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Safety profile and probe placement accuracy of intraspinal pressure monitoring for traumatic spinal cord injury: Injured Spinal Cord Pressure Evaluation study

Isaac Phang, Argyro Zoumprouli, Samira Saadoun, and Marios C. Papadopoulos

M onitoring intracranial pressure (ICP) by inserting a pressure probe into the brain parenchyma is central to the management of patients with traumatic brain injury (TBI). 4 , 14 ICP is used to compute cerebral perfusion pressure (CPP) as the mean arterial pressure (MAP) minus ICP. Management aims to reduce elevated ICP and optimize CPP in order to prevent secondary ischemic brain damage. In contrast to TBI, in traumatic spinal cord injury (TSCI) there is currently no monitoring from the injury site in clinical use to guide the management. As a result

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Cervical spine trauma associated with moderate and severe head injury: incidence, risk factors, and injury characteristics

Langston T. Holly, Daniel F. Kelly, George J. Counelis, Thane Blinman, David L. McArthur, and H. Gill Cryer

Scores 9–14) in which CT scanning demonstrated evidence of mass effect, intracranial pressure ICP monitoring was performed. In such patients, goals of head injury management included maintenance of intracranial pressure less than 20 mm Hg and cerebral perfusion pressure higher than 70 mm Hg. Global neurological outcome was determined at 6 months postinjury by the GOS. Favorable outcome was defined as good recovery or moderate disability and poor outcome as severe disability, persistent vegetative state, or death. 15 Statistical Analysis Data were managed by

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Sudden death from diffuse leptomeningeal oligodendrogliomatosis

Case report

Renee M. Reynolds, Elizabeth Boswell, Christine M. Hulette, Thomas J. Cummings, Michael M. Haglund, Thomas J. Cumm ings, and Michael M. Haglund

her ICP began to rise into the 30s, and subsequent treatment with scheduled combined hyperosmolar therapy, including mannitol and hypertonic saline, failed to return it to normal. Further treatment with Versed, fentanyl, cooling, and subsequent pentobarbital coma also failed, and her ICP eventually reached 90 mm Hg. Multiple pressors were used to maintain her cerebral perfusion pressure above 60 mm Hg throughout. Despite aggressive medical management, her ICP remained significantly elevated, and examination revealed a deterioration of her condition as her pupils

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Abdominal complications following kyphosis correction in ankylosing spondylitis

Report of 2 cases

Patrick A. Sugrue, Brian A. O'Shaughnessy, Fadi Nasr, Tyler R. Koski, and Stephen L. Ondra

pressure, hypoxia, oliguria, and even decreased cerebral perfusion pressure. 4 , 5 , 12 , 15 , 19 The development of abdominal compartment syndrome is most commonly seen in the trauma population or those who have undergone abdominal surgery. However, its incidence is extremely variable and has been estimated to range from 0.1 to 33%. 10 , 16 , 22 Mortality from abdominal compartment syndrome has been reported to range from 28 to nearly 77%. 15 , 19 In Case 2, emergency decompression reversed the physiological dysfunction almost immediately, in accordance with other

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Letter to the Editor: Should we really avoid the supine position in patients with spinal cord injury who undergo laminectomy?

Fubing Liu, Bing Wang, Yunchao Li, Guohua Lv, and Xiaoxing Jiang

, although the difference of intraspinal pressure (ΔISP) was up to 18 mm Hg after thoracic laminectomies, and up to 8 mm Hg after cervical laminectomies, the average difference was approximately 2 mm Hg and 1 mm Hg, respectively. It seems that the authors were exaggerating the difference of ISP in the supine versus lateral position. In another retrospective study of traumatic brain injury, Aries et al. 1 found that patients with a median cerebral perfusion pressure (CPP) close to the optimum CPP (CPPopt) were more likely to have a favorable outcome than those in whom the

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Intraspinal pressure and spinal cord perfusion pressure after spinal cord injury: an observational study

Georgios V. Varsos, Melissa C. Werndle, Zofia H. Czosnyka, Peter Smielewski, Angelos G. Kolias, Isaac Phang, Samira Saadoun, B. Anthony Bell, Argyro Zoumprouli, Marios C. Papadopoulos, and Marek Czosnyka

intraspinal pressure (ISP) within the injured compartment, as the low-distensible dura is unable to provide any CSF buffering. This, in turn, may produce intraspinal hypertension, thereby producing irreversible local spinal cord ischemia that leads to neuronal death. In traumatic brain injury (TBI), increased intracranial pressure (ICP) may impede cerebral blood flow as it reduces cerebral perfusion pressure (CPP), which is calculated as the difference between arterial blood pressure (ABP) and ICP. 8 , 14 , 16 , 21 Similarly, ISP affects the spinal cord perfusion pressure

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Assessing changes in cervical epidural pressure during biportal endoscopic lumbar discectomy

Taewook Kang, Si Young Park, Soon Hyuck Lee, Jong Hoon Park, and Seung Woo Suh

catheter, and correct catheter placement was confirmed by contrast injection under fluoroscopic guidance. ICP is associated with CSF, brain tissue, and circulating cerebral blood, which coexist in a rigid space. The Monro-Kellie hypothesis states that an increase in one of the elements should be compensated for by a decrease in other elements, or it will result in the elevation of ICP. 16 ICP and blood pressure interact and affect cerebral blood flow. Under normal circumstances, cerebral blood flow is made constant over a wide range of cerebral perfusion pressures by

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Multimodal interventions to optimize spinal cord perfusion in patients with acute traumatic spinal cord injuries: a systematic review

Carly Weber-Levine, Brendan F. Judy, Andrew M. Hersh, Tolulope Awosika, Yohannes Tsehay, Timothy Kim, Alejandro Chara, and Nicholas Theodore

pressure (ISP). SCPP is analogous to cerebral perfusion pressure and is optimal at approximately 90 mm Hg. Although ISP monitoring is not routinely done, it can be measured through intradural insertion of a pressure probe. 9 The use of SCPP as a perfusion marker is reinforced by the Monro-Kellie doctrine, which describes the reciprocal nature of the volumes of three intracranial contents: brain parenchyma, cerebral blood flow, and CSF. As the volume of one increases, the volumes of the others must decrease to compensate, given the fixed volume of the cranium. 9 , 10

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Building consensus for the medical management of children with moderate and severe acute spinal cord injury: a modified Delphi study

Travis S. CreveCoeur, Nikita G. Alexiades, Christopher M. Bonfield, Douglas L. Brockmeyer, Samuel R. Browd, Jason Chu, Anthony A. Figaji, Mari L. Groves, Todd C. Hankinson, David H. Harter, Steven W. Hwang, Andrew Jea, Steven G. Kernie, Jeffrey R. Leonard, Jonathan E. Martin, Matthew E. Oetgen, Alexander K. Powers, Curtis J. Rozzelle, David L. Skaggs, Jennifer M. Strahle, John C. Wellons III, Michael G. Vitale, and Richard C. E. Anderson

downstream effect of hypotension is to diminish the cerebral perfusion pressure (CPP), defined as the mean arterial pressure (MAP) minus the intracranial pressure (ICP), with most TBI literature and guidelines focused on identifying optimal CPP ranges. One study noted decreased survival with prolonged CPP below different thresholds in different pediatric age groups: 50–60 mm Hg in children 18 years of age and older, < 50 mm Hg in children 6–17 years, and < 40 mm Hg in children 0–5 years. 31 Many clinicians extrapolate their experience in managing TBI to how they manage