EVD

An interesting study comes from Dr. Gardner et al. at the Department of Neurological Surgery, University of Pittsburgh, Pennsylvania. The external ventricular drainage placement is a common practice in everyday neurosurgical activity but the complications relying on hemorrhage were not clearly depicted. This study involving 188 EVD placements tries to quantify and qualify the extent of this complication and interestingly 41% of the patients showed imaging evidence of hemorrhage. Most of the hemorrhages were  of insignificant value (punctuate, trace SAH, or small volume) while 10.6% of the patients had >15ml hemorrhage or associated IVH. The study concludes that there is an increased risk concerning EVD placement and hemorrhage but rarely a surgical intervention is needed. There was no significant risk reduction when the placement was done in the OR or the NICU.

You can read the article here, at the Journal of Neurosurgery issue of May 2009.

Hemorrhage rates after external ventricular drain placement
Paul A. Gardner, M.D., Johnathan Engh, M.D., Dave Atteberry, M.D., and John J. Moossy, M.D.

Journal of Neurosurgery, May 2009 Volume 110, Number 5

The Annual International Neurosurgery Conference at the Internet has become a continious source of education in the field of neurosurgery. Dr. G. Narenthiran has established the online track of participation in the neurosurgical internet educational field and this is the fourth consecutive attempt to prove that Neurosciences share no borders and education can be approached from every part of the world through the internet.

If you want to participate in the online initiative please remember these dates:

Fourth Annual International Neurosurgery Conference

http://www.surgicalneurology.org/conf4/index.html

The conference is held online between 27-30 December 2008.

Closing date for abstract submission is 21 November 2008

E-mail the abstract to g_narenthiran@hotmail.com as an e-mail attachment

AVM calculator is an new IT tool in a Neuroscientist’s armamentarium. It is published by Dr G Narenthiran and it uses sophisticated algorithms in order to provide you with a estimation of an AVM risk in the following years according to information provided. Data are based in epidemiological and clinical studies. The use of this tool is for experts and healthcare professionals only. It implements .NET framework so its use is for Windows platforms only.

Great work!

Please feel free to try it at:

http://www.nsurgery.org/publish.htm

                

 

The 12th of May is a day that Neurosurgery has to remember.

    The first ever robotic microneurosurgical tumor excision guided by intraoperative imaging is a reality! This is a giant step introduced to the specialty of neurosurgery by Dr. Sutherland and his team in University of Calgary, Canada. In the past, various robotic approaches were introduced but they applied stereotactic biopsy techniques. Dr Sutherland’s team used neuroArm (presented in our blog in the past), a robot using image-guiding techniques and utilizing force feedback in neurosurgeon’s hands in order to represent the parameters and the “feeling” of the operative field.

   Paige Nickason, 21, is the first human operated by a microneurosurgical, image guided robot. The neurosurgical scientific community salutes this step. Prof. Peter Black, PhD, Franc D. Ingraham professor of neurosurgery at  Harvard Medical School, a pioneer in the field of minimally invasive, image guided neurosurgery,  encourages the adoption of this approach from other centers in his announcement.

Official announcement

 

Comment:

The vision of innovation leads the touch of neurosurgical reality in fields that the human mind ”touched” first  and the neurosurgeon’s hands used afterwards. There is a lot of brilliant thought in Neurosciences and now innovation is not science fiction, it is reality…

MRI of Brain Repair (see text)

Credit: Image courtesy Philip Liu of Harvard Medical School.

Well MRI is a an imaging modality that has altered the path of medicine and especially aided neurosciences. Brain and spine mysteries unveiled by MRI and the quality of health care has substantially increased. So one could say that MRI has completed its trip to aid medicine. WRONG! What about imaging in the submicroscopical level ? MRI cannot “see” the world of genes and proteins, right ? WRONG!

Harvard researchers invented a non-invasive way of gene-targeting and imaging by utilizing a novel contrast agent (SPION) linked to cerebral GFAP, a protein that binds to glia and astrocytes under repairing or damaging conditions. This novel agent was included in a eye-drop solution that delivered to the studied animals! The results were the demonstration of  localization of the specific binding of GFAP to cells in the brain of rat that had undergone blood brain barrier leakage in various settings like ischemia, puncture wound, e.t.c. The SPION component revealed its co-localization with GFAP in the MRI imaging (see picture).

The results of this research were published in the FASEB journal:

 

Noninvasive delivery of gene targeting probes to live brains for transcription MRI.

Liu CH, You Z, Ren J, Kim YR, Eikermann-Haerter K, Liu PK.

FASEB J. 2008 Apr;22(4):1193-203. Epub 2007 Nov 20

Copyright © 2008 by The Federation of American Societies for Experimental Biology.

This is a novel agent that utilizes non-invasiveness in the world of studying brain damage. A great step has been achieved. It needs time in order to unveil the mysteries of brain genes but brilliant minds make the trip shorter and more beautiful!

 

  image from The Matrix © movie – hacking view 

It is unbelievable! This is a show of ruthless behavior of a hacking group against the nonprofit Epilepsy Foundation forum. In March 29th, hackers utilized an automatic script in order to flood the posts of Epilepsy Foundation with specially designed images that demonstrated altered luminance and image patterns capable of eliciting an epileptic episode in individuals that belong to the photosensitive epilepsy group! After 12h the administrators of the forum managed to clear the website. Various testimonials are described by patients visiting this forum during the hackers’ attack. One lady reported that she experienced absence epileptic episodes accompanied by ocular upward gaze rotation. Others report the sudden start of headaches and hallucinations!

This is an attack from a hackers’ group that it was quite canny and targeted a sensitive group of population. Photosensitive epilepsy accounts for about 3% of epilepsies and surely the attacker targeted these people. This action is far from a hacker’s philosophy for free, unrestricted knowledge for all and should be criticized fiercely.  

  

a small gun…that is what we have for brain edema… 

AN OPINION: 

I was reading the literature about traumatic brain injury and I was feeling terrible as the treatment of post-traumatic brain edema lies after years in mannitol, hyperventilation and hydration with or without hypertonous fluids. We have to admit that we have a lot to find and we are back. We have a lot of mysteries to resolve. I cannot admit that we have an osmotic diuretic in the first line of treating brain edema in the years of molecular biology, advanced immunology and decoded human genome! These practices were pioneered years before when medical research was bereaved of advanced scientific methods.

Mannitol devastates the osmotic regulation and its effect lasts for a few days but still it is in the front line. Multiple injured patients with life threatening brain and abdominal injuries may be in shock and this is an everyday reality in emergency rooms as elder people with cardiac history are. These patients are in shock and we are forced to use a substance like mannitol for their brain edema while it may worsen the situation. Its all we got after all!

Don’t you think that we should put our best to find something novel, clever, and effective concerning the treatment of post traumatic edema? Don’t you think that we are back when we are compared with the miracles and advances of immunology and molecular biology ? Aquaporins are a new family of water channels aged about 20 years and the literature is promising… Are we close to changing the level to neurosurgery ? Who knows…maybe in some years we would be in another difficult situation…Which aquaporin inhibitor of 50 is the appropriate ?

 

  © Riken Research, Japan

Nishimura et al published a research article in Science, related to brain functional activity after spinal cord injury. This topic is unclear to the scientific community and the question raised is of great value: How brain reacts and interferes with rehabilitation after a spinal cord injury ? The researchers reproduced a spinal cord injury model in  macaque monkeys by transecting the direct cortico-motoneuronal pathway at the mid-cervical segment of the spinal cord, resulting in transient impairment of finger movements. Normal finger function returns in months. 

The research team used PET scans in injured monkeys in early and late post-injury period. They found that during the early post-injury period, the activation of bilateral motor cortex takes place. The late post-injury period (near normal function) is characterized by the activation of the contralateral (in relation to the injured forepaw) motor cortex and the disappearance  of the ipsilateral cortex activation. 

The data presented reveal that brain regions distant to the corresponding motor cortex that is responsible for the movement of a limb with neurological deficit are activated during the “healing” period. It seems that brain centers are activated in order to help and organize the neuronal adaptation needed in order to return to normal function!

Nishimura, Y., Onoe, H., Morichika, Y., Perfiliev, S., Tsukada, H. & Isa, T. Time-dependent central compensatory mechanisms of finger dexterity after spinal cord injury. Science 318, 1150–1155 (2007) 

Riken research webpage 

  

 

We are all aware of the Neurosurgical FOCUS online free journal from AANS. The March-April issue revealed a surprise to the neurosurgeons since the editors decided to launch a neurosurgical forum that offers neurosurgical podcasts!

The forum is called “Neurosurgical FOCUS reader’s forum” and can be accessed at http://nsforum.org.

The podcast RSS can be accessed at http://feeds.feedburner.com/NeurosurgicalFocusReadersForum.

The first podcasted article is about “Stem Cells and Central Nervous System Therapeutics”. 

©1990-2008 by the American Association of Neurological Surgeons    

 

The evidence-based medical journal Cochrane Database of Systematic Reviews, published in 28th of January a meta-analysis article by Dr Roelofs et al. The aim of the study was to access the ability of non-steroidal anti-inflammatory drugs (NSAIDs) and COX inhibitors concerning the treatment of non-specific low back pain with or without sciatica. They included 65 trials with 11,237 patients enrolled.

The authors found that NSAIDs are NOT more effective than other drugs (e.g. paracetamol/acetaminophen, narcotic, muscle relaxants). The COX treated group showed fewer side effects in the form of peptic ulcers but we should recall that they are associated with increased cardiovascular risk.

The authors noted that few clinical trials were of high quality (only 42%) show more data are needed for long term results.

 Please read the abstract by clicking the link:

Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD000396

Copyright© 1999-2007 John Wiley & Sons, Inc. All rights reserved  

 

You can also complete a CME exam by Medscape ® at:

 http://www.medscape.com/viewarticle/569247?src=top10