The treatment of traumatic brain injury (TBI) involves multidisciplinary collaboration and comprehensive treatment strategies. With the advancement of medical technology in recent years,diagnostic and treatment methods are continuously updated and perfected. The application of various emerging technologies in diagnosis, treatment, and rehabilitation has improved the treatment level of TBI,significantly improving the prognosis and quality of life of patients. However, there is still uncertainty regarding the application effects and safety of these new technologies,which requires further research and validation. This article mainly reviews the latest developments and future directions in advanced imaging technology, biomarkers, neurocritical care monitoring technology, drug treatment, surgical treatment, and rehabilitation treatment in TBI treatment.
To study the changes in the concentrations of calcium ion (Ca2+)in neurons and calcitonin-gene-related peptide (CGRP) in plasma and their relationship with the severity of spinal cord injury (SCI).
Methods
A total of 100 male Wistar rats were randomly divided into experimental group(75 rats)and control group (25 rats)in a ratio of 3∶1 according to the random number table method.The experimental group was made into pathological models of SCI rats with light, medium and heavy injuries according to the principle of free fall injury by Feeney method, and divided into mild group(25 rats), moderate group (25 rats) and severe group (25 rats) according to the severity of injuries. The control group only underwent surgery, and did not cause SCI. At each time period (0.5, 6, 12, 24, 48 and 72 h) after the establishment of the model, 10 rats in each group were randomly selected to take blood from the eye canthus, and the CGRP concentration in plasma was determined by radioimmunoassay,among which 3 rats were randomly selected (including 3 rats randomly selected from 10 rats with blood taken from the canthus at 72 h after modeling)to be killed by neck-breaking,and the spinal cord (T9-11)was taken out, and the neurons were isolated and the purity was detected, the intracellular Ca2+concentration of neurons was measured by laser scanning confocal microscopy.
Results
The intracellular Ca2+ fluorescence pixel values of the experimental group rats rapidly increased after injury, reaching the highest value at 24 h and gradually decreased thereafter.Ca2+fluorescence pixel values at each time point were significantly higher than those of the control group, with severe group＞moderate group＞mild group,and the differences were statistically significant (P＜0.05).The concentration of CGRP in the plasma of the experimental group rats rapidly increased at 0.5 h after injury,significantly higher than that of the control group, and the difference was statistically significant (P＜0.05); The concentration of CGRP in the plasma began to decrease at 6 h after injury and gradually increased at 48 h, the concentrations of CGRP in the plasma at 6, 12, 24, and 48 h after injury were all lower than those in the control group, and the differences were statistically significant (P＜0.05). In the experimental group, there was no statistically significant difference in the concentration of CGRP in the plasma of the three groups of rats at 0.5 h after injury (P＞0.05); The plasma concentration of CGRP was compared at 12, 24, and 48 h after injury, with the severe grouP＜moderate grouP＜mild group, and the differences were statistically significant (P＜0.05).Correlation analysis showed a negative correlation between Ca2+concentration and CGRP concentration in the moderate and severe groups (moderate group: r=-0.513,P＜0.001; severe group: r=-0.391, P=0.013).
Conclusion
In the early stage of SCI, there may be intracellular calcium overload and abnormal CGRP concentration in neurons, which are negatively correlated and may be closely related to the transmission of primary injury signals and secondary cascade reactions. Maintaining the steady state of intracellular Ca2+ concentration and CGRP concentration in plasma as soon as possible after SCI is beneficial for the treatment and improvement of prognosis of SCI patients.
To compare the short-term efficacy, postoperative complications, operative time, and long-term outcomes of using different materials of artificial dura for duraplasty or outer dural layer incision after posterior fossa decompression in patients with Chiari malformation type Ⅰ(CM-Ⅰ).
Methods
A retrospective analysis was performed on the clinical data of 169 patients with CM-I treated at Neurosurgery Department of the First Affiliated Hospital of Harbin Medical University from September 2012 to December 2023.Among them,30 patients underwent posterior fossa decompression+outer dural layer incision (group A), and 139 patients underwent posterior fossa decompression + duraplasty (group B), including 61 patients using collagen-based biological dura (group B1); 59 patients using polyester urethane fiber synthetic dura (group B2);and 19 patients using artificial dura composed of Polyglactin910 sutures and Polydioxanone (PDO) sutures (group B3). The postoperative short - term Tator scores,complications,surgical time,and long-term prognosis of four groups were compared.
Results
There was no statistically significant difference in the short-term efficacy, improvement rate, and complication rates between group A and groups B1, B2, and B3 (P＞0.05). The median surgical time of group A was shorter than that of groups B1, B2, and B3, and the differences were statistically significant (P＜0.05). The evaluation results of CCOS score and Tator score showed that the improvement rate and progression rate of group A were higher than those of groups B1, B2, and B3, and the differences were statistically significant (P＜0.05);there was no statistically significant differences among the B1,B2,and B3 groups(P＞0.05).
Conclusion
In CM-I patients,dural outer layer incision following posterior fossa decompression has a relatively shorter surgical time and better long-term outcomes compared to expanded duraplasty with different dural materials.
To explore the effect of different treatment timing on prognosis of aneurysmal subarachnoid hemorrhage (aSAH) patients with different Hunt-Hess grades.
Methods
Clinical data of 331 patients with aSAH admitted to Neurosurgery Department of Sanya Central Hospital from January 2017 to December 2022 were retrospectively analyzed, and were divided into low-grade group (Hunt-Hess grades Ⅰ-Ⅲ, 265 cases) and high-grade group (Hunt-Hess grades Ⅳ-Ⅴ, 66 cases)according to preoperative Hunt-Hess grading. According to different surgical methods, it can be divided into low-grade craniotomy treatment,low-grade interventional treatment,high-grade craniotomy treatment,and high-grade interventional treatment. According to the timing of treatment, low-grade patients are classified into ultra-early treatment (＜24 h), early treatment (24-72 h), and delayed treatment (＞72 h);High grading is divided into ultra-early treatment (＜24 h) and non-ultra-early treatment (≥24 h). The postoperative complications and prognosis of patients with low-grade and high-grade aSAH at different treatment timings were compared, and the correlation between prognosis and treatment timing was analyzed.
Results
There was no statistically significant difference in postoperative complications among patients of different grades undergoing craniotomy or interventional therapy at different treatment opportunities (P＞0.05); There was no statistically significant difference in the postoperative modified Rankin scale (mRS)scores of low-grade aSAH patients undergoing craniotomy or interventional treatment between ultra-early treatment, early treatment, and delayed treatment (P＞0.05); There was a statistically significant difference in postoperative mRS scores of high-grade aSAH patients undergoing craniotomy or interventional treatment between ultra-early treatment and non-ultra-early treatment (P＜0.05).Correlation analysis showed that the prognosis of advanced aSAH patients undergoing surgery and interventional treatment is correlated with the timing of treatment (r=0.352,0.481,P＜0.05).
Conclusion
Patients with low-grade aSAH who undergo craniotomy or interventional surgery have a better overall prognosis, while different treatment timing has no effect on prognosis; The overall prognosis of high-grade aSAH patients treated with ultra-early craniotomy or interventional surgery is improved compared to non-ultra-early treatment,which helps to improve the quality of life of patients.
To explore the application value of CT scanning combined with threedimensional visualization technology in preoperative positioning for microchannel lumbar posterior approach surgery.
Methods
Clinical data of 113 patients with spinal stenosis who underwent microchannel lumbar posterior approach surgery from June 2018 to March 2021 in Neurosurgery Department of the 900th Hospital of Joint Logistics Force were collected. Patients were randomly divided into experimental group (58 cases) and control group (55 cases) using a random number table. The experimental group underwent preoperative CT scanning with preoperative positioning using Mimics threedimensional visualization technology.The control group underwent X-ray anterior-posterior scanning with preoperative positioning using metal paper clips placed in the waist. The accuracy of preoperative positioning,the number of intraoperative fluoroscopies,the number of intraoperative channel adjustments,and the duration of surgery were compared between the two groups.Pain visual analogue score (VAS)and Oswestry dysfunction index (ODI) scores were used to assess the improvement in pain and functional disability 1 d before surgery and 1 week,3 months,and 1 year after surgery.
Results
The intraoperative fluoroscopy frequency, intraoperative channel adjustment frequency, and surgery duration of the experimental group were lower than those of the control group, and the difference was statistically significant (P＜0.05); There was no statistically significant difference in the accuracy of positioning between the two groups (P＞0.05). The VAS and ODI scores of the experimental group were lower than those of the control group 1 week after surgery, and the difference was statistically significant (P＜0.05);There was no statistically significant difference in VAS and ODI scores between the two groups at 3 months and 1 year after surgery(P＞0.05).The postoperative VAS and ODI scores of both groups gradually decreased with the prolongation of time, and the differences at each time point were statistically significant (P＜0.05).
Conclusion
In preoperative positioning for microchannel lumbar posterior approach surgery, CT scanning combined with Mimics three-dimensional visualization technology has more advantages than traditional X-ray positioning technology and is considered as an ideal preoperative positioning method.
To explore the predictive value of CT perfusion imaging (CTP) parameters and thromboelogram (TEG) for early neurological deterioration (END) in acute anterior circulation cerebral infarction.
Methods
A total of 149 patients with acute anterior circulation cerebral infarction admitted to Neurology Department of Wuxi Huishan District People's Hospital from February 2021 to February 2023 were selected as the research subjects. Patients were divided into END group and non END group based on whether END occurred within 3 d of admission. The National Institutes of Health stroke scale (NIHSS) scores, time to peak ischemic zone (TTP), cerebral blood volume (CBV), cerebral blood flow(CBF),dynamic time(KT),and reaction time(RT)were compared between the two groups;CTP parameters and thromboelogram parameters for different causes of stroke were compared. Pearson method was used to analyze the correlation between NIHSS score and CBV, TTP, CBF, RT, KT; The multi factor binary Logistic regression model was used to analyze the independent influencing factors of END in patients with acute anterior circulation cerebral infarction; ROC curve was established to analyze the predictive performance of CTP and TEG related indicators.
Results
Among the 149 patients, there were 26 patients in the END group and 123 patients in the non END group. The difference in NIHSS scores between the two groups was statistically significant (P＜0.05). The TTP, CBV, and CBF in the ischemic area of patients in the END group were higher than those in the non END group, while KT and RT were lower than those in the non END group, and the differences were statistically significant (P＜0.05). According to Pearson analysis, NIHSS score was positively correlated with TTP, CBV, and CBF,and negatively correlated with RT (P＜0.05). The binary Logistic regression model analysis showed that TTP,CBV,CBF,KT,and RT were independent influencing factors of END in patients with acute anterior circulation cerebral infarction.ROC curve analysis showed that the AUC of TTP,CBV,CBF,KT,RT,and their combined prediction of END in patients with acute anterior circulation cerebral infarction were 0.759, 0.694, 0.758, 0.736, 0.794, and 0.965, respectively. The AUC of the combination of 5 indicators was compared with the AUC of TTP, CBV, CBF, KT, and RT, and the differences were statistically significant (P＜0.05).
Conclusion
CTP and TEG can effectively predict the END of patients with acute anterior circulation cerebral infarction,and have certain prognostic value.
To analyze the therapeutic effect of medication on paroxysmal sympathetic hyperactivity (PSH) after cranial trauma.
Methods
Sixty-eight patients with PSH after cranial trauma admitted to Neurosurgery Department of Xuzhou Central Hospital from January 2018 to June 2022 were selected as the research subjects. Patients were divided into control group and treatment group using a random number table method, with 34 cases in each group. Both groups of patients were given basic treatments such as oxygen therapy, appropriate control of intracranial pressure, maintenance of stable cerebral perfusion, and nutritional support. The control group received oral propranolol, while the treatment group received oral propranolol combined with dexmedetomidine infusion. The length of ICU stay and frequency of PSH attack were compared between the two groups.Changes in PSH-AM scores and levels of tumor necrosis factor α (TNF-α), serum neuron specific enolase (NSE), and central nervous system specific protein β (S100-β) were compared before and after treatment with two different regimens.
Results
The length of ICU stay and frequency of PSH attacks in the treatment group were significantly reduced compared to the control group (P＜0.05).After treatment,the PSH-AM scores of both groups were lower than before treatment, and the treatment group were lower than the control group, with statistical significance (P＜0.05). The average levels of TNF-α, NSE, and S100-β in two groups after treatment were lower than before treatment, and the treatment group were lower than the control group, with statistical significance (P＜0.05).
Conclusion
In patients with PSH after cranial trauma, the combination of propranolol and dexmedetomidine in treatment can more effectively control symptoms of sympathetic hyperactivity and alleviate neurological damage.
To explore 12 T cytokines and screen a new,simple and feasible test index for preoperative prediction and evaluation of the grading and prognosis of glioma patients, in order to assist in treatment plans.
Methods
A retrospective analysis was conducted on the data of preoperative T-cell cytokine (12 items) measurements in 36 glioma patients at Xuzhou University Affiliated Hospital from January 2018 to June 2023. According to the postoperative pathological results, patients were divided into high-grade group (26 cases)and low-grade group (10 cases).The preoperative T cell cytokine level characteristics of patients in different grade groups were compared, and their correlation with prognosis was analyzed by combining immunohistochemical results (Ki-67 expression score).
Results
The difference in IL-4 levels between the two groups was statistically significant, with IL-4 levels significantly lower in the low-grade glioma group than in the high-grade glioma group (P＜0.05). The expression level of Ki-67 in the low-grade glioma group was significantly lower than that in the high-grade glioma group, and the difference was statistically significant (P＜0.05). Correlation analysis showed that IL-4 was significantly correlated with glioma grade (r=0.337,P=0.044)and Ki-67 expression(r=0.356,P=0.033).
Conclusion
Elevated serum IL-4 levels are associated with the pathological grade and prognosis of glioma,suggesting that preoperative serum IL-4 levels may have potential value in predicting patient prognosis.
To investigate the surgical technique and clinical effect of three -dimensional (3D) robotic digital microscope microchannel surgery for lumbar disc herniation (LDH).
Methods
The clinical data of 5 patients with LDH admitted to Neurosurgery Department of the First Affiliated Hospital of Shandong First Medical University from June to August 2023 were retrospectively analyzed. All 5 patients underwent 3D robotic digital microscope microchannel surgery. The degree of pain relief was evaluated by visual analogue scale (VAS) score 2 weeks after surgery. Spinal stability and facet joint injury were assessed by CT and 3D reconstruction of the lumbar spine. MacNab score was modified to evaluate the clinical effect 6 months after surgery.
Results
All 5 cases successfully completed the surgery, with the operation time of (68.00±7.11) min, and the intraoperative blood loss of(22.00±3.10) mL. After surgery, the symptoms of lumbago, lower limb numbness, hypoesthesia and other symptoms of 5 patients were significantly improved. The VAS score was 2.20±0.40 2 weeks after surgery;CT three-dimensional reconstruction of lumbar spine 1 month after surgery showed that facet joints and facet processes were well protected.The excellent and good rate of the modified MacNab score was 100%6 months after surgery, with with 4 cases being excellent and 1 case being good. None of the 5 patients had recurrent low back pain,lumbar instability and other complications.
Conclusion
3D robotic digital microscope microchannel surgery is a safe and effective procedure for the treatment of LDH, and good curative effect can be observed in short and medium follow-up.
Aneurysmal subarachnoid hemorrhage (aSAH) is a neurological emergency with extremely high rates of mortality and disability. Elevated intracranial pressure (ICP) is a common clinical manifestation of aSAH. Early brain injury, including blood-brain barrier disruption, brain edema, and impaired cerebral autoregulation,is considered to be a major cause of elevated ICP following aSAH.If left untreated, elevated ICP can pose a serious threat to the patient's life. However, the pathophysiological mechanisms underlying ICP elevation after aSAH are complex and not yet fully understood. In recent years, growing evidence has indicated that oxidative stress is closely associated with ICP elevation following aSAH. Although there have been certain advances in the treatment of aSAH, there is currently no unified consensus or guideline for managing elevated ICP in aSAH. This review summarizes the pathophysiological characteristics of ICP elevation in aSAH and examines the existing management strategies, aiming to identify the best approaches for ICP monitoring and management, with the goal of providing reference for clinical practice.
