Journal of neurosurgery
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Journal of neurosurgery · Jan 2011
Incorporating a parenchymal thermal diffusion cerebral blood flow probe in bedside assessment of cerebral autoregulation and vasoreactivity in patients with severe traumatic brain injury.
Cerebral autoregulation may be altered after traumatic brain injury (TBI). Recent evidence suggests that patients' autoregulatory status following severe TBI may influence cerebral perfusion pressure management. The authors evaluated the utility of incorporating a recently upgraded parenchymal thermal diffusion probe for the measurement of cerebral blood flow (CBF) in the neurointensive care unit for assessing cerebral autoregulation and vasoreactivity at bedside. ⋯ Use of the Hemedex thermal diffusion probe appears to be a safe and feasible method that enables continuous monitoring of CBF at the bedside. Cerebral autoregulation and CO(2) vasoreactivity can be assessed in patients with severe TBI using the CBF probe by calculating (loc)CVR in response to MAP and hyperventilation challenges. Determining whether CVR increases or decreases with a MAP challenge ((loc)CVR(normalized)) may be a simple provocative test to determine patients' autoregulatory status following severe TBI and helping to optimize CPP management.
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Journal of neurosurgery · Jan 2011
Venous thromboembolism: deep venous thrombosis and pulmonary embolism in a neurosurgical population.
Venous thromboembolism (VTE), a combination of deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major cause of morbidity and death in neurosurgical patients. This study evaluates 1) the risk of developing lower-extremity DVT following a neurosurgical procedure; 2) the timing of initiation of pharmacological DVT prophylaxis upon the occurrence of VTE; and 3) the relationship between DVT and PE as related to VTE prophylaxis in neurosurgical patients. ⋯ The majority of DVTs occurred within the first week after a neurosurgical procedure. There was a linear correlation between the duration of surgery and DVT occurrence. Use of early subcutaneous heparin (at either 24 or 48 hours) was associated with a 43% reduction of developing a lower-extremity DVT, without an increase in surgical site hemorrhage. There was no association of pharmacological prophylaxis with overall PE occurrence.
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Journal of neurosurgery · Jan 2011
Comparative StudyPremorbid oral antithrombotic therapy and risk for reaccumulation, reoperation, and mortality in acute subdural hematomas.
Acute subdural hematomas (SDHs) impart serious morbidity and mortality on the elderly population, with only 5% of those older than 65 years of age attaining functional independence. Despite its widespread use, oral antithrombotic therapy (OAT) in the context of acute SDH has not been extensively studied. The authors sought to evaluate the impact of premorbid OAT on recurrence of SDH, radiographic outcome, and mortality in patients undergoing surgical evacuation of an acute SDH. ⋯ Premorbid OAT was not a significant risk factor for recurrence of SDH necessitating additional evacuation following acute SDH. Additionally, postoperative Rotterdam score, volume of SDH reaccumulation, and overall mortality were not predicted by antithrombotic history. While premorbid use may predispose the patient to an SDH, OAT does not increase the risk of morbidity or mortality following surgical intervention.
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Journal of neurosurgery · Jan 2011
Case ReportsPreoperative or preembolization lesion targeting using rotational angiographic fiducial marking in the neuroendovascular suite.
Three-dimensional rotational digital subtraction (DS) angiography and DynaCT allow precise localization of intracranial arteriovenous fistulas (AVFs) with fiducial markers that have helped in surgical planning. These techniques are particularly useful when the AVF is not evident on cross-sectional imaging. The authors demonstrate the utility of 3D DS angiography and DynaCT in the localization of intracranial AVFs in 3 cases. ⋯ They also used 3D DS angiography and DynaCT with fiducials for precise localization of a superficial pial AVF (Case 2) and a tentorial AVF (Case 3) not visible on cross-sectional angiography. With the precise localization of the target lesion, the neurosurgeons were able to perform relatively small craniotomies, minimizing the cranial opening yet allowing the opening for full access to the lesion. By correlating 3D DS angiography/DynaCT with CT images, the neurosurgeon could use neuronavigation in cases of AVF not appreciated on cross-sectional imaging.
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Journal of neurosurgery · Jan 2011
The role of hypoxia-inducible factor-1α, aquaporin-4, and matrix metalloproteinase-9 in blood-brain barrier disruption and brain edema after traumatic brain injury.
The present study investigated the role of hypoxia-inducible factor-1α (HIF-1α), aquaporin-4 (AQP-4), and matrix metalloproteinase-9 (MMP-9) in blood-brain barrier (BBB) permeability alterations and brain edema formation in a rodent traumatic brain injury (TBI) model. ⋯ The data support the notion that HIF-1α plays a role in brain edema formation and BBB disruption via a molecular pathway cascade involving AQP-4 and MMP-9. Pharmacological blockade of this pathway in patients with TBI may provide a novel therapeutic strategy.