Brain energetics and neurosurgery

1971 ◽  
Vol 34 (1) ◽  
pp. 3-14 ◽  
Author(s):  
Barnes Woodhall ◽  
Richard S. Kramer ◽  
William D. Currie ◽  
Aaron P. Sanders
Keyword(s):  
Hyperbaric Oxygenation ◽  
Energy Levels ◽  
Energy System ◽  
Theory And Practice ◽  
Laboratory Animals ◽  
Content Type ◽  
Duke University ◽  
Brain Energy ◽  
Fine Print ◽  
Brain Energetics

✓ Consecutive studies of brain energetics undertaken at Duke University during a period of 5 years are described. Various forms of stress such as hypoxia, hyperbaric oxygenation, and selected drugs were used to depict quantitative adverse effects upon the brain's basic energy system, and protectant measures evaluated including hypothermia and appropriate substrates. A systematic survey of substrate protectants was carried out in laboratory animals, and the theory and practice of preserving brain energy levels explored. A foundation for clinical application has been established.

Terminal syringohydromyelia and occult spinal dysraphism

1994 ◽  
Vol 81 (4) ◽  
pp. 513-519 ◽  
Author(s):  
Bermans J. Iskandar ◽  
Jerry Oakes ◽  
Colleen McLaughlin ◽  
Alan K. Osumi ◽  
Robert D. Tien
Keyword(s):  
Spinal Cord ◽  
Mr Imaging ◽  
Medical Center ◽  
Spinal Dysraphism ◽  
Occult Spinal Dysraphism ◽  
Content Type ◽  
Bowel And Bladder Dysfunction ◽  
Duke University ◽  
Tight Filum Terminale ◽  
Fine Print

✓ Terminal syringohydromyelia is a cystic dilatation of the lower third of the spinal cord. The authors describe its incidence and characteristics, its frequent association with occult spinal dysraphism, and its clinical significance and need for surgical treatment. All 143 cases of occult spinal dysraphism treated at the Duke University Medical Center between 1972 and 1992 were reviewed. A terminal syrinx was found in 24 (27%) of the 90 cases that were evaluated by magnetic resonance (MR) imaging. In contrast, three (6.2%) of 48 cases evaluated by myelography and postmyelographic computerized tomography had a syrinx documented. The relative radiographic severity of the different syringes was estimated by using measurements of the syrinx and spinal cord on the MR images, classifying the cysts into large and small. Large syringes were frequently symptomatic, commonly presenting with pain, motor and sensory deficits of the lower extremities, scoliosis, and bowel and bladder dysfunction. Terminal syringohydromyelia with occult spinal dysraphic lesions was most often associated with tethered spinal cord from a tight filum terminale in the presence of an anorectal anomaly (67% of cases), meningocele manqué (54%), and diastematomyelia (38%). An infrequent association was seen with other spinal cord anomalies. The results of surgical management of terminal syringohydromyelia were analyzed, highlighting the necessity and effectiveness of shunting the large cysts, especially in the setting of a progressive symptomatology. Of the 11 patients with shunts who underwent MR imaging, 10 showed either complete or significant resolution of the syrinx; all five patients who had presented with pain (mainly back pain) showed complete resolution of the pain after shunting; finally, one-third of patients with shunt placement had significant postoperative improvement in their neurological examination, whereas none worsened. It is stressed that terminal syringohydromyelia is an important pathological entity that should be considered in patients with occult spinal dysraphism, and treated surgically when clinically or radiographically significant.

Gangliosides: the relevance of current research to neurosurgery

1991 ◽  
Vol 74 (4) ◽  
pp. 606-619 ◽  
Author(s):  
Frank A. Rodden ◽  
Herbert Wiegandt ◽  
Bernard L. Bauer
Keyword(s):  
Nervous System ◽  
Mammalian Cells ◽  
Human Subjects ◽  
Laboratory Animals ◽  
Trophic Effect ◽  
Content Type ◽  
Degree Of Malignancy ◽  
Fine Print

✓ Gangliosides are complex glycolipids found on the outer surface of most cell membranes: they are particularly concentrated in tissues of the nervous system. Gangliosides form part of the immunological identity of mammalian cells and are involved in a variety of cell-surface phenomena such as cell-substrate binding and receptor functions. In tumorous tissue, the ganglioside composition is altered, sometimes in direct proportion to the degree of malignancy. The literature on the glycosphingolipid composition and immunology of intracranial tumors is reviewed. Some gangliosides induce neuritogenesis and exhibit a trophic effect on nerve cells grown in vitro. In vivo, a particular ganglioside, GM1, reduces cerebral edema and accelerates recovery from injury (traumatic and ischemic) to the peripheral and central nervous systems of laboratory animals. Preliminary clinical studies have shown that treatment with gangliosides may have corresponding effects on lesions of the human peripheral nervous system. Gangliosides have not been tested in human subjects with brain injury.

Effects of hyperbaric oxygenation therapy on cerebral metabolism and intracranial pressure in severely brain injured patients

2001 ◽  
Vol 94 (3) ◽  
pp. 403-411 ◽  
Author(s):  
Sarah B. Rockswold ◽  
Gaylan L. Rockswold ◽  
Janet M. Vargo ◽  
Carla A. Erickson ◽  
Richard L. Sutton ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Intracranial Pressure ◽  
Hyperbaric Oxygenation ◽  
Cerebral Metabolism ◽  
Content Type ◽  
Brain Injured ◽  
Csf Lactate ◽  
Injured Patients ◽  
Fine Print

Object. Hyperbaric oxygenation (HBO) therapy has been shown to reduce mortality by 50% in a prospective randomized trial of severely brain injured patients conducted at the authors' institution. The purpose of the present study was to determine the effects of HBO on cerebral blood flow (CBF), cerebral metabolism, and intracranial pressure (ICP), and to determine the optimal HBO treatment paradigm. Methods. Oxygen (100% O2, 1.5 atm absolute) was delivered to 37 patients in a hyperbaric chamber for 60 minutes every 24 hours (maximum of seven treatments/patient). Cerebral blood flow, arteriovenous oxygen difference (AVDO2), cerebral metabolic rate of oxygen (CMRO2), ventricular cerebrospinal fluid (CSF) lactate, and ICP values were obtained 1 hour before and 1 hour and 6 hours after a session in an HBO chamber. Patients were assigned to one of three categories according to whether they had reduced, normal, or raised CBF before HBO. In patients in whom CBF levels were reduced before HBO sessions, both CBF and CMRO2 levels were raised 1 hour and 6 hours after HBO (p < 0.05). In patients in whom CBF levels were normal before HBO sessions, both CBF and CMRO2 levels were increased at 1 hour (p < 0.05), but were decreased by 6 hours after HBO. Cerebral blood flow was reduced 1 hour and 6 hours after HBO (p < 0.05), but CMRO2 was unchanged in patients who had exhibited a raised CBF before an HBO session. In all patients AVDO2 remained constant both before and after HBO. Levels of CSF lactate were consistently decreased 1 hour and 6 hours after HBO, regardless of the patient's CBF category before undergoing HBO (p < 0.05). Intracranial pressure values higher than 15 mm Hg before HBO were decreased 1 hour and 6 hours after HBO (p < 0.05). The effects of each HBO treatment did not last until the next session in the hyperbaric chamber. Conclusions. The increased CMRO2 and decreased CSF lactate levels after treatment indicate that HBO may improve aerobic metabolism in severely brain injured patients. This is the first study to demonstrate a prolonged effect of HBO treatment on CBF and cerebral metabolism. On the basis of their data the authors assert that shorter, more frequent exposure to HBO may optimize treatment.

The effect of hemoglobin and its metabolites on energy metabolism in cultured cerebrovascular smooth-muscle cells

1995 ◽  
Vol 82 (2) ◽  
pp. 244-249 ◽  
Author(s):  
Kazuhiko Nagatani ◽  
Jeffery E. Masciopinto ◽  
Peter B. Letarte ◽  
Robert A. Haworth ◽  
Thomas A. Duff
Keyword(s):  
Smooth Muscle ◽  
Smooth Muscle Cells ◽  
Energy Levels ◽  
Cerebral Arteries ◽  
Muscle Cells ◽  
Inhibitory Effect ◽  
Intact Cells ◽  
Content Type ◽  
Cerebrovascular Smooth Muscle Cells ◽  
Fine Print

✓ Cerebral arteries in spasm have been found to contain low levels of adenosine triphosphate (ATP), and it has been postulated that this change in levels results from hypoxia produced by arterial encasement in clotted material. This study was undertaken to determine whether any of four blood-derived agents, ferrous hemoglobin, methemoglobin, hemin, or bilirubin, is capable of reducing energy levels in cerebral artery smooth-muscle cells. Twenty-four-hour exposure of cultured canine basilar artery cells to ferrous hemoglobin and bilirubin led to a significant decline in ATP levels (to 8.9 nmol/mg protein and 2.8 nmol/mg protein, respectively) versus control (16.6 nmol/mg protein); methemoglobin and hemin showed no effect. Bilirubin but not hemoglobin was found to interfere with electron transport and with creatine phosphokinase activity in intact cells; however, bilirubin showed no inhibitory effect on this enzyme in cell-free conditions. The findings indicate that hemoglobin and bilirubin may be responsible for diminished energy levels in cerebral arteries. These observations also suggest that bilirubin may exert its effect on ATP by impairing mitochondrial function.

Effects of hyperbaric oxygenation and tissue oxygen studies in experimental paraplegia

1972 ◽  
Vol 36 (4) ◽  
pp. 425-429 ◽  
Author(s):  
David L. Kelly ◽  
Kenneth R. L. Lassiter ◽  
Arbha Vongsvivut ◽  
Jack M. Smith
Keyword(s):  
Spinal Cord ◽  
Hyperbaric Oxygen ◽  
Untreated Control ◽  
Hyperbaric Oxygenation ◽  
Control Group ◽  
Tissue Oxygen ◽  
Untreated Control Group ◽  
Content Type ◽  
Fine Print

✓ This study demonstrates that the tissue pO2 of the normal spinal cord of dogs can be modified by ventilating the animals with oxygen and carbogen. Following trauma to the cord, the tissue pO2 responded only to hyperbaric oxygen. A series of animals rendered paraplegic and treated with hyperbaric oxygen recovered to a greater degree than those in an untreated control group.

The role of multiple hyperbaric oxygenation in expanding therapeutic windows after acute spinal cord injury in rats

2003 ◽  
Vol 99 (2) ◽  
pp. 198-205 ◽  
Author(s):  
Lixin Huang ◽  
Maheshkumar P. Mehta ◽  
Anil Nanda ◽  
John H. Zhang
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Hyperbaric Oxygenation ◽  
Rating Scale ◽  
Therapeutic Window ◽  
Content Type ◽  
Cord Injury ◽  
Weight Drop ◽  
Fine Print

Object. Hyperbaric oxygenation (HBO) therapy has been reported to improve neurological recovery after spinal cord injury (SCI). In the present study, the authors examined whether multiple HBO therapy can expand the therapeutic window after acute SCI. Methods. Seventy rats were randomly assigned to seven groups: sham surgery; SCI without treatment; single HBO treatment beginning at 30 minutes, 3 hours, and 6 hours after SCI; and multiple HBO treatments starting at 6 and 24 hours postinjury. Mild SCI was induced by adjusting the height of a weight drop (10 g) to 6.25 mm above the exposed spinal cord. A single HBO administration was performed at 2.82 ata for 1 hour. The multiple HBO treatment modality was performed once daily for 1 week. All rats underwent behavioral testing with the Basso-Beattie-Breshnahan locomotor rating scale twice a week. Rats were killed on Day 42 postinjury and specimens comprising the lesioned area were histopathologically examined. Those rats that received single HBO intervention beginning at 30 minutes and 3 hours and those that received multiple HBO treatment starting at 6 hours following injury made significantly greater neurological recoveries than those in the nontreatment SCI group. These rats also retained more sparing tissue than controls. Conclusions. The results of this study demonstrate that multiple HBO treatments can expand the therapeutic window for acute SCI to 6 hours after injury.

New laboratory model for neurosurgical training that simulates live surgery

2002 ◽  
Vol 97 (6) ◽  
pp. 1367-1372 ◽  
Author(s):  
Emad Aboud ◽  
Ossama Al-Mefty ◽  
M. Gazi Yaşargil
Keyword(s):  
Surgical Procedures ◽  
Surgical Skills ◽  
Human Anatomy ◽  
Laboratory Animals ◽  
Laboratory Model ◽  
Clear Fluid ◽  
Content Type ◽  
Wide Range ◽  
Live Surgery ◽  
Fine Print

Object. Laboratory training models are essential for developing and refining surgical skills, especially for microsurgery. The closer to live surgery the model is, the greater the benefit. In this paper the authors introduce a cadaver model with unique characteristics: dynamic filling of the cerebral vasculature with colored liquid and clear fluid filling of the arachnoid cisterns. This model is distinctive and has great practical value for training in a wide range of surgical procedures. Methods. Cadaveric heads were prepared for surgical procedures in the following manner: the carotid arteries (CAs) and vertebral arteries (VAs) in the neck were cannulated, as were the internal jugular veins (JVs) on both sides. Two tubes were introduced into the spinal canal and each one was advanced into one of the cerebellopontine angle cisterns. A CA, VA, or both were then connected to a reservoir containing light red fluid and a pressure of 80 to 120 mm Hg and a pulse rate of 60 beats/minute were established using a pump. The JV on the side currently being dissected was connected to a reservoir containing dark red fluid and kept at a pressure between 20 and 40 mm Hg. The remaining vessels were clamped in the neck. The cisternal tubes were connected to a reservoir of clear fluid that was regulated by an adjustable flow. Nine trainees have tested this model on eight specimens by practicing a variety of surgical procedures and maneuvers, including craniotomies; hemostasis; cisternal and vascular dissection; vascular anastomosis and repair; establishment of arterial bypasses; aneurysm creation, dissection, and clipping; management of an aneurysm rupture; intraparenchymal resection such as amygdalohippocampectomy; ventricular endoscopy and third ventriculostomy; cavernous sinus and skull base approaches; and resection of artificial tumors in the basal cisterns. Conclusions. This model mimics the normal human anatomy and dynamic vascular filling found in real surgery and presents it from the training perspective, allowing a wide range of skill development and repeated practice. It provides an alternative model to laboratory animals. It is inexpensive and readily available, and has great value for the acquisition and refinement of surgical skills that are not only specific to neurosurgery, but are applicable to other surgical disciplines.

Brain energetics and circulatory control after subarachnoid hemorrhage

1976 ◽  
Vol 45 (5) ◽  
pp. 498-507 ◽  
Author(s):  
Jack M. Fein
Keyword(s):  
Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Perfusion ◽  
Perfusion Pressure ◽  
Content Type ◽  
Vascular Responses ◽  
Intravascular Thrombosis ◽  
Circulatory Control ◽  
Fine Print ◽  
Brain Energetics

✓ Ischemia-provoking factors such as vasospasm, decreased cerebral perfusion pressure, and intravascular thrombosis may be present after subarachnoid hemorrhage (SAH). When these factors were not present during controlled SAH, a primary depression of cerebral glycolysis associated with normal stores of energy-rich phosphates was found. Although cerebral blood flow usually changes in response to changes in cerebral metabolic needs, this influence on the circulation was not evident in the early hours after SAH. After 3 to 4 hours an erratic decrease in blood flow occurred, probably related to vasospasm; and there were measurable decreases in energy-rich phosphates similar to those occurring after more severe and prolonged ischemias. These findings are indicative of abnormally erratic vascular responses to metabolic cues and may play a role in producing the encephalopathy of SAH.

The Duke University Medical Center

1993 ◽  
Vol 78 (2) ◽  
pp. 301-304
Author(s):  
Robert H. Wilkins ◽  
David C. Sabiston
Keyword(s):  
Trinity College ◽  
Medical Center ◽  
Content Type ◽  
School Of Medicine ◽  
Duke University ◽  
The Creation ◽  
Neurosurgical Operation ◽  
Fine Print

✓ The events leading up to the creation of Duke University, the Duke University School of Medicine, and Duke Hospital are reviewed. The efforts of many individuals during more than 80 years were rewarded by an endowment and then a bequest by James B. Duke that converted Trinity College into Duke University and made possible the origination of its Medical Center. The first neurosurgical operation at the new hospital was performed on July 24, 1930, the fourth day it was open.

Evaluation of gamma thalamotomy for parkinsonian and other tremors: survival of neurons adjacent to the thalamic lesion after gamma thalamotomy

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 120-127 ◽  
Author(s):  
Chihiro Ohye ◽  
Tohru Shibazaki ◽  
Junji Ishihara ◽  
Jie Zhang
Keyword(s):  
Tissue Reaction ◽  
Vascular Lesions ◽  
Thalamic Lesion ◽  
Mr Images ◽  
Unsatisfactory Result ◽  
Content Type ◽  
Rhythmic Discharge ◽  
Latent Interval ◽  
Fine Print

Object. The effects of gamma thalamotomy for parkinsonian and other kinds of tremor were evaluated. Methods. Thirty-six thalamotomies were performed in 31 patients by using a 4-mm collimator. The maximum dose was 150 Gy in the initial six cases, which was reduced to 130 Gy thereafter. The longest follow-up period was 6 years. The target was determined on T2-weighted and proton magnetic resonance (MR) images. The point chosen was in the lateral-most part of the thalamic ventralis intermedius nucleus. This is in keeping with open thalamotomy as practiced at the authors' institution. In 15 cases, gamma thalamotomy was the first surgical procedure. In other cases, previous therapeutic or vascular lesions were visible to facilitate targeting. Two types of tissue reaction were onserved on MR imaging: a simple oval shape and a complex irregular shape. Neither of these changes affected the clinical course. In the majority of cases, the tremor subsided after a latent interval of approximately 1 year after irradiation. The earliest response was demonstrated at 3 months. In five cases the tremor remained. In four of these cases, a second radiation session was administered. One of these four patients as well as another patient with an unsatisfactory result underwent open thalamotomy with microrecording. In both cases, depth recording adjacent to the necrotic area revealed normal neuronal activity, including the rhythmic discharge of tremor. Minor coagulation was performed and resulted in immediate and complete arrest of the remaining tremor. Conclusions. Gamma thalamotomy for Parkinson's disease seems to be an alternative useful method in selected cases.

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