Confounding factors impacting the Glasgow coma score: a literature review.

Background: The Glasgow coma score (GCS) is a clinical tool used to measure level of consciousness in traumatic brain injury and other settings. Despite its widespread use, there are many inaccuracies in its reporting. One source of inaccuracy is confounding factors which affect consciousness as well as each sub-score of the GCS.

A Retrospective Analysis of Intracranial Pressure Monitoring and Outcomes in Adults after Severe Traumatic Brain Injury at Kaiser Permanente Trauma Centers.

Background: The role of intracranial pressure (ICP) monitoring in improving outcomes after severe traumatic brain injury especially at level II trauma centers remains controversial. A retrospective analysis was undertaken to assess the impact of ICP monitoring on mortality and long-term functional outcome in adults after severe traumatic brain injury at level II trauma centers.

Methods: The data were extracted from the Kaiser Permanente trauma database.

Diagnosis, Classification, and Management of Fourth Ventriculomegaly in Adults: Report of 9 Cases and Literature Review.

Objective: An enlarged fourth ventricle, otherwise known as fourth ventriculomegaly (4th VM), has been reported previously in the pediatric population, yet literature on adults is scant. We report our experience with 4th VM in adults over an 11-year period and review the literature.

Materials And Methods: This was a retrospective chart review of adult patients with the diagnosis of 4th VM admitted to the intensive care unit in a tertiary care center.

Type 2 Diabetes Mellitus and Glioblastoma Multiforme-Assessing Risk and Survival: Results of a Large Retrospective Study and Systematic Review of the Literature.

Objective: Despite studies showing a positive correlation between type 2 diabetes mellitus (DM2), a modifiable risk factor, and various cancer types, the link remains controversial in the setting of glioblastoma multiforme (GBM). In this study, we assessed whether DM2 and DM2-associated factors were associated with a higher risk of developing GBM and also determined if DM2 affected the survival of patients with GBM.

Methods: A cross-sectional case-control study of 1144 GBM cases diagnosed between 2000 and 2013 of which 969 patients matched for age and sex was performed to assess the association between DM2, hyperlipidemia, and obesity with the incidence of GBM.

Cerebral venous overdrainage: an under-recognized complication of cerebrospinal fluid diversion.

Understanding the altered physiology following cerebrospinal fluid (CSF) diversion in the setting of adult hydrocephalus is important for optimizing patient care and avoiding complications. There is mounting evidence that the cerebral venous system plays a major role in intracranial pressure (ICP) dynamics especially when one takes into account the effects of postural changes, atmospheric pressure, and gravity on the craniospinal axis as a whole. An evolved mechanism acting at the cortical bridging veins, known as the "Starling resistor," prevents overdrainage of cranial venous blood with upright positioning.

The cerebral venous system and the postural regulation of intracranial pressure: implications in the management of patients with cerebrospinal fluid diversion.

Loss of cerebrospinal fluid (CSF) occurs commonly in daily neurosurgical practice. Understanding the altered physiology following CSF loss is important for optimization of patient care and avoidance of complications. There is overwhelming evidence now that the cerebral venous system plays a major role in intracranial pressure (ICP) dynamics especially when one takes into account the effects of postural changes, atmospheric pressure, and gravity on the craniospinal axis as a whole.

Nurses and nutrition: a survey of knowledge and attitudes regarding nutrition assessment and care of hospitalized elderly patients.

Background: Nurses' knowledge and attitudes regarding nutrition care play an important role in patient nutrition assessment and intervention. This study measured the association between nutrition knowledge and attitudes about nutrition care and feeding patients among nurses working in hospital settings.

Methods: This cross-sectional survey queried nutrition knowledge, attitudes, clinical applications, and task rankings using structured questionnaires in a representative sample of 106 nurses employed at two large government hospitals.

Experience with transforaminal interbody fusion in corrective surgery for adolescent idiopathic scoliosis.

One of the surgical goals during the treatment of adolescent idiopathic scoliosis (AIS) is to preserve segments and thus mobility while achieving a well-balanced spine on all planes. The transforaminal interbody fusion (TLIF) technique allows for a significant degree of rotational correction and thus may allow for preservation of more mobile segments. This retrospective study analyzed the use of TLIF in AIS patients who underwent surgery between 2006 and 2009 at a single center, and discusses the degree of curve correction, complications and outcomes.

Incidence, risk factors and management of delayed wound dehiscence after craniotomy for tumor resection.

Dehiscence after a wound has healed is a known complication of craniotomy for tumor resection. We conducted a retrospective analysis of 64 patients who underwent craniotomy for tumor resection followed by radiation or radiosurgery between 2006 and 2010. Five patients (7.

CyberKnife radiosurgery for management of intracranial perineural spread of cutaneous malignancies.

Intracranial perineural spread (PNS) is a rare complication of cutaneous malignancies and refers to access of the tumor to the intracranial space typically by tracking along cranial nerves. Patients are usually treated with palliative external-beam radiotherapy or with radiosurgery if there has been prior standard radiotherapy. Two patients are presented, both with cranial neuropathies occurring years after treatment for cutaneous malignancies.

Oncomodulatory mechanisms of human cytomegalovirus in gliomas.

Human cytomegalovirus (HCMV), a widespread beta-herpes virus, infects a high percentage of high grade gliomas. Although HCMV is not recognized as an oncogenic virus, it might increase the malignancy of the infected cell by disrupting cellular pathways involved in the cell cycle, apoptosis, angiogenesis, cell invasion and the host immune response. This article reviews the recent evidence of the modulatory effects of HCMV infection leading to the malignant progression of gliomas and explores novel therapeutic targets against such lethal tumors.

Lipopolysaccharide-induced inflammatory cytokine production by Schwann's cells dependent upon TLR4 expression.

Signaling of Toll-like receptor-4 (TLR4) through its cognate ligand endotoxin appears critical in tissue inflammation associated with bacterial infection. We found that anti-GM1 antibody (Ab) enhances TLR4 expression in Schwann's cells (SCs) in vivo and in vitro. The anti-GM1 Ab-treated SC also showed increased release of pro-inflammation cytokines IL-1beta and TNF-alpha after incubation with lipopolysaccharide (LPS).

Relationship of gliomas to the ventricular walls.

The role of neural stem cells in gliomagenesis remains controversial. The aim of this study was to determine the anatomic relationship of human gliomas to the lining of the ventricular walls, known as the subventricular zone, an area replete with neural stem cells. We performed a retrospective radiographic analysis of 100 consecutive patients with gliomas and sought to determine the relationship of the lesions to the ventricular walls as seen on their MRI scans.

Relationship of neural stem cells with their vascular niche: implications in the malignant progression of gliomas.

During embryogenesis and in regions of the adult brain undergoing post-natal neurogenesis, neural stem cells and endothelial precursors are found within a vascular niche, where the coordinated interactions between neurogenesis and vasculogenesis dictates development and responses to the environment. Moreover, recent evidence suggests that gliomas may arise from transformed neural stem cells and that angiogenesis is important in the malignant progression of these tumors. Taken together, these findings have led researchers to focus on the dynamic interaction between neural stem cells and their vascular niche so as to find new therapeutic strategies to halt the progression of gliomas.

Endoscope-assisted posterior approach for the resection of ventral intradural spinal cord tumors: report of two cases.

We report our experience with the removal of ventral intradural spinal tumors through a posterior approach with the assistance of an endoscope. The endoscope allowed us to remove the tumor with minimal retraction of the spinal cord and to inspect for involvement of structures that were difficult to visualize with the microscope. Moreover, it obviated the use of a more involved anterior approach.

Biology of the subventricular zone in relation to gliomagenesis.

There is recent compelling evidence that gliomas arise from neural stem cells residing in the lining of the lateral ventricles, known as the subventricular zone, that have undergone malignant transformation. This article reviews the operative elements, including cytoskeletal proteins, tumor suppressor genes, cell adhesion molecules, growth factors, transcription factors and developmental pathways that link the subventricular zone to gliomagenesis. It is hoped that with an improved understanding of the putative source of gliomas, new therapeutic strategies will be developed against such deadly tumors.

Vascular complications after radiosurgery for meningiomas.

During the past 25 years, radiosurgery has evolved as a primary treatment modality for certain meningiomas when resection would be associated with high patient morbidity. In addition, radiosurgery is now routinely used as an adjunctive therapy for residual or recurrent meningiomas after surgical removal. In this review the authors summarize the vascular complications that occur after radiosurgery for meningiomas as well as experimental study data that give insight into the pathogenesis of this complication.

The role of cadherins and catenins in gliomagenesis.

Cell-cell adhesion is a crucial process occurring during normal tissue development. Cadherins are calcium-dependent cell-surface adhesion molecules involved in cell-cell adhesion. They reorganize the actin cytoskeleton via interaction with the catenins.

Paraclinoid Carotid Aneurysms: Surgical Management, Complications, and Outcome Based on a New Classification Scheme.

The site of origin, projection, and relationship of aneurysms arising from the ophthalmic segment of the internal carotid artery (ICA) to adjacent structures are heterogeneous. Based on a retrospective analysis of 61 patients with aneurysms in this location, we developed a simple numerical classification system to guide surgical planning. We used angiographic findings to categorize the aneurysms.