Acta neurochirurgica. Supplement
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Acta Neurochir. Suppl. · Jan 2016
Patient-Specific Thresholds and Doses of Intracranial Hypertension in Severe Traumatic Brain Injury.
Based on continuous monitoring of the pressure reactivity index (PRx), we defined individualized intracranial pressure (ICP) thresholds by graphing the relationship between ICP and PRx. We hypothesized that an "ICP dose" based on individually assessed ICP thresholds might correlate more closely with 6-month outcome compared with ICP doses derived from the recommended universal thresholds of 20 and 25 mmHg. Data from 327 patients with severe traumatic brain injury (TBI) were analyzed. ⋯ DPRx was found to be the best discriminator of mortality, despite the fact that D20 was twice as large as DPRx. Individualized doses of intracranial hypertension were stronger predictors of mortality than doses derived from the universal thresholds of 20 and 25 mm Hg. The PRx could offer a method of individualizing the ICP threshold.
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Acta Neurochir. Suppl. · Jan 2016
Case ReportsEmergency Non-occlusive High Capacity Bypass Surgery for Ruptured Giant Internal Carotid Artery Aneurysms.
Managing ruptured giant internal carotid artery (ICA) aneurysms in an emergency situation is very challenging. By reporting two cases, we discuss the role of the Excimer Laser-assisted Non-occlusive Anastomosis (ELANA) technique as an armamentarium for cerebrovascular surgeons dealing with giant ICA aneurysms presenting with subarachnoid hemorrhage (SAH). ⋯ Emergency ELANA bypass surgery is a useful instrument for managing patients with giant ICA aneurysms presenting with SAH. In experienced hands, the technique does not seem to carry increased risk and may expand the surgical options due to its non-occlusive nature.
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Acta Neurochir. Suppl. · Jan 2016
Artefact in Physiological Data Collected from Patients with Brain Injury: Quantifying the Problem and Providing a Solution Using a Factorial Switching Linear Dynamical Systems Approach.
High-resolution, artefact-free and accurately annotated physiological data are desirable in patients with brain injury both to inform clinical decision-making and for intelligent analysis of the data in applications such as predictive modelling. We have quantified the quality of annotation surrounding artefactual events and propose a factorial switching linear dynamical systems (FSLDS) approach to automatically detect artefact in physiological data collected in the neurological intensive care unit (NICU). ⋯ The influence of artefact on physiological data collected in the NICU is a significant problem. This pilot study using an FSLDS approach shows real promise and is under further development.
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Acta Neurochir. Suppl. · Jan 2016
Observational StudyWaveform Analysis of Intraspinal Pressure After Traumatic Spinal Cord Injury: An Observational Study (O-64).
Following a traumatic brain injury (TBI), intracranial pressure (ICP) increases, often resulting in secondary brain insults. After a spinal cord injury, here the cord may be swollen, leading to a local increase in intraspinal pressure (ISP). We hypothesised that waveform analysis methodology similar to that used for ICP after TBI may be applicable for the monitoring of patients with spinal cord injury. ⋯ With increasing mean ISP, the pulse amplitude increased in all cases. This suggests that the ISP signal is of a similar character to ICP recorded after TBI. Therefore, the methods of ICP analysis can be helpful in ISP analysis.
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Acta Neurochir. Suppl. · Jan 2016
Measurement of Intraspinal Pressure After Spinal Cord Injury: Technical Note from the Injured Spinal Cord Pressure Evaluation Study.
Intracranial pressure (ICP) is routinely measured in patients with severe traumatic brain injury (TBI). We describe a novel technique that allowed us to monitor intraspinal pressure (ISP) at the injury site in 14 patients who had severe acute traumatic spinal cord injury (TSCI), analogous to monitoring ICP after brain injury. A Codman probe was inserted subdurally to measure the pressure of the injured spinal cord compressed against the surrounding dura. ⋯ The ISP signal characteristics after TSCI were similar to the ICP signal characteristics recorded after TBI. Importantly, there were no associated complications. Future studies are required to determine whether reducing ISP improves neurological outcome after severe TSCI.