scholarly journals CT-Guided Placement of a Neuromonitoring Suite in Swine for Trauma and Resuscitation Research

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Janet Elise Bonin, BS ◽  
Hossam Abdou, MD ◽  
Joseph Edwards, MD ◽  
Neerav Patel, MD ◽  
Michael Richmond, BS ◽  
...  
Keyword(s):  
Cerebral Perfusion ◽  
Brain Perfusion ◽  
Brain Parenchyma ◽  
Burr Hole ◽  
Valuable Insight ◽  
Ct Guided ◽  
Laser Doppler Flow ◽  
The Brain ◽  
Insight Into ◽  
Pressure Catheter

Background: This manuscript aims to describe a standardized method for placement of a neuromonitoring suite into the brain of a porcine model using CT guidance for use in trauma and resuscitation research. Methods: A baseline CT allowed for precise planning of the placement of the neuromonitoring suite including measurement of skull thickness at the location of the intended burr hole. After the burr hole was drilled, three neuromonitoring probes (pressure catheter, temperature probe, and laser doppler flow probe) were advanced into the brain parenchyma of the swine. A subsequent CT confirmed appropriate placement of the neuromonitoring suite. Results: Effective placement of the neuromonitoring suite was accomplished successfully and without complication in 6 Yorkshire swine. Mean duration of the procedure was 49.6 minutes ± 6.3. Representative data from one animal includes the following presented as mean ± standard deviation: intracranial pressure of 10 ± 0 mmHg, cerebral perfusion pressure of 61 ± 1 mmHg, intracranial temperature of 34.8 ± 0 °C, and brain perfusion of 704 ± 13 relative perfusion units. Conclusions: This CT-guided method facilitates placement of a neuromonitoring suite in a safe and reliable manner. The use of a neuromonitoring suite using CT may offer valuable insight into cerebral perfusion in the context of endovascular resuscitation.

One- vs Two-Burr-Hole Technique for Combined Endoscopic Third Ventriculostomy and Pineal Region Biopsy: Volumetric Analysis of Brain at Risk

2020 ◽  
Vol 19 (2) ◽  
pp. 175-180
Author(s):  
Brandon D Liebelt ◽  
Fangxiang Chen ◽  
Antonio Biroli ◽  
Xiaochun Zhao ◽  
Peter Nakaji
Keyword(s):  
At Risk ◽  
Endoscopic Third Ventriculostomy ◽  
Brain Parenchyma ◽  
Pineal Region ◽  
Burr Hole ◽  
Third Ventriculostomy ◽  
Tumor Biopsy ◽  
Burr Holes ◽  
The Brain ◽  
The Ideal

Abstract BACKGROUND Pineal region tumors are associated with the ventricular system. Endoscopic third ventriculostomy (ETV) is often performed at the same time as tumor biopsy. OBJECTIVE To investigate the volume of brain possibly undergoing injury and forniceal stretching during ETV and tumor biopsy. METHODS We performed a retrospective review of preoperative magnetic resonance imagings (MRIs) and computed tomography (CTs) of patients with pineal region masses and used volumetric image-guided navigation to simulate a 1-burr-hole vs a 2-burr-hole approach through the brain parenchyma. We compared the volumes of parenchyma and fornix at the risk of injury. RESULTS The ideal entry point for ETV using 2 burr holes was a mean ± standard deviation (SD) of 25.8 ± 6 mm from the midline and 11.4 ± 9 mm behind the coronal suture. The ideal entry point using 2 burr holes for tumor biopsy was 25.7 ± 8 mm from the midline and 53.7 ± 14 mm anterior to the coronal suture. With 1 burr hole, the mean ± SD volume of brain parenchyma at risk was 852 ± 440 mm3. The volume of brain parenchyma at risk with 2 burr holes was 2159 ± 474 mm3 (P < .001; paired t-test). The use of 1 burr hole predisposed the fornix to 14 ± 3 mm of possible stretch, which was minimized with the 2-burr-hole approach. CONCLUSION Using 1 burr hole for both the ETV and tumor biopsy is less likely to traumatize the brain parenchyma than using 2 burr holes. However, 1 burr hole predisposes the fornix to stretch injury. We recommend tailoring the entry to each patient according to their anatomy rather than using a 1-size-fits-all approach.

Antibodies to β-Amyloid Decrease the Blood-to-Brain Transfer of β-Amyloid Peptide1

2002 ◽  
Vol 227 (8) ◽  
pp. 609-615 ◽  
Author(s):  
Weihong Pan ◽  
Beka Solomon ◽  
Lawrence M. Maness ◽  
Abba J. Kastin
Keyword(s):  
Ex Vivo ◽  
Amyloid Β ◽  
Brain Perfusion ◽  
Brain Parenchyma ◽  
Amyloid Angiopathy ◽  
Β Amyloid ◽  
Blocking Antibodies ◽  
The Brain

Amyloid-β peptides (Aβ) play an important role in the pathophysiology of dementia of the Alzheimer's type and in amyloid angiopathy. Aβ outside the CNS could contribute to plaque formation in the brain where its entry would involve interactions with the blood-brain barrier (BBB). Effective antibodies to Aβ have been developed in an effort to vaccinate against Alzheimer's disease. These antibodies could interact with Aβ in the peripheral blood, block the passage of Aβ across the BBB, or prevent Aβ deposition within the CNS. To determine whether the blocking antibodies act at the BBB level, we examined the influx of radiolabeled Aβ (125I-Aβ1-40) into the brain after ex-vivo incubation with the antibodies. Antibody mAb3D6 (élan Company) reduced the blood-to-brain influx of Aβ after iv bolus injection. It also significantly decreased the accumulation of Aβ in brain parenchyma. To confirm the in-vivo study and examine the specificity of mAb3D6, in-situ brain perfusion in serum-free buffer was performed after incubation of 125I-Aβ1-40 with another antibody mAbmc1 (DAKO Company). The presence of mAbmc1 also caused significant reduction of the influx of Aβ into the brain after perfusion. Therefore, effective antibodies to Aβ can reduce the influx of Aβ1-40 into the brain.

scholarly journals Quantification and selection of ictogenic zones in epilepsy surgery

2019 ◽  
Author(s):  
Petroula Laiou ◽  
Eleftherios Avramidis ◽  
Marinho A. Lopes ◽  
Eugenio Abela ◽  
Michael Müller ◽  
...  
Keyword(s):  
Computational Models ◽  
Brain Networks ◽  
Network Models ◽  
Combinatorial Problem ◽  
Valuable Insight ◽  
Potential Applicability ◽  
Healthy Functioning ◽  
The Brain ◽  
Insight Into ◽  
Selection Of

AbstractNetwork models of brain dynamics provide valuable insight into the healthy functioning of the brain and how this breaks down in disease. A pertinent example is the use of network models to understand seizure generation (ictogenesis) in epilepsy. Recently, computational models have emerged to aid our understanding of seizures and to predict the outcome of surgical perturbations to brain networks. Such approaches provide the opportunity to quantify the effect of removing regions of tissue from brain networks and thereby search for the optimal resection strategy.Here, we use computational models to elucidate how sets of nodes contribute to the ictogenicity of networks. In small networks we fully elucidate the ictogenicity of all possible sets of nodes and demonstrate that the distribution of ictogenicity across sets depends on network topology. However, the full elucidation is a combinatorial problem that becomes intractable for large networks. Therefore, we develop a global optimisation approach to search for minimal sets of nodes that contribute significantly to ictogenesis. We demonstrate the potential applicability of these methods in practice by identifying optimal sets of nodes to resect in networks derived from 20 individuals who underwent resective surgery for epilepsy.

Do Complication Rates of Ventricular Drain Placement Differ between Twist Drill and Burr Hole in Acute Hydrocephalus?

2019 ◽  
Vol 80 (04) ◽  
pp. 277-284 ◽  
Author(s):  
Christine Brand ◽  
Andrej Pala ◽  
Wilhelm Kielhorn ◽  
Christian Rainer Wirtz ◽  
Thomas Kapapa
Keyword(s):  
External Ventricular Drainage ◽  
Brain Parenchyma ◽  
Burr Hole ◽  
Acute Subdural Hematoma ◽  
Complication Rates ◽  
Twist Drill ◽  
Acute Hydrocephalus ◽  
Duration Of Surgery ◽  
The Difference ◽  
The Brain

Objective The aim of the study was to compare two techniques for external ventricular drainage (EVD) placement with respect to their complication rates. Methods A retrospective descriptive study was performed to analyze all patients who had undergone EVD implantation for acute hydrocephalus between January 2010 and December 2013 with a focus on surgical technique and rate of complications. The burr hole technique (BHT) was used in one group and the twist-drill technique (TDT) in the other. Particular attention was paid to malposition, hemorrhage, and catheter-associated infection. Results A total of 350 consecutive patients underwent EVD implantation for acute hydrocephalus: BHT was performed in 201 and TDT in 147 of the patients, whereas in two patients the technique used was unknown. The overall infection rate was 6.3% (n = 22). Fourteen patients (4%) in the BHT group developed an infection compared with eight patients (9.5%) in the TDT group (p = 0.154). In 16 (4.5%) of all cases, postoperative computed tomography revealed catheter-induced hemorrhage.In one case (0.3%), surgery was necessary due to acute subdural hematoma. The difference between both techniques was not statistically significant (p = 0.343). In 44 (12.6%) of all cases, the position of the EVD tip was contralateral; in 36 (10.3%) of all cases, the EVD tip was in the brain parenchyma. The rate of malposition was 11.6% (n = 17) in the TDT group and 9.5% (n = 19) in the BHT group (p = 0.078). Conclusion Neither technique showed significantly different numbers in terms of infection, malposition, and hemorrhagic complications. EVD implantation using the TDT is an adequate method compared with BHT. The advantages of TDT are clear: the duration of surgery is shorter, the size of the wound is smaller, and the surgeon is not confined to the operating room.

scholarly journals Distribution of Suramin, an Antitrypanosomal Drug, across the Blood-Brain and Blood-Cerebrospinal Fluid Interfaces in Wild-Type and P-Glycoprotein Transporter-Deficient Mice

2007 ◽  
Vol 51 (9) ◽  
pp. 3136-3146 ◽  
Author(s):  
Lisa Sanderson ◽  
Adil Khan ◽  
Sarah Thomas
Keyword(s):  
Choroid Plexus ◽  
Brain Perfusion ◽  
Brain Parenchyma ◽  
Sleeping Sickness ◽  
New Drugs ◽  
Wild Type ◽  
P Glycoprotein ◽  
Blood Brain ◽  
Targeted Mutation ◽  
The Brain

ABSTRACT Although 60 million people are exposed to human African trypanosomiasis, drug companies have not been interested in developing new drugs due to the lack of financial reward. No new drugs will be available for several years. A clearer understanding of the distribution of existing drugs into the brains of sleeping sickness patients is needed if we are to use the treatments that are available more safely and effectively. This proposal addresses this issue by using established animal models. Using in situ brain perfusion and isolated incubated choroid plexus techniques, we investigated the distribution of [3H]suramin into the central nervous systems (CNSs) of male BALB/c, FVB (wild-type), and P-glycoprotein-deficient (Mdr1a/Mdr1b-targeted mutation) mice. There was no difference in the [3H]suramin distributions between the three strains of mice. [3H]suramin had a distribution similar to that of the vascular marker, [14C]sucrose, into the regions of the brain parenchyma that have a blood-brain barrier. However, the association of [3H]suramin with the circumventricular organ samples, including the choroid plexus, was higher than that of [14C]sucrose. The association of [3H]suramin with the choroid plexus was also sensitive to phenylarsine oxide, an inhibitor of endocytosis. The distribution of [3H]suramin to the brain was not affected by the presence of other antitrypanosomal drugs or the P-glycoprotein efflux transporter. Overall, the results confirm that [3H]suramin would be unlikely to treat the second or CNS stage of sleeping sickness.

scholarly journals TWO PATTERNS ОF CT-BRAIN PERFUSION AND DC-POTENTIALS ОF THE BRAIN EVOKED COGNITIVE TASK IN DISCIRCULATORY ENCEPHALOPATHY PATIENTS

2012 ◽  
Vol 67 (10) ◽  
pp. 38-43
Author(s):  
V. F. Fokin ◽  
N. V. Ponomareva ◽  
M. V. Krotenkova ◽  
R. N. Konovalov ◽  
M. M. Tanashyan ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Heart Rate ◽  
Verbal Fluency ◽  
Cerebral Perfusion ◽  
Cognitive Task ◽  
Brain Perfusion ◽  
Verbal Fluency Test ◽  
The Brain ◽  
Fluency Test ◽  
Dc Potentials

In patients with discirculatory encephalopathy the influence of verbal fluency test on the characteristics of cerebral perfusion, DC-potentials of the brain, as well as on blood pressure and heart rate was investigated. Two patterns of responses to the verbal fluency test were observed. The first one is the process of generalized activation, manifested by the reduction of the TTP (time to peak) parameters of brain perfusion, the rise of the DC-potentials in all areas of brain and the modulation of blood pressure and heart rate. The second process, directly connected with cognitive processing, was manifested by the shifts of local characteristics of brain perfusion and DC-potentials in the frontal, temporal and central cortex, especially in the left hemisphere. Correlations were found between the characteristics of cerebral perfusion and DC-potentials on the one hand and the number of words during the verbal fluency test performance on the other hand. 

scholarly journals Cerebral Vessels: An Overview of Anatomy, Physiology, and Role in the Drainage of Fluids and Solutes

2021 ◽  
Vol 11 ◽  
Author(s):  
Nivedita Agarwal ◽  
Roxana Octavia Carare
Keyword(s):  
Cerebral Arteries ◽  
Lymphatic Vessels ◽  
Vascular Anatomy ◽  
Brain Perfusion ◽  
Brain Parenchyma ◽  
Basement Membranes ◽  
Cervical Lymph Nodes ◽  
Waste Products ◽  
Venous Sinuses ◽  
The Brain

The cerebral vasculature is made up of highly specialized structures that assure constant brain perfusion necessary to meet the very high demand for oxygen and glucose by neurons and glial cells. A dense, redundant network of arteries is spread over the entire pial surface from which penetrating arteries dive into the cortex to reach the neurovascular units. Besides providing blood to the brain parenchyma, cerebral arteries are key in the drainage of interstitial fluid (ISF) and solutes such as amyloid-beta. This occurs along the basement membranes surrounding vascular smooth muscle cells, toward leptomeningeal arteries and deep cervical lymph nodes. The dense microvasculature is made up of fine capillaries. Capillary walls contain pericytes that have contractile properties and are lined by a highly specialized blood–brain barrier that regulates the entry of solutes and ions and maintains the integrity of the composition of ISF. They are also important for the production of ISF. Capillaries drain into venules that course centrifugally toward the cortex to reach cortical veins and empty into dural venous sinuses. The walls of the venous sinuses are also home to meningeal lymphatic vessels that support the drainage of cerebrospinal fluid, although such pathways are still poorly understood. Damage to macro- and microvasculature will compromise cerebral perfusion, hamper the highly synchronized movement of neurofluids, and affect the drainage of waste products leading to neuronal and glial degeneration. This review will present vascular anatomy, their role in fluid dynamics, and a summary of how their dysfunction can lead to neurodegeneration.

Treatment of Severe Traumatic Brain Injury in the Scandinavian Countries, with Special Emphasis on the Lund Concept

Neurotrauma ◽  
2018 ◽  
pp. 29-40
Author(s):  
Magnus Olivecrona ◽  
Per-Olof Grände
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Fluid Therapy ◽  
Cerebral Perfusion ◽  
Brain Perfusion ◽  
Brain Trauma ◽  
Volume Control ◽  
Brain Trauma Foundation ◽  
The Brain

The Lund concept (LC) and the Brain Trauma Foundation (BTF) guidelines are used in Scandinavia and the Nordic countries to treat severe brain trauma (s-TBI). In this chapter, the authors focus on the LC developed in Scandinavia. When introduced in 1992, it was a theoretical approach, based mainly on principles of brain volume control and of optimization of brain perfusion. The BTF guidelines presented in 1996 were based on meta-analytic approaches. The LC gives relatively strict outlines regarding cerebral perfusion pressure, fluid therapy, ventilation, sedation, nutrition, the use of vasopressors, and osmotherapy. The treatment is standardized, with less need for individualization.

scholarly journals Own experience of mri T2 and ct perfusion of the brain, how to avoid «failures»

2021 ◽  
Vol 20 (2) ◽  
pp. 43-48
Author(s):  
V. A. Sukhanov ◽  
О. N. Chernova ◽  
М. О. Shubny ◽  
R. Е. Shtentsel
Keyword(s):  
Cerebral Perfusion ◽  
Ct Perfusion ◽  
Brain Perfusion ◽  
Perfusion Study ◽  
Factors Affecting ◽  
Perfusion Studies ◽  
The Many ◽  
The Brain ◽  
Correct Data ◽  
Ct And Mri

Introduction. To reduce the number of cerebral perfusion studies, the interpretation of which is not possible or can be performed with errors, we retrospectively analyzed cerebral perfusion studies for three years, analyzed the identified errors at the stage of data collection and the stage of study interpretation.Aims and objectives: to analyze and divide into groups the reasons that led to limitations or impossibility to assess perfusion during interpretation of the obtained data, to develop an algorithm of actions to reduce the number of uninterpreted studies.Materials and Methods. The study retrospectively evaluated 275 CT and MRI brain perfusion studies performed between 2017 and 2019 on 1.5 T MR and 32-slice CT scans.Results. The result of this study was a better understanding of the causes of the most common errors in perfusion studies. Analysis of the causes allowed us to identify factors that affect the performance of the study and the interpretation of the data obtained. Discussion. In order to perform a quality perfusion study, given the many factors affecting the interpretation of the data obtained, a number of conditions on the planning and execution of the study, as well as on the evaluation of the data obtained, must be followed. Conclusions. Understanding the reasons that lead to limitations or inability to evaluate MRI and CT perfusion studies, adhering to guidelines for planning and evaluating studies allows for correct data and avoids obtaining uninformative studies or studies whose interpretation is limited.

Postural influence on intracranial and cerebral perfusion pressure in ambulatory neurosurgical patients

2016 ◽  
Vol 310 (1) ◽  
pp. R100-R104 ◽  
Author(s):  
L. G. Petersen ◽  
J. C. G. Petersen ◽  
M. Andresen ◽  
N. H. Secher ◽  
M. Juhler
Keyword(s):  
Cerebral Perfusion Pressure ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Body Position ◽  
Standing Position ◽  
Brain Parenchyma ◽  
Focal Lesions ◽  
Neurosurgical Patients ◽  
Standing Up ◽  
The Brain

We evaluated postural effects on intracranial pressure (ICP) and cerebral perfusion pressure [CPP: mean arterial pressure (MAP) − ICP] in neurosurgical patients undergoing 24-h ICP monitoring as part of their diagnostic workup. We identified nine patients (5 women, age 44 ± 20 yr; means ± SD), who were “as normal as possible,” i.e., without indication for neurosurgical intervention (e.g., focal lesions, global edema, abnormalities in ICP-profile, or cerebrospinal fluid dynamics). ICP (tip-transducer probe; Raumedic) in the brain parenchyma ( n = 7) or in the lateral ventricles ( n = 2) and cardiovascular variables (Nexfin) were determined from 20° head-down tilt to standing up. Compared with the supine position, ICP increased during 10° and 20° of head-down tilt (from 9.4 ± 3.8 to 14.3 ± 4.7 and 19 ± 4.7 mmHg; P < 0.001). Conversely, 10° and 20° head-up tilt reduced ICP to 4.8 ± 3.6 and 1.3 ± 3.6 mmHg and ICP reached −2.4 ± 4.2 mmHg in the standing position ( P < 0.05). Concordant changes in MAP maintained CPP at 77 ± 7 mmHg regardless of body position ( P = 0.95). During head-down tilt, the increase in ICP corresponded to a hydrostatic pressure gradient with reference just below the heart, likely reflecting the venous hydrostatic indifference point. When upright, the decrease in ICP was attenuated, corresponding to formation of a separate hydrostatic gradient with reference to the base of the skull, likely reflecting the site of venous collapse. ICP therefore seems to be governed by pressure in the draining veins and collapse of neck veins may protect the brain from being exposed to a large negative pressure when upright. Despite positional changes in ICP, MAP keeps CPP tightly regulated.

Sign in / Sign up

Export Citation Format

Share Document