Guidelines for the Management of Severe Traumatic Brain Injury: 2020 Update of the Decompressive Craniectomy Recommendations.

When the fourth edition of the Brain Trauma Foundation's Guidelines for the Management of Severe Traumatic Brain Injury were finalized in late 2016, it was known that the results of the RESCUEicp (Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension) randomized controlled trial of decompressive craniectomy would be public after the guidelines were released. The guideline authors decided to proceed with publication but to update the decompressive craniectomy recommendations later in the spirit of "living guidelines," whereby topics are updated more frequently, and between new editions, when important new evidence is published. The update to the decompressive craniectomy chapter presented here integrates the findings of the RESCUEicp study as well as the recently published 12-mo outcome data from the DECRA (Decompressive Craniectomy in Patients With Severe Traumatic Brain Injury) trial.

Vagal Nerve Stimulation: Indications for Revision in Adult Refractory Epilepsy.

Objective: The goal of this study was to assess the indications of revision for vagal nerve stimulation at a single institution in an adult population with drug-resistant epilepsy.

Methods: This was a retrospective review of a prospectively collected database who underwent vagal nerve stimulator implantation for drug-resistant epilepsy during 1992-2017. Patients receiving vagal nerve stimulation (VNS) implants were monitored throughout their perioperative and postoperative course and were classified according to type of seizure at the time of diagnosis and indications for VNS revision.

Hydroxyapatite bone cement application for the reconstruction of retrosigmoid craniectomy in the treatment of cranial nerves disorders.

Background: Retromastoid craniectomy (RSC) is a cardinal surgical approach used to access the posterior fossa. Hydroxyapetite bone cement (HBC) is frequently employed for cranioplasty in efforts to prevent cerebrospinal fluid (CSF) leak, whilst maintaining low complication rates and good cosmetic satisfaction. The authors aim to determine the safety and effectiveness of HBC for reconstruction RSC used for treatment of various cranial nerves disorders.

Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition.

The scope and purpose of this work is 2-fold: to synthesize the available evidence and to translate it into recommendations. This document provides recommendations only when there is evidence to support them. As such, they do not constitute a complete protocol for clinical use.

The clinical significance of isolated traumatic subarachnoid hemorrhage.

Background: Mild traumatic brain injury is a clinical diagnosis predicated on a patient's neurologic status and encompasses a variety of pathologies on computed tomography. We wondered whether isolated traumatic subarachnoid hemorrhage (iSAH) without other intracranial pathologic diagnosis is a more benign form of minor head injury that does not warrant extensive (and expensive) observation and follow-up.

Methods: This is a retrospective review of patients identified prospectively via a trauma registry during a period of 7 years, who had the computed tomographic finding of iSAH on admission scan and a Glasgow Coma Scale (GCS) score of 13 or greater.

Refractory status epilepticus treated with vagal nerve stimulation: case report.

Background And Importance: Status epilepticus (SE) refractory to medical treatment has a high mortality rate and few effective treatments.

Clinical Presentation: We describe the implantation of a vagal nerve stimulator to help terminate a case of refractory SE. A 23-year-old man was in SE for 3 weeks without being able to be weaned from intravenous anesthetic agents.

Mathematical modeling to define optimum operating room staffing for pediatric patients in trauma centers.

Background: Adult trauma centers (TCs) in the United States may be verified with an on-call operating room team if the performance improvement program shows no adverse outcome. Using queuing and simulation methodology, this study attempts to add a volume guideline for injured children.

Methods: Data from 63 verified TCs identified demographic factors including specific information regarding the first pediatric trauma-related operation done between 11 pm and 7 am each month for 1 year.

Survey of the h index for all of academic neurosurgery: another power-law phenomenon?

Object: The h index is a recently developed bibliometric that assesses an investigator's scientific impact with a single number. It has rapidly gained popularity in the physical and, more recently, medical sciences.

Methods: The h index for all 1120 academic neurosurgeons working at all Electronic Residency Application Service-listed training programs was determined by reference to Google Scholar.

Hydrogel coil-related delayed hydrocephalus in patients with unruptured aneurysms.

Object: Because of high recanalization rates associated with wide-necked intracranial aneurysms treated with bare platinum coils, hydrogel coils (HydroCoil, MicroVention, Inc.) have been developed. Hydrogel coils undergo progressive expansion once exposed to the physiological environment of blood and increase overall aneurysm filling.

Relation among aneurysm size, amount of subarachnoid blood, and clinical outcome.

Object: The authors of recent reports have suggested that smaller aneurysms are associated with more extensive subarachnoid hemorrhage (SAH), which could potentially presage poor outcome in patients harboring these lesions. The authors reviewed their clinical experience to determine if this theory has a basis in truth.

Methods: The authors undertook a retrospective review of a consecutive series of patients with aneurysmal SAH.