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: 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]