Guidelines for the management of severe traumatic brain injury. Part 3. Surgical management of severe traumatic brain injury (Options)

Потапов, А А; Krylov, V. V.; Ag, Gavrilov; Кравчук, А Д; Likhterman, L. B.; Петриков, С. С.; Talypov, Aleksandr; Захарова, Н. Е.; Солодов, А. А.

doi:10.17116/neiro201680293-101

Cited by 22 publications

(12 citation statements)

References 78 publications

(9 reference statements)

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“…Preoperative cerebral angiography or CTA is recommended to evaluate suspected vascular injury or reveal the location of the hematoma. 16 Follow-up CT angiography or digital subtraction angiography is beneficial to rule out the possibility of a delayed carotid cavernous fistula and traumatic aneurysm. When a vascular injury is highly suspected based on CTA or digital subtraction angiography findings, 17 a craniotomy and removal of the foreign body under direct vision are recommended as the best approach.…”

Section: Discussionmentioning

confidence: 99%

Penetrating transorbital injury by a coloring pencil in a 3-year-old child: A case report

et al. 2019

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A transorbital penetrating injury by a foreign body is an extremely rare type of injury, and its severity is often difficult to estimate by examination of the superficial wound alone. Thus, such injuries are challenging for neurosurgeons to investigate and manage. We herein present a peculiar case involving a 3-year-old girl with a penetrating transorbital skull-base injury caused by a coloring pencil and discuss the anatomical location of the foreign body, radiological examination findings, diagnosis, and treatment strategy. The pencil was completely removed by manual extraction. Follow-up investigations confirmed a good outcome. Multidisciplinary cooperation, radiological examination, correct diagnosis, timely treatment, and detailed follow-up studies are necessary to manage penetrating transorbital skull-base injuries caused by foreign bodies. The orbital walls are very thin in children, and the orbital roof and superior orbital fissure are often penetrated by foreign bodies in cases such as that described herein. The anatomical location of the foreign body influences the clinical management strategy.

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Section: Discussionmentioning

confidence: 99%

Penetrating transorbital injury by a coloring pencil in a 3-year-old child: A case report

et al. 2019

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“…During the original RCT, patients were treated using the following uniform protocol. (1) According to the Guidelines for the management of severe TBI [ 19 ], craniotomy for TBI was performed primarily to decompress and remove hematomas. (2) During the procedure, all patients underwent ventricular puncture.…”

Section: Methodsmentioning

confidence: 99%

Association between blood glucose levels and Glasgow Outcome Score in patients with traumatic brain injury: secondary analysis of a randomized trial

Yuan

Liu

et al. 2022

Trials

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Background Blood glucose levels that are too high or too low after traumatic brain injury (TBI) negatively affect patient prognosis. This study aimed to demonstrate the relationship between blood glucose levels and the Glasgow Outcome Score (GOS) in TBI patients. Methods This study was based on a randomized, dual-center, open-label clinical trial. A total of 208 patients who participated in the randomized controlled trial were followed up for 5 years. Information on the disease, laboratory examination, insulin therapy, and surgery for patients with TBI was collected as candidate variables according to clinical importance. Additionally, data on 5-year and 6-month GOS were collected as primary and secondary outcomes, respectively. For multivariate analysis, a generalized additive model (GAM) was used to investigate relationships between blood glucose levels and GOS. The results are presented as odds ratios (ORs) with 95% confidence intervals (95% CIs). We further applied a two- piecewise linear regression model to examine the threshold effect of blood glucose level and GOS. Results A total of 182 patients were included in the final analysis. Multivariate GAM analysis revealed that a bell-shaped relationship existed between average blood glucose level and 5-year GOS score or 6-month GOS score. The inflection points of the average blood glucose level were 8.81 (95% CI: 7.43–9.48) mmol/L considering 5-year GOS as the outcome and were 8.88 (95% CI 7.43−9.74) mmol/L considering 6-month GOS score as the outcome. The same analysis revealed that there was also a bell relationship between average blood glucose levels and the favorable outcome group (GOS score ≥ 4) at 5 years or 6 months. Conclusion In a population of patients with traumatic brain injury, blood glucose levels were associated with the GOS. There was also a threshold effect between blood glucose levels and the GOS. A blood glucose level that is either too high or too low conveys a poor prognosis. Trial registration ClinicalTrials.gov NCT02161055. Registered on 11 June 2014.

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“…Patients with brain herniation often suffer from intracranial lesions and simultaneous or habitual damage to other organs. Posttraumatic cerebral infarction (PTCI) is one of the most common secondary lesions in patients with cerebral herniation ( 1 ). The incidence rate in the first 2 weeks after injury is as high as 71.6% ( 2 ).…”

Section: Introductionmentioning

confidence: 99%

Predictive role of shock index in the early formation of cerebral infarction in patients with TBI and cerebral herniation

Hu¹,

Tian²,

Xie³

et al. 2022

Front. Neurol.

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Background and purposeTraumatic brain injury (TBI) with brain herniation predisposes to posttraumatic cerebral infarction (PTCI), which in turn seriously affects the prognosis of patients. At present, there is a lack of effective indicators that can accurately predict the occurrence of PTCI. We aimed to find possible risk factors for the development of PTCI by comparing the preoperative and postoperative clinical data of TBI patients with brain herniation.MethodsThe clinical data of 120 patients with craniocerebral trauma and brain herniation were retrospectively analyzed. Among them, 54 patients had cerebral infarction within 3–7 days after injury. The two groups of patients were compared through univariate and multivariate logistic regression analysis, and a classification tree model and a nomogram model were constructed. Finally, receiver operating characteristic curve analysis and decision curve analysis were conducted to analyze the clinical utility of the prediction model.ResultsLogistic regression analysis showed that factors like the Glasgow Coma Scale (GCS) score (P = 0.002), subarachnoid hemorrhage (SAH) (P = 0.005), aspiration pneumonia (P < 0.001), decompressive craniectomy (P < 0.05), intracranial pressure (ICP) monitoring (P = 0.006), the shock index (SI) (P < 0.001), the mean arterial pressure (MAP) (P = 0.005), and blood glucose (GLU) (P < 0.011) appeared to show a significant statistical correlation with the occurrence of infarction (P < 0.05), while age, sex, body temperature (T), D-dimer levels, and coagulation tests were not significantly correlated with PTCI after cerebral herniation. Combined with the above factors, Classification and Regression Tree was established, and the recognition accuracy rate reached 76.67%.ConclusionsGCS score at admission, no decompressive craniectomy, no ICP monitoring, combined SAH, combined aspiration pneumonia, SI, MAP, and high GLU were risk factors for infarction, of which SI was the primary predictor of PTCI in TBI with an area under the curve of 0.775 (95% CI = 0.689–0.861). Further large-scale studies are needed to confirm these results.

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Guidelines for the management of severe traumatic brain injury. Part 3. Surgical management of severe traumatic brain injury (Options)

Cited by 22 publications

References 78 publications

Penetrating transorbital injury by a coloring pencil in a 3-year-old child: A case report

Penetrating transorbital injury by a coloring pencil in a 3-year-old child: A case report

Association between blood glucose levels and Glasgow Outcome Score in patients with traumatic brain injury: secondary analysis of a randomized trial

Predictive role of shock index in the early formation of cerebral infarction in patients with TBI and cerebral herniation

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