NEUROSURGERY Report

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Posts Tagged ‘traumatic brain injury

Current Concepts in Sports Concussion: The Current State of Concussion Education Programs

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Concussion is an important cause of morbidity in young student athletes. The prevention, accurate diagnosis, and prompt management of concussions require that players, parents, coaches, and medical personnel are accurately educated on current concussion data and guidelines. All states have laws that mandate concussion education for high school athletes. There is currently no uniform educational program to disseminate information to student athletes regarding concussions. This article highlights a few nationally recognized educational programs that aim to accurately and effectively inform all members of the athletic, academic, and medical communities about the importance and urgency of concussion.

From: Concussion 101: The Current State of Concussion Education Programs by Williamson et al.

Current Concepts in Sports Concussion is online and full-text access is free.

Written by NEUROSURGERY® Editorial Office

October 17, 2014 at 8:00 AM

Current Concepts in Sports Concussion: Emergent Treatment of Athletes With Brain Injury

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The focus of this article is the early recognition and emergent treatment of severe or catastrophic traumatic brain injury. The pathophysiology and management of mild traumatic brain injury are reviewed extensively in other sections. Classification of head injuries can be based on anatomic location (epidural, subdural, intraparenchymal), mechanism of injury (coup, contrecoup, linear, rotational), distribution (focal or diffuse), and clinical presentation. Severe head injuries include epidural hematoma, subdural hematoma, intracerebral contusion/hemorrhage, traumatic subarachnoid hemorrhage, diffuse axonal injury, and malignant brain edema syndrome, either alone or in combinations. Protective equipment, regulations, and athletic training have improved dramatically as a result of the recognition of potentially devastating neurological injuries from competitive play. Physicians and other healthcare professionals have become integral members of organized sport and must advocate for the players’ best interest. Once a neurological injury has been identified on field, it is imperative that prompt management and prevention of secondary injury occur. The goal of this article is to help provide a clear plan of action that is well thought out and rehearsed and that will lead to improved outcomes for the players, particularly those with severe or catastrophic brain injury.

From: Emergent Treatment of Athletes With Brain Injury by Morris et al.

Current Concepts in Sports Concussion is online and full-text access is free.

Editor Choice: Mechanical Tissue Resuscitation at the Site of Traumatic Brain Injuries

Screen Shot 2014-08-04 at 7.51.35 AMBackground: Traumatic brain injuries (TBIs) continue to be a devastating problem with limited treatment options. Previous research applying controlled vacuum to TBI in a rat model resulted in smaller injuries and more rapid recovery.

Objective: To examine the effects of the application of a controlled vacuum (mechanical tissue resuscitation) to TBI in a large-animal model. The magnitude of vacuum, length of application, and length of delay between injury and the application of mechanical tissue resuscitation were investigated.

Methods: Localized, controlled cortical injuries were created in swine. Vacuums of −50 and −100 mm Hg were compared. Mechanical tissue resuscitation for 3 or 5 days was compared. Delays of 0, 3, or 6 hours between the creation of the TBI and the initiation of mechanical tissue resuscitation were examined. Analysis included histological assessments, computed tomographic perfusion, and magnetic resonance imaging (T2, proton magnetic spectra).

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Written by NEUROSURGERY® Editorial Office

August 4, 2014 at 8:00 AM

Ahead of Print: Neonatal Autoregulation During Hypertension

Background: The upper limit of cerebrovascular pressure autoregulation (ULA) is inadequately characterized.

Objective: To delineate the ULA in an infant swine model.

Methods: Neonatal piglets with sham surgery (n=9), interventricular fluid infusion (INF; n=10), controlled cortical impact (CCI; n=10), or impact + infusion (CCI + INF; n=11) had intracranial pressure monitoring and bilateral cortical laser-Doppler flux recordings during arterial hypertension to lethality using an aortic balloon catheter. An increase of red cell flux as a function of cerebral perfusion pressure was determined by piecewise linear regression, and static rates of autoregulation (SRoR) were determined above and below this inflection. The ULA was rendered as the first instance of an upward deflection of Doppler flux causing an SRoR decrease greater than 0.5.

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Written by NEUROSURGERY® Editorial Office

June 17, 2014 at 8:00 AM

Ahead of Print: Elucidating the Severity of Preclinical TBI Models

Background: Concussion remains a symptom-based diagnosis clinically, yet preclinical studies investigating traumatic brain injury, of which concussion is believed to represent a ‘mild’ form, emphasize histological endpoints with functional assessments often minimized or ignored all together. Recently, clinical studies have identified the importance of cognitive and neuropsychiatric symptoms, in addition to somatic complaints, following concussion. How these findings may translate to preclinical studies is unclear at present.

Objective: To address the contrasting endpoints utilized clinically compared to those in preclinical studies and the potential role of functional assessments in a commonly used model of diffuse axonal injury (DAI).

Methods: Animals were subjected to DAI using the impact-acceleration model. Functional and behavioral assessments were conducted over 1 week following DAI prior to completion of histological assessment at 1-week post-DAI.

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Written by NEUROSURGERY® Editorial Office

February 19, 2014 at 8:00 AM

Simulation in Neurosurgery Supplement: Craniotomy Simulator Enhances TBI Training

A_Novel_Craniotomy_Simulator_Provides_a_ValidatedBackground: In a variety of surgical specialties, simulation-based technologies play an important role in resident training. The Congress of Neurological Surgeons (CNS) established an initiative to enhance neurosurgical training by developing a simulation-based curriculum to complement standard didactic and clinical learning.

Objective: To enhance resident education in the management of traumatic brain injury by the use of simulation-based training.

Methods: A course-based neurosurgical simulation curriculum was developed and offered at the 2012 CNS annual meeting. Within this curriculum, a trauma module was developed to teach skills necessary in the management of traumatic brain injury, including the performance of craniotomy for trauma. Didactic and simulator-based instruction were incorporated into the course. Written and practical pre- and posttests, as well as questionnaires, were used to assess the improvement in skill level and to validate the simulator as a teaching tool.

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Written by NEUROSURGERY® Editorial Office

October 28, 2013 at 2:53 PM

Free Article: The Epidemiology of Outpatient Visits for Minor Head Injury

Background: The Centers for Disease Control and Prevention have called for studies detailing the prevalence and burden of mild traumatic brain injury (mTBI) in the outpatient clinical setting.

Objective: The aim of this study was to describe the prevalence of outpatient visits for minor head injury and compare the number of outpatient visits for minor head injury with the number of emergency department (ED) visits.

Methods: This was a cross-sectional study of outpatient visits for minor head injuries from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS). We examined outpatient visits for minor head injury between 2005 and 2009 and compared them with visits in the ED for the same diagnoses using simple survey-weighted descriptive statistics.

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Written by NEUROSURGERY® Editorial Office

June 25, 2013 at 2:00 PM

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