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Intraparenchymal spinal pressure

Femke Streijger, Kitty So, Neda Manouchehri, Ana Gheorghe, Elena B Okon, Ryan M Chan, Benjamin Ng, Katelyn Shortt, Mypinder S Sekhon, Donald E Griesdale, Brian K Kwon
Current clinical guidelines recommend elevating the mean arterial blood pressure (MAP) to increase spinal cord perfusion in patients with acute spinal cord injury (SCI). This is typically achieved with vasopressors such as norepinephrine (NE) and phenylephrine (PE). These drugs differ in their pharmacological properties and potentially have different effects on spinal cord blood flow (SCBF), oxygenation (PO2 ), and downstream metabolism after injury. Using a porcine model of thoracic SCI, we evaluated how these vasopressors influenced intraparenchymal SCBF, PO2 , hydrostatic pressure, and metabolism within the spinal cord adjacent to the injury site...
March 28, 2018: Journal of Neurotrauma
Femke Streijger, Kitty So, Neda Manouchehri, Seth Tigchelaar, Jae H T Lee, Elena B Okon, Katelyn Shortt, So-Eun Kim, Kurt McInnes, Peter Cripton, Brian K Kwon
Traumatic spinal cord injury (SCI) triggers many perturbations within the injured cord, such as decreased perfusion, reduced tissue oxygenation, increased hydrostatic pressure, and disrupted bioenergetics. While much attention is directed to neuroprotective interventions that might alleviate these early pathophysiologic responses to traumatic injury, the temporo-spatial characteristics of these responses within the injured cord are not well documented. In this study, we utilized our Yucatan mini-pig model of traumatic SCI to characterize intraparenchymal hemodynamic and metabolic changes within the spinal cord for 1 week post-injury...
December 15, 2017: Journal of Neurotrauma
Jennifer E S Bell, Jennifer L Seifert, Eileen N Shimizu, Daniel J Sucato, Mario I Romero-Ortega
Corrective forces during spine deformity surgery, including distraction, impart significant stresses to the spinal cord that may result in permanent injury. Intraoperative neuromonitoring is commonly used by surgeons to recognize possible damage to the spinal cord in cases of evident traumatic or vascular damage to the spinal cord. However, mild insult to the spinal cord that does not result in obvious trauma or electrophysiological changes present a major clinical challenge as the mechanisms of this type of spinal cord injury (SCI) remain largely unknown, and thus preventive strategies are lacking...
June 15, 2017: Journal of Neurotrauma
Zin Z Khaing, Lindsay N Cates, Amanda E Fischedick, Abbi M McClintic, Pierre D Mourad, Christoph P Hofstetter
Traumatic spinal cord injury (SCI) often leads to permanent neurological impairment. Currently, the only clinically effective intervention for patients with acute SCI is surgical decompression by removal of impinging bone fragments within 24 h after injury. Recent clinical studies suggest that elevated intraparenchymal spinal pressure (ISP) limits functional recovery following SCI. Here, we report on the temporal and spatial patterns of elevated ISP following a moderate rodent contusion SCI. Compared with physiological ISP in the intact cord (2...
February 2017: Journal of Neurotrauma
Nicholas Theodore, Randall Hlubek, Jill Danielson, Kristin Neff, Lou Vaickus, Thomas R Ulich, Alexander E Ropper
BACKGROUND AND IMPORTANCE: A porous bioresorbable polymer scaffold has previously been tested in preclinical animal models of spinal cord contusion injury to promote appositional healing, spare white matter, decrease posttraumatic cysts, and normalize intraparenchymal tissue pressure. This is the first report of its human implantation in a spinal cord injury patient during a pilot study testing the safety and feasibility of this technique ( Identifier: NCT02138110). CLINICAL PRESENTATION: A 25-year-old man had a T11-12 fracture dislocation sustained in a motocross accident that resulted in a T11 American Spinal Injury Association Impairment Scale (AIS) grade A traumatic spinal cord injury...
August 2016: Neurosurgery
Alp Ozpinar, Jesse J Liu, Zachary J Tempel, Phillip A Choi, Robert A Hart, D Kojo Hamilton
BACKGROUND: Intracranial pressure (ICP) monitoring is not routinely used during complex spinal deformity correction surgery. The authors report a 66-year-old male who during thoracolumbar deformity surgery required the placement of an ICP monitor due to the underlying history of a superior vena cava syndrome (e.g., s/p right jugular stent). CASE DESCRIPTION: A 66-year-old male with multiple prior lumbar spinal procedures presented with lower back and bilateral lower extremity pain, paresthesias, and weakness...
2016: Surgical Neurology International
Gustavo Henrique Frigieri Vilela, Brenno Cabella, Sérgio Mascarenhas, Marek Czosnyka, Peter Smielewski, Celeste Dias, Danilo Augusto Cardim, Yvonne Maria Mascarenhas, Charles Chenwei Wang, Rodrigo Andrade, Koji Tanaka, Luiza Silva Lopes, Benedicto Oscar Colli
In this chapter we present in vivo experiments with a new minimally invasive method of monitoring intracranial pressure (ICP). Strain gauge deformation sensors are externally glued onto the exposed skull. The signal from these sensors is amplified, filtered, and sent to a computer with appropriate software for analysis and data storage. Saline infusions into the spinal channel of rats were performed to produce ICP changes, and minimally invasive ICP and direct Codman intraparenchymal ICP were simultaneously acquired in six animals...
2016: Acta Neurochirurgica. Supplement
Daniel M Harwell, Justin L Gibson, Richard David Fessler, Jeffrey Holtz, David B Pettigrew, Charles Kuntz
STUDY DESIGN: Intraparenchymal pressure (IPP) measurements in an in vitro cadaveric model of CNS edema. OBJECTIVE: To assess the contribution of pia mater to IPP and the effect of piotomy. SUMMARY OF BACKGROUND DATA: Multicenter randomized control trials have shown that decompression with durotomy/duroplasty significantly decreases intracranial pressure (ICP). There is a paucity of evidence regarding the effectiveness of decompression of the spinal cord by piotomy...
May 2016: Spine
Daniel M Harwell, Justin L Gibson, R David Fessler, Jeffrey Holtz, David B Pettigrew, Charles Kuntz
STUDY DESIGN: Intraparenchymal pressure (IPP) measurements in an in vitro cadaveric model of CNS edema OBJECTIVE.: To assess the contribution of pia mater to IPP and the effect of piotomy. SUMMARY OF BACKGROUND DATA: Multicenter randomized control trials have shown that decompression with durotomy/duroplasty significantly decreases intracranial pressure (ICP). There is a paucity of evidence regarding the effectiveness of decompression of the spinal cord by piotomy...
November 30, 2015: Spine
Isaac Phang, Marios C Papadopoulos
BACKGROUND: We recently described a technique for monitoring intraspinal pressure (ISP) after traumatic spinal cord injury (TSCI). This is analogous to intracranial pressure monitoring after brain injury. We showed that, after severe TSCI, ISP at the injury site is elevated as the swollen cord is compressed against the dura. METHODS: In a patient with complete thoracic TSCI, we sequentially monitored subdural ISP above the injury, at the injury site, and below the injury intraoperatively...
December 2015: Neurocritical Care
Elena B Okon, Femke Streijger, Jae H T Lee, Lisa M Anderson, Amy K Russell, Brian K Kwon
In animal models, spinal cord injury (SCI) is typically imparted by contusion alone (e.g., weight drop) or by compression alone (e.g., clip compression). In humans, however, the cord is typically injured by a combination of violent contusion followed by varying degrees of ongoing mechanical compression. Understanding how the combination of contusion and compression influences the early pathophysiology of SCI is important for the pre-clinical development of neuroprotective therapies that are applicable to the human condition...
September 15, 2013: Journal of Neurotrauma
Yuichi Takahashi, Kenki Nishida, Koichi Ogawa, Takao Yasuhara, Shinji Kumamoto, Tatsuomi Niimura, Takashi Tanoue
A 69-year-old woman presented with a rare case of multiple supra- and infratentorial intracranial hemorrhages after cervical laminoplasty for cervical spondylotic myelopathy without intraoperative liquorrhea. A wound drainage tube under negative pressure was placed with subsequent 380 ml of drainage in the first 12 hours. She had no complaint of headache and nausea at that time. Computed tomography of the brain obtained at 15 hours after surgery demonstrated cerebellar hemorrhage, acute subdural hemorrhage, subarachnoid hemorrhage, supratentorial intraparenchymal hemorrhage, and pneumocephalus...
2012: Neurologia Medico-chirurgica
A Behrens, N Lenfeldt, S Qvarlander, L-O Koskinen, J Malm, A Eklund
OBJECTIVE: The aim of this study was to investigate whether pulsations measured in the brain correspond to those measured in lumbar space, and subsequently whether lumbar punctures could replace invasive recordings. METHODS: In ten patients with normal pressure hydrocephalus, simultaneous recordings of the intracranial pressure (ICP; intraparenchymal) and lumbar pressure (LP; cerebrospinal fluid pressure) were performed. During registration, pressure was altered between resting pressure and 45 mmHg using an infusion test...
April 2013: Acta Neurologica Scandinavica
Paolo Missori, Gianluca Coppola, Sergio Paolini, Francesco Pierelli, Antonio Currà
The lumbar tap test as a diagnostic and therapeutic procedure in idiopathic normal pressure hydrocephalus is used widely. Complications from lumbar punctures are rare. We report a man who underwent a tap-test for secondary normal pressure hydrocephalus, and after clinical improvement, suffered a fatal intraparenchymal brain haemorrhage three days later.
June 2012: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
John S Winestone, Chad W Farley, Bradford A Curt, Albert Chavanne, Neal Dollin, David B Pettigrew, Charles Kuntz
OBJECT: Previous studies have shown that cervical and thoracic kyphotic deformity increases spinal cord intramedullary pressure (IMP). Using a cadaveric model, the authors investigated whether posterior decompression can adequately decrease elevated IMP in severe cervical and thoracic kyphotic deformities. METHODS: Using an established cadaveric model, a kyphotic deformity was created in 16 fresh human cadavers (8 cervical and 8 thoracic). A single-level rostral laminotomy and durotomy were performed to place intraparenchymal pressure monitors in the spinal cord at C-2, C4-5, and C-7 in the cervical study group and at T4-5, T7-8, and T11-12 in the thoracic study group...
February 2012: Journal of Neurosurgery. Spine
Takahiro Ando, Shunichi Sato, Terushige Toyooka, Yoichi Uozumi, Hiroshi Nawashiro, Hiroshi Ashida, Minoru Obara
Nonviral, site-specific gene delivery to deep tissue is required for gene therapy of a spinal cord injury. However, an efficient method satisfying these requirements has not been established. This study demonstrates efficient and targeted gene transfer into the spinal cord by using photomechanical waves (PMWs), which were generated by irradiating a black laser absorbing rubber with 532-nm nanosecond Nd:YAG laser pulses. After a solution of plasmid DNA coding for enhanced green fluorescent protein (EGFP) or luciferase was intraparenchymally injected into the spinal cord, PMWs were applied to the target site...
October 2011: Journal of Biomedical Optics
Christian A Bowers, Philipp Taussky, Bradley S Duhon, Meic H Schmidt
STUDY DESIGN: Case report and review of the literature. OBJECTIVE: To describe a case of multiple supra- and infratentorial hemorrhages after spinal surgery presenting with seizure. SUMMARY OF BACKGROUND DATA: Cerebrospinal fluid overdrainage is a well-documented factor associated with remote cerebellar hemorrhage, but supratentorial hemorrhages after spinal surgery have been reported rarely. METHODS: A 64-year-old woman underwent a sacral laminectomy for recurrent chordoma...
February 15, 2011: Spine
James Guest, Francisco Benavides, Kyle Padgett, Eric Mendez, Diego Tovar
Spinal cord injections may be used to transplant cellular suspensions for the experimental treatment of spinal cord injury. These injections cause some additional injury due to needle penetration, spinal cord motion during injection, creation of intraparenchymal pressure gradients and hydrodynamic dissection, instillation of a deforming cell mass and possible cord ischemia. It is important to understand these variables to maximize the safety of injections and avoid injury to spared structures. Surprisingly little knowledge exists regarding these variables...
March 10, 2011: Brain Research Bulletin
Paul Gigante, Brian Y Hwang, Geoffrey Appelboom, Christopher P Kellner, Michael A Kellner, E Sander Connolly
External ventricular drain (EVD) placement is standard of care in the management of aneurysmal subarachnoid haemorrhage-associated hydrocephalus (aSAH). However, there are no guidelines for EVD placement and management after aSAH. Optimal EVD insertion conditions, techniques to reduce the risk of EVD-associated infection and aneurysmal rebleeding, and methods of EVD removal are critical, yet incompletely answered management variables. The present literature consists primarily of small studies with heterogeneous populations and variable outcome measures, and suggests the following: EVDs may increase the risk of rebleeding; EVDs are increasingly placed by non-neurosurgeons with unclear results; intraparenchymal ICP monitors may be safely considered (with or without spinal drainage) in the setting of difficult EVD placement; the optimal timing and manner of EVD removal has yet to be defined; and the efficacy of prophylactic systemic antibiotics and antibiotic-coated EVDs needs further investigation...
December 2010: British Journal of Neurosurgery
Matthew K Knox, Cynthia Ménard, Warren P Mason
Leptomeningeal gliomatosis is a known, yet uncommon, complication of malignant gliomas. In rare instances it can present with non-specific symptoms prior to the development of detectable intraparenchymal lesions, posing a diagnostic challenge. Gliomatosis cerebri is also a rare disease, characterized by extensive diffuse infiltration of neoplastic glial cells. For both entities, limited data exist to guide treatment and prognosis is poor. We describe the case of a patient who presented with symptoms of increased intracranial pressure and diffuse leptomeningeal enhancement in the brain and spinal cord on MRI...
October 2010: Journal of Neuro-oncology
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