“Microendoscopic” versus “pure endoscopic” surgery for spinal intradural mass lesions: a comparative study and review

Background Context

Endoscopy is increasingly being used for minimal invasiveness and panoramic visualization, with unclear efficacy and safety among spinal intradural mass.

An evaluation and comparison of intraventricular, intraparenchymal, and fluid-coupled techniques for intracranial pressure monitoring in patients with severe traumatic brain injury

Objective

Intracranial pressure measurements have become one of the mainstays of traumatic brain injury management. Various technologies exist to monitor intracranial pressure from a variety of locations. Transducers are usually placed to assess pressure in the brain parenchyma and the intra-ventricular fluid, which are the two most widely accepted compartmental monitoring sites. The individual reliability and inter-reliability of these devices with and without cerebrospinal fluid diversion is not clear. The predictive capability of monitors in both of these sites to local, regional, and global changes also needs further clarification. The technique of monitoring intraventricular pressure with a fluid-coupled transducer system is also reviewed. There has been little investigation into the relationship among pressure measurements obtained from these two sources using these three techniques.

Methods

Eleven consecutive patients with severe, closed traumatic brain injury not requiring intracranial mass lesion evacuation were admitted into this prospective study. Each patient underwent placement of a parenchymal and intraventricular pressure monitor. The ventricular catheter tubing was also connected to a sensor for fluid-coupled measurement. Pressure from all three sources was measured hourly with and without ventricular drainage.

Results

Statistically significant correlation within each mon- itoring site was seen. No monitoring location was more predictive of global pressure changes or more responsive to pressure changes related to patient stimulation. However, the intraven- tricular pressure measurements were not reliable in the presence of cerebrospinal fluid drainage whereas the parenchymal measure- ments remained unaffected.

Conclusion

Intraparenchymal pressure monitoring provides equivalent, statistically similar pressure measurements when compared to intraventricular monitors in all care and clinical settings. This is particularly valuable when uninterrupted cerebrospinal fluid drainage is desirable.     

Curcumin attenuates vascular inflammation and cerebral vasospasm after subarachnoid hemorrhage in mice

Cerebral vasospasm is a major cause of death and disability after subarachnoid hemorrhage (SAH); however, clinical therapies to limit the development of cerebral vasospasm are lacking. Although the causative factors underlying the development of cerebral vasospasm are poorly understood, oxidative stress contributes to disease progression. In the present study, curcumin (150 or 300 mg/kg) protected against the development of cerebral vasospasm and limited secondary cerebral infarction after SAH in mice. The protective effect of curcumin was associated with a significant attenuation of inflammatory gene expression and lipid peroxidation within the cerebral cortex and the middle cerebral artery. Despite the ability of curcumin to limit the development of cerebral vasospasm and secondary infarction, behavioral outcome was not improved, indicating a dissociation between cerebral vasospasm and neurologic outcome. Together, these data indicate a novel role for curcumin as a possible adjunct therapy after SAH, both to prevent the development of cerebral vasospasm and to reduce oxidative brain injury after secondary infarction.     

Is ligation and division of anterior third of superior sagittal sinus really safe?

Background/object

Ligation and division of anterior third (AT) of superior sagittal sinus (SSS) is presumed to be safe and is commonly used for approaching anterior skull base tumors and distal anterior cerebral artery aneurysms (DACA). Contrary to this belief we found complications secondary to this procedure more often than described and we have described them along with probable etiology.

Materials and methods

A total of 62 patients who underwent bifrontal or extended bifrontal craniotomies with ligation and division of the proximal end of SSS were studied retrospectively. The clinical profiles and postoperative CT scans were studied to look for venous edema and hemorrhages. Venogram (digital subtraction) was done in one of the patients who had developed this complication.

Results

Five patients developed bifrontal venous hemorrhagic infarcts (4 patients with anterior skull base tumors and 1 with DACA aneurysm). These patients had a morbid postoperative hospital stay with memory disturbances and urinary incontinence in the follow up period. Two patients died. The venogram done in one patient revealed complete occlusion of the AT-SSS. The morbidity and mortality that can be attributed to ligation of AT-SSS was 8.06% and 1.6% respectively.

Conclusions

The safety of ligation and division of the AT-SSS is questionable, contrary to traditional teaching. Though only the proximal end of SSS is ligated, the occlusion extends upto the distal craniotomy edge possibly due to reflection of the dural leaf with AT-SSS that causes kinking and thrombosis. It is more often seen in patients with anterior skull base lesions, probably because of already compromised basal venous drainage. A preoperative venogram could possibly predict the safety of this procedure.     

Effect of high-fat diet on cholesterol distribution in plasma lipoproteins, cholesterol esterifying activity in leucocytes, and erythrocyte membrane components studied: importance of body weight

Effects of isocaloric changes in dietary fat on plasma lipoproteins and lipids and enzymes of erythrocytes and leucocytes were assessed. Subjects with a higher Brocca index showed increase in total and LDL cholesterol, significant reduction in HDL cholesterol, and increased total cholesterol:HDL cholesterol ratio after high-fat diet consumption. Due to high-fat diet feeding, erythrocyte membrane and leucocyte cholesterol and phospholipid contents were increased, cholesterol:phospholipid molar ratio was elevated, and erythrocyte enzymes (G6PD and 6PGD) and leucocyte enzymes (CEH and CES) were elevated. Erythrocyte membrane glycoprotein components showed marked increase, indicating possible alterations of membrane surfaces. The metabolic alterations were reversed slowly after resumption of the normal (low-fat) diet. Body weight plays an important role in the alterations in major lipoprotein cholesterol contents in response to changes in dietary fat composition. Cellular changes indicate alterations in structure and function of blood cells due to high-fat diet feeding.