المؤلفون: Chau, Charlene YC, Craven, Claudia L, Rubiano, Andres M, Adams, Hadie, Tülü, Selma, Czosnyka, Marek, Servadei, Franco, Ercole, Ari, Hutchinson, Peter J, Kolias, Angelos G

مصطلحات موضوعية: EVD, ICP, TBI, intracranial pressure, neurosurgery, neurotrauma, ventriculostomy

الوصف: External ventricular drains (EVDs) are commonly used in neurosurgery in different conditions but frequently in the management of traumatic brain injury (TBI) to monitor and/or control intracranial pressure (ICP) by diverting cerebrospinal fluid (CSF). Their clinical effectiveness, when used as a therapeutic ICP-lowering procedure in contemporary practice, remains unclear. No consensus has been reached regarding the drainage strategy and optimal timing of insertion. We review the literature on EVDs in the setting of TBI, discussing its clinical indications, surgical technique, complications, clinical outcomes, and economic considerations.

وصف الملف: Electronic; application/pdf

العلاقة: https://www.repository.cam.ac.uk/handle/1810/296746Test

الإتاحة: https://doi.org/10.17863/CAM.43789Test
https://www.repository.cam.ac.uk/handle/1810/296746Test

المؤلفون: Craven, Claudia L.¹ (AUTHOR) claudia.craven@gmail.com, Sae-Huang, Morrakot¹ (AUTHOR), Hoskote, Chandrashekar² (AUTHOR), Watkins, Laurence D.¹ (AUTHOR), Reddy, Ugan³ (AUTHOR), Toma, Ahmed K.¹ (AUTHOR)

المصدر: World Neurosurgery. May2021, Vol. 149, pe942-e946. 5p.

مصطلحات موضوعية: *TRANSCRANIAL Doppler ultrasonography, *INTERNAL carotid artery, *RECEIVER operating characteristic curves, *CEREBRAL anoxia, *SUBARACHNOID hemorrhage

مستخلص: Multimodal monitoring of intracranial pressure and brain tissue oxygen tension (PbtO 2) have been increasingly used to detect delayed cerebral ischemia (DCI) after subarachnoid hemorrhage. At our center, patients who cannot be easily assessed clinically will undergo intracranial pressure and PbtO 2 monitoring via a NEUROVENT-PTO bolt. We aimed to determine whether the Lindegaard ratios (LRs) computed from transcranial Doppler ultrasonography (TCDU) would correlate with, or can predict, the simultaneously recorded PbtO 2 value. Patients with aneurysmal subarachnoid hemorrhage, PbtO 2 recordings from the middle cerebral artery territory, and simultaneous TCDU scans available from the ipsilateral middle cerebral artery and internal carotid artery from August 2018 to 2019 were included in the present study. The index test result was vasospasm (LR of ≥3) found on TCDU. The reference standard was the presence of regional hypoxia (PbtO 2 <20 mm Hg). The PbtO 2 results were compared with those from computed tomography angiography as a radiological standard. The predictive values were calculated using a contingency table and receiver operating characteristic curve. A total of 28 patients (6 men and 22 women; age, 59.04 ± 13.75 years) were identified with simultaneous brain tissue oxygen and TCDU recordings available. Of the 28 patients, 7 had cerebral hypoxia (PbtO 2 <20 mm Hg). We found no correlation between the PbtO 2 measurements and simultaneously recorded LRs (r 2 = 0.048; P = 0.26). A LR of ≥3 had high specificity (95.24%) for hypoxia but relatively low sensitivity (42.86%; P = 0.037). We find TCDU to be specific for predicting cerebral hypoxia (measured via an intraparenchymal probe). Therefore, it could be a useful and noninvasive tool in the context of preventative DCI monitoring. However, given the low sensitivity, the lack of vasospasm on TCDU should not preclude the possibility of the presence of evolving DCI. [ABSTRACT FROM AUTHOR]

المؤلفون: D'Antona, Linda^1,2 (AUTHOR) linda.d'antona@nhs.net, Craven, Claudia Louise¹ (AUTHOR), Merchan, Melida Andrea Jaime¹ (AUTHOR), Thompson, Simon David¹ (AUTHOR), Bremner, Fion^2,3 (AUTHOR), Thorne, Lewis¹ (AUTHOR), Matharu, Manjit Singh^2,4 (AUTHOR), Watkins, Laurence Dale^1,2 (AUTHOR), Toma, Ahmed Kassem^1,2 (AUTHOR)

المصدر: Acta Neurochirurgica. Oct2020, Vol. 162 Issue 10, p2451-2458. 8p.

مصطلحات موضوعية: *INTRACRANIAL pressure, *CEREBROSPINAL fluid shunts, *INTRACRANIAL hypertension, *VALVES

مستخلص: Background: The hydrodynamics of cerebrospinal fluid shunts have been described in vitro; however, knowledge on the response of intracranial pressure (ICP) to valve settings adjustments in vivo is limited. This study describes the effect of adjusting the shunt valve setting on ICP in a cohort of patients with complex symptom management. Method: Single-centre retrospective observational study. Patients who underwent ICP-guided valve setting adjustments during 24-h continuous ICP monitoring, between 2014 and 2019, were included. Patients with suspected shunt malfunction were excluded. Median night ICP before and after the valve adjustments were compared (Δ night ICP). The responses of ICP to valve adjustment were divided into 3 different groups as follows: expected, paradoxical and no response. The frequency of the paradoxical response and its potential predicting factors were investigated. Results: Fifty-one patients (37 females, 14 males, mean age 38 years) receiving 94 valve setting adjustments met the study inclusion criteria. Patients' underlying conditions were most commonly hydrocephalus (47%) or idiopathic intracranial hypertension (43%). The response of ICP to valve setting adjustments was classified as 'expected' in 54 cases (57%), 'paradoxical' in 17 cases (18%) and 'no effect' (Δ night ICP < 1 mmHg) in 23 cases (24%). There was a significant correlation between the Δ night ICP and the magnitude of valve setting change in both the investigated valves (Miethke ProGAV, p = 0.01 and Medtronic Strata, p = 0.02). Conclusions: Paradoxical ICP changes can occur after shunt valve setting adjustments. This observation should be taken into account when performing ICP-guided valve adjustments and is highly relevant for the future development of "smart" shunt systems. [ABSTRACT FROM AUTHOR]

المؤلفون: Craven, Claudia L., Asif, Hasan, Curtis, Carmel, Thompson, Simon D., D'Antona, Linda, Ramos, Joana, Thorne, Lewis, Watkins, Laurence D., Toma, Ahmed K.

المصدر: Journal of Clinical Neuroscience; Jun2020, Vol. 76, p15-19, 5p

مستخلص: • Leukocytosis in lumbar cerebrospinal fluid (CSF) can occur after cranial surgery. • The relevance of ascetic meningitis to remains unclear. • Immediately after minor intracranial surgery lumbar CSF white cell count raised. • This increase in CSF white cell count was not associated with organism growth. Raised white cell count (WCC) in lumbar CSF is a commonly used marker of meningitis. The effect of cranial neurosurgery per se on lumbar WCC is not established. At this single centre, many patients undergo ICPM followed by lumboperitoneal shunt (LPS), with lumbar CSF WCC samples taken during insertion. We aimed to determine the effect of ICP bolt insertion on lumbar CSF WCC. We undertook a retrospective analysis of lumbar CSF samples in patients who had recently undergone 24-h ICPM. Thirty-three patients (16F:7M) aged 43.31 ± 12.1 years (mean ± SD) had lumbar CSF samples after ICPM. Fourteen had CSF sampled within 6 weeks and 19 after 6 weeks of ICPM. Twenty-five samples were taken during LPS insertion, 5 during lumbar drainage/puncture and 3 during LPS revision. All 33 patients were afebrile at the point of CSF sampling. The mean lumbar WCC within 6 weeks of ICPM was significantly higher than the mean lumbar WCC after 6 weeks, being 15.4 ± 18.0 and 2.32 ± 1.79 cells/microlitre respectively respectively. There was no significant increase in RBC. In patients with raised CSF WCC, 60% of raised WCC were predominantly lymphoctyes and 40% predominantly neutrophils. Only one patient grew an organism (S. aureus). We conclude that lumbar CSF WCC can be raised following minor intracranial surgery, despite no clinical sign of infection. We caution against using lumbar CSF WCC values independently as the only marker of infection following neurosurgery. [ABSTRACT FROM AUTHOR]

: Copyright of Journal of Clinical Neuroscience is the property of Churchill Livingstone, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Chari, Aswin, Dasgupta, Debayan, Smedley, Alexander, Craven, Claudia, Dyson, Edward, Matloob, Samir, Thompson, Simon, Thorne, Lewis, Toma, Ahmed, Watkins, Laurence

المصدر: Acta Neurochirurgica; Oct2017, Vol. 159 Issue 10, p1967-1978, 12p

مصطلحات موضوعية: INTRACRANIAL pressure, HYDROCEPHALUS, CEREBROSPINAL fluid, INTRACRANIAL hypertension, CEREBROSPINAL fluid shunts, DIAGNOSIS

مستخلص: Background: Elective intraparenchymal intracranial pressure (ICP) monitoring is useful for the diagnosis and treatment of hydrocephalus and cerebrospinal fluid (CSF) disorders. This retrospective study analyzes median ICP and pulse amplitude (PA) recordings in neurosurgically naïve patients undergoing elective ICP monitoring for suspected CSF disorders. Methods: Retrospective review of prospectively collated database of neurosurgically naïve patients undergoing elective ICP monitoring for suspected hydrocephalus and CSF disorders. Following extraction of the median ICP and PA values (separated into all, day and night time recordings), principal component analysis (PCA) was performed to identify the principal factors determining the spread of the data. Exploratory comparisons and correlations of ICP and PA values were explored, including by post hoc diagnostic groupings and age. Results: A total of 198 patients were identified in six distinct diagnostic groups ( n = 21-47 in each). The PCA suggested that there were two main factors accounting for the spread in the data, with 61.4% of the variance determined largely by the PA and 33.0% by the ICP recordings. Exploratory comparisons of PA and ICP between the diagnostic groups showed significant differences between the groups. Specifically, significant differences were observed in PA between a group managed conservatively and the Chiari/syrinx, IIH, and NPH/LOVA groups and in the ICP between the conservatively managed group and high-pressure, IIH, and low-pressure groups. Correlations between ICP and PA revealed some interesting trends in the different diagnostic groups and correlations between ICP, PA, and age revealed a decreasing ICP and increasing PA with age. Conclusions: This study provides insights into hydrodynamic disturbances in different diagnostic groups of patients with CSF hydrodynamic disorders. It highlights the utility of analyzing both median PA and ICP recordings, stratified into day and night time recordings. [ABSTRACT FROM AUTHOR]

: Copyright of Acta Neurochirurgica is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Craven, Claudia, Reddy, Ugan

المصدر: Anaesthesia & Intensive Care Medicine; Dec2016, Vol. 17 Issue 12, p630-634, 5p

مستخلص: The brain uses large amounts of glucose for its basal energy requirements, and these are further increased during cerebral activation. In order that glucose can provide this energy, a plentiful and uninterrupted supply of oxygen is necessary. Cerebral blood flow is therefore critical for normal cerebral function. Its control is dictated by local intrinsic metabolic needs as well as extraneous factors such as arterial blood pressure, arterial carbon dioxide and oxygen tension, temperature and neural factors. This article reviews cerebral metabolism and cerebral blood flow and techniques by which both can be monitored. [ABSTRACT FROM AUTHOR]

: Copyright of Anaesthesia & Intensive Care Medicine is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Craven, Claudia¹ claudia.craven@gmail.com, Toma, Ahmed¹, Khan, Akbar¹, Watkins, Laurence¹

المصدر: Acta Neurochirurgica. Sep2016, Vol. 158 Issue 9, p1813-1819. 7p. 2 Diagrams, 1 Chart.

مصطلحات موضوعية: *SPINAL surgery, *HYDROCEPHALUS, *CEREBROSPINAL fluid otorrhea

مستخلص: Background: Cerebrospinal fluid (CSF) leak following spinal surgery is a relatively common surgical complication. A disturbance in the underlying CSF dynamics could be the causative factor in a small group of patients with refractory CSF leaks that require multiple surgical repairs and prolonged hospital admission. Methods: A retrospective case series of patients with persistent post spinal surgery CSF leak referred to the hydrocephalus service for continuous intracranial pressure (ICP) monitoring. Patients' notes were reviewed for medical history, ICP data, radiological data, and subsequent management and outcome. Results: Five patients (two males/three females, mean age, 35.4 years) were referred for ICP monitoring over a 12-month period. These patients had prolonged CSF leak despite multiple repair attempts 252 ± 454 days (mean ± SD). On ICP monitoring, all five patients had abnormal results, with the mean ICP 8.95 ± 4.41 mmHg. Four had abnormal pulse amplitudes, mean 6.15 mmHg ± 1.22 mmHg. All five patients underwent an intervention. Three patients underwent insertion of ventriculoperitoneal (VP) shunts. One patient had venous sinus stent insertion and one patient underwent medical management with acetazolamide. All five of the patients' CSF leak resolved post intervention. The mean time to resolution of CSF leak post intervention was 10.8 ± 12.9 days. Conclusions: Abnormal cerebrospinal fluid dynamics could be the underlying factor in patients with a persistent and treatment-refractory CSF leak post spinal surgery. Treatments aimed at lowering ICP may be beneficial in this group of patients. Whether abnormal pressure and dynamics represent a pre-existing abnormality or is induced by spinal surgery should be a subject of further study. [ABSTRACT FROM AUTHOR]

المؤلفون: Pradini-Santos, Laura¹ (AUTHOR), Craven, Claudia L.¹ (AUTHOR) claudia.craven@gmail.com, Sayal, Parag P.¹ (AUTHOR)

المصدر: World Neurosurgery. Dec2019, Vol. 132, p67-68. 2p.

مصطلحات موضوعية: *EHLERS-Danlos syndrome, *CEREBROSPINAL fluid, *INTRACRANIAL pressure, *ARNOLD-Chiari deformity, *NERVE block

مستخلص: Ehlers-Danlos syndrome can be associated with cerebrospinal fluid (CSF) disturbances including recurrent CSF leak and Chiari I malformations. Persistent pseudomeningoceles are known to be associated with raised intracranial pressure. We present an unusual case of a compressive epidural CSF collection occurring after a computed tomography−guided L5 nerve root block and describe an effective management strategy. [ABSTRACT FROM AUTHOR]

المؤلفون: Goel, Aimee¹ (AUTHOR) aimee.goel@hotmail.com, Asif, Hasan¹ (AUTHOR), Craven, Claudia¹ (AUTHOR), D'Antona, Linda¹ (AUTHOR), Das, Pranoy¹ (AUTHOR), Thorne, Lewis¹ (AUTHOR), Toma, Ahmed¹ (AUTHOR)

المصدر: World Neurosurgery. Jun2022, Vol. 162, p43-46. 4p.

مصطلحات موضوعية: *NERVE block, *SCALP, *CONDUCTION anesthesia, *PATIENT satisfaction, *INTRACRANIAL pressure, *FLUID dynamics

مستخلص: Elective insertion of intracranial pressure (ICP) monitoring bolts is useful for the diagnosis and treatment of disorders of cerebrospinal fluid dynamics. Patients typically report severe discomfort on bolt removal, which negatively impacts overall patient satisfaction of ICP monitoring. We assessed the efficacy and safety of using supratrochlear and supraorbital nerve block—a commonly used form of scalp anesthesia—alongside oral analgesia before bolt removal. We compared the efficacy and safety of regional scalp block anesthesia alongside oral analgesia versus oral analgesia alone in a cohort of 85 patients undergoing removal of diagnostic ICP bolts between June 2017 and April 2019 using retrospective patient questionnaires, as well as electronic admission documentation. We found that scalp block alongside oral analgesia improved bolt removal experience (4/5 vs. 3/5 on a 1−5 point Likert scale) and that a majority (70.6%) of patients would have preferred local anesthetic before removal in the oral analgesia−only group. Only 2 patients experienced mild and localized side effects: mild bruising and temporary facial and eyelid swelling following regional scalp block. We conclude that regional supraorbital and supratrochlear nerve block is a simple, safe, and effective adjunct to minimizing discomfort during bolt removal and improving overall patient satisfaction of ICP monitoring. [ABSTRACT FROM AUTHOR]

المؤلفون: Chau, Charlene Y. C.¹ (AUTHOR), Craven, Claudia L.² (AUTHOR), Rubiano, Andres M.^3,4 (AUTHOR), Adams, Hadie¹ (AUTHOR), Tülü, Selma^1,5 (AUTHOR), Czosnyka, Marek¹ (AUTHOR), Servadei, Franco⁶ (AUTHOR), Ercole, Ari⁷ (AUTHOR), Hutchinson, Peter J.^1,4 (AUTHOR), Kolias, Angelos G.^1,4 (AUTHOR) angeloskolias@gmail.com

المصدر: Journal of Clinical Medicine. Sep2019, Vol. 8 Issue 9, p1422. 1p.

مصطلحات موضوعية: *BRAIN injuries, *DRAINAGE, *INTRACRANIAL pressure, *CLINICAL indications, *CEREBROSPINAL fluid

مستخلص: External ventricular drains (EVDs) are commonly used in neurosurgery in different conditions but frequently in the management of traumatic brain injury (TBI) to monitor and/or control intracranial pressure (ICP) by diverting cerebrospinal fluid (CSF). Their clinical effectiveness, when used as a therapeutic ICP-lowering procedure in contemporary practice, remains unclear. No consensus has been reached regarding the drainage strategy and optimal timing of insertion. We review the literature on EVDs in the setting of TBI, discussing its clinical indications, surgical technique, complications, clinical outcomes, and economic considerations. [ABSTRACT FROM AUTHOR]