Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2010
Following brain trauma, copeptin, a stable peptide derived from the AVP precusor, does not reflect osmoregulation but correlates with injury severity.
The incidence of water and electrolyte disturbances following traumatic brain injury (TBI) is considerable and has been attributed to a dysregulation of the hypothalamic peptide arginine-vasopressin (AVP). Copeptin, the C-terminal part of the AVP prohormone, reflects AVP activity. In 71 TBI patients we measured copeptin in serum by a sandwich immunoassay. ⋯ Copeptin was significantly decreased following skullbase fracture (p = 0.016). Our data reveal a loss of hypothalamic osmoregulation following TBI. The measurement of Copeptin/AVP release reveals a significant predictive function for the severity of TBI.
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Acta Neurochir. Suppl. · Jan 2010
Randomized Controlled TrialEffects of magnesium sulfate infusion on cerebral perfusion in patients after aneurysmal SAH.
A meta-analysis of current data suggests that magnesium sulfate infusion improves the outcome after aneurysmal subarachnoid hemorrhage through a reduction in delayed ischemic neurological deficit. Two multi-center randomized controlled trials are currently underway to investigate this hypothesis. The possible pharmacological basis of this hypothesis includes neuroprotection and vasodilatation. We aim to investigate the cerebral hemodynamic effects of magnesium sulfate infusion in aneurysmal subarachnoid hemorrhage patients. ⋯ Magnesium sulfate infusion, in the dosage of current clinical trials, did not increase cerebral blood volume and cerebral blood flow, as postulated by dilation of small vessels and/or collateral pathways.
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Acta Neurochir. Suppl. · Jan 2010
Dynamics of S100B release into serum and cerebrospinal fluid following acute brain injury.
High S100B serum levels are considered to reflect brain injury severity. However, the dynamics of S100B passage from the cerebral compartment into the blood remain unclear. We examined the temporal profile of S100B release into the cerebrospinal fluid (CSF) and blood in acute brain injury. ⋯ Following brain injury, the S100B passage from the CSF to the blood was significantly impaired. Further, higher ratios were correlated with better neurological function (p = 0.002). Because stimulated active S100B release may serve as a repair mechanism, a higher S100B serum/CSF ratio may contribute to neurological recovery.
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Acta Neurochir. Suppl. · Jan 2010
Randomized Controlled Trial Multicenter StudyIs it possible to minimize overdrainage complications with gravitational units in patients with idiopathic normal pressure hydrocephalus? Protocol of the randomized controlled SVASONA Trial (ISRCTN51046698).
Overdrainage is a common complication observed after shunting patients with idiopathic normal-pressure hydrocephalus (iNPH), with an estimated incidence up to 25%. Gravitational units that counterbalance intracranial pressure changes were developed to overcome this problem. We will set out to investigate whether the combination of a programmable valve and a gravitational unit (proGAV, Aesculap/Miethke, Germany) is capable of reducing the incidence of overdrainage and improving patient-centered outcomes compared to a conventional programmable valve (Medos-Codman, Johnson & Johnson, Germany). ⋯ One planned interim analysis for safety and efficacy will be performed halfway through the study. To detect the hypothesized difference in the incidence of overdrainage with a type I error of 5% and a type II error of 20%, correcting for multiple testing and an anticipated dropout rate of 10%, 200 patients will be enrolled. The presented trial is currently recruiting patients, with the first results predicted to be available in late 2008.
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Acta Neurochir. Suppl. · Jan 2010
Clinical TrialOutcome of patients with severe head injury after decompressive craniectomy.
Decompressive craniectomy is an operative option for the neurosurgeon in cases of generalized traumatic brain edema. While the outcome of patients after decompressive craniectomy is often poor, we tried to identify predictors of a favorable course of the injury. Therefore, 131 patients who received a decompressive craniectomy at the Unfallkrankenhaus Berlin (ukb) between September 1997 and September 2005 due to severe traumatic brain injury were followed up. ⋯ The results stress again that the prognosis after traumatic brain injury (TBI) with decompressive craniectomy (DC) is unfavorable. Age, midline shift, and status of the basal cisterns on cranial computed tomography (cCT) were associated with the long-term outcome. When weighing whether to initiate the last resort intervention of decompressive craniectomy, the predictive factors detailed here should be taken into consideration.