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Posts Tagged ‘traumatic brain injury

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

Ahead of Print: Traumatic Intracranial Hemorrhage in Patients Taking Dabigatran

Screen Shot 2013-06-11 at 11.40.47 AMBackground and Importance: Dabigatran is a direct thrombin inhibitor gaining popularity as a stroke prevention agent in atrial fibrillation patients. Compared to warfarin, dabigatran showed superiority in stroke prevention, but lower rates of major hemorrhage and intracerebral hemorrhage. While warfarin has a well-established reversal strategy, there is far less experience reversing dabigatran.

Clinical Presentation: We present our experience with three patients who suffered intracranial hemorrhage either spontaneously or after low energy cranial trauma and review the available literature describing dabigatran use in traumatic brain injury patients.

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Written by NEUROSURGERY® Editorial Office

June 13, 2013 at 2:00 PM

Ahead of Print: Pressure Reactivity vs. Cerebral Autoregulation

Background: Cerebrovascular pressure reactivity is the principal mechanism of autoregulation of cerebral blood flow. Assessment of cerebral autoregulation can be performed using the mean flow index (Mx) based on transcranial Doppler (TCD) ultrasonography. Pressure reactivity can be monitored using the pressure reactivity index (PRx), which is based on intracranial pressure (ICP) monitoring. From a practical point of view, PRx can be monitored continuously, while Mx can only in short periods when TCD probes can be applied.

Objective: To assess to what degree impairment in pressure reactivity (PRx) is associated with impairment in cerebral autoregulation (Mx).

Methods: A database of 345 traumatic brain injury (TBI) patients was screened for data availability including simultaneous Mx and PRx monitoring. Absolute differences, temporal changes, and association with outcome of the two indices were analyzed.

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Written by NEUROSURGERY® Editorial Office

July 13, 2012 at 8:00 AM


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