Ahead of Print: Bloody CSF and Human Astrocytes

Background: Calcium (Ca2+ ) is a cofactor of multiple cellular processes. The mechanisms that lead to elevated cytosolic Ca2+ concentration are unclear.

Objective: To illuminate how cerebrospinal fluid (bCSF) from patients with intraventricular hemorrhage causes cell death of cultured human astrocytes.

Methods: Cultured astrocytes were incubated with bCSF. In control experiments, native CSF (nCSF) was used. Cytosolic Ca2+ concentration was measured by fura-2 fluorescence. Apoptosis and necrosis were evaluated by staining with Hoechst-3342 and propidium-iodide.

Ahead of Print: Cerebral Dural Arteriovenous Fistulae Natural History

Background: Hemorrhage from cerebral dural arteriovenous fistulae (dAVF) is a considerable source of neurologic morbidity and even mortality.

Objective: To evaluate the natural history of cerebral dAVF.

Methods: We reviewed our own cohort of 70 dAVF and incorporated results from the literature, synthesizing pooled hemorrhage rates and evaluating risk factors for 395 dAVF in 6 studies.

Ahead of Print: Indomethacin in Refractory Intracranial Hypertension

Background: Intracranial hypertension is the final pathway of many neurocritical entities, such as spontaneous intracerebral hemorrhage (sICH) and severe traumatic brain injury (sTBI).

Objective: To determine: (1) alterations in intracranial pressure (ICP) and cerebral hemodynamics following an Indomethacin (INDO) infusion test and the related association with survival in patients with refractory intracranial hypertension (RICH) secondary to sICH or sTBI; and (2) to assess the safety profile following INDO.

Methods: INDO was administered in a loading dose (.8 mg/kg/15 minutes), followed by a 2-hour continuous infusion (.5 mg/kg/h) in RICH patients with ICP>20 mmHg who did not respond to first line therapies. Changes in ICP, cerebral perfusion pressure (CPP) and cerebrovascular variables (assessed by transcranial Doppler and jugular bulb saturation) were observed. Clinical outcome was assessed at 1 and 6 months according to Glasgow Outcome Scale and correlated to INDO infusion test response. Analysis of INDO safety profile was conducted.

Ahead of Print: Prognostic Value of Intraventricular Bleeding in Spontaneous Intraparenchymal Cerebral Hemorrhage of Small Volume: A Prospective Cohort Study

Full article access for Neurosurgery subscribers at Neurosurgery-Online.com.

BACKGROUND: The literature is controversial on whether intraventricular bleeding has a negative impact on the prognosis of spontaneous intracerebral hemorrhage. Nevertheless, an association between intraventricular bleeding and spontaneous intracerebral hemorrhage volumes has been consistently reported.

OBJECTIVE: To evaluate the prognostic value of intraventricular bleeding in deep intraparenchymal hypertensive spontaneous hemorrhage with a bleeding volume < 30 cm3.

METHODS: Of the 320 patients initially evaluated, 33 met the inclusion criteria and were enrolled in this prospective study. The volume of intraparenchymal hemorrhage was calculated by brain computed tomography (CT) image analysis and of intraventricular bleeding by the LeRoux scale. Clinical data, including neurological complications, were collected daily during hospitalization. Neurological outcome was evaluated 30 days after the event using the Glasgow outcome scale. Patients were assigned to one of three groups according to intraventricular bleeding: Control – no intraventricular bleeding; LR 1 – intraventricular bleeding with LeRoux scale scores of 1 to 8; or LR 2 – intraventricular bleeding with LeRoux scale scores > 8.

Ahead of Print: Independent Validation of The Secondary Intracerebral Hemorrhage Score with Catheter Angiography and Findings of Emergent Hematoma Evacuation

Full article access for Neurosurgery subscribers at Neurosurgery-Online.com.

BACKGROUND: The secondary intracerebral hemorrhage (SICH) score, derived from a cohort of ICH patients examined with CT angiography, predicts a patient’s risk of harboring a vascular etiology.

OBJECTIVE: To validate the SICH score in an independent patient population.

METHODS: We retrospectively reviewed all adult non-traumatic ICH patients who presented to our institution during a 5.4-year period and were evaluated with catheter angiography or underwent emergent hematoma evacuation, and applied the SICH score to this cohort. Receiver operating characteristic analysis was performed to determine the area under the curve (AUC) and maximum operating point (MOP). Patients with subarachnoid hemorrhage in the basal cisterns were excluded.