Brain Oxygen-Directed Management of Aneurysmal Subarachnoid Hemorrhage. Temporal Patterns of Cerebral Ischemia During Acute Brain Attack, Early Brain Injury, and Territorial Sonographic Vasospasm.

Background: Neurocritical management of aneurysmal subarachnoid hemorrhage focuses on delayed cerebral ischemia (DCI) after aneurysm repair.

Methods: This study conceptualizes the pathophysiology of cerebral ischemia and its management using a brain oxygen-directed protocol (intracranial pressure [ICP] control, eubaric hyperoxia, hemodynamic therapy, arterial vasodilation, and neuroprotection) in patients with subarachnoid hemorrhage, undergoing aneurysm clipping (n = 40).

Results: The brain oxygen-directed protocol reduced Lbo (Pbto [partial pressure of brain tissue oxygen] <20 mm Hg) from 67% to 15% during acute brain attack (<24 hours of ictus), by increasing Pbto from 11.

Creation of false pedicles and a neo-pelvis for lumbopelvic reconstruction following en bloc resection of an iliosacral chondrosarcoma with lumbar spine extension: technical note.

En bloc resection with negative tumor margins remains the principal treatment option for control or cure of primary pelvic chondrosarcomas, as current adjuvant therapies remain ineffective. Iliosacral chondrosarcomas with involvement of the sciatic notch are sufficiently challenging tumors. However, when there is concomitant lumbar extension requiring resection of the pedicles to maintain negative surgical margins, transpedicular screw fixation is not possible, making reconstruction of the lumbopelvic junction extremely challenging.

Physiological complexity of acute traumatic brain injury in patients treated with a brain oxygen protocol: utility of symbolic regression in predictive modeling of a dynamical system.

Predictive modeling of emergent behavior, inherent to complex physiological systems, requires the analysis of large complex clinical data streams currently being generated in the intensive care unit. Brain tissue oxygen protocols have yielded outcome benefits in traumatic brain injury (TBI), but the critical physiological thresholds for low brain oxygen have not been established for a dynamical patho-physiological system. High frequency, multi-modal clinical data sets from 29 patients with severe TBI who underwent multi-modality neuro-clinical care monitoring and treatment with a brain oxygen protocol were analyzed.

Calcifying fibrous tumor of the spine.

Objective: Calcifying fibrous tumor is a rare, benign soft-tissue tumor of unknown etiology, characterized by hyalinized collagenous fibrous tissue with psammomatous or dystrophic calcification and focal lymphoplasmacytic infiltrate known to involve different organ systems. Involvement of the spine and the presence of metaplastic ossification previously have not been reported.

Intervention: We report a 44-year-old female with progressive nontraumatic flank pain.

Taming an old enemy: a profile of intracranial suppuration.

Intracranial suppurative disorders (ICSDs; brain abscess, empyema, and purulent ventriculitis), have been a scourge through the ages and attempts at curative surgery, as for cranial trauma, are considered to be one of the first true neurosurgical interventions performed. ICSDs, seen initially as a consequence of poor socioeconomic conditions and neglected otorhinogenic infections, predominantly manifest today as postsurgical complications, and/or in immunocompromised patients where they continue to result in significant neurologic morbidity and death. The reduction in the incidence of "old world" classic ICSDs can be attributed to the modernization of society, driven inter alia by a shift from an agricultural to an industrial economic society.

Brain abscess: management and outcome analysis of a computed tomography era experience with 973 patients.

Objective: Brain abscess (BA) is a neurosurgical emergency and despite significant medical advances, it remains a surgical challenge. A single institution's two decade computed tomography era management experience with BA is reported.

Methods: A retrospective analysis of patients with BA, admitted to the Department of Neurosurgery, Wentworth Hospital, Durban, KwaZulu-Natal, South Africa, was performed.

History of the vertebral venous plexus and the significant contributions of Breschet and Batson.

Before the 18th century, the vertebral venous plexus (VVP) received scant mention, had no clinical relevance, and was largely ignored by anatomists, most likely because of its location and nondistensible nature. Gilbert Breschet in 1819 provided the first detailed anatomic description of the VVP, describing it as a large plexiform valveless network of vertebral veins consisting of 3 interconnecting divisions and spanning the entire spinal column with connections to the cranial dural sinuses distributed in a longitudinal pattern, running parallel to and communicating with the venae cavae, and having multiple interconnections. More than a century passed before any work of significance on the VVP was noted.

Reconstruction of the pelvis and lumbar-pelvic junction using 2 vascularized autologous bone grafts after en bloc resection for an iliosacral chondrosarcoma.

Primary pelvic sarcomas remain challenging and complex surgical problems with significant potential for postoperative impairment of ambulation, as well as bowel, bladder, and sexual function. En bloc resection with negative tumor margins represents the best chance of control or cure as current adjuvant therapies remain ineffective. Tumor involvement of the sacrum with extension to the greater sciatic notch and ipsilateral ilium requires an external hemipelvectomy and sagittal sacrectomy with sacrifice of the lower extremity to achieve en bloc resection, followed by lumbar-pelvic reconstruction.

Nail-gun injury of the cervical spine: simple technique for removal of a barbed nail.

Although nail-gun injuries are a common form of penetrating low-velocity injury, impalement with barbed nails has been underreported to date. Barbed nails are designed to resist dislodgment once embedded, and any attempt at removal may splay open the barbs along the path of entry, with the potential for significant soft-tissue and neurovascular injury. A 25-year-old man sustained a nail impalement of the cervical spine from accidental discharge of a nail gun.

Brain tissue oxygen monitoring in traumatic brain injury and major trauma: outcome analysis of a brain tissue oxygen-directed therapy.

Object: Cerebral ischemia is the leading cause of preventable death in cases of major trauma with severe traumatic brain injury (TBI). Intracranial pressure (ICP) control and cerebral perfusion pressure (CPP) manipulation have significantly reduced the mortality but not the morbidity rate in these patients. In this study, the authors describe their 5-year experience with brain tissue oxygen (PbtO(2)) monitoring, and the effect of a brain tissue oxygen-directed critical care guide (PbtO(2)-CCG) on the 6-month clinical outcome (based on the 6-month Glasgow Outcome Scale score) in patients with TBIs.

The first direct human blood transfusion: the forgotten legacy of George W. Crile.

GEORGE W. CRILE is best known as the father of physiological surgery in the United States, a pioneer surgeon, an innovator and inventor, a founding member of the American College of Surgeons, and the principal founder of the Cleveland Clinic Foundation. However, Crile's legacy of performing the first direct blood transfusion in humans has been all but forgotten, even though the results were published in the leading scientific journals of the day.

Collagen matrix duraplasty for posterior fossa surgery: evaluation of surgical technique in 52 adult patients. Clinical article.

Object: Complete dural closure is not always possible following posterior fossa surgery, often requiring a graft to secure complete closure. The authors report their experience of using a collagen matrix as an onlay dural graft for repair of a posterior fossa dural defect.

Methods: A retrospective analysis was performed in 52 adult patients who had undergone collagen matrix duraplasty for the posterior fossa.

Management of hypertensive emergencies in acute brain disease: evaluation of the treatment effects of intravenous nicardipine on cerebral oxygenation.

Object: Inappropriate sudden blood pressure (BP) reductions may adversely affect cerebral perfusion. This study explores the effect of nicardipine on regional brain tissue O(2) (PbtO(2)) during treatment of acute hypertensive emergencies.

Methods: A prospective case-control study was performed in 30 patients with neurological conditions and clinically elevated BP.

Collagen matrix duraplasty for cranial and spinal surgery: a clinical and imaging study.

Object: The repair of dural defects is controversial in contemporary neurosurgery. To date, collagen-based products remain a continued area of interest in the development of dural grafts. The authors conducted a prospective case-control study in which they evaluated collagen matrix in the repair of dural defects following cranial and spinal surgery by using specific clinical and magnetic resonance (MR) imaging outcome measures.

Gamma knife radiosurgery for glomus jugulare tumors: volumetric analysis in 17 patients.

Objective: Stereotactic radiosurgery has been used increasingly for the treatment of glomus jugulare tumors. The authors report their experience treating these tumors using gamma knife radiosurgery (GKRS), documenting the clinical and radiological outcome.

Methods: A retrospective analysis identified 17 patients with glomus jugulare tumors who underwent GKRS.

The role of 111indium-octreotide brain scintigraphy in the diagnosis of cranial, dural-based meningiomas.

Objective: Meningiomas are common brain tumors with somatostatin receptors that bind octreotide. We report the use of (111)indium-octreotide brain scintigraphy (OBS) for the non-invasive differentiation of meningiomas from other cranial dural-based pathology.

Methods: A retrospective analysis of our experience with OBS for non-invasive identification of meningiomas was performed.

Increased expression of 5-lipoxygenase in high-grade astrocytomas.

Objective: 5-Lipoxygenase (5-LO) oxidizes arachidonic acid into proinflammatory eicosanoids that may promote tumorigenesis. In this study, we investigated whether 5-LO is expressed in human astrocytomas and what effect its expression may have on patient outcome.

Methods: Increased 5-LO messenger ribonucleic acid and protein expression was detected by the polymerase chain reaction and antibody-based approaches, respectively, in surgical astrocytoma specimens and established glioblastoma multiforme cell lines compared with primary cell culture from the human white matter.