World Neurosurg
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Intracranial pressure (ICP) monitoring and monitoring of brain tissue oxygen (Pbto2) in addition to ICP have been used in the management of traumatic brain injury (TBI). However, the optimal monitoring method is inconclusive. We searched 4 databases with no language restrictions through January 2024 for peer-reviewed randomized controlled trials (RCTs) comparing ICP monitoring with combined Pbto2 and ICP monitoring in patients with traumatic brain injury. ⋯ There was no difference in favorable neurologic outcome (risk ratio: 1.21; 95% confidence interval: 0.93, 1.58; I2: 45%; 5 RCTs: 512 patients; moderate certainty) and survival (risk ratio: 1.10; 95% confidence interval: 0.99, 1.21; I2: 13%; 5 RCTs: 512 patients; moderate certainty). We found no evidence that the combination of Pbto2 and ICP is more useful than ICP. The included RCTs are few and small, and further study is needed to draw conclusions.
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Review Meta Analysis
Invasive and Non-Invasive Techniques for Intracranial Pressure Monitoring after Decompressive Craniectomy: a systematic review and meta-analysis.
The use of invasive or noninvasive intracranial pressure (ICP) monitoring post-decompressive craniectomy (DC) has been a continuous matter of debate. Accordingly, this meta-analysis aims to examine the existing evidence of both approaches and compare their impact among patients undergoing DC, guiding clinical decision-making in the management of elevated ICP. The databases used were Pubmed, Cochrane, Web of Science, and Embase. ⋯ Whereas in the noninvasive sample, a mortality rate of 20% (95% CI: 15%-26%) and a good outcome rate of 38% (95% CI: 25%-52%) were obtained. It seems that the effectiveness of invasive and noninvasive ICP monitoring methods are comparable in post-DC patients. While invasive monitoring remains gold standard, noninvasive methods offer a safer and cost-effective alternative, potentially improving post-DC patient care, and can mostly be used simultaneously with invasive methods.
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Anterior pituitary dysfunction is one of the major causes of disability and morbidity in patients suffering from traumatic brain injury (TBI). The present study was undertaken to evaluate the incidence of anterior pituitary dysfunction in cases of moderate and severe TBI, its value in long-term prognostication, and the factors that predispose to a higher incidence of anterior pituitary dysfunction in acute and chronic phases. ⋯ Thyroid and gonadotropin axes were most commonly affected and deficiency of at least 1 axis was found in 82.4% patients in the acute phase and 59.3% in the chronic phase. Thyroid axis deficiency had a negative impact on prognosis in post-TBI patients.
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This study aims to comprehend the natural history of adolescent idiopathic scoliosis (AIS) patients and determine risk factors for facet joint bridging in adolescent-onset adult idiopathic scoliosis with thoracolumbar/lumbar (TL/L) curves. ⋯ This research revealed that large SVA, the presence of vertebral bridging, and large AVR are associated with facet joint bridging in adolescent-onset adult idiopathic scoliosis patients with TL/L curves. The cutoff value for facet joint bridging based on SVA was 2.1 cm.
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Observational Study
Neuromonitoring Signal Changes in Degenerative Cervical Myelopathy: An Analysis of Risk Factors for Signal Drops During Posterior Cervical Decompression.
To analyze intraoperative neuromonitoring data of patients with degenerative cervical myelopathy undergoing cervical laminectomy and assess the incidence of signal drops and their risk factors. ⋯ Patients with cervical OPLL have a higher incidence of false positive and transient signal drops after decompression compared with patients with CSM. Longer duration of symptoms, high-grade myelopathy, continuous OPLL, hill type OPLL, and negative K-line were risk factors for signal drops.