Search Results

You are looking at 1 - 4 of 4 items for :

  • "cerebral perfusion pressure" x
  • Journal of Neurosurgery: Case Lessons x
  • Refine by Access: all x
Clear All
Open access

Decision-making for decompressive craniectomy in traumatic brain injury aided by multimodality monitoring: illustrative case

Myranda B. Robinson, Peter Shin, Robert Alunday, Chad Cole, Michel T. Torbey, and Andrew P. Carlson

ICP can lead to a higher rate of mortality if left untreated by impairing cerebral perfusion, resulting in secondary brain injury. 4 ICP (and cerebral perfusion pressure [CPP])-directed therapy is therefore currently the cornerstone of management of severe TBI. 5 When ICP becomes refractory to lower tiers of treatment, decompressive craniectomy (DC) can be used as a late-tier procedure. Two recent trials, however, arrived at complex and somewhat contradictory results regarding the efficacy of this intervention, which led to complex new recommendations. 6 The

Open access

Multimodal monitoring to guide neurosurgical intervention in high-grade aneurysmal subarachnoid hemorrhage: illustrative case

Bradley Kolb, Daniel Wolfson, Ivan Da Silva, and Stephan A. Munich

from multimodal monitoring systems has been used to guide medical interventions, including insulin therapy, enteral nutrition, cerebral perfusion pressure targets, detection of early cerebral ischemia, red blood cell transfusion, and targeted management of PaO 2 /FiO 2 via normobaric hyperoxia, in patients with acute brain injury. 1 Of particular use from the neurosurgical perspective has been the increasing amount of data implicating rises in the brain microfluid lactate-to-pyruvate ratio (L/P ratio) as an early predictor of DCI. 2 , 3 Guidelines exist for using

Open access

Low-field magnetic resonance imaging in a boy with intracranial bolt after severe traumatic brain injury: illustrative case

Awais Abbas, Kiran Hilal, Aniqa Abdul Rasool, Ume-Farwah Zahidi, Muhammad Shahzad Shamim, and Qalab Abbas

intraventricular dissection and cerebral edema with mass effect ( Fig. 1D ). In the PICU, an invasive Codman metallic ICP monitoring bolt was placed in the left frontal cortex. The ICP ranged from 9 to 22 mm Hg throughout the admission, and cerebral perfusion pressure ranged from 65 to 85 mm Hg. Fluctuations in ICP were managed as per standard TBI guidelines. 12 FIG. 1. A: Axial T2 pMRI showing the burr hole ( arrow ). B: Corresponding axial bone window CT scan showing the ICP bolt through the burr hole ( arrow ). C: Axial T2 pMRI image showing hypointense abnormal

Open access

Intra-arterial infusion of fasudil hydrochloride for cerebral vasospasm secondary to carotid artery stenting: illustrative case

Nozomi Sasaki, Yoshinori Kotani, Yohei Ito, and Shinji Noda

occurred several hours after surgery. The third mechanism involves the disruption of autoregulation of the cerebral vasculature. 2 , 3 Normally, due to autoregulation of the cerebral vasculature, the cerebral vessels constrict when cerebral perfusion pressure (CPP) increases and dilates when CPP decreases. Owing to this autoregulation system, CBF is constantly maintained regardless of the increase or decrease in CPP. However, in the presence of chronic intracranial hypoperfusion due to carotid artery stenosis, autoregulation of the cerebral vasculature is often impaired