and has a strong, almost linear correlation with invasive methods. Thus, ONSD should be considered one of the most effective noninvasive techniques for ICP estimation in TBI patients.
Thecoperitoneal Shunts—Our 20 Years Experience Arumalla, Kirit; Mohammed, Naseer; Bhat, Dhananjaya I ...
Indian journal of neurosurgery,
12/2023, Letnik:
12, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Abstract
Introduction The thecoperitoneal shunt is a modality of cerebrospinal fluid (CSF) diversion used to treat various clinical conditions such as idiopathic intracranial hypertension (IIH), ...normal pressure hydrocephalus (NPH), and CSF leaks. There is a wide variability in the data regarding the utility and complications associated with it. We thus reviewed the outcomes and complications of the shunt done in our setting.
Methods The study is a retrospective review of all the thecoperitoneal shunts performed at NIMHANS (National Institute of Mental Health and Neurosciences) from January 2000 to December 2020. The demographic details, clinical profile, indications for the shunt, magnetic resonance imaging, follow-up and complications, and shunt revisions were collected and analyzed.
Results Three-hundred twelve patients underwent shunt primarily at our institute. The mean follow-up of the patients was 5.2 years. The indications include pseudomeningocele in 31.4%, CSF leak from surgical site in 25.3%, IIH in 17.6%, and NPH in 7.3% patients.
The shunt was more effective in pseudomeningocele in up to 95% and CSF leaks in 91% compared to 64‰ in IIH, though it is not significant (p > 0.05). The complication rate was 17% that included shunt block, wound CSF leak, infection, and subdural hygromas. The shunt malfunction was seen in 14.69% patients who underwent revision.
Conclusion Thecoperitoneal shunt is a useful treatment option for various pathologies including IIH, NPH, and wound CSF leaks. They have good clinical outcomes and acceptable revision rates especially in conditions with slit ventricle. The complications such as low-pressure headache can be overcome by using adjuncts as programmable valve or antisiphon device.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
This study was undertaken to address the epidemiological characteristics, operative details, and surgical outcome of peripheral nerve injuries in children treated in a tertiary hospital in India ...(NIMHANS, Bangalore).
This is a retrospective study of epidemiology, operative findings, and surgical outcomes over the period of 2000-2016. Our series includes 102 children with peripheral nerve injuries of various causes.
Intramuscular injections were the most common cause (52.9%), followed by entrapment (15.6%). The most common nerve involved was the sciatic nerve (54.9%), followed by the common peroneal nerve (13.7%), the ulnar nerve (10.8%), and the radial nerve (10.8%). Perineural adhesion was the most common intraoperative finding (74.5%), followed by a neuroma in continuity (14.7%) and gap (10.8%). Most of the children with peripheral adhesion underwent external and internal neurolysis (75.5%). Follow-up was available for 67 children. The median follow-up period was 7 months (range 3-36). The outcome was assessed according to MRC grading. Favorable functional improvement was noted in 76.1% of the children. Age less than 10 years (p = 0. 06), injury before 6 months (p = 0.03), and MRC motor grade (<3) (p = 0. 01) were positive predictive factors related to the final outcome.
Early surgical intervention, age less than 10 years, and incomplete motor palsy were the best predictors of a superior functional outcome. This study can serve as a guide to determine the epidemiology, duration of intervention, and surgical outcome of traumatic peripheral nerve injuries in the pediatric population.
Laboratory evaluation of autonomic nervous system (ANS) in patients with cervical compressive myelopathy (CCM).
To study the autonomic functions and heart rate variability (HRV) in patients with CCM ...and compare the findings after surgery.
ANS dysfunction is well known after traumatic spinal cord injury. There are very few studies of ANS dysfunction in noncompressive myelopathy and there are no studies on compressive myelopathies.
After excluding patients on cervical traction or with medical comorbidities, 29 adult patients with CCM were evaluated. Conventional autonomic function tests and HRV were studied in these patients. The same tests were done on 29 age- and sex-matched healthy controls. Student t test was used to find the significance of study parameters on continuous scale. Chi-square/Fisher exact test was used to find the significance of study parameters on categorical scale between two groups. Significance was assessed at 5% level.
Patients with CCM as compared with controls, showed significant difference in following parameters; deep breathing, Valsalva ratio, 30:15 (longest RR interval (duration between two consecutive R waves of ECG) around 30th second and the minimum RR interval around 15 seconds after standing up), and orthostatic fall of blood pressure. Except 30:15, there was no significant change of other autonomic function tests after surgery. Among the HRV parameters, there was a trend in increase in total power and decrease in root-mean-square differences of successive RR intervals; however, it did not reach statistical significance.
Patients with CCM have definite ANS dysfunction as compared to healthy age- and sex-matched controls. There is significant improvement in 30:15 ratio after surgery. HRV indices are also impaired and there is a trend for change in total power and root-mean-square differences of successive RR intervals suggesting loss of HRV.
1,2 Stereotactic biopsy (STB) offers a rapid and accurate histological diagnosis for the subsequent management of brain lesions, with minimal morbidity and mortality. 1 Our study aims to analyze the ...spectrum of cases that have undergone the stereotactic procedure using the BRA-K (FN) Virtuoso Universa system in a single neurosurgical hospital.
Diffusion tensor imaging (DTI) is an advanced and sensitive technique that detects sub-threshold pathology in normal imaging brain injury patients. Currently, there are no longitudinal DTI studies to ...look for time-based changes. The present study has investigated longitudinal imaging and its association with cognitive deficits.
Twenty-one patients were available for MRI and neuropsychological test (NPT) assessment for all the 3 time points. Initially (<36 hours), all patients presented with GCS 15 and normal scan findings. The DTI (P<0.0001) and NPT scores (P<0.05) were analyzed using repeated-measure of analysis. The tensor values were correlated with specific time-point NPT scores using partial correlation (0.05).
Right cerebral-hemisphere showed significant alterations in both anisotropy and diffusivity values overtime. Cingulate gyrus and occipital lobe showed prominent changes in anisotropy value. Significant improvement in thalamo-cortical anisotropy value after 3-4 months after injury was seen. The changes in diffusivity values were mainly seen in frontal, parietal lobe, right inferior fronto-occipital and superior longitudinal fasciculus, and posterior supramarginal gyrus. Time-related changes of tensor values of thalamus, frontal and temporal lobe had persistent and significant association with attention and learning/memory aspects.
The findings of this study suggest that DTI detects and observes natural-recovery of brain regions affected by sub-threshold force.
The study aims to evaluate the role of substance P in cerebral edema and outcomes associated with acute TBI.
Patients with acute TBI who presented within 6 h and a CT scan showed predominantly ...cerebral edema were included in the study. Substance P level was assessed from a serum sample collected within 6 h of trauma. We also evaluated the brain-specific gravity using the Brain View software.
A total of 160 (128 male) patients were recruited. The median serum substance P concentration was 167.89 (IQR: 101.09–238.2). Substance P concentration was high in the early hours after trauma (p = 0.001). The median specific gravity of the entire brain was 1.04. Patients with a low Glasgow coma scale (GCS) at admission had a high concentration of the substance P. In the univariate analysis, low GCS, elevated serum concentrations of substance P level, high Rotterdam grade, high cerebral edema grade, a high international normalized ratio value, and high blood sugar levels were associated with poor outcomes at six months. In logistic regression analysis, low GCS at admission, high cerebral edema grade, and elevated blood sugar level were strongly associated with poor outcomes at six months. The area under the receiver operating characteristic curve was 0.884 (0.826–0.941).
Serum substance P is strongly associated with the severity of cerebral edema after TBI. However, brain-specific gravity does not directly correlate with posttraumatic cerebral edema severity. Serum substance P does not influence the clinical outcome of traumatic brain injury.
There are many chapters, which are usually not covered in standard textbooks on the subject, e.g., 'Animal Models of Venous Stroke', 'Role of Cerebral Venous System in Neurodegenerative Disorders' ...and 'Role of Cerebral Venous System in Traumatic Brain Injury. ...intensive care management of venous thrombosis is also not covered. With the evidence presented in this book, future clinical management of acutely brain-injured patients will expand to include the recirculation concept, establishing a harmony between arterial and venous systems, in addition to the established recanalization and reperfusion strategies.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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