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Puhahn-Schmeiser B, Wegent H, Won SY, Zentner J, Freiman TM. Efficacy and safety of bedside percutaneous three-millimeter twist-drill trephination under local anesthesia-a retrospective study of 1000 patients. Acta Neurochir (Wien) 2024; 166:87. [PMID: 38366108 DOI: 10.1007/s00701-024-05958-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/10/2024] [Indexed: 02/18/2024]
Abstract
PURPOSE Percutaneous 3-mm twist-drill trephination (TDT) under local anesthesia as a bedside operative technique is an alternative to the conventional open surgical trephination in the operating theatre. The aim of this study was to verify the efficacy and safety of this minimal invasive procedure. METHODS This retrospective study comprises 1000 patients who were treated with TDT under local anesthesia at bedside due to chronic subdural hematoma (cSDH), intracerebral hemorrhage (ICH), and hydrocephalus (HYD) as a result of subarachnoid hemorrhage or non-hemorrhagic causes, increased intracranial pressure (IIP) in traumatic brain injury or non-traumatic brain edema, and other pathologies (OP) requiring drainage. Medical records, clinical outcome, and results of pre- and postoperative computed tomography (CT) and/or magnetic resonance tomography (MRT) were analyzed. RESULTS Indications for TDT were cSDH (n = 275; 27.5%), ICH (n = 291; 29.1%), HYD (n = 316; 31.6%), IIP (n = 112; 11.2%), and OP (n = 6; 0.6%). Overall, primary catheter placement was sufficient in 93.8% of trephinations. Complication rate was 14.1% and mainly related to primary catheter malposition (6.2%), infections (5.2%), and secondary hemorrhage (2.7%); the majority of which were clinically inapparent puncture channel bleedings not requiring surgical intervention. The revision rate was 13%. CONCLUSIONS Bedside TDT under local anesthesia has proven to be an effective and safe alternative to the conventional burr-hole operative technique as usually performed under general anesthesia in the operation theatre, and may be particularly useful in emergency cases as well as in elderly and multimorbid patients.
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Affiliation(s)
- Barbara Puhahn-Schmeiser
- Department of Neurosurgery, University Medical Center, Albert-Ludwigs-University, Breisacher Strasse 64, Freiburg, 79106, Germany.
| | - Hendrike Wegent
- Department of Neurosurgery, University Medical Center, Albert-Ludwigs-University, Breisacher Strasse 64, Freiburg, 79106, Germany
| | - Sae-Yeon Won
- Department of Neurosurgery, University Medical Center Rostock, Schillingallee 35, Rostock, 18097, Germany
| | - Josef Zentner
- Department of Neurosurgery, University Medical Center, Albert-Ludwigs-University, Breisacher Strasse 64, Freiburg, 79106, Germany
| | - Thomas M Freiman
- Department of Neurosurgery, University Medical Center Rostock, Schillingallee 35, Rostock, 18097, Germany
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Kalisvaart ACJ, Abrahart AH, Coney AT, Gu S, Colbourne F. Intracranial Pressure Dysfunction Following Severe Intracerebral Hemorrhage in Middle-Aged Rats. Transl Stroke Res 2023; 14:970-986. [PMID: 36367666 PMCID: PMC10640482 DOI: 10.1007/s12975-022-01102-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/14/2022] [Accepted: 11/02/2022] [Indexed: 11/13/2022]
Abstract
Rising intracranial pressure (ICP) aggravates secondary injury and heightens risk of death following intracerebral hemorrhage (ICH). Long-recognized compensatory mechanisms that lower ICP include reduced cerebrospinal fluid and venous blood volumes. Recently, we identified another compensatory mechanism in severe stroke, a decrease in cerebral parenchymal volume via widespread reductions in cell volume and extracellular space (tissue compliance). Here, we examined how age affects tissue compliance and ICP dynamics after severe ICH in rats (collagenase model). A planned comparison to historical young animal data revealed that aged SHAMs (no stroke) had significant cerebral atrophy (9% reduction, p ≤ 0.05), ventricular enlargement (9% increase, p ≤ 0.05), and smaller CA1 neuron volumes (21%, p ≤ 0.05). After ICH in aged animals, contralateral striatal neuron density and CA1 astrocyte density significantly increased (12% for neurons, 7% for astrocytes, p ≤ 0.05 vs. aged SHAMs). Unlike young animals, other regions in aged animals did not display significantly reduced cell soma volume despite a few trends. Nonetheless, overall contralateral hemisphere volume was 10% smaller in aged ICH animals compared to aged SHAMs (p ≤ 0.05). This age-dependent pattern of tissue compliance is not due to absent ICH-associated mass effect (83.2 mm3 avg. bleed volume) as aged ICH animals had significantly elevated mean and peak ICP (p ≤ 0.01), occurrence of ICP spiking events, as well as bilateral evidence of edema (e.g., 3% in injured brain, p ≤ 0.05 vs. aged SHAMs). Therefore, intracranial compliance reserve changes with age; after ICH, these and other age-related changes may cause greater fluctuation from baseline, increasing the chance of adverse outcomes like mortality.
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Affiliation(s)
| | - Ashley H Abrahart
- Department of Psychology, University of Alberta, Edmonton, AB, Canada
| | - Alyvia T Coney
- Department of Psychology, University of Alberta, Edmonton, AB, Canada
| | - Sherry Gu
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada
| | - Frederick Colbourne
- Department of Psychology, University of Alberta, Edmonton, AB, Canada.
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, AB, Canada.
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Lee H, Choi SH, Park B, Hong YH, Lee HB, Jeon SB. Quantitative assessments of pupillary light reflexes in hospital-onset unresponsiveness. BMC Neurol 2021; 21:234. [PMID: 34167470 PMCID: PMC8223317 DOI: 10.1186/s12883-021-02275-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 06/09/2021] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Patients who develop hospital-onset unresponsiveness should be promptly managed in order to avoid clinical deterioration. Pupillary examination through pupillary light reflex is the gold standard method in the initial evaluation of unresponsive patients. However, the current method of shining light and subjective description often shows poor reliability. The objective of this study is to explore whether a quantitative measurement of pupillary light reflexes is useful in detecting brain herniation syndrome and predicting neurological outcomes in patients who developed hospital-onset unresponsiveness after admission for non-neurological reasons. METHODS This was a registry-based observational study on patients who activated the neurological rapid response team at Asan Medical Center (Seoul, Korea). Hospital-onset unresponsiveness was defined as a newly developed unresponsive state as assessed by the ACDU (Alert, Confused, Drowsy, and Unresponsive) scale during the hospital stay. Demographics, comorbidities, pupillometry parameters including Neurological Pupil index, brain herniation syndrome, in-hospital mortality, and modified Rankin Scale at 3-months were analyzed. RESULTS In 214 consecutive patients with hospital-onset unresponsiveness, 37 (17%) had brain herniation syndrome. The optimal cut-off value of Neurological Pupil index for detecting brain herniation syndrome was < 1.6 (specificity, 91% [95% confidence interval (CI) = 86-95]; sensitivity, 49% [95% CI = 32-66]). The in-hospital mortality rate was 28% (59/214); the Neurological Pupil index was negatively associated with in-hospital mortality after adjustments for the presence of brain herniation syndrome (adjusted odds ratio = 0.77, 95% CI = 0.62-0.96). Poor neurological outcomes (modified Rankin Scale ≥4) at 3 months was observed in 76% (152/201) of the patients; the Neurological Pupil index was negatively associated with poor neurological outcomes after adjustments for clinical variables (adjusted odds ratio = 0.67, 95% CI = 0.49-0.90). CONCLUSIONS Quantitative measurements of pupillary light reflexes may be useful for early detection of potentially life-threatening neurological conditions in patients with hospital-onset unresponsiveness.
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Affiliation(s)
- Hyunjo Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Soh Hyun Choi
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Bobin Park
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Yoon-Hee Hong
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Han-Bin Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Sang-Beom Jeon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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de Almeida CM, Pollo CF, Meneguin S. Nursing Interventions for Patients with Intracranial Hypertension: Integrative Literature Review. AQUICHAN 2019. [DOI: 10.5294/aqui.2019.19.4.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: the study sought to identify, in national and international publications, the principal Nursing interventions aimed at patients with intracranial hypertension. Materials and Method: integrative literature review with search in LILACS, PubMed, Scopus, Web of Science, Cinahal, and Google Scholar databases, from 2013 to 2018. Results: the sample was comprised of seven articles fulfilling the inclusion criteria. Two thematic categories were established for the Nursing interventions aimed at patients with intracranial hypertension: cognitive skills and clinical reasoning, necessary to control neuro-physiological parameters and prevent intracranial hypertension, and evidence-based practices to improve care for neuro-critical patients. Conclusions: intracranial hypertension is an event of great clinical impact, whose complications can be minimized and control through specific Nursing interventions that encompass control of neuro-physiological and hemodynamic parameters and prevention of increased intracranial pressure related with the performance of procedures by the Nursing staff.
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