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The vagus nerve and nicotinic receptors involve inhibition of HMGB1 release and early pro-inflammatory cytokines function in collagen-induced arthritis.

J Clin Immunol. 2010 Mar;30(2):213-20

Authors: Li T, Zuo X, Zhou Y, Wang Y, Zhuang H, Zhang L, Zhang H, Xiao X

OBJECTIVES: The cholinergic anti-inflammatory pathway, a vagus nerve-dependent mechanism, inhibits cytokine releases in models of acute inflammatory disease. We investigated the efficacy and elucidated the possible mechanism of the cholinergic anti-inflammatory pathway on collagen-induced arthritis (CIA) in mice. METHODS: Fifty-six male DBA/1 mice were divided into four groups: control mice (sham vagotomy + phosphate-buffered saline; shamVGX+PBS), model mice (shamVGX+PBS+CIA), vagotomy mice (VGX+PBS+CIA), and nicotine (Nic) mice (shamVGX+Nic+CIA). We subjected mice to left-side cervical vagotomy 4 days before induction of arthritis. Mice in the nicotine group were injected with nicotine (250 microg/kg per day) 4 days before arthritis induction. Arthritis score was measured and histopathologic assessment of joint sections carried out. The concentration of tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, and IL-10 in serum were evaluated by ELISA. Expression of high-mobility group box chromosomal protein 1(HMGB1) was evaluated by immunohistochemical staining of joints. RESULTS: Vagotomy exaggerated, whereas nicotine attenuated, clinical arthritis. Histopathologic findings confirmed that nicotine reduced infiltration of inflammatory cell and bone destruction. Expression of TNF-alpha and IL-6 decreased in nicotine-pretreated mice compared with model and vagotomy mice; IL-10 levels were not significantly different between the model group and nicotine group. Nicotine reduced the expression and translocation of HMGB1 in the inflamed joints of CIA mice. CONCLUSIONS: The cholinergic anti-inflammatory pathway has an anti-inflammatory role in the pathophysiology of rheumatoid arthritis (RA) via inhibiting HMGB1 release and early pro-inflammatory cytokines function. Study of this pathway could be used for RA therapy.

PMID: 19890701 [PubMed - indexed for MEDLINE]

Pilot study of a new acrylic cage in a dog cervical spine fusion model.

J Spinal Disord Tech. 2010 Jun;23(4):272-7

Authors: Farrokhi MR, Torabinezhad S, Ghajar KA

STUDY DESIGN: An experimental pilot study using an acrylic interbody cage in a dog cervical spine fusion model. OBJECTIVE: To compare bony fusion in autologous bone grafting with a novel acrylic cage in terms of preservation of disc height, biomechanical properties, and histologic characteristics. SUMMARY OF BACKGROUND DATA: Degenerative diseases of cervical intervertebral discs are commonly treated by anterior decompression and interbody fusion. To restore physiologic disc height and achieve fusion, the disc is replaced with bone graft, bone cement, interbody fusion cages, or other materials. The advantages of bone cement in contrast to bone graft and interbody fusion cages are immediate stability and less subsidence, although real bony fusion cannot be achieved. To overcome this problem, we designed a new, inexpensive acrylic cage. METHODS: Ten adult hybrid dogs underwent C3/C4 (5 dogs) and C4/C5 (5 dogs) discectomy and fusion with an acrylic interbody fusion cage made of polymethylmethacrylate filled with bone graft (n=5, group1) or an autologous iliac bone graft (n=5, group 2). Dynamic functional x-ray was obtained 1 and 12 weeks after the operation. After 12 weeks, the animals were killed and fusion sites were evaluated with quantitative computed tomographic scanning to evaluate bone mineral density. Subsistence was quantified with biomechanical testing. Histopathologic analysis was used to evaluate fusion and possible foreign body reactions associated with the acrylic cage. RESULTS: The acrylic cage led to significantly higher disc space height and less subsidence than bone grafting (P<0.021). Bone mineral density after 12 weeks was greater with the acrylic cage, but the difference was not statistically significant. Histologically, new bony tissue and hyaline cartilage were seen inside the acrylic cage, accompanied by mild chronic inflammation. CONCLUSIONS: The acrylic cage showed significantly higher mechanical stiffness and less subsidence than bone grafting. Additional studies with more subjects and longer follow-up periods are needed to compare the cost effectiveness of acrylic cages and polyetheretherketone devices.

PMID: 20087221 [PubMed - indexed for MEDLINE]

A combined fMRI and DTI examination of functional language lateralization and arcuate fasciculus structure: Effects of degree versus direction of hand preference.

Brain Cogn. 2010 Jul;73(2):85-92

Authors: Propper RE, O'Donnell LJ, Whalen S, Tie Y, Norton IH, Suarez RO, Zollei L, Radmanesh A, Golby AJ

The present study examined the relationship between hand preference degree and direction, functional language lateralization in Broca's and Wernicke's areas, and structural measures of the arcuate fasciculus. Results revealed an effect of degree of hand preference on arcuate fasciculus structure, such that consistently-handed individuals, regardless of the direction of hand preference, demonstrated the most asymmetric arcuate fasciculus, with larger left versus right arcuate, as measured by DTI. Functional language lateralization in Wernicke's area, measured via fMRI, was related to arcuate fasciculus volume in consistent-left-handers only, and only in people who were not right hemisphere lateralized for language; given the small sample size for this finding, future investigation is warranted. Results suggest handedness degree may be an important variable to investigate in the context of neuroanatomical asymmetries.

PMID: 20378231 [PubMed - indexed for MEDLINE]

Successful treatment of acromegaly in a diabetic cat with transsphenoidal hypophysectomy.

J Feline Med Surg. 2010 May;12(5):406-10

Authors: Meij BP, Auriemma E, Grinwis G, Buijtels JJ, Kooistra HS

PATIENT AND SURGICAL TREATMENT: An 11-year-old, castrated male cat was referred for insulin-resistant diabetes mellitus. It had a ravenous appetite, increased body weight, polyuria/polydipsia and a dull hair coat. The cat was receiving 25 IU insulin four times daily but blood glucose concentrations remained elevated. Plasma concentrations of growth hormone (GH) (51 microg/l, reference range 0.8-7.2 microg/l) and insulin-like growth factor 1 (IGF-1) (3871 microg/l, reference range 39-590 microg/l) were highly elevated, whereas those of alpha-melanocyte-stimulating hormone, adrenocorticotropic hormone and cortisol were normal. Computed tomography revealed a thick palatum molle and an enlarged pituitary gland, indicating a pituitary neoplasm. Microsurgical transsphenoidal hypophysectomy was performed and microscopic examination of the surgical specimen revealed an acidophilic, infiltrative pituitary adenoma that showed positive immunostaining for GH. OUTCOME: The clinical signs resolved and 3 weeks after surgery the cat no longer required insulin administration. One year after hypophysectomy the plasma concentrations of GH and IGF-1 were 2.4 microg/l and 113 microg/l, respectively. PRACTICAL RELEVANCE: This is the first report detailing transsphenoidal hypophysectomy as a feasible and effective treatment for feline acromegaly due to a pituitary somatotroph adenoma. Moreover, in this patient, concurrent insulin-resistant diabetes mellitus resolved completely. The surgery is discussed in the context of human and other feline therapies for acromegaly.

PMID: 20417901 [PubMed - indexed for MEDLINE]

Arthroscopic ganglionectomy through an intrafocal cystic portal for wrist ganglia.

Arthroscopy. 2010 May;26(5):617-22

Authors: Chen AC, Lee WC, Hsu KY, Chan YS, Yuan LJ, Chang CH

PURPOSE: A retrospective study was conducted on arthroscopic ganglionectomy in wrists using a novel intrafocal cystic portal. The safety and efficacy of this technique were assessed by treatment of 15 wrists in 15 patients. METHODS: Arthroscopic ganglionectomy was performed by the same surgeon with the patient under general anesthesia or regional block. Preoperative complaints, intraoperative findings, and postoperative results of all the patients were reported. The mean follow-up was 15.3 months. Functional assessment by use of modified Mayo wrist scores, patient satisfaction, and recurrence were included in the follow-up evaluation. RESULTS: Two thirds of the patients acquired good to excellent results, whereas the results for the remaining third were fair. Complications included 1 recurrence and 1 case of transient paresthesia sensation. The most common arthroscopic findings were capsular and ligament lesions, rather than ganglionic stalks. CONCLUSIONS: Arthroscopic ganglionectomy through an intrafocal cystic portal is a safe and efficacious option for the treatment of painful wrist ganglia. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

PMID: 20434658 [PubMed - indexed for MEDLINE]

Locomotor changes in length and EMG activity of feline medial gastrocnemius muscle following paralysis of two synergists.

Exp Brain Res. 2010 Jun;203(4):681-92

Authors: Maas H, Gregor RJ, Hodson-Tole EF, Farrell BJ, English AW, Prilutsky BI

The mechanism of the compensatory increase in electromyographic activity (EMG) of a cat ankle extensor during walking shortly after paralysis of its synergists is not fully understood. It is possible that due to greater ankle flexion in stance in this situation, muscle spindles are stretched to a greater extent and, thus, contribute to the EMG enhancement. However, also changes in force feedback and central drive may play a role. The aim of the present study was to investigate the short-term (1- to 2-week post-op) effects of lateral gastrocnemius (LG) and soleus (SO) denervation on muscle fascicle and muscle-tendon unit (MTU) length changes, as well as EMG activity of the intact medial gastrocnemius (MG) muscle in stance during overground walking on level (0%), downslope (-50%, presumably enhancing stretch of ankle extensors in stance) and upslope (+50%, enhancing load on ankle extensors) surfaces. Fascicle length was measured directly using sonomicrometry, and MTU length was calculated from joint kinematics. For each slope condition, LG-SO denervation resulted in an increase in MTU stretch and peak stretch velocity of the intact MG in early stance. MG muscle fascicle stretch and peak stretch velocity were also higher than before denervation in downslope walking. Denervation significantly decreased the magnitude of MG fascicle shortening and peak shortening velocity during early stance in level and upslope walking. MG EMG magnitude in the swing and stance phases was substantially greater after denervation, with a relatively greater increase during stance of level and upslope walking. These results suggest that the fascicle length patterns of MG muscle are significantly altered when two of its synergists are in a state of paralysis. Further, the compensatory increase in MG EMG is likely mediated by enhanced MG length feedback during downslope walking, enhanced feedback from load-sensitive receptors during upslope walking and enhanced central drive in all walking conditions.

PMID: 20458472 [PubMed - indexed for MEDLINE]

Disruption of cutaneous feedback alters magnitude but not direction of muscle responses to postural perturbations in the decerebrate cat.

Exp Brain Res. 2010 Jun;203(4):765-71

Authors: Honeycutt CF, Nichols TR

Quadrupeds and bipeds respond to horizontal perturbations of the support surface with muscular responses that are broadly tuned and directionally sensitive. Since the discovery of this directional sensitivity, interest has turned toward the critical sensory systems necessary to generate these responses. We hypothesize that cutaneous feedback affects the magnitude of muscle responses to postural perturbation but has little effect on the directionality of the muscle response. We developed a modified premammillary decerebrate cat preparation to evaluate the sensory mechanisms driving this directionally sensitive muscle activation in response to support surface perturbation. This preparation allows us the flexibility to isolate the proprioceptive (cutaneous and muscle receptors) system from other sensory influences. We found that loss of cutaneous feedback leads to a significant loss in background activity causing a smaller muscular response to horizontal perturbations. However, the directional properties of the muscular responses remained intact.

PMID: 20473753 [PubMed - indexed for MEDLINE]

Pain management in chronic pancreatitis: A treatment algorithm.

Best Pract Res Clin Gastroenterol. 2010 Jun;24(3):323-35

Authors: Chauhan S, Forsmark CE

Abdominal pain is common and frequently debilitating in patients with chronic pancreatitis. Medical therapy includes abstinence from tobacco and alcohol and the use of analgesics and adjunctive agents. In many patients, a trial of non-enteric-coated pancreatic enzymes and/or antioxidants may be tried. Endoscopic or surgical therapy requires careful patient selection based on a detailed analysis of pancreatic ductal anatomy. Those with a non-dilated main pancreatic duct have limited endoscopic and surgical alternatives. The presence of a dilated main pancreatic duct makes endoscopic or surgical therapy possible, which may include ductal decompression or pancreatic resection, or both. Randomised trials suggest surgical therapy is more durable and effective than endoscopic therapy. Less commonly employed options include EUS-guided coeliac plexus block, thoracoscopic splanchnicectomy, or total pancreatectomy with auto islet cell transplantation. These are used rarely when all other options have failed and only in very carefully selected patients.

PMID: 20510832 [PubMed - indexed for MEDLINE]

Microdecompressive laminatomy with a 5-year follow-up period for severe lumbar spinal stenosis.

J Spinal Disord Tech. 2010 Jun;23(4):229-35

Authors: Celik SE, Celik S, Göksu K, Kara A, Ince I

STUDY DESIGN: The 2 groups of patients with severe lumbar spinal stenosis were prospectively compared as a case control study. OBJECTIVES: This prospective case control study sought to evaluate bilateral microdecompressive laminatomy (MDL) for treatment of severe lumbar spinal stenosis. SUMMARY OF BACKGROUND DATA: Total laminectomy is a general consensus on the therapy of severe spinal stenosis. The authors tried to investigate a new minimal invasive approach. METHODS: Patients were randomly divided into 2 groups. In first group, 34 patients underwent total laminectomy (TL) for severe lumbar spinal stenosis. In the second group, 37 patients with the same diagnosis underwent bilateral MDL. The groups were compared for disability, walking distance, degree of postoperative back and leg pain, perioperative complications, and postoperative instability. Radiographic analyses were performed at regular intervals to demonstrate satisfactory decompression. RESULTS: Mean follow-up was 5 years. Postoperative computerized tomography and magnetic resonance imaging demonstrated adequate decompressions in both groups. The walking distance, pain control, and disability scores were slightly higher among patients in the MDL group, although these results did not achieve statistical significance. Perioperative complications and postoperative instability were significantly higher in the TL group (P<0.05). CONCLUSIONS: Compared with classic approaches, bilateral MDL provides adequate and safe decompression in lumbar spinal stenosis. It significantly reduces clinical symptoms and disability. However, TL shows higher perioperative complications and postoperative instability. To the best of our knowledge, this is the first study to define a bilateral MDL approach to treat the stenotic lumbar spine without a herniated disc.

PMID: 20526152 [PubMed - indexed for MEDLINE]

Continuous monitoring of intracranial pressure after endoscopic third ventriculostomy in the management of CSF shunt failure.

Minim Invasive Neurosurg. 2010 Apr;53(2):49-54

Authors: Elgamal EA

INTRODUCTION: The effectiveness of continuous intracranial pressure (ICP) monitoring in the adaptation period, after endoscopic third ventriculostomy (ETV), and removal of the failed shunt in the management of CSF shunt failure is assessed. METHODS: Nine patients with active hydrocephalus presenting with CSF shunt obstruction or infection were managed by ETV, removal of the shunt and insertion of an external ventricular drain (EVD) containing an ICP sensor for the purpose of postoperative monitoring of the ICP, and intermittent drainage of CSF. Patient ages ranged from 8 months to 24 years, and six of them were females. Hydrocephalus was obstructive in seven patients, and multiloculated in two. Six patients had an ventriculoperitoneal shunt (VPS), one with a bilateral VPS, one patient had a ventriculoatrial shunt, and one had a VPS and cystoperitoneal shunt (CPS). Shunt failure was caused by obstruction in six patients and infection in three. RESULTS: The post-operative ICP monitoring period ranged from 1-7 days. Intracranial hypertension was persistent in the first day after ETV in 3 patients, and up to 110 mL of CSF were drained to improve its symptoms. ETV was successful in six patients and 3 had permanent VPS. CONCLUSION: Post-operative continuous ICP monitoring and EVD insertion were very useful in the treatment of CSF shunt failure with ETV. This procedure allowed intermittent CSF drainage, relieving symptoms of elevated ICP, and provided accurate assessment of the success of the ETV and patency of the stoma in the early postoperative days by CT ventriculography and can also be used to install antibiotics in cases of infection.

PMID: 20533134 [PubMed - indexed for MEDLINE]

First manifestation of lambda positive plasmacytoma in the orbital apex with acute unilateral loss of vision.

Minim Invasive Neurosurg. 2010 Apr;53(2):74-6

Authors: Wachter D, Böker DK, Huegens-Penzel M, Kuchelmeister K, Jödicke A

INTRODUCTION: An intracranial plasmacytoma is a rare form, which can involve the calvarium, dura or the cranial base. Only few case reports describe the manifestation of plasmacytoma of the skull base with affection of visual acuity. CASE REPORT: We describe the case of a 43-year-old woman, presenting with an acute unilateral loss of vision. The presumption diagnosis was retrobulbar neuritis as first manifestation of multiple sclerosis. MR imaging disclosed a tumour in the left orbital region and a meningioma was suspected. After complete resection with decompression of the optic nerve, the neuropathological examination revealed a lambda positive plasmacytoma. Additional work-up disclosed an involvement of multiple vertebral bodies. Due to the diagnosis of multiple myeloma, oncological therapy had been initiated. CONCLUSION: Skull base plasmacytoma is a rare disease. Solitary lesions causing neurological deficits should be treated aggressively including surgery for histological diagnosis and decompression of neural structures. Prognosis and further therapy depends on the systemic stage of disease, which has to be defined by diagnostic work-up.

PMID: 20533138 [PubMed - indexed for MEDLINE]

Removal of a cavernous hemangioma in the orbital apex via the endoscopic transnasal approach: a case report.

Minim Invasive Neurosurg. 2010 Apr;53(2):77-9

Authors: Yoshimura K, Kubo S, Yoneda H, Hasegawa H, Tominaga S, Yoshimine T

INTRODUCTION: The aim of this study is to describe the case of a cavernous hemangioma extending from the orbital apex to the pterygopalatine fossa that was completely removed via an endoscopic transnasal approach. CASE REPORT: We report the case of a 48-year-old man who presented with right hemianopsia of the left eye. MRI revealed a 1.5 x 1.1 cm mass lesion extending from the infero-medial part of the left orbital apex to the pterygopalatine fossa. Removal of the lesion was performed via the endoscopic transnasal approach. Using this approach, a wide operative view of the entire extent of the lesion from the optic canal to the orbital apex and the pterygopalatine fossa was obtained, and complete removal of the lesion was performed safely. The pathological diagnosis was cavernous hemangioma. CONCLUSION: The endoscopic transnasal approach is a safe, effective, and less invasive therapeutic modality for the removal of lesions extending from the infero-medial part of the left orbital apex to the pterygopalatine fossa. With appropriate patient selection, this approach improves access and visualization, and it enables performance of operative procedures with much less risk than the conventional microscopic transcranial or transfacial approaches.

PMID: 20533139 [PubMed - indexed for MEDLINE]

Combined surgical and radiosurgical treatment of symptomatic aggressive vertebral osteomyelitis.

Minim Invasive Neurosurg. 2010 Apr;53(2):80-2

Authors: Zausinger S, Schoeller K, Arzberger T, Muacevic A

INTRODUCTION: The surgical treatment of vertebral osteomyelitis can be complicated by severe additional diseases or the need for extensive debridement with concomitant risks. We report a case of combined surgical and radiosurgical treatment of idiopathic vertebral osteomyelitis of L4. CASE REPORT: The patient presented with progressive enlargement of the right side of the vertebral body L4 due to chronic fibrous osteomyelitis without evidence of infection, leading to compression of nerve roots L4, L5 and the dural sac with resulting radicular paresis. During decompression of the nerve roots via a dorsal approach, massive bleeding from the inflammatory vertebral body occurred, making abortion of surgery necessary. Remnant inflammatory masses of vertebral body L4 were treated by spinal robotic radiosurgery with a high tumoricidal dose of 20 Gy without clinical and radiological signs of relapse of disease in the following three years. CONCLUSION: We describe a case of the combined surgical and radiosurgical treatment of lumbar osteomyelitis with symptomatic nerve root compression. Dorsal decompression followed by spinal radiosurgery for the anterior vertebral parts with avoidance of potentially dangerous anterior spondylectomy led to a rapid improvement of paresis and pain with persistent control of vertebral inflammation and enlargement. The described case of close cooperation of surgeons and radiosurgeons offered an effective and functionality preserving treatment in this challenging case.

PMID: 20533140 [PubMed - indexed for MEDLINE]

Navigation-guided fence-post tube technique for resection of a brain tumor: technical note.

Minim Invasive Neurosurg. 2010 Apr;53(2):86-90

Authors: Kajiwara K, Yoshikawa K, Ideguchi M, Nomura S, Fujisawa H, Akimura T, Kato S, Fujii M, Suzuki M

INTRODUCTION: A new technique using a navigation system to minimize the influence of brain shift and to perform precise resection of brain tumors is demonstrated. To determine the resection plane, one to six tubes were inserted around the tumor under the guidance of a navigation system before dural incision. RESULTS: This technique termed the "navigation-guided fence-post tube" (NGFP) procedure was used to treat 34 patients with intraaxial brain tumors including gliomas (23 cases), malignant lymphomas (4 cases) and metastatic tumors (7 cases). Tumors were removed totally in 23 cases (67.6%), subtotally (95% or more removal) in 6 cases (17.6%) and partially (less than 95% removal) in 5 cases (14.7%). The cases with subtotal or partial resection contained tumors that were close to or involved the eloquent area, or disseminated lesions. No complications due to tube insertion occurred. CONCLUSION: NGFP is a useful and safe technique for brain tumor surgery with no influence of brain shift during tumor resection.

PMID: 20533142 [PubMed - indexed for MEDLINE]

Low-voltage bilateral pallidal stimulation for severe meige syndrome in a patient with primary segmental dystonia: case report.

Neurosurgery. 2010 Sep;67(3 Suppl Operative):E308; discussion E308

Authors: Romito LM, Elia AE, Franzini A, Bugiani O, Albanese A

BACKGROUND AND IMPORTANCE: Meige syndrome (MS) is an adult-onset segmental dystonia characterized by the combination of upper and lower cranial involvement. Its treatment is challenging and the use of oral medication or of botulinum neurotoxin treatment is not decisive. Deep brain stimulation of the globus pallidus internum (GPi DBS) has been used occasionally in severe cases. CLINICAL PRESENTATION: We report the long-term efficacy of low-voltage chronic bilateral GPi DBS in a patient with segmental dystonia featuring severe MS and cervical brachial involvement. The patient received a bilateral ventroposterolateral GPi implant. Postoperative 3-dimensional reconstruction allowed checking of the definitive position of the electrode and contacts within the targeted nucleus. Following implant, the patient received bilateral low-voltage stimulation, consisting in amplitude of 1.3 V with a pulse width of 90 microseconds and a frequency of 130 Hz, yielding a current of 23 microA. Clinical follow-up for 38 months showed a progressive and sustained improvement of dystonia with unchanged electrical settings throughout the observation period. The patient again undertook normal life activities. CONCLUSION: Bilateral low-voltage GPi stimulation allowed efficient control of MS symptoms and the associated brachial cervical dystonia.

PMID: 20729656 [PubMed - in process]

[Needed collaboration in neurosurgery--status quo in beginning of 2010]

Ideggyogy Sz. 2010 Jul 30;63(7-8):278-9

Authors: András C

PMID: 20812456 [PubMed - in process]

Improving the management of neuropathic pain.

Practitioner. 2010 Jul-Aug;254(1731):27-30, 3

Authors: Lee J, Nandi P

Neuropathic pain is defined as 'pain arising as a direct consequence of a lesion or disease of the somatosensory system'. It may reflect a widespread neuropathic process (e.g. diabetic neuropathy) or a more focal disorder (e.g. post-herpetic neuralgia). The practical importance of recognising neuropathic pain (as distinct from nociceptive pain) lies in the difference in effective treatments. The patient may be experiencing more than one type of pain. Many long-term disabling neurological disorders, such as multiple sclerosis, as well as causing neuropathic pain, may also give rise to musculoskeletal pains which may be more readily amenable to treatment. Most treatment for long-term pain, including neuropathic pain, should be provided in primary care, with specialist support. When taking the history it is important to elicit information about the site, duration, intensity and character of the pain, or pains, and what precipitates and relieves it. Accompanying somatosensory disturbance in the painful territory (numbness; allodynia; hyperalgesia; paraesthesia and dysaesthesia) is strongly suggestive of neuropathic pain. A specialist opinion should be sought where the diagnosis is uncertain, or the patient's condition is rapidly deteriorating or uncontrolled. This may be a specialist in a particular condition, to address issues of primary diagnosis, or a specialist in pain medicine to advise on, or provide, further treatment. Patients who are struggling with their pain are best served by specialist centres that can endeavour to explain the condition and encourage self-management.

PMID: 20812611 [PubMed - in process]

Post-traumatic Hydrocephalus after Decompressive Craniectomy: an Underestimated Risk Factor.

J Neurotrauma. 2010 Sep 2;

Authors: De Bonis P, Pompucci A, Mangiola A, Rigante L, Anile C

The incidence rate of post-traumatic hydrocephalus (PTH) has been reported to be 0.7-51.4%. We have frequently observed the development of PTH in patients undergoing DC. This stimulated us to perform a retrospective review of a consecutive series of patients undergoing DC for traumatic brain injury. From January 2006 to December 2009, 41 patients underwent DC after closed head injury. Study outcomes focused specifically on the development of hydrocephalus after DC. Variables described by other authors to be associated with PTH were studied, including: older age, longer timing of cranioplasty, higher score at Fisher grading system, low post-resuscitation GCS, CSF infection. We also analysed the influence of area of craniotomy and distance of craniotomy from midline. Logistic regression was used with Hydrocephalus as the primary outcome measure Of the nine patients who developed Hy, eight patients (89%) had undergone craniotomy whose superior limit was less than 25mm from the midline. That association was statistically significant (p=0.004). Logistic regression analysis showed that the only factor independently associated with the development of Hy was the distance from the midline. Patients with craniotomy whose superior limit was less than 25mm from the midline had a markedly increased risk of developing Hy (OR=17). Craniectomy whose superior limit is too close to the midline can predispose patients undergoing DC to the development of Hy. We therefore suggest to perform wide DCs with superior limit >25mm from the midline.

PMID: 20812777 [PubMed - as supplied by publisher]

Non-invasive monitoring of cerebrovascular reactivity with near infrared spectroscopy in head injured patients.

J Neurotrauma. 2010 Sep 2;

Authors: Zweifel C, Castellani G, Czosnyka M, Helmy A, Anne M, Carrera E, Brady KM, Hutchinson P, Menon D, Pickard J, Smieleweski P

Monitoring of cerebrovascular pressure reactivity (PRx) has diagnostic and prognostic value in head injured patients but needs invasive monitoring of intracranial pressure (ICP). Near infrared spectroscopy (NIRS) is a non-invasive method, suitable for continuous detection of cerebral blood volume changes. We compared a NIRS-based index of cerebrovascular reactivity, called total hemoglobin reactivity (THx), against standard measurements of PRx in a prospective observational study. Forty patients with closed head injury were monitored daily with arterial blood pressure (ABP), ICP and a NIRS-based Total Hemoglobin Index. PRx and THx were calculated as the moving correlation coefficients, using 5 minute time-windows, between 10-second averaged values of ICP and ABP, and Total Hemoglobin Index and ABP, respectively. Total number of 120 recordings were performed between the median first (IQR 0.75-2) and fourth (IQR 2-6) day after head injury, giving a total duration of 1760 hours. PRx and THx demonstrated significant association across averaged individual recordings (r=0.49 p<0.0001) and across patients (r=0.56, p=0.0002). Assessment of optimal CPP and ABP using THx was possible in about 50% of recordings and showed a significant agreement with the optimal CPP and ABP assessed with PRx. THx may be of diagnostic value to optimize therapy oriented on restoration and continuity of a cerebrovascular reactivity, especially in patients for whom direct ICP monitoring is not feasible.

PMID: 20812789 [PubMed - as supplied by publisher]

Oxidative Stress in Ischemic Brain Damage: Mechanisms of Cell Death and Potential Molecular Targets for Neuroprotection.

Antioxid Redox Signal. 2010 Sep 2;

Authors: Chen H, Yoshioka H, Kim GS, Jung JE, Okami N, Sakata H, Maier CM, Narasimhan P, Goeders CE, Chan P

Significant amounts of oxygen free radicals (oxidants) are generated during cerebral ischemia/reperfusion, and oxidative stress plays an important role in brain damage after stroke. In addition to oxidizing macromolecules, leading to cell injury, oxidants are also involved in cell death/survival signal pathways and cause mitochondrial dysfunction. Experimental data from laboratory animals that either overexpress (transgenic) or are deficient in (knock-out) antioxidant proteins, mainly superoxide dismutase (SOD), have provided strong evidence of the role of oxidative stress in ischemic brain damage. In addition to mitochondria, recent reports demonstrate that NADPH oxidase (NOX), an important pro-oxidant enzyme, is also involved in the generation of oxidants in the brain after stroke. Inhibition of NOX is neuroprotective against cerebral ischemia. We propose that SOD and NOX activity in the brain is a major determinant for ischemic damage/repair and that these major anti- and pro-oxidant enzymes are potential endogenous molecular targets for stroke therapy.

PMID: 20812869 [PubMed - as supplied by publisher]

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