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Fotakopoulos G, Siasios I, Gatos C, Georgakopoulou VE, Trakas N, Sklapani P, Fountas KN. Acute intracranial hemorrhage during the installation of the LICOX microdialysis system: A case report. MEDICINE INTERNATIONAL 2024; 4:39. [PMID: 38827950 PMCID: PMC11140294 DOI: 10.3892/mi.2024.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 05/02/2024] [Indexed: 06/05/2024]
Abstract
Neuro-monitoring is widely employed for the evaluation of intubated patients in the intensive care unit with stroke, severe head trauma, subarachnoid hemorrhage and/or hepatic encephalopathy. The present study reports the case of a patient with acute intracranial hemorrhage following the insertion of neuromonitoring catheters, which required surgical management. The patient was a 14-year-old male who sustained a severe traumatic brain injury and underwent a right-sided hemicraniectomy. During the installation of the neuromonitoring catheters, an acute hemorrhage was noted with a rapidly elevating intracranial pressure. A craniotomy was performed to identify and coagulate the injured cortical vessel. As demonstrated herein, the thorough evaluation of the clotting profile of the patient, a meticulous surgical technique and obtaining a post-insertion computed tomography scan may minimize the risk of any neuromonitoring-associated hemorrhagic complications.
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Affiliation(s)
- George Fotakopoulos
- Department of Neurosurgery, General University Hospital of Larissa, 41221 Larissa, Greece
| | - Ioannis Siasios
- Department of Neurosurgery, Papageorgiou Hospital, 56429 Thessaloniki, Greece
| | - Charalampos Gatos
- Department of Neurosurgery, General University Hospital of Larissa, 41221 Larissa, Greece
| | | | - Nikolaos Trakas
- Department of Biochemistry, Sismanogleio Hospital, 15126 Athens, Greece
| | - Pagona Sklapani
- Department of Biochemistry, Sismanogleio Hospital, 15126 Athens, Greece
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Trignano E, Fallico N, Fiorot L, Bolletta A, Maffei M, Ciudad P, Maruccia M, Chen HC, Campus GV. Flap monitoring with continuous oxygen partial tension measurement in breast reconstructive surgery: A preliminary report. Microsurgery 2017; 38:402-406. [DOI: 10.1002/micr.30256] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 08/14/2017] [Accepted: 10/03/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Emilio Trignano
- Department of Plastic and Reconstructive Surgery; University of Sassari; Sassari 07100 Italy
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung 40447 Taiwan Republic of China
| | - Nefer Fallico
- Department of Plastic and Reconstructive Surgery; “Sapienza” University of Rome; Rome 00161 Italy
| | - Luca Fiorot
- Department of Plastic and Reconstructive Surgery; University of Sassari; Sassari 07100 Italy
| | - Alberto Bolletta
- Department of Plastic and Reconstructive Surgery; University of Sassari; Sassari 07100 Italy
| | - Matteo Maffei
- Department of Plastic and Reconstructive Surgery; University of Sassari; Sassari 07100 Italy
| | - Pedro Ciudad
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung 40447 Taiwan Republic of China
| | - Michele Maruccia
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung 40447 Taiwan Republic of China
- Department of Plastic and Reconstructive Surgery; “Sapienza” University of Rome; Rome 00161 Italy
- Department of Emergency and Organ Transplantation, Plastic and Reconstructive Surgery and Burns Unit; “Aldo Moro” University of Bari; Bari Italy
| | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery; China Medical University Hospital; Taichung 40447 Taiwan Republic of China
| | - Gian Vittorio Campus
- Department of Plastic and Reconstructive Surgery; University of Sassari; Sassari 07100 Italy
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Galgano M, Toshkezi G, Qiu X, Russell T, Chin L, Zhao LR. Traumatic Brain Injury: Current Treatment Strategies and Future Endeavors. Cell Transplant 2017; 26:1118-1130. [PMID: 28933211 PMCID: PMC5657730 DOI: 10.1177/0963689717714102] [Citation(s) in RCA: 339] [Impact Index Per Article: 42.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 10/16/2016] [Accepted: 10/18/2016] [Indexed: 01/04/2023] Open
Abstract
Traumatic brain injury (TBI) presents in various forms ranging from mild alterations of consciousness to an unrelenting comatose state and death. In the most severe form of TBI, the entirety of the brain is affected by a diffuse type of injury and swelling. Treatment modalities vary extensively based on the severity of the injury and range from daily cognitive therapy sessions to radical surgery such as bilateral decompressive craniectomies. Guidelines have been set forth regarding the optimal management of TBI, but they must be taken in context of the situation and cannot be used in every individual circumstance. In this review article, we have summarized the current status of treatment for TBI in both clinical practice and basic research. We have put forth a brief overview of the various subtypes of traumatic injuries, optimal medical management, and both the noninvasive and invasive monitoring modalities, in addition to the surgical interventions necessary in particular instances. We have overviewed the main achievements in searching for therapeutic strategies of TBI in basic science. We have also discussed the future direction for developing TBI treatment from an experimental perspective.
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Affiliation(s)
- Michael Galgano
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Gentian Toshkezi
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Xuecheng Qiu
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA
- VA Health Care Upstate New York, Syracuse VA Medical Center, Syracuse, NY, USA
| | - Thomas Russell
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Lawrence Chin
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Li-Ru Zhao
- Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, NY, USA
- VA Health Care Upstate New York, Syracuse VA Medical Center, Syracuse, NY, USA
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Hou H, Khan N, Gohain S, Eskey CJ, Moodie KL, Maurer KJ, Swartz HM, Kuppusamy P. Dynamic EPR Oximetry of Changes in Intracerebral Oxygen Tension During Induced Thromboembolism. Cell Biochem Biophys 2017; 75:285-294. [PMID: 28434138 DOI: 10.1007/s12013-017-0798-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 04/12/2017] [Indexed: 12/19/2022]
Abstract
Cerebral tissue oxygenation (oxygen tension, pO2) is a critical parameter that is closely linked to brain metabolism, function, and pathophysiology. In this work, we have used electron paramagnetic resonance oximetry with a deep-tissue multi-site oxygen-sensing probe, called implantable resonator, to monitor temporal changes in cerebral pO2 simultaneously at four sites in a rabbit model of ischemic stroke induced by embolic clot. The pO2 values in healthy brain were not significantly different among the four sites measured over a period of 4 weeks. During exposure to 15% O2 (hypoxia), a sudden and significant decrease in pO2 was observed in all four sites. On the other hand, brief exposure to breathing carbogen gas (95% O2 + 5% CO2) showed a significant increase in the cerebral pO2 from baseline value. During ischemic stroke, induced by embolic clot in the left brain, a significant decline in the pO2 of the left cortex (ischemic core) was observed without any change in the contralateral sites. While the pO2 in the non-infarct regions returned to baseline at 24-h post-stroke, pO2 in the infarct core was consistently lower compared to the baseline and other regions of the brain. The results demonstrated that electron paramagnetic resonance oximetry with the implantable resonator can repeatedly and simultaneously report temporal changes in cerebral pO2 at multiple sites. This oximetry approach can be used to develop interventions to rescue hypoxic/ischemic tissue by modulating cerebral pO2 during hypoxic and stroke injury.
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Affiliation(s)
- Huagang Hou
- Department of Radiology, The Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive,, Lebanon, 03756, NH, USA
| | - Nadeem Khan
- Department of Radiology, The Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive,, Lebanon, 03756, NH, USA
| | - Sangeeta Gohain
- Department of Radiology, The Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive,, Lebanon, 03756, NH, USA
| | - Clifford J Eskey
- Department of Radiology, The Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive,, Lebanon, 03756, NH, USA
| | - Karen L Moodie
- Center for Comparative Medicine and Research, Dartmouth College, 1 Medical Center Drive,, Lebanon, 03756, NH, USA
| | - Kirk J Maurer
- Center for Comparative Medicine and Research, Dartmouth College, 1 Medical Center Drive,, Lebanon, 03756, NH, USA
| | - Harold M Swartz
- Department of Radiology, The Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive,, Lebanon, 03756, NH, USA
| | - Periannan Kuppusamy
- Department of Radiology, The Geisel School of Medicine, Dartmouth College, 1 Medical Center Drive,, Lebanon, 03756, NH, USA.
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Patrick MM, Grillot JM, Derden ZM, Paul DW. Long-term Drifts in Sensitivity Caused by Biofouling of an Amperometric Oxygen Sensor. ELECTROANAL 2016. [DOI: 10.1002/elan.201600653] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Galgano MA, Tovar-Spinoza Z. Multimodality Neuromonitoring in Pediatric Neurocritical Care: Review of the Current Resources. Cureus 2015; 7:e385. [PMID: 26719828 PMCID: PMC4689558 DOI: 10.7759/cureus.385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Brain insults in children represent a daily challenge in neurocritical care. Having a constant grasp on various parameters in the pediatric injured brain may affect the patient's outcome. Currently, new advances provide clinicians with the ability to utilize several modalities to monitor brain function. This multi-modal approach allows real-time information, leading to faster responses in management and furthermore avoiding secondary insults in the injured brain.
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Khan N, Hou H, Swartz HM, Kuppusamy P. Direct and Repeated Measurement of Heart and Brain Oxygenation Using In Vivo EPR Oximetry. Methods Enzymol 2015; 564:529-52. [PMID: 26477264 DOI: 10.1016/bs.mie.2015.06.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Low level of oxygen (hypoxia) is a critical factor that defines the pathological consequence of several pathophysiologies, particularly ischemia, that usually occur following the blockage of a blood vessel in vital organs, such as brain and heart, or abnormalities in the microvasculature, such as peripheral vascular disease. Therefore, methods that can directly and repeatedly quantify oxygen levels in the brain and heart will significantly improve our understanding of ischemic pathologies. Importantly, such oximetry capability will facilitate the development of strategies to counteract low levels of oxygen and thereby improve outcome following stroke or myocardial infarction. In vivo electron paramagnetic resonance (EPR) oximetry has the capability to monitor tissue oxygen levels in real time. The method has largely been tested and used in experimental animals, although some clinical measurements have been performed. In this chapter, a brief overview of the methodology to repeatedly quantify oxygen levels in the brain and heart of experimental animal models, ranging from mice to swine, is presented. EPR oximetry requires a one-time placement of an oxygen-sensitive probe in the tissue of interest, while the rest of the procedure for reliable, accurate, and repeated measurements of pO2 (partial pressure of oxygen) is noninvasive and can be repeated as often as desired. A multisite oximetry approach can be used to monitor pO2 at many sites simultaneously. Building on significant advances in the application of EPR oximetry in experimental animal models, spectrometers have been developed for use in human subjects. Initial feasibility of pO2 measurement in solid tumors of patients has been successfully demonstrated.
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Affiliation(s)
- Nadeem Khan
- Department of Radiology, EPR Center for the Study of Viable Systems, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Huagang Hou
- Department of Radiology, EPR Center for the Study of Viable Systems, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Harold M Swartz
- Department of Radiology, EPR Center for the Study of Viable Systems, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Periannan Kuppusamy
- Department of Radiology, EPR Center for the Study of Viable Systems, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
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Reis C, Wang Y, Akyol O, Ho WM, Ii RA, Stier G, Martin R, Zhang JH. What's New in Traumatic Brain Injury: Update on Tracking, Monitoring and Treatment. Int J Mol Sci 2015; 16:11903-65. [PMID: 26016501 PMCID: PMC4490422 DOI: 10.3390/ijms160611903] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/04/2015] [Accepted: 05/06/2015] [Indexed: 12/11/2022] Open
Abstract
Traumatic brain injury (TBI), defined as an alteration in brain functions caused by an external force, is responsible for high morbidity and mortality around the world. It is important to identify and treat TBI victims as early as possible. Tracking and monitoring TBI with neuroimaging technologies, including functional magnetic resonance imaging (fMRI), diffusion tensor imaging (DTI), positron emission tomography (PET), and high definition fiber tracking (HDFT) show increasing sensitivity and specificity. Classical electrophysiological monitoring, together with newly established brain-on-chip, cerebral microdialysis techniques, both benefit TBI. First generation molecular biomarkers, based on genomic and proteomic changes following TBI, have proven effective and economical. It is conceivable that TBI-specific biomarkers will be developed with the combination of systems biology and bioinformation strategies. Advances in treatment of TBI include stem cell-based and nanotechnology-based therapy, physical and pharmaceutical interventions and also new use in TBI for approved drugs which all present favorable promise in preventing and reversing TBI.
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Affiliation(s)
- Cesar Reis
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - Yuechun Wang
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, 11041 Campus Street, Risley Hall, Room 219, Loma Linda, CA 92354, USA.
- Department of Physiology, School of Medicine, University of Jinan, Guangzhou 250012, China.
| | - Onat Akyol
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, 11041 Campus Street, Risley Hall, Room 219, Loma Linda, CA 92354, USA.
| | - Wing Mann Ho
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, 11041 Campus Street, Risley Hall, Room 219, Loma Linda, CA 92354, USA.
- Department of Neurosurgery, University Hospital Innsbruck, Tyrol 6020, Austria.
| | - Richard Applegate Ii
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - Gary Stier
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - Robert Martin
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
| | - John H Zhang
- Department of Anesthesiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA.
- Department of Physiology and Pharmacology, Loma Linda University School of Medicine, 11041 Campus Street, Risley Hall, Room 219, Loma Linda, CA 92354, USA.
- Department of Neurosurgery, Loma Linda University School of Medicine, Loma Linda, CA 92354, USA.
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Watanabe H, Velmurugan J, Mirkin MV, Svirsky MA, Lalwani AK, Llinas RR. Scanning electrochemical microscopy as a novel proximity sensor for atraumatic cochlear implant insertion. IEEE Trans Biomed Eng 2015; 61:1822-32. [PMID: 24845292 DOI: 10.1109/tbme.2014.2308058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A growing number of minimally invasive surgical and diagnostic procedures require the insertion of an optical, mechanical, or electronic device in narrow spaces inside a human body. In such procedures, precise motion control is essential to avoid damage to the patient's tissues and/or the device itself. A typical example is the insertion of a cochlear implant which should ideally be done with minimum physical contact between the moving device and the cochlear canal walls or the basilar membrane. Because optical monitoring is not possible, alternative techniques for sub millimeter-scale distance control can be very useful for such procedures. The first requirement for distance control is distance sensing. We developed a novel approach to distance sensing based on the principles of scanning electrochemical microscopy (SECM). The SECM signal, i.e., the diffusion current to a microelectrode, is very sensitive to the distance between the probe surface and any electrically insulating object present in its proximity. With several amperometric microprobes fabricated on the surface of an insertable device, one can monitor the distances between different parts of the moving implant and the surrounding tissues. Unlike typical SECM experiments, in which a disk-shaped tip approaches a relatively smooth sample, complex geometries of the mobile device and its surroundings make distance sensing challenging. Additional issues include the possibility of electrode surface contamination in biological fluids and the requirement for a biologically compatible redox mediator.
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Scholes J. What's in this issue? Nurs Crit Care 2012; 17:165-6. [PMID: 22698156 DOI: 10.1111/j.1478-5153.2012.00521.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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