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Lenell, S., Svedung-Wettervik, T., Howells, T., Hånell, A., Lewén, A. & Enblad, P. (2024). Cerebrovascular reactivity (PRx) and optimal cerebral perfusion pressure in elderly with traumatic brain injury. Acta Neurochirurgica, 166(1), Article ID 62.
Open this publication in new window or tab >>Cerebrovascular reactivity (PRx) and optimal cerebral perfusion pressure in elderly with traumatic brain injury
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2024 (English)In: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 166, no 1, article id 62Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Cerebral perfusion pressure (CPP) guidance by cerebral pressure autoregulation (CPA) status according to PRx (correlation mean arterial blood pressure (MAP) and intracranial pressure (ICP)) and optimal CPP (CPPopt = CPP with lowest PRx) is promising but little is known regarding this approach in elderly. The aim was to analyze PRx and CPPopt in elderly TBI patients.

METHODS: A total of 129 old (≥ 65 years) and 342 young (16-64 years) patients were studied using monitoring data for MAP and ICP. CPP, PRx, CPPopt, and ΔCPPopt (difference between actual CPP and CPPopt) were calculated. Logistic regression analyses with PRx and ΔCPPopt as explanatory variables for outcome. The combined effects of PRx/CPP and PRx/ΔCPPopt on outcome were visualized as heatmaps.

RESULTS: The elderly had higher PRx (worse CPA), higher CPPopt, and different temporal patterns. High PRx influenced outcome negatively in the elderly but less so than in younger patients. CPP close to CPPopt correlated to favorable outcome in younger, in contrast to elderly patients. Heatmap interaction analysis of PRx/ΔCPPopt in the elderly showed that the region for favorable outcome was centered around PRx 0 and ranging between both functioning and impaired CPA (PRx range - 0.5-0.5), and the center of ΔCPPopt was - 10 (range - 20-0), while in younger the center of PRx was around - 0.5 and ΔCPPopt closer to zero.

CONCLUSIONS: The elderly exhibit higher PRx and CPPopt. High PRx influences outcome negatively in the elderly but less than in younger patients. The elderly do not show better outcome when CPP is close to CPPopt in contrast to younger patients.

Place, publisher, year, edition, pages
Springer Nature, 2024
Keywords
Cerebral autoregulation, Elderly, Neurointensive care monitoring, Optimal cerebral perfusion pressure, Pressure reactivity index, Traumatic brain injury
National Category
Neurology
Research subject
Neurosurgery
Identifiers
urn:nbn:se:uu:diva-522380 (URN)10.1007/s00701-024-05956-9 (DOI)001154580300001 ()38305993 (PubMedID)
Available from: 2024-02-04 Created: 2024-02-04 Last updated: 2024-03-06Bibliographically approved
Dyhrfort, P., Svedung-Wettervik, T., Clausen, F., Enblad, P., Hillered, L. & Lewén, A. (2023). A Dedicated 21-Plex Proximity Extension Assay Panel for High-Sensitivity Protein Biomarker Detection Using Microdialysis in Severe Traumatic Brain Injury: The Next Step in Precision Medicine?. NEUROTRAUMA REPORTS, 4(1), 25-40
Open this publication in new window or tab >>A Dedicated 21-Plex Proximity Extension Assay Panel for High-Sensitivity Protein Biomarker Detection Using Microdialysis in Severe Traumatic Brain Injury: The Next Step in Precision Medicine?
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2023 (English)In: NEUROTRAUMA REPORTS, ISSN 2689-288X, Vol. 4, no 1, p. 25-40Article in journal (Refereed) Published
Abstract [en]

Cerebral protein profiling in traumatic brain injury (TBI) is needed to better comprehend secondary injury pathways. Cerebral microdialysis (CMD), in combination with the proximity extension assay (PEA) technique, has great potential in this field. By using PEA, we have previously screened >500 proteins from CMD samples collected from TBI patients. In this study, we customized a PEA panel prototype of 21 selected candidate protein biomarkers, involved in inflammation (13), neuroplasticity/-repair (six), and axonal injury (two). The aim was to study their temporal dynamics and relation to age, structural injury, and clinical outcome. Ten patients with severe TBI and CMD monitoring, who were treated in the Neurointensive Care Unit, Uppsala University Hospital, Sweden, were included. Hourly CMD samples were collected for up to 7 days after trauma and analyzed with the 21-plex PEA panel. Seventeen of the 21 proteins from the CMD sample analyses showed significantly different mean levels between days. Early peaks (within 48 h) were noted with interleukin (IL)-1 beta, IL-6, IL-8, granulocyte colony-stimulating factor, transforming growth factor alpha, brevican, junctional adhesion molecule B, and neurocan. C-X-C motif chemokine ligand 10 peaked after 3 days. Late peaks (>5 days) were noted with interleukin-1 receptor antagonist (IL-1ra), monocyte chemoattractant protein (MCP)-2, MCP-3, urokinase-type plasminogen activator, Dickkopf-related protein 1, and DRAXIN. IL-8, neurofilament heavy chain, and TAU were biphasic. Age (above/below 22 years) interacted with the temporal dynamics of IL-6, IL-1ra, vascular endothelial growth factor, MCP-3, and TAU. There was no association between radiological injury (Marshall grade) or clinical outcome (Extended Glasgow Outcome Scale) with the protein expression pattern. The PEA method is a highly sensitive molecular tool for protein profiling from cerebral tissue in TBI. The novel TBI dedicated 21-plex panel showed marked regulation of proteins belonging to the inflammation, plasticity/repair, and axonal injury families. The method may enable important insights into complex injury processes on a molecular level that may be of value in future efforts to tailor pharmacological TBI trials to better address specific disease processes and optimize timing of treatments.

Place, publisher, year, edition, pages
Mary Ann Liebert, 2023
Keywords
biomarker, cerebral microdialysis, neurointensive care, proximity extension assay, traumatic brain injury
National Category
Neurology Neurosciences
Identifiers
urn:nbn:se:uu:diva-497708 (URN)10.1089/neur.2022.0067 (DOI)000915436800001 ()36726870 (PubMedID)
Note

De tre första författarna delar förstaförfattarskapet.

De två sista författarna delar sistaförfattarskapet.

Available from: 2023-03-09 Created: 2023-03-09 Last updated: 2023-03-09Bibliographically approved
Baldvinsdóttir, B., Kronvall, E., Ronne-Engström, E., Enblad, P., Lindvall, P., Aineskog, H., . . . Nilsson, O. G. (2023). Adverse events associated with microsurgial treatment for ruptured intracerebral aneurysms: a prospective nationwide study on subarachnoid haemorrhage in Sweden. Journal of Neurology, Neurosurgery and Psychiatry, 94(7), 575-580
Open this publication in new window or tab >>Adverse events associated with microsurgial treatment for ruptured intracerebral aneurysms: a prospective nationwide study on subarachnoid haemorrhage in Sweden
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2023 (English)In: Journal of Neurology, Neurosurgery and Psychiatry, ISSN 0022-3050, E-ISSN 1468-330X, Vol. 94, no 7, p. 575-580Article in journal (Refereed) Published
Abstract [en]

Background Adverse events (AEs) or complications may arise secondary to the treatment of aneurysmal subarachnoid haemorrhage (SAH). The aim of this study was to identify AEs associated with microsurgical occlusion of ruptured aneurysms, as well as to analyse their risk factors and impact on functional outcome.

Methods Patients with aneurysmal SAH admitted to the neurosurgical centres in Sweden were prospectively registered during a 3.5-year period (2014–2018). AEs were categorised as intraoperative or postoperative. A range of variables from patient history and SAH characteristics were explored as potential risk factors for an AE. Functional outcome was assessed approximately 1 year after the bleeding using the extended Glasgow Outcome Scale.

Results In total, 1037 patients were treated for ruptured aneurysms, of which, 322 patients were treated with microsurgery. There were 105 surgical AEs in 97 patients (30%); 94 were intraoperative AEs in 79 patients (25%). Aneurysm rerupture occurred in 43 patients (13%), temporary occlusion of the parent artery >5 min in 26 patients (8%) and adjacent vessel injury in 25 patients (8%). High Fisher grade and brain oedema on CT were related to increased risk of AEs. At follow-up, 38% of patients had unfavourable outcome. Patients suffering AEs were more likely to have unfavourable outcome (OR 2.3, 95% CI 1.10 to 4.69).

Conclusion Intraoperative AEs occurred in 25% of patients treated with microsurgery for ruptured intracerebral aneurysm in this nationwide survey. Although most operated patients had favourable outcome, AEs were associated with increased risk of unfavourable outcome.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2023
Keywords
subarachnoid haemorrhage, cerebrovascular disease, neurosurgery
National Category
Surgery Neurology
Identifiers
urn:nbn:se:uu:diva-511755 (URN)10.1136/jnnp-2022-330982 (DOI)000953649500001 ()36931713 (PubMedID)
Available from: 2023-09-15 Created: 2023-09-15 Last updated: 2023-09-15Bibliographically approved
Baldvinsdottir, B., Klurfan, P., Eneling, J., Ronne-Engström, E., Enblad, P., Lindvall, P., . . . Nilsson, O. G. (2023). Adverse events during endovascular treatment of ruptured aneurysms: A prospective nationwide study on subarachnoid hemorrhage in Sweden. BRAIN AND SPINE, 3, Article ID 102708.
Open this publication in new window or tab >>Adverse events during endovascular treatment of ruptured aneurysms: A prospective nationwide study on subarachnoid hemorrhage in Sweden
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2023 (English)In: BRAIN AND SPINE, ISSN 2772-5294, Vol. 3, article id 102708Article in journal (Refereed) Published
Abstract [en]

Introduction: A range of adverse events (AEs) may occur in patients with subarachnoid hemorrhage (SAH). Endovascular treatment is commonly used to prevent aneurysm re-rupture.

Research question: The aim of this study was to identify AEs related to endovascular treatment, analyze risk factors for AEs and how AEs affect patient outcome.

Material and methods: Patients with aneurysmal SAH admitted to all neurosurgical centers in Sweden during a 3.5-year period (2014-2018) were prospectively registered. AEs related to endovascular aneurysm treatment were thromboembolic events, aneurysm re-rupture, vessel dissection and puncture site hematoma. Potential risk factors for the AEs were analyzed using multivariate logistic regression. Functional outcome was assessed at one year using the extended Glasgow outcome scale.

Results: In total, 1037 patients were treated for ruptured aneurysms. Of which, 715 patients were treated with endovascular occlusion. There were 115 AEs reported in 113 patients (16%). Thromboembolic events were noted in 78 patients (11%). Aneurysm re-rupture occurred in 28 (4%), vessel dissection in 4 (0.6%) and puncture site hematoma in 5 (0.7%). Blister type aneurysm, aneurysm smaller than 5 mm and endovascular techniques other than coiling were risk factors for treatment-related AEs. At follow-up, 230 (32%) of the patients had unfavorable outcome. Patients suffering intraprocedural aneurysm re-rupture were more likely to have unfavorable outcome (OR 6.9, 95% CI 2.3-20.9).

Discussion and conclusion: Adverse events related to endovascular occlusion of a ruptured aneurysm were seen in 16% of patients. Aneurysm re-rupture during endovascular treatment was associated with increased risk of unfavorable functional outcome.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Aneurysm, Subarachnoid hemorrhage, Endovascular, Adverse event, Complication, Outcome
National Category
Neurology Surgery
Identifiers
urn:nbn:se:uu:diva-519118 (URN)10.1016/j.bas.2023.102708 (DOI)001113709100001 ()38021017 (PubMedID)
Available from: 2024-01-03 Created: 2024-01-03 Last updated: 2024-01-03Bibliographically approved
Kultanen, H., Lewén, A., Ronne-Engström, E., Enblad, P. & Svedung Wettervik, T. (2023). Antithrombotic agent usage before ictus in aneurysmal subarachnoid hemorrhage: relation to hemorrhage severity, clinical course, and outcome. Acta Neurochirurgica, 165(5), 1241-1250
Open this publication in new window or tab >>Antithrombotic agent usage before ictus in aneurysmal subarachnoid hemorrhage: relation to hemorrhage severity, clinical course, and outcome
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2023 (English)In: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 165, no 5, p. 1241-1250Article in journal (Refereed) Published
Abstract [en]

Background

The number of patients with aneurysmal subarachnoid hemorrhage (aSAH) who are on antithrombotic agents before ictus is rising. However, their effect on early brain injury and disease development remains unclear. The primary aim of this study was to determine if antithrombotic agents (antiplatelets and anticoagulants) were associated with a worse initial hemorrhage severity, rebleeding rate, clinical course, and functional recovery after aSAH.

Methods

In this observational study, those 888 patients with aSAH, treated at the neurosurgical department, Uppsala University Hospital, between 2008 and 2018 were included. Demographic, clinical, radiological (Fisher and Hijdra score), and outcome (Extended Glasgow Outcome Scale one year post-ictus) variables were assessed.

Results

Out of 888 aSAH patients, 14% were treated with antithrombotic agents before ictus. Seventy-five percent of these were on single therapy of antiplatelets, 23% on single therapy of anticoagulants, and 3% on a combination of antithrombotic agents. Those with antithrombotic agents pre-ictus were significantly older and exhibited more co-morbidities and a worse coagulation status according to lab tests. Antithrombotic agents, both as one group and as subtypes (antiplatelets and anticoagulants), were not associated with hemorrhage severity (Hijdra score/Fisher) nor rebleeding rate. The clinical course did not differ in terms of delayed ischemic neurological deficits or last-tier treatment with thiopental and decompressive craniectomy. These patients experienced a higher mortality and lower rate of favorable outcome in univariate analyses, but this did not hold true in multiple logistic regression analyses after adjustment for age and co-morbidities.

Conclusions

After adjustment for age and co-morbidities, antithrombotic agents before aSAH ictus were not associated with worse hemorrhage severity, rebleeding rate, clinical course, or long-term functional recovery.

Place, publisher, year, edition, pages
Springer, 2023
Keywords
Aneurysmal subarachnoid hemorrhage, Anticoagulant, Antiplatelet, Clinical outcome, Hijdra score, Neurointensive care
National Category
Surgery Neurology
Identifiers
urn:nbn:se:uu:diva-509213 (URN)10.1007/s00701-023-05556-z (DOI)000949700100002 ()36917361 (PubMedID)
Funder
Uppsala University
Available from: 2023-08-16 Created: 2023-08-16 Last updated: 2024-02-08Bibliographically approved
Lewén, A., Fahlström, M., Borota, L., Larsson, E.-M., Wikström, J. & Enblad, P. (2023). ASL-MRI-guided evaluation of multiple burr hole revascularization surgery in Moyamoya disease. Acta Neurochirurgica, 165(8), 2057-2069
Open this publication in new window or tab >>ASL-MRI-guided evaluation of multiple burr hole revascularization surgery in Moyamoya disease
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2023 (English)In: Acta Neurochirurgica, ISSN 0001-6268, E-ISSN 0942-0940, Vol. 165, no 8, p. 2057-2069Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Moyamoya (MM) disease is characterized by progressive intracranial arterial stenosis. Patients commonly need revascularization surgery to optimize cerebral blood flow (CBF). Estimation of CBF and cerebrovascular reserve (CVR) is therefore necessary before and after surgery. However, assessment of CBF before and after indirect revascularization surgery with the multiple burr hole (MBH) technique in MM has not been studied extensively. In this study, we describe our initial experience using arterial spin labeling magnetic resonance perfusion imaging (ASL-MRI) for CBF and CVR assessment before and after indirect MBH revascularization surgery in MM patients.

METHODS: Eleven MM patients (initial age 6-50 years, 1 male/10 female) with 19 affected hemispheres were included. A total of 35 ASL-MRI examinations were performed using a 3D-pCASL acquisition before and after i.v. acetazolamide challenge (1000 mg in adults and 10 mg/kg in children). Twelve MBH procedures were performed in seven patients. The first follow-up ASL-MRI was performed 7-21 (mean 12) months after surgery.

RESULTS: Before surgery, CBF was 46 ± 16 (mean ± SD) ml/100 g/min and CVR after acetazolamide challenge was 38.5 ± 9.9 (mean ± SD)% in the most affected territory (middle cerebral artery). In cases in which surgery was not performed, CVR was 56 ± 12 (mean ± SD)% in affected hemispheres. After MBH surgery, there was a relative change in CVR compared to baseline (preop) of + 23.5 ± 23.3% (mean ± SD). There were no new ischemic events.

CONCLUSION: Using ASL-MRI we followed changes in CBF and CVR in patients with MM. The technique was encouraging for assessments before and after revascularization surgery.

Place, publisher, year, edition, pages
Springer Nature, 2023
Keywords
Cerebrovascular reserve, Indirect revascularization, Moyamoya disease, Moyamoya syndrome, Multiple burr hole technique, Outcome
National Category
Radiology, Nuclear Medicine and Medical Imaging Surgery
Identifiers
urn:nbn:se:uu:diva-505308 (URN)10.1007/s00701-023-05641-3 (DOI)001009178600001 ()37326844 (PubMedID)
Funder
Uppsala UniversityThe Swedish Stroke Association
Available from: 2023-06-19 Created: 2023-06-19 Last updated: 2024-01-08Bibliographically approved
Svedung-Wettervik, T., Engquist, H., Hånell, A., Howells, T., Rostami, E., Ronne-Engström, E., . . . Enblad, P. (2023). Cerebral Microdialysis Monitoring of Energy Metabolism: Relation to Cerebral Blood Flow and Oxygen Delivery in Aneurysmal Subarachnoid Hemorrhage. Journal of Neurosurgical Anesthesiology, 35(4), 384-393
Open this publication in new window or tab >>Cerebral Microdialysis Monitoring of Energy Metabolism: Relation to Cerebral Blood Flow and Oxygen Delivery in Aneurysmal Subarachnoid Hemorrhage
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2023 (English)In: Journal of Neurosurgical Anesthesiology, ISSN 0898-4921, E-ISSN 1537-1921, Vol. 35, no 4, p. 384-393Article in journal (Refereed) Published
Abstract [en]

Introduction: In this study, we investigated the roles of cerebral blood flow (CBF) and cerebral oxygen delivery (CDO2) in relation to cerebral energy metabolism after aneurysmal subarachnoid hemorrhage (aSAH).

Methods: Fifty-seven adult aSAH patients treated on the neurointensive care unit at Uppsala, Sweden between 2012 and 2020, with at least 1 xenon-enhanced computed tomography (Xe-CT) scan in the first 14 days after ictus and concurrent microdialysis (MD) monitoring, were included in this retrospective study. CBF was measured globally and focally (around the MD catheter) with Xe-CT, and CDO2 calculated. Cerebral energy metabolites were measured using MD.

Results: Focal ischemia (CBF <20 mL/100 g/min around the MD catheter was associated with lower median [interquartile range]) MD-glucose (1.2 [0.7 to 2.2] mM vs. 2.3 [1.3 to 3.5] mM; P=0.05) and higher MD-lactate-pyruvate (LPR) ratio (34 [29 to 66] vs. 25 [21 to 32]; P=0.02). A compensated/normal MD pattern (MD-LPR <25) was observed in the majority of patients (22/23, 96%) without focal ischemia, whereas 4 of 11 (36%) patients with a MD pattern of poor substrate supply (MD-LPR >25, MD-pyruvate <120 µM) had focal ischemia as did 5 of 20 (25%) patients with a pattern of mitochondrial dysfunction (MD-LPR >25, MD-pyruvate >120 µM) (P=0.04). Global CBF and CDO2, and focal CDO2, were not associated with the MD variables.

Conclusions: While MD is a feasible tool to study cerebral energy metabolism, its validity is limited to a focal area around the MD catheter. Cerebral energy disturbances were more related to low CBF than to low CDO2. Considering the high rate of mitochondrial dysfunction, treatments that increase CBF but not CDO2, such as hemodilution, may still benefit glucose delivery to drive anaerobic metabolism.

Place, publisher, year, edition, pages
Ovid Technologies (Wolters Kluwer Health), 2023
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-491010 (URN)10.1097/ANA.0000000000000854 (DOI)001065804300007 ()
Available from: 2022-12-16 Created: 2022-12-16 Last updated: 2024-01-23Bibliographically approved
Velle, F., Lewén, A., Howells, T., Hånell, A., Nilsson, P. & Enblad, P. (2023). Cerebral pressure autoregulation and optimal cerebral perfusion pressure during neurocritical care of children with traumatic brain injury. Journal of Neurosurgery: Pediatrics, 31(5), 503-513
Open this publication in new window or tab >>Cerebral pressure autoregulation and optimal cerebral perfusion pressure during neurocritical care of children with traumatic brain injury
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2023 (English)In: Journal of Neurosurgery: Pediatrics, ISSN 1933-0707, E-ISSN 1933-0715, Vol. 31, no 5, p. 503-513Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE

The management of cerebral perfusion pressure (CPP) is a challenge in children with traumatic brain injury (TBI) because the normal blood pressure is age dependent and the role of cerebral pressure autoregulation (CPA) is unclear. In this study, the authors aimed to examine the pressure reactivity index (PRx), CPP, optimal CPP (CPPopt), and deviations from CPPopt (ΔCPPopt) in a series of children with TBI generally and regarding age relations, temporal changes, and the influence on outcome.

METHODS

Intracranial pressure (ICP) and mean arterial pressure (MAP) monitoring data were collected during neurointensive care in 57 children who sustained a TBI and were ≤ 17 years of age. CPP, PRx, CPPopt, and ΔCPPopt (actual CPP − CPPopt) were calculated. Clinical outcomes at 6 months postinjury were dichotomized into favorable outcomes (Glasgow Outcome Scale [GOS] score 4 or 5) and unfavorable outcomes (GOS scores 1–3).

RESULTS

The median patient age was 15 (range 0.5–17) years, and the median Glasgow Coma Scale motor score at admission was 5 (range 2–5). Forty-nine (86%) of the 57 patients had favorable outcomes. For the entire group, lower PRx (better preserved CPA) was associated with a more favorable outcome (p = 0.023, ANCOVA adjusted for age). When the children were divided into age groups, this finding was statistically significant in children ≤ 15 years of age (p = 0.016), but not in children ≥ 16 years (p = 0.528). In children ≤ 15 years, a lower proportion of time with ΔCPPopt < −10% was significantly associated with a favorable outcome (p = 0.038), but not in the older age group. Temporal analysis indicated that PRx was higher (more impaired CPA) from day 4 and CPPopt was higher from day 6 in the unfavorable outcome group compared with the favorable outcome group, although those findings were not significant.

CONCLUSIONS

Impaired CPA is related to poor outcome, particularly in children ≤ 15 years of age. In that age group, actual CPP below the CPPopt level contributed significantly to unfavorable outcome, while levels close to or above the CPPopt were unrelated to outcome. CPPopt appears to be higher during the time period when CPA is most impaired.

Place, publisher, year, edition, pages
American Association of Neurological Surgeons (AANS), 2023
Keywords
traumatic brain injury, children, autoregulation, optimal cerebral perfusion pressure, trauma
National Category
Neurosciences Neurology Pediatrics
Identifiers
urn:nbn:se:uu:diva-503092 (URN)10.3171/2023.1.PEDS22352 (DOI)000990554500007 ()36804198 (PubMedID)
Available from: 2023-06-09 Created: 2023-06-09 Last updated: 2023-11-14Bibliographically approved
Decraene, B., Klein, S. P., Piper, I., Gregson, B., Enblad, P., Ragauskas, A., . . . Depreitere, B. (2023). Decompressive craniectomy as a second/third-tier intervention in traumatic brain injury: A multicenter observational study. Injury, 54(9), Article ID 110911.
Open this publication in new window or tab >>Decompressive craniectomy as a second/third-tier intervention in traumatic brain injury: A multicenter observational study
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2023 (English)In: Injury, ISSN 0020-1383, E-ISSN 1879-0267, Vol. 54, no 9, article id 110911Article in journal (Refereed) Published
Abstract [en]

Objectives: RESCUEicp studied decompressive craniectomy (DC) applied as third-tier option in severe traumatic brain injury (TBI) patients in a randomized controlled setting and demonstrated a decrease in mortality with similar rates of favorable outcome in the DC group compared to the medical management group. In many centers, DC is being used in combination with other second/third-tier therapies. The aim of the present study is to investigate outcomes from DC in a prospective non-RCT context.Methods: This is a prospective observational study of 2 patient cohorts: one from the University Hospitals Leuven (2008-2016) and one from the Brain-IT study, a European multicenter database (2003-2005). In thirty-seven patients with refractory elevated intracranial pressure who underwent DC as a second/third-tier intervention, patient, injury and management variables including physiological monitoring data and administration of thio-pental were analysed, as we l l as Extended Glasgow Outcome score (GOSE) at 6 months.Results: In the current cohorts, patients were older than in the surgical RESCUEicp cohort (mean 39.6 vs. 32.3; p < 0.001), had higher Glasgow Motor Score on admission (GMS < 3 in 24.3% vs. 53.0%; p = 0.003) and 37.8% received thiopental (vs. 9.4%; p < 0.001). Other variables were not significantly different. GOSE distribution was: death 24.3%; vegetative 2.7%; lower severe disability 10.8%; upper severe disability 13.5%; lower moderate disability 5.4%; upper moderate disability 2.7%, lower good recovery 35.1%; and upper good recover y 5.4%. The outcome was unfavorable in 51.4% and favorable in 48.6%, as opposed to 72.6% and 27.4% respectively in RESCUEicp (p = 0.02).Conclusion: Outcomes in DC patients from two prospective cohorts reflecting everyday practice were better than in RESCUEicp surgical patients. Mortality was similar, but fewer patients remained vegetative or severely disabled and more patients had a good recovery. Although patients were older and injury severity was lower, a potential partial explanation may be in the pragmatic use of DC in combination with other second/third-tier therapies in real-life cohorts. The findings underscore that DC maintains an important role in managing se-vere TBI.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Traumatic brain injury, Decompressive craniectomy, Neurointensive care, Intracranial pressure, Cerebral autoregulation, TBI
National Category
Neurology Surgery Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:uu:diva-519805 (URN)10.1016/j.injury.2023.110911 (DOI)001059883700001 ()37365094 (PubMedID)
Available from: 2024-01-10 Created: 2024-01-10 Last updated: 2024-01-10Bibliographically approved
Svedung-Wettervik, T., Fahlström, M., Wikström, J., Enblad, P. & Lewén, A. (2023). Editorial: Moyamoya disease - natural history and therapeutic challenges. Frontiers in Neurology, 14, Article ID 1270197.
Open this publication in new window or tab >>Editorial: Moyamoya disease - natural history and therapeutic challenges
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2023 (English)In: Frontiers in Neurology, E-ISSN 1664-2295, Vol. 14, article id 1270197Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
Frontiers Media S.A., 2023
Keywords
cerebral blood flow, imaging, moyamoya disease, revascularization, stroke
National Category
Neurosciences
Identifiers
urn:nbn:se:uu:diva-513325 (URN)10.3389/fneur.2023.1270197 (DOI)001069566100001 ()37731851 (PubMedID)
Available from: 2023-10-05 Created: 2023-10-05 Last updated: 2023-10-06Bibliographically approved
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