Tag: Brain injury

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Circulating Brain Injury Biomarkers: A Novel Method for Quantification of the Impact on the Brain After Tumor Surgery

Neurosurgery 93:847–856, 2023

Clinical methods to quantify brain injury related to neurosurgery are scarce. Circulating brain injury biomarkers have recently gained increased interest as new ultrasensitive measurement techniques have enabled quantification of brain injury through blood sampling.

OBJECTIVE: To establish the time profile of the increase in the circulating brain injury biomarkers glial fibrillary acidic protein (GFAP), tau, and neurofilament light (NfL) after glioma surgery and to explore possible relationships between these biomarkers and outcome regarding volume of ischemic injury identified with postoperative MRI and new neurological deficits.

METHODS: In this prospective study, 34 adult patients scheduled for glioma surgery were included. Plasma concentrations of brain injury biomarkers were measured the day before surgery, immediately after surgery, and on postoperative days 1, 3, 5, and 10.

RESULTS: Circulating brain injury biomarkers displayed a postoperative increase in the levels of GFAP (P < .001), tau (P < .001), and NfL (P < .001) on Day 1 and a later, even higher, peak of NFL at Day 10 (P = .028). We found a correlation between the increased levels of GFAP, tau, and NfL on Day 1 after surgery and the volume of ischemic brain tissue on postoperative MRI. Patients with new neurological deficits after surgery had higher levels of GFAP and NfL on Day 1 compared with those without new neurological deficits.

CONCLUSION: Measuring circulating brain injury biomarkers could be a useful method for quantification of the impact on the brain after tumor surgery or neurosurgery in general.

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A new simple and free tubular device for microscopic transcortical approach to deep‑seated lesions

Acta Neurochirurgica (2022) 164:2049–2055

Surgery for deep-seated brain tumors remains challenging. Transcortical approaches often require brain retraction to ensure an adequate surgical corridor, thus possibly leading to brain damage. Various techniques have been developed to minimize brain retraction such as self-retaining retractors, endoscopic approaches, or tubular retractor systems. Even if they evenly distribute the mechanical pressure over the parenchyma, rigid retractors can also cause some degree of brain damage and have significant disadvantages. We propose here a soft cottonoid retractor for microscopic resection of deepseated and ventricular lesions.

Methods Through a small corticectomy, a channel route with a blunt cannula is developed until the lesion is reached. Then, a “balloon-like system” made with a surgical glove is progressively inflated, dilatating the surgical corridor. A mini-tubular device, handmade by suturing a surgical cottonoid, is positioned into the corridor, unfolded, and sutured to the edge of the dura, to prevent it from being progressively expelled from the working channel. This allows a good visualization of the lesion and surrounding structures under the microscope.

Results Advantages of this technique are the softness of the tube walls, the absence of rigid arm to hold the tube, and the possibility for the tube to follow the movements of the instruments and to modify its orientation according to the working area.

Conclusion This simple and inexpensive tubular working channel for microscopic transcortical approach is a valuable alternative technique to traditional self-retaining retractor and rigid tube for the microsurgical resection of deep-seated brain tumors.

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Evolution and Impact of the Brain Trauma Foundation Guidelines

Neurosurgery 89:1148–1156, 2021

The Brain Trauma Foundation (BTF) Guidelines for the Management of Severe Head Injury were the first clinical practice guidelines published by any surgical specialty. These guidelines have earned a reputation for rigor and have been widely adopted around the world. Implementation of these guidelines has been associated with a 50% reduction in mortality and reduced costs of patient care.

Over their 25-yr history the traumatic brain injury (TBI) guidelines have been expanded, refined, and made increasingly more rigorous in conjunction with new clinical evidence and evolving methodologic standards.

Here, we discuss the history and accomplishments of BTF guidelines for TBI as well as their limitations. We also discuss planned changes to future TBI guidelines intended to increase their utility and positive impact in an evolving medical landscape. Perhaps the greatest limitation of TBI guidelines now is the lack of high-quality clinical research as well as novel diagnostics and treatments with which to generate substantially new recommendations.

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The Impact of Minimizing Brain Retraction in Aneurysm Surgery: Evaluation Using Magnetic Resonance Imaging

Neurosurgery 69:344–348, 2011 DOI: 10.1227/NEU.0b013e31821819a0

Recent advances in skull base and microsurgical techniques minimize the need for brain retraction.

OBJECTIVE: We studied the impact of such techniques in 36 patients (51 aneurysms) using magnetic resonance imaging (MRI).

METHODS: Preoperative and 24 hours postoperative MR imaging was performed in patients undergoing microsurgical clipping of intracranial aneurysms. Images were evaluated for parenchymal signal changes. During surgery, use and time of brain retraction were recorded. The degree of cortical injury was quantified using a 0 to 3 scale (grade 0 = normal surface; 1 = pial/arachnoidal damage; 2 = gray matter injury; 3 = contusion/necrosis).

RESULTS: Brain retraction by use of a brain spatula was used in all patients. Retraction times ranged from 14 to 290 minutes (mean, 84.1). Cortical surface changes were grade 0 in 86% and grade 1 in 14%; none showed grade 2 or 3 changes. In the postoperative MRI, 4 patients presented with parenchymal alterations, 4 with edema (11.1%), and 1 patient had additional contusion (2.8%). All lesions were confined to the temporal pole. The grade of cortical surface changes was not related to lesions found on MR imaging. No patients showed retraction-related neurological deficits.

CONCLUSION: The incidence of evident mechanical parenchymal injury (infarction or contusion) is very low when appropriate microsurgical and skull base techniques are used. Minor pia-arachnoid injury should nevertheless continue to be attended through future advances.

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