Despite the growing fund of knowledge on the pathophysiology of traumatic brain injury, the outcomes of severe TBI remain abysmal. While the necrotic and apoptotic cascades triggered off by the primary traumatic insult remain refractory to treatment, the secondary sequelae of increased intracranial pressure remain within the therapeutic realm. The benefit of evacuation of mass producing hematomas is beyond dispute. The management of brain edema however remains suboptimal despite the best medical management. The role of surgical evacuation of edema inducing contusions recalcitrant to osmotherapy is explored in this paper. The role of decompressive craniectomy in the control of refractory hypertension and the rationale and timing of the procedure are discussed.
Chondrosarcoma of nasal cavity is a rare entity, and only few case reports exist. Diagnosis is made on histopathological analysis. Differentiating chondrosarcoma from chondromas can be challenging. Surgical excision remains the treatment of choice. We report a case of a 73-year-old male who presented to us with complaints of bilateral nasal obstruction. Histopathology reported as moderately differentiating chondrosarcoma. Patient subsequently underwent excision of tumor by craniofacial resection with adjuvant radiotherapy. Patient is on regular follow-up and has shown no evidence of recurrence.
While the indications for surgery in extra- and subdural hematomas are relatively established, the role, timing and the indications for the surgical treatment of cerebral contusions remains nebulous. The pathophysiology of brain edema and the resultant increase in intracranial pressure due to brain contusions is discussed. The role and limitations of early evacuation of contused brain are considered in this article.
Stem cells capable of proliferating along neuronal and glial lines persist in the adult central nervous system (CNS). These cells are found pedominantly in the subventricular zones and in the hippocampus. The therapeutic potential of both endogenous and exogenous stem cells in achieving repair of the injured CNS is being explored. Stem cells from embyonal lines, mescnchymal stromal cells and neural stem cells are being investigated for their potential role in the management of neural loss due to traumatic hypoxic or infl ammatory insult.
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