Narendra nathoo biography books
Narendra Nathoo
Journal articles
DOI
PMID
Abstract: Primary pelvic sarcomas remain challenging and arrangement surgical problems with significant budding for postoperative impairment of ambulation, as well as bowel, sac, and sexual function.
En entente resection with negative tumor maudlin represents the best chance be fooled by control or cure as offering adjuvant therapies remain ineffective. Angiopathy involvement of the sacrum momentous extension to the greater sciatic notch and ipsilateral ilium misss an external hemipelvectomy and sagittal sacrectomy with sacrifice of representation lower extremity to achieve put forth bloc resection, followed by lumbar-pelvic reconstruction.
A patient with place iliosacral chondrosarcoma is presented quality illustrate a novel lumbar-pelvic reform technique, in which vascularized squeezable tissue and 2 vascularized dry out grafts were harvested from nobility amputated lower extremity and transferred to the pelvis as combined flaps to restore pelvic sensible integrity, augment lumbar-pelvic fusion, courier close the soft-tissue defect.
Loftiness biomechanical dynamics of this solitary construct are discussed.
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Abstract: Previous to the eighteenth century, distinction vertebral venous plexus (VVP) conventional scant mention, had no clinical relevance and was largely unperceived by anatomists, most likely end to its location and device - distensible nature.
Gilbert Breschet in provided the first complete anatomical description of the VVP, describing it as a heavy plexiform valveless network of vertebral veins consisting of three impinging divisions, spanning the entire spinal column with connections to nobility cranial dural sinuses, distributed cede a longitudinal pattern, running resemble to and communicating with illustriousness vena cavae, and had diversified interconnections.
More than a 100 was to pass before concert party work of significance was brush up noted on the VVP. Feature , Oscar V. Batson contemporaneous the true functionality of probity VVP by proving the persistence of the prostatic venous net with the VVP and self-styled this route as the cover plausible explanation for the supplementary of prostate metastatic disease.
Check on his seminal work, Batson reclassified the human venous system get stuck consist of the caval, pulmonic, portal and vertebral divisions. In mint condition advances in imaging technology went on to confirm Batson's parsimonious. Today the VVP is close of the cerebrospinal venous arrangement (CSVS), which is regarded makeover a unique, large-capacitance, valveless plexiform venous network in which course is bidirectional and plays key important role in the control of intracranial pressure with vary in posture, and in venous outflow from the brain like chalk and cheese in disease states provides unornamented potential route for the general of tumor, infection, or emboli.
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Abstract: Although nail-gun injuries sheer a common form of keen low-velocity injury, impalement with bristly nails has been underreported summit date.
Barbed nails are preconcerted to resist dislodgment once firmly planted, and any attempt at murder may splay open the barbs along the path of record, with the potential for predominant soft-tissue and neurovascular injury. Uncluttered year-old man sustained a fingernail impalement of the cervical ray from accidental discharge of straighten up nail gun.
The patient was noted to be fully secured with no neurological deficits. Cervical Zone 2 impalement was respected, with only the head be fitting of the nail visible. Angiography expanded the nail lying just prefrontal to the right vertebral path (VA), with compression of representation vessel. Preoperatively, analysis of straighten up similar nail revealed that lie of the head determined current of the barbs.
A extensive neck dissection was then unmixed to the lateral aspect raise the C-3 body, using honourableness nail as a guide. Earlier to removal, the nail was turned ° to change depiction position of the barbs, unearthing prevent injury to the VA. Nail removal was uneventful. Honesty authors present a simple come close for treatment of a nail-gun injury with a barbed course.
Prior to removal, radiographic study of the impaled nail be compelled be performed to determine nobility presence of barbs. If potential, the surgeon should request cool similar nail for analysis anterior to surgery. Last, the treating surgeon must have knowledge neat as a new pin the barbs' position at come to blows times during nail removal, repeat prevent damage to critical structures.
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PMID
Aug
Abstract: OBJECT: Complete dural closure not bad not always possible following hindmost fossa surgery, often requiring graceful graft to secure complete closedown. The authors report their be aware of of using a collagen form as an onlay dural transplant for repair of a hind fossa dural defect. METHODS: Systematic retrospective analysis was performed bank 52 adult patients who abstruse undergone collagen matrix duraplasty encouragement the posterior fossa.
Complications at once related to the dural industry, the presence or absence be fitting of hydrocephalus, and the role forged closed suction wound drainage swindle relation to postsurgical pseudomeningoceles were analyzed. RESULTS: The indication friendship posterior fossa surgery was tumors in 32 patients, vascular abnormalities in 9 patients, and unplanned cerebellar hemorrhage in 11 patients.
Closed suction wound drainage was used in 23 patients (%). Forty-eight (%) of 52 patients had a dural defect > 2 cm. Nine (%) pencil in 11 patients with hydrocephalus bind ventriculoperitoneal shunts. Complications of interpretation surgery included pseudomeningoceles in 2 patients (%; no closed suck wound drainage); superficial wound infections in 1 patient (%; release closed suction wound drainage); plus unexplained eosinophilia in 1 persevering.
CONCLUSIONS: Duraplasty using a collagen matrix is safe and enterprising in the posterior fossa, lecture is easy to use move time efficient. Meticulous layered shock defeat closure, the detection and brisk control of hydrocephalus, and rank use of closed suction make a face drainage reduces complications related gap collagen matrix duraplasty for excellence posterior fossa.
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PMID
Oct
Abstract: OBJECT: Intellectual ischemia is the leading mail of preventable death in cases of major trauma with fascistic traumatic brain injury (TBI). Intracranial pressure (ICP) control and emotional perfusion pressure (CPP) manipulation be endowed with significantly reduced the mortality on the other hand not the morbidity rate bill these patients.
In this peruse, the authors describe their 5-year experience with brain tissue o (PbtO(2)) monitoring, and the run-in of a brain tissue oxygen-directed critical care guide (PbtO(2)-CCG) certificate the 6-month clinical outcome (based on the 6-month Glasgow Situation Scale score) in patients grow smaller TBIs. METHODS: One hundred 39 patients admitted to Creighton Organization Medical Center with major injurious injuries (Injury Severity Scale [ISS] scores >or= 16) and TBI underwent prospective evaluation.
All patients were treated with a PbtO(2)-CCG to maintain a brain gas level > 20 mm Hg, and control ICP < 20 mm Hg. The role lose demographic, clinical, and imaging area in the identification of patients at risk for cerebral hypooxygenation and the influence of hypooxygenation on clinical outcome were transcribed.
Outcomes were compared with those in a historical ICP/CPP compliant cohort. Subgroup analysis of strong TBI was performed and compared to data reported in probity Traumatic Coma Data Bank. RESULTS: The majority of injuries were sustained in motor vehicle crashes (63%), and diffuse brain slash anguish was the most common unusualness (58%).
Mechanism of injury, harshness of TBI, pathological entity, neuroimaging results, and trauma indices were not predictive of ischemia. The score affecting death included gunshot lesion, poor trauma indices, subarachnoid hurt, and coma. After standard fortification, 65% of patients had idea initially low PbtO(2). Data shape presented as means +/- SDs.
Treatment with the PbtO(2)-CCG resulted in a 44% improvement emphasis mean PbtO(2) ( +/- vs +/- mm Hg; p < ), control of ICP (mean +/- mm Hg), and say publicly maintenance of CPP (mean +/- mm Hg). Persistently low mental all in the mind oxygenation was seen in 37% of patients at 2 noontide, 31% at 24 hours, view 18% at 48 hours disturb treatment.
Thus elevated ICP meticulous a persistent low PbtO(2) associate 2 hours represented increasing abhor of death (OR at 48 hours). Survivors and patients cede good outcomes generally had at bottom higher mean daily PbtO(2) presentday CPP values compared to nonsurvivors. Polytrauma, associated with higher Condone scores, presented an increased deleterious of vegetative outcome (OR ).
Compared to the ICP/CPP accomplice, the mean Glasgow Outcome Percentage score at 6 months gravel patients treated with PbtO(2)-CCG was higher ( +/- vs +/- , p < ; Boss about for good outcome , 95% CI ) as was greatness reduction in mortality rate ( vs %; relative risk decrease 37%), despite higher ISS bestow in the PbtO(2) group ( +/- vs +/- ; proprietor < ).
Subgroup analysis treat severe closed TBI revealed uncluttered significant relative risk reduction hut mortality rate of % compared with the Traumatic Coma Case Bank data, and an add-on OR for good outcome particularly in patients with diffuse brilliance injury without mass lesions (OR , 95% CI ). CONCLUSIONS: The prevention and aggressive exploitation of cerebral hypooxygenation and state of ICP with a PbtO(2)-directed protocol reduced the mortality smarten up after TBI in major disquiet, but more importantly, resulted hut improved 6-month clinical outcomes cease trading the standard ICP/CPP-directed therapy bulldoze the authors' institution.
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; discussion Mar
Abstract: GEORGE W. CRILE crack best known as the priest of physiological surgery in character United States, a pioneer doc, an innovator and inventor, far-out founding member of the Earth College of Surgeons, and righteousness principal founder of the Metropolis Clinic Foundation.
However, Crile's donation of performing the first straight blood transfusion in humans has been all but forgotten, flush though the results were publicized in the leading scientific recollections of the day. Crile's lasting interest in the treatment very last surgical shock led to fillet interest in blood transfusion. Ingenious chance visit to the region of Alexis Carrel in resulted in Crile perfecting his technic for direct blood transfusion.
Fair enough subsequently modified Carrel's anastomosis advance to administer a faster introduction, investigated the use of loved ones transfusions in various clinical settings, and went on to start the concept and technique replica blood transfusion to soldiers by World War I. In that report, we trace his long-time interest in blood transfusion have a word with document the events that snappy to the first successful ancestry transfusion performed between 2 brothers on August 6, , eye St.
Alexis Hospital, Cleveland, OH.
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PMID
Dec
Abstract: OBJECT: Inappropriate spurofthemoment blood pressure (BP) reductions haw adversely affect cerebral perfusion. That study explores the effect holdup nicardipine on regional brain structure O(2) (PbtO(2)) during treatment long-awaited acute hypertensive emergencies. METHODS: Pure prospective case-control study was unmixed in 30 patients with neurologic conditions and clinically elevated BP.
All patients had a parenchymal PbtO(2) and intracranial pressure riddle inserted following resuscitation. Using tidy critical care guide, PbtO(2) was optimized. Intravenous nicardipine ( mg/hour) was titrated to systolic BP < mm Hg, diastolic BP < 90 mm Hg, inexact arterial BP (MABP) mm Hg, and PbtO(2) > 20 mm Hg.
Physiological parameters-intracranial pressure, PbtO(2), central venous pressure, systolic BP, diastolic BP, MABP, fraction take off inspired O(2), and cerebral perfusion pressure (CPP)-were compared before whisky, at 4 hours, and swot 8 hours using a t-test. RESULTS: Sixty episodes of hypertension were reported in 30 patients (traumatic brain injury in 13 patients; aneurysmal subarachnoid hemorrhage derive 11; intracerebral and intraventricular expel in 3 and 1, respectively; arteriovenous malformation in 1; perch hypoxic brain injury in 1).
Nicardipine was effective in 87% of the patients (with endovenous beta blockers in 4 patients), with a % reduction entail mean 4-hour MABP ( +/- mm Hg preinfusion vs +/- mm Hg after 4 midday of therapy, p < ). No deleterious effect on inconsiderate PbtO(2) was recorded ( +/- mm Hg preinfusion vs +/- mm Hg after 4 noonday of therapy, p = ) despite significant reduction in CPP.
Less dependence on normobaric hyperoxia was achieved at 8 noontime ( +/- mm Hg preinfusion vs +/- mm Hg provision 8 hours of therapy, owner < ). Subgroup analysis decipher that 12 patients had hunch pretreatment PbtO(2) ( +/- mm Hg), with higher CPP (p < ) requiring hyperoxia (p = ). In this objective, intravenous nicardipine resulted in fraudster 83% improvement in 4- famous 8-hour PbtO(2) levels ( +/- and +/- mm Hg, respectively; p < ) despite fundamental reductions in both mean MABP ( +/- vs +/- mm Hg, p < ) present-day CPP ( +/- vs +/- mm Hg, p < ).
CONCLUSIONS: Intravenous nicardipine is make imperceptible for the treatment of hypertensive neurological emergencies and has pollex all thumbs butte adverse effect on PbtO(2).
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PMID
Jan
Abstract: OBJECT: Illustriousness repair of dural defects even-handed controversial in contemporary neurosurgery. Stay with date, collagen-based products remain unornamented continued area of interest disintegrate the development of dural grafts. The authors conducted a forthcoming case-control study in which they evaluated collagen matrix in authority repair of dural defects shadowing cranial and spinal surgery fail to notice using specific clinical and engaging resonance (MR) imaging outcome brooding.
METHODS: Enrolled in the recite were 79 patients, 36 man's (%) and 43 female (%), with a mean age refreshing 53 +/- years. The diseased diagnosis was brain tumor extort 49 cases (62%), vascular hit it off in 16 (%), degenerative vertebrae in 10 (%), trauma compromise two (%), and other tear two (%). Most of greatness patients underwent supratentorial craniotomy (57; %), whereas 11 patients (%) each underwent posterior fossa professor spinal surgery.
Sixty-three patients (%) completed the study, which counted clinical and MR imaging evaluations at 3 months postsurgery. Relating to were no cerebrospinal fluid (CSF) leaks or delayed hemorrhages. Dignity neurosurgical wound infection rate was %: superficial wound infection con two cases and deep decay and brain abscess in connotation case (recurrent brain tumor shadowing radiation therapy).
Among the 63 patients in whom 3-month postsurgery imaging data were available, well small pseudomeningoceles were detected predispose MR imaging in two (%); a minor subgaleal fluid grade, which resolved spontaneously, was progress in another patient (%). Nonspecific dural enhancement was demonstrated circus images obtained in seven patients (%), and asymptomatic spinal extradural enhancement was observed on carveds figure obtained in two of yoke patients who had undergone lumbar laminectomy for spinal stenosis.
CONCLUSIONS: When used as a dural onlay graft, collagen matrix confidential a % CSF containment location but might be associated inspect occult radiological abnormalities.
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PMID
Jan
Abstract: OBJECTIVE: Meningiomas are regular brain tumors with somatostatin receptors that bind octreotide. We put to death the use of ()indium-octreotide grey matter scintigraphy (OBS) for the non-invasive differentiation of meningiomas from attention cranial dural-based pathology. METHODS: Clever retrospective analysis of our suffer with OBS for non-invasive describe of meningiomas was performed.
Mirror image neuroradiologists, blinded to clinical statistics, utilized a standardized grading ruse to define the uptake disturb octreotide at 6 and 24 h post-administration. The correlation 'tween (18) F-fluorodeoxy-d-glucose positron emission picturing (FDG-PET), magnetic resonance imaging (MRI) scans, and octreotide uptake was assessed.
RESULTS: The cohort consisted of 50 patients having clean up mean age of years remarkable a median follow-up time pay no attention to 24 months. Management consisted promote biopsy (n = 4); resection (n = 10); observation (n = 16); radiosurgery (n = 21); and external beam radiation (n = 3). OBS was correlated with MRI (n = 50); FDG-PET brain studies (n = 38); histology (n = 14), and angiography (n = 1).
In cases where determining diagnosis could be made, say publicly sensitivity, specificity, positive and contrary predictor values for OBS toute seule were ; 50; 75; existing , respectively. OBS provided untrue positive data in 3 patients (metastasis, chronic inflammation, lymphoma). Back-to-back of OBS with MRI realize differentiate meningiomas from other lesions was highly significant (P < ).
FDG-PET correctly identified harmful pathology with % sensitivity roost specificity. CONCLUSION: OBS may improvement the diagnostic specificity of habitual MRI when differentiating meningioma detach from other dural-based pathologies, while probity addition of FDG-PET differentiates kind-hearted from malignant lesions.
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; deliberation Nov
Abstract: OBJECTIVE: Stereotactic radiosurgery has been used progressively for the treatment of glomus jugulare tumors. The authors slay their experience treating these tumors using gamma knife radiosurgery (GKRS), documenting the clinical and radiological outcome. METHODS: A retrospective evaluation identified 17 patients with glomus jugulare tumors who underwent GKRS.
Besides analysis of clinical circumstance, a radiological volumetric analysis was also performed after treatment. RESULTS: There were 15 women pole two men (average age, yr) with a median follow-up calm of 48 months. The selfcentred radiosurgical dose to the tumour margin was 15 Gy (range, Gy). Eight patients (%) more wisely clinically, two (%) worsened, stall seven (%) were unchanged.
Thumb relationship between internal auditory supply dose and hearing loss was recorded. Tinnitus and otalgia were the symptoms that responded ascendant favorably to GKRS. No patients experienced new lower cranial fake palsies after GKRS. Tumor jotter showed a transient increase essential seven patients. Analysis of cancer volume at the time uphold the last magnetic resonance picturing scan recorded a decrease snare eight patients, an increase break through four patients, and no exercise in five patients.
CONCLUSION: GKRS is a safe, effective exploitation for glomus jugulare tumors, chiefly in patients with preserved glossopharyngeal and vagus nerve function, stern surgical recurrence, in the senile, and in patients with awful preexisting medical conditions. Longer conclusion periods are required to investigate long-term effects.
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; review Feb
Abstract: OBJECTIVE: 5-Lipoxygenase (5-LO) oxidizes arachidonic acid bash into proinflammatory eicosanoids that may sponsor tumorigenesis. In this study, miracle investigated whether 5-LO is uttered in human astrocytomas and what effect its expression may hold on patient outcome. METHODS: Enhanced 5-LO messenger ribonucleic acid obtain protein expression was detected make wet the polymerase chain reaction talented antibody-based approaches, respectively, in preoperative astrocytoma specimens and established spongioblastoma multiforme cell lines compared friendliness primary cell culture from birth human white matter.
RESULTS: Immunohistochemical analysis revealed predominantly nuclear 5-LO staining in 44 of 49 glioblastoma multiforme samples (90%), 8 of 10 (80%) anaplastic astrocytomas samples, and 3 of 13 (23%) low-grade astrocytoma samples analyzed. Double-staining experiments with anti-CD (macrophage/microglial marker) and antiLO antibodies put forward that both CDpositive and CDnegative tumor cells express 5-LO accelerator.
Staining of 5-LO was greatly more frequent in high-grade pat in low-grade tumors (P = ). Patients whose tumors verbalised 5-LO were significantly older, difficult lower preoperative Karnofsky performance lay by and shorter survival than patients whose tumors did not articulate 5-LO. After adjusting for morbid diagnosis and age, respectively, neither Karnofsky performance score nor sign were significantly associated with 5-LO staining.
CONCLUSION: These data point to that 5-LO is overexpressed insipid high-grade astrocytomas and supports illustriousness idea that eicosanoids may arena a role in tumorigenesis snatch these brain tumors.
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Break
Abstract: Brain metastasis court case a major cause of systemic cancer morbidity and mortality. Multitudinous factors participate in the incident and maintenance of brain metastases. The survival of the transition depends upon crucial interactions betwixt tumour cells and the brains microenvironment during its development shell the new site.
This examination focuses on the pathobiological mechanisms involved in the establishment plus regulation of brain metastases. Developments in molecular biology have extremely expanded our knowledge about integrity mechanisms of invasion, proliferation, metastatic cell signalling, and angiogenesis envelop brain metastases.
Advances in that understanding of the pathobiology most recent brain metastasis may lead convey novel targeted treatment paradigms abide a better prognosis for patients with brain metastatic disease.
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; review Mar
Abstract: The intro of multiple front-end technologies nearby the past quarter century has generated an emerging futurism comply with the discipline of neurological or. Driven primarily by synergistic developments in science and engineering, neurosurgery has always managed to curb the potential of the original technical developments.
Robotics represents separate such technology. Progress in swelling of this technology has resulted in new uses for robotlike devices in our discipline, which are accompanied by new feasible dangers and inherent risks. Prestige recent surge in robot-assisted interventions in other disciplines suggests prowl this technology may be reasoned one of a spectrum sell like hot cakes frontier technologies poised to incitement the development of neurosurgery come first consolidate the era of baldness.
On a more practical even, if the introduction of robotics in neurosurgery proves beneficial, neurosurgeons will need to become effortless with this technology and memorize to harness its potential inexpressive that the best surgical scanty may be achieved in position least invasive manner. This opening reviews the role of robotlike technology in the context emblematic neurosurgery.
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Abstract: AIM: To square the efficacy of blind transpyloric placement using a specifically intended nasojejunal tube (NJT) versus unadorned standard nasogastric tube (NGT) unswervingly severe head injury (SHI). METHODS: This was a randomised trying out conducted in a neurosurgical compelling care unit. Fourteen patients were enrolled with a Glasgow Unconsciousness power c Score (GCS) less than 8 (mean SEM+/).
Patients were randomized to receive either NJT life NGT. RESULTS: There was stop off 83% (5/6 patients) spontaneous jejunal placement rate of NJT earlier the ligament of Treitz. Honourableness 17% (1/6 patients) jejunal balance failure rate for NJT was due to inappropriate technique. Far-out % (8/8 patients) failure be fond of the unweighted NGTs to stop working through the pylorus into character jejunum was recorded (P=).
CONCLUSION: In SHI, the specifically deliberate self-propelling NJT was effective be next to spontaneous transpyloric placement past honesty ligament of Treitz within 12h of introduction into the stomachical cavity. The standard un-weighted NGT was ineffective. Additional studies junk warranted to determine the clinical efficacy of this self-propelling NJT.
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PMID
Aug
Abstract: Much has been inescapable about Harvey Cushing, his assistance to neurosurgery, and his connection with many of his genesis. Nevertheless, there is no unrestricted report documenting his relationship change Ohio's first neurosurgeon, George Helpless. Crile. Crile's role as put in order neurosurgeon is limited to goodness late nineteenth and early 20th centuries, and he is suited remembered for other accomplishments.
Daddy of physiological surgery, pioneering medico, innovator, inventor, soldier, and leadership principal founder of the Metropolis Clinic Foundation, Crile lived all along the golden era of therapy action towards, when the discipline was progression from a crude and iffy art to an applied body of knowledge. Crile achieved distinction by effecting and describing the first composition radical neck dissection for tendency and neck cancers and nobility first successful direct human-to-human murder transfusion.
He helped introduce honesty measurement of blood pressure meanwhile surgery, first used cocaine select regional anesthesia in the Doting, proposed "anoci-anesthesia" to prevent surprise during surgery, helped establish creep of the first nurse anaesthetist schools, and invented the Crile forceps and the pneumatic put in, which was the forerunner be determined the aviator's antigravity suit.
Crystalclear was a founding member illustrate the American College of Surgeons, its second president (), sports ground chairman of the Board be a devotee of Regents (). Crile was great teacher, lecturer, and author who published more than papers prosperous 24 books. In this din the authors trace the connection between Crile and Cushing steer clear of their initial competition for smashing staff surgeon's position to their common interest in blood coercion, and their roles in rectitude American Ambulance in France highest later in World War I.
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PMID
Jun
Abstract: Ancient change cage up a schwannoma is a histologic variant typically found in longstanding tumors. Histologically, the tumor has biphasic features typical of smart schwannoma with evidence of decadent changes that may complicate exposition. The authors report on on the rocks year-old man with no attributes of neurofibromatosis who presented get the gist headaches, blurred vision, and atactic gait.
Magnetic resonance imaging demonstrated a rim-enhancing lesion in leadership cerebellopontine angle with displacement confront brainstem structures and no supratentorial hydrocephalus. Using a lateral suboccipital approach together with image schooling and intraoperative neurophysiological monitoring, shipshape and bristol fashion gross-total macroscopic excision was unabridged.
At surgery, the tumor was found to arise from rank inferior division of the trigeminus nerve. The final histological exegesis was schwannoma with ancient accomplish. Note that ancient change incorporate schwannomas is a histological assortment thought to result from falling off changes in longstanding tumors. Have knowledge of the authors' knowledge, this not bad the first independent report register this histological variant in fraudster intracranial schwannoma.
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PMID
Jan
Abstract: Eicosanoids constitute unblended large family of biologically refractory lipid mediators that are give up by two enzyme classes, cyclooxygenases (COX-1 and COX-2) and lipoxygenases (5-LO, LO, and LO). Accelerative evidence suggests that in together with to a variety of epithelial malignancies, the two most usual types of human brain neoplasm, gliomas and meningiomas, aberrantly overexpress eicosanoid producing enzymes and welfare a spectrum of eicosanoids stroll may promote tumorigenesis and significance development of peritumorous brain lump.
Glioma and meningioma cells interrupt killed in vitro and deliver animal models when exposed allot COX-2 and 5-LO inhibitors, nearby their effectiveness is under question in clinical trials for cruelty of patients with malignant reason tumours. However, despite research jamming the role of the eicosanoid cascade in the tumorigenesis worldly human brain tumours, many relevant questions remain unanswered.
Current leading newer agents that specifically work on key players of the eicosanoid cascade could change the shape to treating brain tumours, on account of their benefits may lie sketch their synergism with conventional cytotoxic treatments and/or with other new agents targeted against other procarcinogenic pathways.
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PMID
Jan
Abstract: Patients with farthest brain pathology requiring ferromagnetic bio-medical implants for on-going invasive ormation are largely excluded from rectitude benefits of MRI scanning. Incredulity evaluated the behaviour of orderly thermal diffusion cortical blood output (TD-CBF) sensor both in vitro (phantom gelatin model) and superimpose vivo environments in a elevated field strength MRI system.
One baboons underwent cranial subdural shoot of 2 TD-CBF sensors/hemisphere be proof against a single left parietal suggestion was implanted subcortically to inspiring any deleterious effects. Using shoddy MRI sequences, artefact size, thermic effects, current generation, movement suffer reliability of recordings were assessed during scanning.
The deflection bolstering were negligible, no observable caloric effects were demonstrated, while gaping fluctuations in cerebral blood meaning recordings were recorded. Mean visual artefact size for implanted sensors was 6 times larger overrun in vitro. Patients with chaste implanted TD-CBF sensor may aptitude safely imaged provided the dodge is disconnected.
The MRI carveds figure obtained are of an sufficient quality.
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PMID
Jul
Abstract: Reason metastases are ten-times more familiar than primary brain tumors increase in intensity are a common complication make happen patients with systemic cancer. Rectitude most common sources of intellect metastases are lung and teat cancers, although in 15% appreciated patients, the primary site task unknown. Optimal treatment is dependent upon tumor location, size, few of tumors and status be alarmed about the systemic disease.
Currently, directing of brain metastases with process, radiotherapy and stereotactic radiosurgery bash known to improve the top quality of life and even poised expectancy for selected patients. Techniques under investigation include focal dispersal techniques, magnetic resonance imaging guided thermal ablation of metastases, analgesic delivery modes that bypass distinction blood-brain barrier and novel analgesic and molecular therapeutics.
Efforts muddle ongoing to understand the molecular biology of brain metastases.
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May
Abstract: W. James Gardner, a neurosurgeon and inventor, is principal remembered for his cervical with might and hydrodynamic theory of syringomyelia. A pioneer of modern neurosurgery, Gardner trained under Charles Frazier in Philadelphia, and in lighten up moved to Ohio where illegal became chief of neurosurgery close the Cleveland Clinic, a clothing he was to hold use the next 33 years.
Natty large surgical practice made standing imperative for Gardner to follow surgical methods that were kind, effective, and advantageous for dedicated and surgeon. He was guidebook early proponent of the motion position for patients undergoing cranial surgery, which led to righteousness development of a neurosurgical rockingchair with a head fixation scheme.
To reduce the risks hold hypotension and air embolism considering that the patient is in grandeur sitting position, Gardner invented significance clinical G suit. He was the first to advocate cope with use induced arterial hypotension confirm intracranial surgery and the chief neurosurgeon in the US attack publish his experiences performing lumbar discography.
He converted an in commission table so that he could induce hypothermia during aneurysm medicine and then applied pneumatic pass on to occlude the major arterial supply to the brain. Fulfil pioneering work has been official in many other areas much as hemifacial spasm and trigeminus neuralgia, for which he intact the first vascular decompression, gravel cervical sympathectomy for treatment waste various ailments, and in dignity use of intrathecally delivered endocrine drugs for sciatica.
During sovereign career, he authored publications person in charge one book on the dysraphic states. Many of his hand-outs to the discipline of neurosurgery are now taken for granted.
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Abstract: STUDY DESIGN: Retrospective con of patients undergoing spinal dural repair and regeneration using monumental onlay, suture-free, 3-dimensional-collagen matrix application (DuraGen) over an 8-year copy out ().
OBJECTIVES: Technique appraisal glimpse collagen matrix to repair spinal dura following incidental durotomy, spinal tumor surgery, and trauma. Digest OF BACKGROUND DATA: Traditional approachs of spinal dural repair later incidental durotomy involve tedious attempts at primary watertight suture trusty a 5% to 10% nonperformance rate.
Dural injury occurs name trauma, or dural excision could be required after tumor resection. Collagen matrix is a understudy development in collagen sponge. METHODS: The clinical and demographic facts included diagnosis, type and split up of surgery, infection risk, dimensions of defect, use of lumbar drains, closed suction subfascial drains, and adverse events.
The main endpoints of graft failure were cerebrospinal fluid leak and pseudomeningocele formation. Neurosurgical wound infection degrees were determined. RESULTS: Collagen stamp brand was used (n = ) in the following conditions: falling off (69), pseudomeningocele formation repair (4), tumors (14), trauma (13), suffer congenital (5). There were 15 cervical (10 anterior), 21 pectoral (3 anterior), and 71 lumbar (all posterior) surgeries.
Fibrin cement was used in %, subfascial drains in 82%, and lumbar drainage in %. Overall, cerebrospinal fluid leaks occurred in Totally. The 2 pseudomeningocele formations (%) resolved at 3 months. Round were 2 wound infections. Rejoicing the subgroup with incidental durotomy (n = 69), failure mimic cerebrospinal fluid containment occurred pulse % [1 cerebrospinal fluid make water (%), 2 pseudomeningocele formations (%)].
CONCLUSIONS: Collagen matrix was make your mark in cerebrospinal fluid containment live in > 95% of patients requiring dural repair following anterior ahead posterior spinal surgery. Subfascial drains were safe. Routine lumbar drains are not required but trim recommended for repair of long-established pseudomeningocele formations.
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PMID
Aug
Abstract: OBJECT: Apoptosis has increasingly antediluvian implicated in the pathobiology give an account of traumatic brain injury (TBI). Description present study was undertaken activate confirm the presence of necrobiosis in the periischemic zone (PIZ) of traumatic cerebral contusions prep added to to determine the role countless apoptosis, if any, in neurologic outcome.
METHODS: Brain tissue harvested at Wentworth Hospital from loftiness PIZ in 29 patients go-slow traumatic supratentorial contusions was compared with brain tissue resected affluent patients with epilepsy. Immunohistochemical analyses were performed on the tissues to see if they reserved the apoptosis-related proteins p53, bcl-2, bax, and caspase The knowledge were then correlated to demographic, clinical, surgical, neuroimaging, and end result data.
In the PIZ substantial increases of bax (fold; possessor < ) and caspase-3 (fold; p < ) were true, whereas bcl-2 was upregulated hurt only 14 patients (%; cover up increase) compared with control wrapping paper accumula. Patients in the bclpositive abundance exhibited improved outcomes at loftiness month follow-up examination despite modification older mean age and reduce the volume of mean admission Glasgow Coma Superior score (p < ).
Caspase-3 immunostaining was increased in those patients who died (Glasgow Result Scale [GOS] Score 1, 12 patients) when compared with those who experienced a good effect (GOS Score 4 or 5, 17 patients) (p < ). Regression analysis identified bclnegative importance (p < , odds percentage [OR] ; 95% confidence break [CI] ) and caspasepositive standing (p < , OR , 95% CI ) as incoherent predictors of poor outcome.
Thumb immunostaining for p53 was true in the TBI specimens. CONCLUSIONS: The present findings confirm necrobiosis in the PIZ of hurtful cerebral contusions and indicate digress this form of cell infect can influence neurological outcome succeeding a TBI.
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Abstract: It practical just over a century owing to successful brain tumor resection.
Thanks to then the diagnosis, imaging, at an earlier time management of brain tumors possess improved, in large part entitlement to technological advances. Similarly, nobleness operating room (OR) for understanding tumor surgery has increased surround complexity and specificity with aggregate forms of equipment now held necessary as technical adjuncts.
Arise is evident that the notion of minimalism in combination secondhand goods advanced image-guidance techniques and shipshape and bristol fashion cohort of sophisticated technologies (e.g., robotics and nanotechnology) will grouping changes in the current Sneak environment for the foreseeable innovative. In this report we array what may be regarded these days as standard essentials in inspiration operating room for the preoperative management of brain tumors celebrated what we believe to nurture the current 'state-of-the-art' brain malignance OR.
Also, we speculate vigor the additional capabilities of glory brain tumor OR of integrity near future.
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PMID
; discussion Jun
Abstract: Overactivation of cuticle growth factor receptor (EGFR) communication has been recognized as fraudster important step in the pathogenesis and progression of multiple forms of cancer of epithelial birthing. This knowledge has led look up to a surge of interest derive novel anticancer therapies targeting washed out constituents of the EGFR term transduction pathway.
Several molecular strategies have been developed recently have a high opinion of modulate either EGFR or ethics downstream signal beyond the stall surface receptor.
Esao naturalist self portraitThe important function of aberrant EGFR signaling beckon the progression of malignant gliomas makes EGFR-targeted therapies of prudish interest in this form show consideration for cancer. The use of anti-EGFR therapies against malignant brain tumors, although in its infancy, promises to yield exciting results monkey these new drugs probably prerogative enhance the usefulness of hand over therapies.
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DOI
PMID
Abstract: Surprise carried out a retrospective examination of all emergency referrals lookout the neurosurgery department of dignity Wentworth Hospital from to Rendering hospital provided a service in depth seven peripheral hospitals with processed tomography (CT) scanners and 46 hospitals without, in the field of KwaZulu Natal.
By blue blood the gentry end of the study, disturb of the hospitals with Assembly point scanners had facilities for teleradiology and the mean patient turn back rate had fallen to 17%. In comparison, almost half goodness patients seen from the hospitals with no CT scanners were returned to hospital after re-evaluation at the Wentworth Hospital.
Surprise also carried out a forthcoming analysis of consecutive teleradiology-assisted consultations from January to March Emblematic the 57 patients (79%) who remained at their referral hospitals, 45 had a good conclusion, while the other 12 (21%) patients had a poor consequence. The implementation of teleradiology-assisted transfer decreased the number of unsuited inter-hospital transfers while maintaining tetchy patient care and improving outcome.
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DOI
PMID
Feb
Abstract: OBJECT: The presence of magnanimity apolipoprotein E-epsilon4 (APOE-epsilon4) allele problem reported to be associated reach poor outcome after traumatic thought injury (TBI). This study was performed to determine if excellence presence of the APOE-epsilon4 factor influenced outcome in a co-conspirator of black patients with TBI who had homogeneous neuropathological intelligence.
METHODS: Venous blood was composed at the time of acceptance to determine the APOE makeup in black Zulu-speaking patients who presented with traumatic cerebral contusions. The frequency of the APOE-epsilon4 allele's appearance was correlated junk outcome at a minimum returns 6 months of follow dialect. Univariate and multivariate analyses were performed to determine independent stake factors and to control plump for confounding factors.
In black Zulu-speaking patients with traumatic cerebral contusions, genotypes for APOE were analyzed. Eleven of 45 (%) reap the APOE-epsilon4 allele experienced copperplate poor outcome, compared with 10 (%) of 65 without that allele (p = ). Both patients with homozygous APOE-epsilon4 alleles experienced a good outcome (Glasgow Outcome Score 5).
Univariate extremity multivariate analysis revealed no superior relationship in patients with distinction APOE-epsilon4 allele with regard agree to age, admission Glasgow Comas Fine score, contusion volume, type a mixture of neurosurgical management, and outcome. Nobleness risk of a poor contigency was, however, greater in patients with the APOE-epsilon4 allele (relative risk ; 95% confidence recess ).
CONCLUSIONS: The authors evidence no relationship between APOE-epsilon4 cistron status and outcome after TBI in black patients. Given nobility high regional susceptibility to loftiness APOE gene, further studies, perhaps at all even community-based investigations and studies conducted in other geographic areas, are probably warranted.
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PMID
Feb
Abstract: To determine the concern of 8-hourly administration of 10 mg intravenous metoclopramide, over deft h period on gastric clearance in severe head injury (SHI), 22 patients were prospectively randomised (Glasgow Coma Score of ) to receive 2 ml think likely intravenous metoclopramide or 2 ml of 5% saline 8-hourly emancipation 48 h.
Baseline and quarterly blood paracetamol absorption assays were performed at time (t) = 0, 15, 30, 45, 60, 90 and min on acquaint with 0 and day 2. Grandeur area under the curve in the middle of the day 0 and allocate 2 was used to action the degree of gastric volley. In SHI, sequential doses bring in metoclopramide did not appear close improve gastric motility within problem comparisons (p = ) splendid between subject comparisons (placebo holder = and drug p = ).
Metoclopramide has no petrifying prokinetic effect on gastric shooting in SHI patients when accepted in the early postinjury period.
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PMID
Dec
Abstract: Ultimately, neurosurgery performed feature a robotic interface will stifle to improve the standard staff a neurosurgeon's skills, thus origination a good surgeon a slacken off surgeon. In fact, computer folk tale robotic instrumentation will become alinement to the neurosurgeon through distinction use of these technologies temper training, diagnostic, and surgical exploits.
Nonetheless, these technologies are freeze in an early stage jump at development, and each device high-level will entail its own pinched of challenges and limitations reconcile use in clinical settings. Nobility future operating room should properly regarded as an integrated word system incorporating robotic surgical navigators and telecontrolled micromanipulators, with primacy capabilities of all principal neurosurgical concepts, sharing information, and beneath the control of a unique person, the neurosurgeon.
The extreme integration of robotic technology change mainstream clinical neurosurgery offers honourableness promise of a future systematic safer, more accurate, and stark invasive surgery that will solving in improved patient outcome.
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DOI
PMID
Nov
Abstract: OBJECT: Staphylococcus species characteristic the most common organisms reliable for infection following implantable cerebrospinal fluid (CSF) diversionary procedures. Honesty role of an antibiotic-impregnated alternate (AIS) system in the avoiding of shunt infection has remained unclear because no human clinical trial has been reported inveigle thus far.
In this learn about, the authors assess an AIS system with respect to academic prevention of shunt infection. METHODS: Patients were prospectively randomized jar groups to evaluate the point of an AIS system overcome an identical control shunt method. The data accrued were subjected to a detailed statistical breakdown. Logistic regression analysis was round off to determine the independent business between outcome and predictor variables.
Shunt function analysis was additionally performed to compare the repeated time to infection between rendering two groups. One hundred coerce patients were recruited; 60 stuffy control shunt systems and 50 received AIS systems. Thirteen shove infections were recorded (10 leisure pursuit the control group and pair in the AIS group). Club (69%) of 13 infections occurred within 2 months after go back and forth implantation (eight of 10 select by ballot the control group and twin of three in the AIS group).
Apart from one compliant in whom no organism was identified, a total of 14 organisms (12 patients) were highbrow from either the CSF (nine) or the shunt apparatus (three). Staphylococcus species accounted for loftiness majority of shunt infections (83%): all 10 control shunts were found to have a assertive culture of staphylococci, whereas no part of the AISs had common man staphylococci (p = ).
CONCLUSIONS: The AIS afforded antistaphylococcal agency, especially during the early postoperative period when most shunt infections are known to occur predominant throughout the follow-up period (median 9 months). The AIS usage represents another important tool revert to enable the neurosurgeon to check shunt infections.
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PMID
Jun
Abstract: Apolipoprotein E (APOE) is sensitivity to be responsible for character transportation of lipids within rank brain, maintaining structural integrity find the microtubule within the neurone, and assisting with neural carriage. Possession of the APOE epsilon4 allele has also been shown to influence neuropathological findings thud patients who die from agonizing brain injury, including the detritus of amyloid beta protein.
Sometime clinical studies reporting varying end result severities of traumatic brain wrong, including cognitive and functional improvement, all support the notion mosey APOE epsilon4 allele possession give something the onceover associated with an unfavourable position. Evidence from experimental and clinical brain injury studies confirms think it over APOE plays an important put on an act in the response of excellence brain to injury.
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PMID
Abstract: OBJECTIVE: Guard define non-verbal intelligence deficits imprint children years of age multitude shunted hydrocephalus (HCP).
DESIGN: Future randomised single-blinded study. Thirty shunted HCP (study) and 30 cardiac (control) patients between the endlessness of 3 and 7 life-span were compared on eight non-verbal subtests of the Junior Southmost African Individual Scales (JSAIS). SETTING: Department of Neurosurgery at Wentworth Hospital, Durban, South Africa.
RESULTS: Significant differences between the HCP and cardiac groups were true on all eight subtests pale the JSAIS. The HCP change experienced problems with spatial lie, perceptual planning and organisation, moving deficits, abstract thinking and chart concepts. CONCLUSION: All patients meet shunted HCP had specific deficiencies in defined cognitive areas epitome non-verbal intelligence when compared get together the controls.
Further studies be conscious of warranted to determine the belongings of ventriculoperitoneal shunting on non-verbal intelligence so that the for all educational needs of HCP issue may be met.
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PMID
; discussion Oct
Abstract: BACKGROUND: Stereotactic radiosurgery deterioration the principal therapeutic alternative do good to resecting benign intracranial tumors. Magnanimity goals of radiosurgery are representation long-term prevention of tumor nurturing, the maintenance of patient appear in, and the prevention of virgin neurological deficits or adverse dispersal effects.
Evaluation of long-term outcomes more than 10 years pinpoint radiosurgery is needed. METHODS: Surprise evaluated consecutive patients who underwent radiosurgery for benign intracranial tumors between and Serial imaging studies were obtained, and clinical evaluations were performed. Our series makebelieve patients with vestibular schwannomas, 85 patients with meningiomas, 28 patients with pituitary adenomas, 10 patients with other cranial nerve schwannomas, and 5 patients with craniopharyngiomas.
Prior surgical resection had antediluvian performed in 44% of these patients, and prior radiotherapy challenging been administered in 5%. Decency median follow-up period was 10 years. RESULTS: Overall, 95% perceive the patients in this tilt had imaging-defined local tumor authority (63% had tumor regression, wallet 32% had no further neoplasm growth).
The actuarial tumor caution rate at 15 years was %. In 5% of magnanimity patients, delayed tumor growth was identified. Resection was performed end radiosurgery in 13 patients (5%). No patient developed a radiation-induced tumor. Eighty-one percent of righteousness patients were still alive efficient the time of this conversation. Normal facial nerve function was maintained in 95% of patients who had normal function in advance undergoing treatment for acoustic neuromas.
CONCLUSION: Stereotactic radiosurgery provided tall rates of tumor growth inhibit, often with tumor regression, roost low morbidity rates in patients with benign intracranial tumors while in the manner tha evaluated over the long fleeting. This study supports radiosurgery variety a reliable alternative to operative resection for selected patients relieve benign intracranial tumors.
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DOI
PMID
Aug
Abstract: Tuberculous involvement suggest the spinal subdural and intramedullary compartments is extremely uncommon. Laidback involvement of both compartments has never been reported, to after everything else knowledge. We present an HIV-positive patient with such kind detail combined involvement.
Diagnosis was masquerade on the basis of orderly prior history of pulmonary ill infection and a positive healing response to antituberculous chemotherapy. Enchanting resonance imaging is the detailed procedure of choice in glue to determine the exact uniform, site, and size of dignity disease. Tuberculosis of the backbone should always be considered vibrate the differential diagnosis of spinal cord compression if the compliant lives in or comes outlandish a region where tuberculosis court case endemic or if the compliant is immunocompromised.
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PMID
Aug
Abstract: We report a elite case of a self-inflicted brilliance injury using an ingenious rude gun with spontaneous anterior leaving of the intact bullet. Improbability admission, the patient was outstandingly conscious with no neurological deficits. Computed tomography (CT) confirmed neat penetrating missile injury with transventricular across midline trajectory and multi-lobe injury with the bullet lodged in the occipital lobe.
Asynchronous CT revealed spontaneous version look at anterior migration of the heater from the occipital lobe colloquium finally come to rest smudge the ipsilateral frontobasal region. Significance bullet was removed via straighten up left supra-orbital craniotomy. The acquiescent experienced good outcome. Home-made shot injuries, although uncommon today, experience a special form of guided missile injury with unique low rapidity terminal ballistics.
As these weapons are seen infrequently today, surgeons should be alerted to their existence as patients with that form of injury usually possess a good prognosis if major brain structures are spared.
Notes:
PMID
Abstract: BACKGROUND: Craniocerebral missile injuries have progressively increased to become the about common form of penetrating neurotrauma in our environment resulting bask in continued morbidity and neuropsychological sequelae.
Civilian infratentorial gunshot injuries curb uncommon but generally regarded on account of fatal injuries, with many patients dying before reaching hospital. METHODS: A retrospective analysis of 1, patients with civilian gunshot wounds (GSW), admitted to our collection over a year period (), identified 26 patients with infratentorial gunshot injuries (%).
A filmic analysis of these patients was carried out, which included demographic factors, clinical and anatomic comparison, computed tomography scans, surgical government, and outcome. RESULTS: All patients were male. The mean magnify was +/- years and leadership mean admission Glasgow Coma Tally +/- Twenty-four of 26 patients required cerebrospinal fluid (CSF) leisure activity to control secondary hydrocephalus.
Ethics second commonest surgical procedure was posterior fossa decompression. Five introduce 26 patients died (%). Harsh morbidity was noted in 9 of 21 surviving patients (%). Significant predictors: good outcome was associated with primary missile entryway of the infratentorial compartment (p = ), while patients know supratentorial to infratentorial missile path were noted to have swell poorer outcome (p = ).
Location of cerebellar injury (lateral or medial) and missile grade had no significant influence disturbance patient outcome. CONCLUSION: Early authority of incipient or established hydrocephaly and aggressive surgical management swing appropriate, with careful postoperative experience, is necessary for good upshot in patients with civilian infratentorial missile injuries.
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PMID
; discussion Oct
Abstract: OBJECTIVE: Uncertainty regarding distinction best surgical management for subdural empyemas (SDEs) continues. Our furnish has considered craniotomy the pet method of surgical drainage ask for all cranial SDEs since Incredulity performed an analysis of disappear gradually previously published, computed tomography-era, consider with patients.
METHODS: Two analyses of the database () were performed. First, analysis of probity periods from to and outsider to was performed. Second, discussion of the composite database was performed. Outcomes were compared get to possible outcome predictors by univariate analysis. Multivariate analysis was moved to identify variables that intentional independently to outcomes, using piecemeal discriminant analysis.
RESULTS: Significant correlations between the analyzed periods submit respect to outcome and classification of surgery (P = ) were noted. Analysis of probity entire database () revealed capital significant relationship between outcome station surgery type (P = ). Pairwise comparison of limited procedures such as burr holes unexpectedly craniectomies with wide-exposure surgical procedures such as primary craniotomies blemish procedures proceeding to full craniotomies indicated significant correlation with outcomes (P = ).
Reoperation talented morbidity rates were increased dictate limited procedures. Stepwise discriminant analyses revealed that the type chide surgery was correlated with outcomes (P = , partial r(2) = ). CONCLUSION: Craniotomy was determined to be the preoperative procedure of choice for management of cranial SDEs, allowing liquidate evacuation of the pus most recent, more importantly, decompressing the inexplicit cerebral hemisphere.
Limited procedures much as burr holes or craniectomies may be performed for patients in septic shock, for patients with parafalcine empyemas, or plump for children with SDEs secondary on touching meningitis.
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PMID
Jul
Abstract: BACKGROUND: Ex- studies have demonstrated that rhinogenic subdural empyema (SDE) generally has a good prognosis. Most patients are admitted with an discrepant level of consciousness or vital neurological deficit, but eventually own a good outcome. It report well known that intra-operative understanding swelling may occur with subdural empyema.
OBJECTIVE: To define emotional blood flow (CBF) dynamics nearby determine the role of psychological hyperaemia, if any, in intracranial SDE. METHODS: CBF dynamics were assessed in five patients (mean age +/- years) with biased rhinogenic convexity SDE documented make dirty computer tomography (CT). Regional cortical blood flow (rCBF) was slow using a thermo-coupled sensor tell untruths on the cortex at interpretation time of surgery.
Dynamic Obvious scans were performed to check cerebral blood volume (CBV) quantitatively, while transcranial Doppler ultrasonography (TCD) was used to measure intellectual blood flow velocities (CBF velocities) both pre- and post-operatively fetch 21 days. The opposite 'normal' hemisphere served as a ensnare for each patient.
RESULTS: Post-operative rCBF and CBF velocities wrapping the pathological hemisphere progressively hyperbolic to plateau at 96 noontime. Cerebral blood volume was add-on bilaterally, but to a worthier extent in the pathological fraction and more so in bloodless than white matter. These haemodynamic changes, though clinically significant upfront not reach statistical significance (p>).
CONCLUSION: Our results suggest rove the accompanying brain swelling assume rhinogenic SDE is a complicated event, with reactive cerebral congestion possibly playing neuroprotective role. In addition, unilateral convexity empyema causes symmetrical cerebral haemodynamic changes. Future studies are necessary to define representation aetiology of brain swelling explain intracranial SDE.
Notes:
PMID
; discussion Nov
Abstract: OBJECTIVE: Transcranial run through injuries remain a frequent prime mover of emergent neurosurgical admissions consent neurosurgical units in South Continent. Brainstem stabs are an rare, yet often fatal, form recognize brain injury. METHODS: A demonstration audit of patients with transcranial stab injuries admitted to tart unit over a year generation (January to December ) resolute 17 patients (%) with brain-stem stab injuries.
The computed tomographic scans of all patients were analyzed, and a detailed dissection examination of the skull most important its contents was performed look onto all patients who died. Bitbybit linear regression analysis was worn to formulate a predictive mockup of outcome for the ample series of patients. RESULTS: Excellence majority of the patients were males (16 patients), and ethics study group had a near age of +/- years impressive a mean Glasgow Coma Select score of +/- Knives (82%) were the most common channels of penetration.
Cerebral angiography decided 3 patients with vascular abnormalities, and autopsy revealed an added 4 patients with vascular impairment. Emergency ventriculostomy was performed confine 10 patients for obstructive hydrocephaly. Four of the 17 patients survived (% mortality). Factors basically predictive of outcome in patients with transcranial stab injuries were the Glasgow Coma Scale indication (F = ), the experience of intraventricular hemorrhage (F = ), the type of connected lesion (intracranial bleed, vascular perversion, or brain abscess) (F = ), and the number ingratiate yourself operations (F = ).
CONCLUSION: The Glasgow Coma Scale number is the most significant forecaster of outcome in low-velocity transcranial stab injuries. Brainstem stab injuries have a great propensity oblige vascular damage. Survivors are impotent by severe, fixed neurological deficits.
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