Historical aspects of the problem of surgical treatment of hemorrhagic stroke. The role of intracranial pressure in the choice of treatment tactics (review of literature)

This article provides a literature review of the past 60 years, conducted using keywords through the PubMed Internet resource, dedicated to the methods of surgical treatment of hemorrhagic stroke. The existing published results of clinical studies do not allow us to draw unambiguous conclusions about the superiority of conservative or neurosurgical treatment in relation to the functional recovery of patients. There is a statistical significance of the advantages of surgery based on the prevention of dislocation syndrome, control of intracranial hypertension, and prevention or at least reduction of the effect of blood and its degradation products on the surrounding healthy tissue. However, large randomized controlled trials have failed to demonstrate this benefit in terms of mortality or functional outcome.There are two main areas of hemorrhagic stroke surgery – open surgery and minimally invasive methods. The practice of open surgery is associated with high trauma rates, as well as with certain risks and complications. However, craniotomy is a lifesaving measure in critical situations with signs of persistent increased intracranial pressure leading to neurological impairment. The ability to control intracranial pressure provides a chance for the choice of more optimal tactics of surgical treatment.Today, the gold standard for intracranial pressure monitoring is the installation of invasive intraventricular or intraparenchymal transducers. The method is appreciated for its accuracy, however, there are a number of disadvantages in the form of the possibility of hemorrhagic and infectious complications, as well as the high cost of the sensor itself, which limits its routine use. The inability to measure intracranial pressure before surgery causes an unreasonable expansion of indications for choosing an open method of surgery, which reduces the possibility of a better functional outcome.All of these points make it urgent to search for a non-invasive method for measuring intracranial pressure, which would contribute to the timely choice of a surgical method without the danger of worsening the clinical outcome.

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Acetazolamide Mitigates Intracranial Pressure Spikes Without Affecting Functional Outcome After Experimental Hemorrhagic Stroke

Translational Stroke Research ◽

10.1007/s12975-018-0663-6 ◽

2018 ◽

Vol 10 (4) ◽

pp. 428-439 ◽

Cited By ~ 4

Author(s):

Michael R. Williamson ◽

Cassandra M. Wilkinson ◽

Kristen Dietrich ◽

Frederick Colbourne

Keyword(s):

Intracranial Pressure ◽

Functional Outcome ◽

Hemorrhagic Stroke

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Perfil Epidemiológico da Espondilodiscite Tratada Cirurgicamente

Acta Médica Portuguesa ◽

10.20344/amp.6549 ◽

2016 ◽

Vol 29 (5) ◽

pp. 319 ◽

Cited By ~ 2

Author(s):

Joaquim Soares do Brito ◽

António Tirado ◽

Pedro Fernandes

Keyword(s):

Staphylococcus Aureus ◽

Mycobacterium Tuberculosis ◽

Surgical Treatment ◽

Epidemiologic Study ◽

Neurological Impairment ◽

Tuberculous Infection ◽

Paravertebral Abscess ◽

Number Of Patients ◽

Epidemiological Profile ◽

Relative Constant

Introduction: The term spondylodiscitis aims to describe any spinal infection. Medical treatment is the gold standard; nevertheless, surgical treatment can be indicated. The aim of this work was to study the epidemiological profile in a group of patients with spondylodiscitis surgically treated in the same medical institution between 1997 and 2013. Material and Methods: Eighty five patients with spondylodiscitis were surgically treated in this period. The authors analysed clinical data and image studies for each patient. Results: We treated 51 male and 34 female patients with an average age of 48 years old (min: 6 - max: 80). The lumbar spine was more often affected and Mycobacterium tuberculosis the most frequent pathogen. The number of cases through the years has been grossly stable, with a slight increase of dyscitis due to Staphylococcus aureus and decrease of the dyscitis without pathogen identification. Paravertebral abscess was identified in 39 patients and 17 had also neurological impairment, mostly located in the thoracic spine and with tuberculous aetheology. Immunosuppression was documented in 10 patients. Discussion: In this epidemiologic study we found a tuberculous infection, male gender and young age predominance. Despite a relative constant number of patients operated over the years, pyogenic infections due to Staphylococcus aureus seems to be uprising. Paravertebral abscess and neurological impairment are important dyscitis complications, especially in tuberculous cases. Conclusion: Spinal infections requiring surgical treatment are still an important clinical condition. Mycobacterium tuberculosis and Staphylococcus aureus represent the main pathogens with a growing incidence for the latest.

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Surgical treatment of increased intracranial pressure

Kazan medical journal ◽

10.17816/kazmj57691 ◽

1926 ◽

Vol 22 (3) ◽

pp. 363

Author(s):

I. Churaev

Keyword(s):

Blood Pressure ◽

Surgical Treatment ◽

Intracranial Pressure ◽

Brain Tumors ◽

Endocrine Glands ◽

Cerebral Ventricles ◽

Increased Intracranial Pressure ◽

Normal Relationship

Disharmony in the growth of the bones of the skull and brain, which is a consequence of a violation of the correlation of the endocrine glands, brain tumors, vascular nodes on the walls of the cerebral ventricles, and finally, a violation of the normal relationship between the blood pressure of the cranial fluid - all this can serve as the cause of increased intracranial pressure.

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Functional Outcomes After Fracture-Dislocation of the Ankle

Foot & Ankle Specialist ◽

10.1177/1938640019826701 ◽

2019 ◽

Vol 13 (1) ◽

pp. 18-26 ◽

Cited By ~ 1

Author(s):

Direk Tantigate ◽

Gavin Ho ◽

Joshua Kirschenbaum ◽

Henrik C. Bäcker ◽

Benjamin Asherman ◽

...

Keyword(s):

Functional Outcome ◽

Functional Outcomes ◽

Ankle Fracture ◽

Statistical Significance ◽

Ankle Fractures ◽

Fracture Dislocation ◽

Wound Complications ◽

Pain Subscale ◽

Fracture Dislocations

Background. Fracture dislocation of the ankle represents a substantial injury to the bony and soft tissue structures of the ankle. There has been only limited reporting of functional outcome of ankle fracture-dislocations. This study aimed to compare functional outcome after open reduction internal fixation in ankle fractures with and without dislocation. Methods. A retrospective chart review of surgically treated ankle fractures over a 3- year period was performed. Demographic data, type of fracture, operative time and complications were recorded. Of 118 patients eligible for analysis, 33 (28%) sustained a fracture-dislocation. Mean patient age was 46.6 years; 62 patients, who had follow-up of at least 12 months, were analyzed for functional outcome assessed by the Foot and Ankle Outcome Score (FAOS). The median follow-up time was 37 months. Demographic variables and FAOS were compared between ankle fractures with and without dislocation. Results. The average age of patients sustaining fracture-dislocation was greater (53 vs 44 years, P = .017); a greater percentage were female (72.7% vs 51.8%, P = .039) and diabetic (24.2% vs 7.1%, P = .010). Wound complications were similar between both groups. FAOS was generally poorer in the fracture-dislocation group, although only the pain subscale demonstrated statistical significance (76 vs 92, P = .012). Conclusion. Ankle fracture-dislocation occurred more frequently in patients who were older, female, and diabetic. At a median of just > 3-year follow-up, functional outcomes in fracture-dislocations were generally poorer; the pain subscale of FAOS was worse in a statistically significant fashion. Levels of Evidence: Therapeutic, Level III

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Neuroprotection after Hemorrhagic Stroke Depends on Cerebral Heme Oxygenase-1

Antioxidants ◽

10.3390/antiox8100496 ◽

2019 ◽

Vol 8 (10) ◽

pp. 496 ◽

Cited By ~ 3

Author(s):

Sandra Kaiser ◽

Sibylle Frase ◽

Lisa Selzner ◽

Judith-Lisa Lieberum ◽

Jakob Wollborn ◽

...

Keyword(s):

Cell Death ◽

Cerebrospinal Fluid ◽

Functional Outcome ◽

Signaling Pathway ◽

Heme Oxygenase ◽

Hemorrhagic Stroke ◽

Mrna Level ◽

Neuronal Cell Death ◽

Neuronal Cell ◽

Heme Oxygenase 1

(1) Background: A detailed understanding of the pathophysiology of hemorrhagic stroke is still missing. We hypothesized that expression of heme oxygenase-1 (HO-1) in microglia functions as a protective signaling pathway. (2) Methods: Hippocampal HT22 neuronal cells were exposed to heme-containing blood components and cell death was determined. We evaluated HO-1-induction and cytokine release by wildtype compared to tissue-specific HO-1-deficient (LyzM-Cre.Hmox1 fl/fl) primary microglia (PMG). In a study involving 46 patients with subarachnoid hemorrhage (SAH), relative HO-1 mRNA level in the cerebrospinal fluid were correlated with hematoma size and functional outcome. (3) Results: Neuronal cell death was induced by exposure to whole blood and hemoglobin. HO-1 was induced in microglia following blood exposure. Neuronal cells were protected from cell death by microglia cell medium conditioned with blood. This was associated with a HO-1-dependent increase in monocyte chemotactic protein-1 (MCP-1) production. HO-1 mRNA level in the cerebrospinal fluid of SAH-patients correlated positively with hematoma size. High HO-1 mRNA level in relation to hematoma size were associated with improved functional outcome at hospital discharge. (4) Conclusions: Microglial HO-1 induction with endogenous CO production functions as a crucial signaling pathway in blood-induced inflammation, determining microglial MCP-1 production and the extent of neuronal cell death. These results give further insight into the pathophysiology of neuronal damage after SAH and the function of HO-1 in humans.

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Impact of health disparities on treatment for single-suture craniosynostosis in an era of multimodal care

Neurosurgical FOCUS ◽

10.3171/2021.1.focus201000 ◽

2021 ◽

Vol 50 (4) ◽

pp. E13

Author(s):

Caitlin Hoffman ◽

Alyssa B. Valenti ◽

Eseosa Odigie ◽

Kwanza Warren ◽

Ishani D. Premaratne ◽

...

Keyword(s):

Open Surgery ◽

Statistical Significance ◽

Demographic Data ◽

Tertiary Care ◽

Insurance Status ◽

Significant Difference ◽

Race Ethnicity ◽

The Impact ◽

Type Of Surgery ◽

Surgical Group

Craniosynostosis is the premature fusion of the skull. There are two forms of treatment: open surgery and minimally invasive endoscope-assisted suturectomy. Candidates for endoscopic treatment are less than 6 months of age. The techniques are equally effective; however, endoscopic surgery is associated with less blood loss, minimal tissue disruption, shorter operative time, and shorter hospitalization. In this study, the authors aimed to evaluate the impact of race/ethnicity and insurance status on age of presentation/surgery in children with craniosynostosis to highlight potential disparities in healthcare access. Charts were reviewed for children with craniosynostosis at two tertiary care hospitals in New York City from January 1, 2014, to August 31, 2020. Clinical and demographic data were collected, including variables pertaining to family socioeconomic status, home address/zip code, insurance status (no insurance, Medicaid, or private), race/ethnicity, age and date of presentation for initial consultation, type of surgery performed, and details of hospitalization. Children with unknown race/ethnicity and those with syndromic craniosynostosis were excluded. The data were analyzed via t-tests and chi-square tests for statistical significance (p < 0.05). A total of 121 children were identified; 62 surgeries were performed open and 59 endoscopically. The mean age at initial presentation of the cohort was 6.68 months, and on the day of surgery it was 8.45 months. Age at presentation for the open surgery cohort compared with the endoscopic cohort achieved statistical significance at 11.33 months (SD 12.41) for the open cohort and 1.86 months (SD 1.1473) for the endoscopic cohort (p < 0.0001). Age on the day of surgery for the open cohort versus the endoscopic cohort demonstrated statistical significance at 14.19 months (SD 15.05) and 2.58 months (SD 1.030), respectively. A statistically significant difference between the two groups was noted with regard to insurance status (p = 0.0044); the open surgical group comprised more patients without insurance and with Medicaid compared with the endoscopic group. The racial composition of the two groups reached statistical significance when comparing proportions of White, Black, Hispanic, Asian, and other (p = 0.000815), with significantly more Black and Hispanic patients treated in the open surgical group. The results demonstrate a relationship between race and lack of insurance or Medicaid status, and type of surgery received; Black and Hispanic children and children with Medicaid were more likely to present later and undergo open surgery.

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Atypical clinical course of cerebral arachnoid cyst

Patologiya krovoobrashcheniya i kardiokhirurgiya ◽

10.21688/1681-3472-2013-2-77-78 ◽

2015 ◽

Vol 17 (2) ◽

pp. 77

Author(s):

A. L. Krivoshapkin ◽

A. V. Gorbatykh ◽

A. S. Gaytan ◽

P. A. Semin ◽

V. V. Kobozev

Keyword(s):

Surgical Treatment ◽

Intracranial Pressure ◽

Female Patient ◽

Arachnoid Cyst ◽

Clinical Course ◽

Operative Management ◽

Middle Cranial Fossa ◽

Raised Intracranial Pressure ◽

Cranial Fossa ◽

Aggressive Clinical Course

In this publication we report a case of atypical, aggressive clinical course of arachnoid cyst in 19-year old female patient, which caused raised intracranial pressure and disruption of bony structures of the middle cranial fossa and the orbit. It also describes peculiarities of operative management and results of surgical treatment of this patient.

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Dynamic Hip Screw versus Proximal Femoral Nail in the Management of Intertrochanteric Fractures - A Retrospective Analysis from Rajasthan

Journal of Evidence Based Medicine and Healthcare ◽

10.18410/jebmh/2021/424 ◽

2021 ◽

Vol 8 (26) ◽

pp. 2271-2277

Author(s):

Gajanand Shriram Dhaked ◽

Abhishek Komalsingh Jaroli ◽

Khushboo Parmanand Malav ◽

Harish Narayan Singh Rajpurohit

Keyword(s):

Functional Outcome ◽

Functional Outcomes ◽

Statistical Significance ◽

Dynamic Hip Screw ◽

Proximal Femoral Nail ◽

Final Decision ◽

Intertrochanteric Fractures ◽

Femoral Nail ◽

Duration Of Surgery ◽

Hip Screw

BACKGROUND Current management of Intertrochanteric (IT) fractures has evolved with the introduction of dynamic hip screw (DHS) and proximal femoral nail (PFN). The purpose of this study was to compare the functional outcomes between the DHS and PFN for IT fracture fixation. METHODS This study is a retrospective comparative analysis of 455 patients with IT fractures; DHS (292) and PFN (163), who were treated from June 2012 to June 2015. The patients were reviewed postoperatively for a minimum of 12 months to evaluate functional outcome using Salvati-Wilson score. Categorical data was present as absolute number or percentages, and parametric variables were presented as Mean ± SD, while non parametric data were presented as median. Statistical significance was defined as P < 0.05. RESULTS Intramedullary nails offer no advantage over extramedullary devices to treat IT fractures caused by low-energy trauma (AO 31 - A1). However, clinically significant outcomes were established for PFN group in terms of duration of surgery, x- ray exposure and SW Score for AO / OTA 31 - A2 and 31 - A3. Reoperations encountered for local pain due to implant prominence were significantly higher in the PFN group (4.90 % versus 1.02 %). Kaplan Meier survival probability of 69.3 % and 79.5 % predicted for DHS and PFN respectively, 3 years postoperatively. CONCLUSIONS Our conclusion reinforces indication for PFN in unstable IT fractures (31 - A2 and 31 - A3), owing to its better functional outcome and biomechanical properties. Functional outcomes for stable IT fracture (AO 31 - A1) were comparable between DHS and PFN, therefore final decision for implant choice depends on implant cost, surgeon’s preference for specific technique. However, understanding the morphology of proximal femur, peritrochanteric region is crucial to analyse the anatomical variations in Indian population which will provide the basis for intramedullary nail design modifications. KEYWORDS Intertrochanteric Fractures, DHS Fixation, PFN Fixation

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Functional outcome after surgical treatment of spinal meningioma

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2020.05.042 ◽

2020 ◽

Vol 77 ◽

pp. 62-66 ◽

Cited By ~ 1

Author(s):

Christoph Hohenberger ◽

Christine Gugg ◽

Nils Ole Schmidt ◽

Florian Zeman ◽

Karl-Michael Schebesch

Keyword(s):

Surgical Treatment ◽

Functional Outcome ◽

Spinal Meningioma

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Arteria iliaca aneurysma nyitott és endovascularis kezelése

Orvosi Hetilap ◽

10.1556/650.2018.30968 ◽

2018 ◽

Vol 159 (13) ◽

pp. 520-525

Author(s):

Dávid Garbaisz ◽

András Boros ◽

Péter Legeza ◽

Zoltán Szeberin

Keyword(s):

Surgical Treatment ◽

Retrospective Analysis ◽

Iliac Artery ◽

Open Surgery ◽

Elective Surgery ◽

Artery Aneurysm ◽

Complication Rates ◽

Iliac Artery Aneurysm ◽

Term Survival ◽

Acute Surgery

Abstract: Introduction and aim: Iliac artery aneurysms make up 2% of all aneurysms. There are only a few data available on the results of surgical treatment, therefore the optimal treatment is unclear. Our objective was the retrospective analysis of the perioperative morbidity and mortality of patients who underwent iliac artery surgery as well as the comparison of elective open surgery and endovascular iliac aneurysm repair (EVIAR). Method: Retrospective analysis of patients who underwent surgery for iliac artery aneurysm between 1 January 2005 and 31 December 2014. Results: During the 10-year period, 62 patients with a mean age of 68.9 years underwent elective surgery for iliac artery aneurysm (54 males, 87.1%). In 10 cases acute surgery was performed due to aneurysm ruptures (13.9%), 3 patients died within the perioperative period (30%). Regarding anatomical localisation, aneurysm developed mostly on the common iliac artery (80.6%). As an elective surgery, 35 patients (56.5%) underwent open surgery, 25 (40.3%) underwent EVIAR and other endovascular interventions were performed in 2 cases (3.2%). Postoperative complications (1 patient [4.0%] vs. 17 patients [48.5%]; p<0.001) and intensive care treatment (29 patients [82.8%] vs. 2 patients [8.0%]; p<0.001) were significantly rarer after EVIAR than after open surgery. Furthermore, EVIAR resulted in considerably shorter postoperative hospital stays (4.7 ± 2.3 days vs. 11.8 ± 12.2 days; p = 0.006) and significantly less blood transfusion demand (1 patient [4.0%] vs. 26 patients [74.2%]; p<0.001). There were no significant differences regarding long-term survival rates between EVIAR and open surgery (81.4% vs. 71.4%; p = 0.95). Conclusion: In case of the surgical treatment of iliac artery aneurysms, owing to the lower complication rates and shorter postoperative length of stay, EVIAR is primarily recommended. Orv Hetil. 2018; 159(13): 520–525.

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