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Ryan Hirschi, Gregory W. J. Hawryluk, Jessica L. Nielson, J. Russell Huie, Lara L. Zimmermann, Rajiv Saigal, Quan Ding, Adam R. Ferguson, and Geoffrey Manley

B rain hypoxia is a frequent and important consequence of traumatic brain injury (TBI). 1 , 7 , 36 Monitoring of brain hypoxia allows corrective intervention and ongoing titration of therapy. S jv O 2 (jugular venous oxygen saturation) monitoring is an established monitoring technique that can intermittently assess the oxygen content of venous blood returning from the brain to provide insights into oxygen utilization in large portions of the cerebrum. 26 Approximately 2 decades ago, new technology emerged that allowed the invasive and continuous monitoring of

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Gregory W. J. Hawryluk

the belief that the volume of the brain was constant. Despite the unquestionable and marked efficacy of this life-saving therapeutic strategy, insufficient literature has come forth over the last 100 years to inform the best use of hyperosmolar therapy. Indeed, the recently published fourth edition of the Brain Trauma Foundation (BTF) Guidelines for the Management of Severe Traumatic Brain Injury (TBI) failed to find any evidence meeting current standards on which to base recommendations. 8 Thus, there is a tremendous need to better understand the different

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Gregory W. J. Hawryluk, Nicolas Phan, Adam R. Ferguson, Diane Morabito, Nikita Derugin, Campbell L. Stewart, M. Margaret Knudson, Geoffrey Manley, and Guy Rosenthal

W hile tissues such as muscle can tolerate ischemia for hours, cells of the brain die after only minutes of anoxia. 8 , 12 Cerebral ischemic injury is a significant problem after traumatic brain injury (TBI); 44 ischemic changes are seen in 80% of brains of patients who die following TBI. 19 Given the limited regenerative capacity of the CNS, as well as evidence that brain tissue hypoxia after TBI is predictive of poor outcome, 3 , 4 , 16 , 23 , 26 , 32 , 35 , 48 , 49 efforts to minimize brain tissue hypoxia following TBI are warranted. To reliably

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Gregory W. J. Hawryluk and Michael D. Cusimano

patients undergoing neurosurgery. These patients are often subject to prolonged immobility or paralysis, increasing their risks of experiencing clotting events. Furthermore, it has been hypothesized that the thrombin generated by rFVIIa may exacerbate brain edema, although this does not seem to be the case clinically. 43 Microvascular thrombi in the brains of patients with traumatic brain injuries 60 may hypothetically be made worse with rFVIIa treatment, but again supporting data are lacking. 60 Tissue thromboplastin, a procoagulant released from the damaged brain

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Gregory W. J. Hawryluk, Perry A. Ball, Zachary L. Hickman, and Joshua E. Medow

. An inability to produce evidence-based guidelines on key topics was a major limitation of the recently published fourth edition of the Brain Trauma Foundation’s Guidelines for the Management of Severe Traumatic Brain Injury. 2 This is not a fault of the guidelines—rather, it is a fault of our profession. It is therefore our hope that this issue will not only educate and advance care but that it will also inspire neurosurgeons to recommit themselves to the critical care aspects of neurosurgery and much needed advancement in this area. It is certainly remarkable to

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Gregory W. J. Hawryluk, James Rowland, Brian K. Kwon, and Michael G. Fehlings

Early benefit was seen in the treatment groups, but this was not maintained at 1 year. At 1 year postinjury, however, those with incomplete cervical injuries receiving high doses of gacyclidine exhibited a nonsignificant trend toward improved motor function. Despite the fact that this negative result likely stems from insufficient statistical power, this agent is no longer being pursued for SCI. Its use is, however, being explored in traumatic brain injury, 95 , 105 organophosphate poisoning, 88 and tinnitus (patent number 20060205789). Nimodipine

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Jian Guan, Michael Karsy, Andrea A. Brock, Ilyas M. Eli, Gabrielle M. Manton, Holly K. Ledyard, Gregory W. J. Hawryluk, and Min S. Park

Pincus M , Abraham N Jr : Interpreting laboratory results , in McPherson R , Pincus M (eds): Henry’s Clinical Diagnosis and Management by Laboratory Methods , ed 22 . Philadelphia : Saunders , 2011 10.1016/B978-1-4377-0974-2.00008-7 22 Raj R , Skrifvars M , Bendel S , Selander T , Kivisaari R , Siironen J , : Predicting six-month mortality of patients with traumatic brain injury: usefulness of common intensive care severity scores . Crit Care 18 : R60 , 2014 10.1186/cc13814 24708781 23 Ravindra VM , Godzik J , Guan J

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Lonnie Schneider, Ethan Reichert, Jenna Faulkner, Brielle Reichert, Joshua Sonnen, and Gregory W. J. Hawryluk

I t has long been known that victims of traumatic brain injury (TBI) are at increased risk of dementia. 13 , 34 The relatively recent description of chronic traumatic encephalopathy (CTE) 29 , 30 has dramatically increased medical, scientific, and societal attention to late neurodegenerative sequelae of central nervous system (CNS) trauma. 4 The mechanisms underlying the dementia that can follow CNS trauma are not well understood, however, impeding the development of targeted treatments. In considering possible etiologies for the dementias that follow CNS

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Jian Guan, Michael Karsy, Andrea A. Brock, Ilyas M. Eli, Holly K. Ledyard, Gregory W. J. Hawryluk, and Min S. Park

SAPS II is an instrument that uses 17 variables including physiological, demographic, and hospitalization-specific factors. The score was derived using an international sample of patients as a tool for calculating the probability of in-hospital mortality irrespective of primary admission diagnosis. The SAPS II has shown efficacy in the NCCU setting 26 and in patients with diagnoses that are commonly seen in the NCCU, including stroke, 14 , 25 subarachnoid hemorrhage, 31 and traumatic brain injury. 29 All 25-hydroxy vitamin D levels were obtained within 24 hours of

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Sergio A. Calero-Martinez, Christian Matula, Aurelia Peraud, Francesco Biroli, José Fernández-Alén, Michael Bierschneider, Michael Cunningham, Gregory W. J. Hawryluk, Maya Babu, M. Ross Bullock, and Andrés M. Rubiano

perspective . J Neurosurg 130 : 1098 – 1106 , 2019 10 Dewan MC , Rattani A , Fieggen G , Arraez MA , Servadei F , Boop FA , : Global neurosurgery: the current capacity and deficit in the provision of essential neurosurgical care . J Neurosurg 130 : 1055 – 1064 , 2019 11 Dewan MC , Rattani A , Gupta S , Baticulon RE , Hung YC , Punchak M , : Estimating the global incidence of traumatic brain injury . J Neurosurg 130 : 1080 – 1097 , 2019 12 Doyle-Scharff M : AO principles of teaching and learning . J Contin Educ Health