World Neurosurg
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Multicenter Study Comparative Study Observational Study
Comparison of Outcomes of Severe Traumatic Brain Injury in 36,929 Patients Treated with or without Intracranial Pressure Monitoring in a Mature Trauma System.
Severe traumatic brain injury (TBI) remains a major cause of morbidity and mortality with mortality rates reaching 35%. Intracranial pressure (ICP) monitoring is used to prevent secondary brain injury and death. However, while the association of elevated ICP and worsened outcomes is accepted, routine ICP monitoring has been questioned after the publication of several studies including the Benchmark Evidence from South American Trials: Treatment of Intracranial Pressure trial. We examined whether severe TBI patients in the trauma system of Pennsylvania fared better with or without ICP monitoring. ⋯ We found that ICP-monitored patients had a lower risk of in-hospital mortality. Our findings support the use of ICP monitors in eligible patients.
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Review Case Reports
Surgical Treatment of an Intracranial Anterior Ethmoidal Aneurysm: Case Report, Literature Review and Surgical Video.
Anterior ethmoid aneurysms are rare with 5 cases of intracranial rupture and 3 cases of life-threatening epistaxis described in recent literature. We present a case of an intracranial ruptured anterior ethmoid aneurysm treated surgically with a favorable outcome. ⋯ Consistent with prior reports, an intracranial, anterior ethmoidal artery aneurysm can occur in isolation without an associated vascular malformation. On the basis of a literature review and this case, surgical ligation is considered effective and possibly superior over endovascular treatment due to the risk of injury to the orbital vascular supply with transarterial treatment.
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Outcome prediction in severe traumatic brain injury (sTBI) has been studied using clinical and radiographic measurements and by using biomarkers such as glial fibrillary acidic protein, ubiquitin C-terminal hydrolase-L1, and tau. Routine blood tests are regularly performed in patients with sTBI and could be used to predict outcomes. This study aims to investigate whether routine blood tests on admission can be predictive of outcome in patients with sTBI. ⋯ No routine blood tests measured on admission were significant predictors of outcome in patients with sTBI. Other clinical and radiologic factors may be better suited to predicting outcomes in this patient population.