Abstract:
OBJECT:Control of intracranial pressure (ICP) and cerebral perfusion pressure (CPP) is the foundation of traumatic brain injury (TBI) management. In this study, the authors examined whether conventional ICP- and CPP-guided neurocritical care ensures adequate brain tissue O2 in the first 6 hours after resuscitation. METHODS:Resuscitated patients with severe TBI (Glasgow Coma Scale score < or = 8 and Injury Severity Scale score > or = 16) who were admitted to a Level I trauma center and who underwent brain tissue O2 monitoring within 6 hours of injury were evaluated as part of a prospective observational database. Therapy was directed to maintain an ICP of 25 mm Hg or less and a CPP of 60 mm Hg or higher. Data from a group of 25 patients that included 19 men and six women (mean age 39 +/- 20 years) were examined. After resuscitation, ICP was 25 mm Hg or less in 84% and CPP was 60 mm Hg or greater in 88% of the patients. Brain O2 probes were allowed to stabilize; the initial brain tissue O2 level was 25 mm Hg or less in 68% of the patients, 20 mm Hg or less in 56%, and 10 mm Hg or less in 36%. Nearly one third (29%) of patients with ICP readings of 25 mm Hg or less and 27% with CPP levels of 60 mm Hg or greater had severe cerebral hypoxia (brain tissue O2 < or = 10 mm Hg). Nineteen patients had both optimal ICP (< 25 mm Hg) and CPP (> 60 mm Hg); brain tissue O2 was 20 mm Hg or less in 47% and 10 mm Hg or less in 21% of these patients. The mortality rate was higher in patients with reduced brain tissue O2. CONCLUSIONS:Brain resuscitation based on current neurocritical care standards (that is, control of ICP and CPP) does not prevent cerebral hypoxia in some patients. This finding may help explain why secondary neuronal injury occurs in some patients with adequate CPP and suggests that the definition of adequate brain resuscitation after TBI may need to be reconsidered.
journal_name
J Neurosurgjournal_title
Journal of neurosurgeryauthors
Stiefel MF,Udoetuk JD,Spiotta AM,Gracias VH,Goldberg A,Maloney-Wilensky E,Bloom S,Le Roux PDdoi
10.3171/jns.2006.105.4.568subject
Has Abstractpub_date
2006-10-01 00:00:00pages
568-75issue
4eissn
0022-3085issn
1933-0693journal_volume
105pub_type
杂志文章abstract:OBJECT:Patients with gliomas frequently have cognitive deficits, and surgery can exacerbate these deficits. Preoperative assessment is therefore crucial in patients undergoing surgery for glioma in eloquent areas, because the proximity of functional areas increases the risk of permanent postoperative cognitive disturba...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2012.7.JNS12263
更新日期:2012-11-01 00:00:00
abstract::Language impairments were reviewed retrospectively in patients who underwent partial or total corpus callosum section for medically refractory secondary generalized epilepsy. Postoperatively, four of 32 patients had clinically significant language impairments that were not present prior to the operation. All involved ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1990.72.1.0085
更新日期:1990-01-01 00:00:00
abstract:OBJECT:Growth factors such as bone morphogenetic protein-2 (BMP-2) have been proven to promote spine fusion and to overcome the disadvantages of an autologous bone graft. The optimum method to deliver such growth factors remains a matter of discussion. The purpose of this study was to determine the safety and efficacy ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/spi.2002.97.1.0040
更新日期:2002-07-01 00:00:00
abstract:OBJECTIVE:Magnetic resonance imaging-guided focused ultrasound (MRgFUS) is a novel and useful treatment for essential tremor (ET); however, the factors impacting treatment outcome are unknown. The authors conducted this study to determine the factors affecting the outcome of MRgFUS. METHODS:From May 2016 through Augus...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2020.2.JNS192814
更新日期:2020-05-01 00:00:00
abstract:OBJECT:The treatment of solitary vestibular schwannomas by performing Gamma Knife surgery is well established. It has been reported that decreasing the surface dose reduces patient morbidity, especially facial weakness and numbness. The authors of this retrospective study examine patient data from a single center to de...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/sup.2006.105.7.154
更新日期:2006-12-01 00:00:00
abstract::A survey of 89 patients with subdural empyema was conducted to assess the incidence of late seizures and morbidity in this disease. Twenty-four patients died during the acute stage of the illness and, of the 65 survivors, 13 were lost or had incomplete follow-up review. Hemiparesis occurred in 48 of the survivors duri...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1983.58.4.0569
更新日期:1983-04-01 00:00:00
abstract::The authors report on the morphological features of a pituitary adenoma that produced growth hormone (GH) and adrenocorticotropic hormone (ACTH). This hormone combination produced by a single adenoma is extremely rare; a review of the available literature showed that only one previous case has been published. The tumo...
journal_title:Journal of neurosurgery
pub_type: 杂志文章,评审
doi:10.3171/jns.1998.88.6.1111
更新日期:1998-06-01 00:00:00
abstract::Intracranial pressure (ICP) and cerebral perfusion pressure were monitored in 12 patients who were comatose secondary to hypoxic (five cases) or hypotensive (seven cases) nontraumatic cerebral insults. Patients who were hypotensive but not hypoxic developed significant increased ICP. In patients who were comatose from...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1981.54.4.0489
更新日期:1981-04-01 00:00:00
abstract::Local experimental subarachnoid hemorrhage (SAH) was produced over the cerebral cortex in 15 cats. The cellular response was monitored using ion-specific electrodes for extracellular potassium (K+) and calcium (Ca++) activity, DC cortical potential, and electrocorticogram. The response was characterized by a profound ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1982.56.2.0216
更新日期:1982-02-01 00:00:00
abstract::Intracranial gas may be epidural, subdural, subarachnoid, parenchymal, or intraventricular. Intracranial air can be easily diagnosed and its location correctly assessed by computerized tomography. Potentially serious complications of intracranial air, such as tension pneumocephalus, can be rapidly and accurately ident...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1978.48.3.0355
更新日期:1978-03-01 00:00:00
abstract:OBJECT:Iliac crest bone graft harvesting can result in major complications, the rates of which range from approximately 6 to 8%. The objective of this study was to evaluate the postoperative regeneration of iliac crest donor defects in an animal model after harvesting a full-thickness tricortical graft. METHODS:In ske...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/spi.2002.97.4.0456
更新日期:2002-11-01 00:00:00
abstract::Surgical sacrifice of the carotid artery is a frequently anticipated event during the treatment of certain aneurysms and tumors. The ability to predict tolerance to carotid artery occlusion is therefore of benefit when planning procedures in which the carotid artery is at risk. A trial of carotid artery occlusion usin...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1994.81.1.0015
更新日期:1994-07-01 00:00:00
abstract:OBJECT:The use of focal brain cooling to eliminate epileptic discharges (EDs) has attracted increasing attention in the scientific community. In this study, the inhibitory effect of selective hippocampal cooling on experimental hippocampal seizures was investigated using a newly devised cooling system with a thermoelec...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/JNS/2008/108/4/0791
更新日期:2008-04-01 00:00:00
abstract:OBJECT:The goals of this study were to report the clinical presentation, radiographic findings, operative strategy, and outcomes among patients with temporal bone encephaloceles and cerebrospinal fluid fistulas (CSFFs) and to identify clinical variables associated with surgical outcome. METHODS:A retrospective case se...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2013.6.JNS13322
更新日期:2013-11-01 00:00:00
abstract::Cavernous hemangiomas of the orbit are benign vascular growths that commonly occur in adults and account for 6% of all intraorbital tumors. Multifocal intraorbital cavernous hemangiomas are quite rare. The reported incidence of arachnoid cysts accounts for only 1% of lesions that occupy intracranial space, and they ar...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/ped.2005.103.5.0454
更新日期:2005-11-01 00:00:00
abstract::A 12-year operative experience with 171 consecutive patients with severe brachial plexus lesions who had at least 1 1/2 years of follow-up review is analyzed. Selection for and timing of operation was helped by categorization of each individual plexus element as "completely" or "incompletely" injured and as "in contin...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1983.58.5.0631
更新日期:1983-05-01 00:00:00
abstract::The author describes the history of neurosurgery in Manitoba, with particular emphasis on events that occurred after his arrival there in 1950. Highlights of global neurosurgery are spliced into the author's reminiscences to anchor the local history with that of neurosurgery as a whole. ...
journal_title:Journal of neurosurgery
pub_type: 历史文章,杂志文章
doi:10.3171/jns.1995.82.5.0900
更新日期:1995-05-01 00:00:00
abstract::Forty-seven patients with medulloblastoma were treated postoperatively with procarbazine, followed by craniospinal radiation therapy in combination with hydroxyurea. The radiation dose to the posterior fossa was 55 Gy; the spinal cord received 25 Gy and the whole brain 25 to 35 Gy (mean 33 Gy). Seventeen tumors recurr...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1988.68.3.0383
更新日期:1988-03-01 00:00:00
abstract::Pericranium is frequently used in duraplasty and is considered superior to the many other alternatives because of its easy availability and because it offers a watertight dural closure while minimizing the problems of adhesion, infection, and rejection. Although the osteogenic potential of all periosteal tissues is re...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.2001.95.2.0350
更新日期:2001-08-01 00:00:00
abstract::Lumbar cerebrospinal fluid (CSF) pressure was recorded in 116 adult neurosurgical patients in the lateral and sitting positions. The level of zero CSF pressure while in the sitting position (ZPS) and hydrostatic indifferent point (HIP) for lateral and sitting positions were determined and referred to the craniospinal ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1976.44.6.0698
更新日期:1976-06-01 00:00:00
abstract::The results of treatment of neoplastic spinal cord compression by vertebral body resection and immediate stabilization in 101 consecutive patients over a 5-year period have been analyzed. Sites of primary cancer included the lung (25 patients), kidney (15 patients), breast (14 patients), connective tissue (12 patients...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1985.63.5.0676
更新日期:1985-11-01 00:00:00
abstract::This study was undertaken to confirm the presence of alpha-1-antitrypsin (alpha 1-AT) in human brain tumors and to attempt to elucidate its significance. Seventy-seven consecutive unselected patients with various brain tumors were entered in this study. The alpha 1-AT and alpha 2-macroglobulin contents of the tumor ex...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1987.67.2.0258
更新日期:1987-08-01 00:00:00
abstract:OBJECT:The risk of surgical site infection (SSI) after craniotomies or craniectomies in patients in whom contaminated bone flaps have been reimplanted has not been determined. The objectives of this study were to identify the prevalence of bone flaps with positive cultures--especially those contaminated with Propioniba...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2011.1.JNS10782
更新日期:2011-06-01 00:00:00
abstract:OBJECT:The aim of this study was to determine the anatomical limitations of the transcallosal transchoroidal approach to the third ventricle. METHODS:Twenty-six formalin-fixed specimens were studied. Sagittal dissections were used to determine the anatomical relationships of the foramen of Monro, the angle of approach...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2008.7.JNS08124
更新日期:2009-09-01 00:00:00
abstract::The authors reviewed 229 consecutive patients treated intramurally by resection of solitary cerebral metastasis. Patients were classified into four groups on the basis of whether a gross total resection or subtotal resection was performed and whether systemic disease was present or absent at the time of craniotomy. Gr...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1992.77.4.0531
更新日期:1992-10-01 00:00:00
abstract:OBJECT:The nitric oxide system has been linked to the pathogenesis of aneurysmal subarachnoid hemorrhage (SAH). The authors performed a case-control study to investigate the association between SAH and common genetic variants within the endothelial nitric oxide synthase gene (NOS3). METHODS:Three hundred thirty-three ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/2014.5.JNS131572
更新日期:2014-09-01 00:00:00
abstract::The benefits of radiosurgery for cavernous malformations are difficult to assess because of the unclear natural history of this vascular lesion, the inability to image malformation vessels, and the lack of an imaging technique that defines "cure." The authors selected for radiosurgery 47 patients who harbored a hemorr...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1995.83.5.0825
更新日期:1995-11-01 00:00:00
abstract::The authors report the results of a study to evaluate the effect of stimulation of the medullary reticular formation on cerebral vasomotor tonus and intracranial pressure (ICP) after the hypothalamic dorsomedial nucleus and midbrain reticular formation were destroyed. Systemic arterial pressure (BP), ICP, and local ce...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1987.66.4.0548
更新日期:1987-04-01 00:00:00
abstract::A case of congenital ventriculocisternostomy is reported. This infant presented with occipital meningocele. Conray ventriculography demonstrated a spontaneous ventriculocisternostomy and stenosis of the aqueduct. The case is discussed and pertinent literature reviewed. ...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1981.54.1.0098
更新日期:1981-01-01 00:00:00
abstract:OBJECT:This study was conducted to determine if there is a change in intracranial arterial diameters after papaverine infusion for vasospasm and to determine whether the change occurs in proximal, intermediate, and distal arteries. METHODS:The authors measured arterial diameters retrospectively in all patients who rec...
journal_title:Journal of neurosurgery
pub_type: 杂志文章
doi:10.3171/jns.1998.88.1.0038
更新日期:1998-01-01 00:00:00