49 research outputs found
Application of biocompatible magnetite nanoparticles for the removal of arsenic and copper from water
No full textHEADS OR TAILS: POST-SURGICAL COMPLICATIONS IN TRAUMATIC BRAIN INJURY - A LITERATURE REVIEW
No full textIntroduction
Craniocerebral trauma oftentimes requires urgent neurosurgical interventions and poses a great threat on its own as a result of inherent complications. Surgery is performed in order to tackle immediate mortality and to enhance long-term recovery. However, it is noteworthy to take into consideration that we can distinguish complications that stem from the procedure itself from those which are attributable to the traumatic event and its physiopathology.
Objectives
This study is a comprehensive review of literature addressing complications related to surgery in traumatic brain injury. To further illustrate the findings, we studied the incidence of post-surgical complications in 100 patients from our department that underwent surgical procedures for head trauma.
Material and Methods
The databases that were enquired were PubMed and Scopus. Literature written in the past two decades has been analysed, with an emphasis on more recent meta-analyses. A retrospective cohort of 100 patients was assembled from our departments’ database. Inclusion criteria consisted of traumatic brain injury that required surgery. The main post-surgical complications (mentioned in the results) were identified and the rate of incidence was calculated using Microsoft Excel 2019.
Results
The complications related to surgical procedures for traumatic brain injury included the following medical entities: brain herniation, hydrocephalus, pneumocephalus, subdural hygroma, subdural effusion after decompression, cerebrospinal fluid leaks, infections, wound complications, syndrome of the trephined, cranioplasty-related issues and neuropsychological outcomes. Out of 100 surgeries for head trauma, we identified 13 cases in which complications occurred, as follows: 5 (35,7%) infections, 4 (28,6%) contralateral subdural effusion, 2 (14,3%) pneumocephalus, equal incidence of 1 (7,1%) for hygroma, intracerebral hematoma and contralateral epidural effusion. Additionally, this study explored comparisons of surgical techniques employed in head trauma (craniectomy vs craniotomy, types of incisions) and long term outcomes of patients.
Conclusions
This literature review highlights the most frequently encountered complications of head trauma surgery, as well as some exceptional ones, with the purpose of informing on previous and current management of such situations which a neurosurgeon may encounter, with special attention to young neurosurgeons, who can benefit from open space discussions on this topic with more experienced neurosurgeons.
References
Stiver SI. Complications of decompressive craniectomy for traumatic brain injury. FOC. 2009; 26(6): E7. doi:10.3171/2009.4.FOCUS0965.
Habibi MA, Kobets AJ, Boskabadi AR, Mousavi Nasab M, Sobhanian P, Saber Hamishegi F, et al. A comprehensive systematic review and meta-analysis study in comparing decompressive craniectomy versus craniotomy in patients with acute subdural hematoma. Neurosurg Rev 2024; 47(1): 77. doi:10.1007/s10143-024-02292-5.
Honeybul S, Ho KM. Decompressive craniectomy for severe traumatic brain injury: The relationship between surgical complications and the prediction of an unfavourable outcome. Injury. 2014; 45(9) :1332-1339.
doi:10.1016/j.injury.2014.03.007.
Honeybul S. Complications of decompressive craniectomy for head injury. J Clin Neurosci. 2010; 17(4): 430-435.
doi:10.1016/j.jocn.2009.09.007.
Hutchinson PJ, Adams H, Mohan M, Devi BI, Uff C, Hasan S, et al. Decompressive Craniectomy versus Craniotomy for Acute Subdural Hematoma. N Engl J Med. 2023; 388(24): 2219-2229. doi:10.1056/NEJMoa2214172.
Kolias AG, Chari A, Santarius T, Hutchinson PJ. Chronic subdural haematoma: modern management and emerging therapies. Nat Rev Neurol. 2014; 10(10): 570-578.
doi:10.1038/nrneurol.2014.163.
Sveikata L, Vasung L, El Rahal A, Bartoli A, Bretzner M, Schaller K, et al. Syndrome of the trephined: clinical spectrum, risk factors, and impact of cranioplasty on neurologic recovery in a prospective cohort. Neurosurg Rev. 2022; 45(2): 1431-1443. doi:10.1007/s10143-021-01655-6.
Lee KS. How to Treat Chronic Subdural Hematoma? Past and Now. J Korean Neurosurg Soc. 2019; 62(2): 144-152.
doi:10.3340/jkns.2018.0156.
Guo Z, Ding W, Cao D, Chen Y, Chen J. Decompressive Craniectomy vs. Craniotomy Only for Traumatic Brain Injury: A Propensity-Matched Study of Long-Term Outcomes in Neuropsychology. Front Neurol. 2022; 13: 813140.
doi:10.3389/fneur.2022.813140.
Hawryluk GWJ, Rubiano AM, Totten AM, O’Reilly C, Ullman JS, Bratton SL, et al. Guidelines for the Management of Severe Traumatic Brain Injury: 2020 Update of the Decompressive Craniectomy Recommendations. Neurosurg. 2020; 87(3): 427-434. doi:10.1093/neuros/nyaa278.
Schuss P, Vatter H, Marquardt G, Imöhl L, Ulrich CT, Seifert V, et al. Cranioplasty after decompressive craniectomy: the effect of timing on postoperative complications. J Neurotrauma. 2012; 29(6): 1090-1095. doi:10.1089/neu.2011.2176
The Epistemological Background of our Strategies
No full textInternational audienceThe major objectives of the long-term strategy in promoting a scientific discipline into the education sphere may be the following : • A permanent presence of the discipline inside the general education • A good harmonisation with other disciplines (at least the scientific ones) • A maximal efficiency of its presence as a required discipline Before any practical approaches (social, administrative, or any other), it is required (necessary) that the promoters of any discipline formulate and underline its cognitive and formative contribution. This can be done only by starting with the epistemological statute of the discipline and its pedagogical implications. Defining the epistemological statute, as well as the requirements of an optimal communication among the options concerning the orientation (re-orientation) of educational strategies, brings forth the necessity of analysing some fundamental concepts, with epistemological characters. Even if it seems to be known by everyone, usually the concepts are not taken into account with their real importance. The fundamental concept we refer to herein constitute a real "conceptual network" who, "volens-nolens", is the epistemological background for any strategy of education relative to science. Being conscious of the importance of the epistemological background will permit the modification of the beginning and the references used in defining the strategy of education in (through) astronomy
Bringing Forth the Spirit of Astronomy by Using Conceptual Maps
No full textInternational audienceNot Availabl
Tackling neuroinflammation with H2S releasing FPR2 agonists
No full textNeuroinflammation is a hallmark of neurodegenerative diseases. It has been linked to tissue
damage by oxidative stress, driving neurodegeneration, and its resolution could alter disease
progression and outcome [1].
Formyl Peptide Receptor 2 (FPR2) is a G protein-coupled receptor (GPCR), highly expressed by
microglial cells and binding several different ligands which elicit either pro-inflammatory or
anti-inflammatory effects depending on their structure. This makes it a notable target for the
resolution of neuroinflammation [2].
In the past, our group developed the ureidopropanamide class of FPR2 agonists. More recent
efforts have led us to try and enhance the anti-inflammatory capabilities of these compounds
following different strategy. Herein we present the introduction of H2S releasing moieties into the
ureidopropanamide scaffold. H2S is a gaseous neuromodulator and neuroprotector, active as a
calcium influx regulator and as an anti-inflammatory and antioxidant agent [3]. Thus we converted
the ureido and amide moieties of our compounds into the corresponding thioureas and
thioamides.
Figure 1: scaffolds of ureidopropanamide FPR2 agonists and their thioureido and thioamide
counterparts.
We assayed the activity of our compounds as FPR2 agonists, their capacity as H2S releasers
and their neuroprotective activity in models of neuroinflammation, showing their potential as new
anti-inflammatory drugs.
[1] Teleanu, D.M. et al. Int J Mol Sci (2022), 23, 5938
[2] Mastromarino, M. et al. J Med Chem (2022), 65, 5004–5028
[3] Dilek, N. et al. Pharmacol Res (2020), 161, 10511
THE ROLE OF NEUROSURGERY IN THE TREATMENT OF VERTEBRAL METASTASES
No full textIntroduction
Vertebral metastases represent a significant clinical challenge due to their potential to cause severe pain, neurological deficits, and spinal instability. Neurosurgery plays a crucial role in the multidisciplinary approach to treating vertebral metastases, aiming to alleviate symptoms, maintain or restore neurological function, and stabilize the spine. This abstract reviews the current role of neurosurgery in the management of vertebral metastases, focusing on surgical indications, techniques, outcomes, and integration with other therapeutic modalities.
Neurosurgical intervention is typically considered in cases of intractable pain, progressive neurological deficits, spinal instability, or failure of non-surgical treatments. Advances in imaging techniques have enhanced the ability to accurately diagnose and plan surgeries, while innovations in surgical technology have improved the precision and safety of these procedures. Surgical options range from minimally invasive techniques, such as vertebroplasty and kyphoplasty, to more extensive decompressive and stabilizing procedures like laminectomy, corpectomy, and spinal fusion.
Outcomes of neurosurgical treatment are generally favorable, particularly when patients are carefully selected based on established criteria such as the Spinal Instability Neoplastic Score (SINS) and the Neurologic, Oncologic, Mechanical, and Systemic (NOMS) framework. These tools assist in determining the most appropriate surgical approach and the timing of intervention. Moreover, neurosurgery is often part of a comprehensive treatment plan that includes radiation therapy, chemotherapy, and targeted biological therapies, which can enhance overall treatment efficacy.
A critical aspect of future radiotherapy strategies involves maintaining a minimum of 2 mm between nervous tissue and cancer cells. This margin is essential to prevent radionecrosis of nervous tissue, a serious complication that can arise from radiotherapy. Ensuring this safe distance can help protect neural structures while effectively targeting cancerous cells, thus optimizing therapeutic outcomes and minimizing adverse effects.
Despite the benefits, neurosurgery for vertebral metastases carries risks, including infection, bleeding, and potential for further neurological injury. Therefore, patient selection and preoperative planning are critical to optimize outcomes. Future directions in this field may include the development of more refined surgical techniques, enhanced integration of multimodal treatments, and better prognostic tools to guide therapy.
Conclusion
Neurosurgery remains a cornerstone in the management of vertebral metastases, offering significant symptomatic relief and functional improvement. Ongoing advancements in surgical methods and interdisciplinary care continue to enhance patient outcomes.
References
Di Perna G, Cofano F, Mantovani et al. (2020) Separation surgery for metastatic epidural spinal cord compression: A qualitative review. J Bone Oncol. Sep 26-25.
Versteeg, A. L., Verlaan, J. J., Sahgal, A., et al. (2021). The role of minimally invasive surgery in the management of spinal metastases and the emerging field of spinal oncology. Journal of Clinical Medicine, 10(4), 847.
Bakar, D., Tanenbaum, J. E., Phan, K., et al. (2016). Decompressive surgery for spinal metastases: The role of minimally invasive surgery and its impact on patient outcomes. Global Spine Journal, 6(6), 600-608.
Pennington, Z., Ahmed, A. K., Molina, C. A., et al. (2020). Safety and efficacy of 3D navigation-guided minimally invasive surgery for the treatment of spinal tumors: A multi-institutional analysis. Journal of Neuro-Oncology, 147(3), 607-617.
Zuckerman, S. L., Laufer, I., Sahgal, A., et al. (2020). When less is more: The indications for minimally invasive spine surgery in oncology. Neurosurgical Review, 43(2), 327-338
Randomized phase-II trial evaluating induction therapy with idarubicin and etoposide plus sequential or concurrent azacitidine and maintenance therapy with azacitidine
No full textThe aim of this randomized phase-II study was to evaluate the effect of substituting cytarabine by azacitidine in intensive induction therapy of patients with acute myeloid leukemia (AML). Patients were randomized to four induction schedules for two cycles: STANDARD (idarubicin, cytarabine, etoposide); and azacitidine given prior (PRIOR), concurrently (CONCURRENT), or after (AFTER) therapy with idarubicin and etoposide. Consolidation therapy consisted of allogeneic hematopoietic-cell transplantation or three courses of high-dose cytarabine followed by 2-year maintenance therapy with azacitidine in the azacitidine-arms. AML with CBFB-MYH11, RUNX1-RUNX1T1, mutated NPM1, and FLT3-ITD were excluded and accrued to genotype-specific trials. The primary end point was response to induction therapy. The statistical design was based on an optimal two-stage design applied for each arm separately. During the first stage, 104 patients (median age 62.6, range 18-82 years) were randomized; the study arms PRIOR and CONCURRENT were terminated early due to inefficacy. After randomization of 268 patients, all azacitidine-containing arms showed inferior response rates compared to STANDARD. Event-free and overall survival were significantly inferior in the azacitidine-containing arms compared to the standard arm (p < 0.001 and p = 0.03, respectively). The data from this trial do not support the substitution of cytarabine by azacitidine in intensive induction therapy
ACUTE MYELOID LEUKEMIA WITH RUNX1 MUTATIONS CONSTITUTE A DISTINCT ENTITY ASSOCIATED WITH CHARACTERISTIC CLINICAL AND GENETIC FEATURES AND POOR OUTCOME. A STUDY OF THE AML STUDY GROUP (AMLSG)
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