Korean Journal of Neurotrauma最新文献

Objective: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Preclinical and clinical studies investigating the effects of curcumin on TBI indicate that curcumin can modulate essential signaling pathways and molecules that mediate neuroinflammation in TBI. This study aimed to explore the effects of turmeric on neuroinflammation and neurodegenerative disorder following repetitive traumatic brain injuries (rTBIs) in a rat model.

Methods: Sixty male Rattus norvegicus were housed in a controlled environment. A modified Marmarou weight drop model was used. Turmeric extract was administered once daily in the morning. The avidin-biotin-peroxidase complex technique was used to evaluate the expression of all markers. Following incubation with normal rabbit serum, the slides were subsequently incubated with monoclonal antibodies targeting tau protein (AT-8), TAR DNA-binding protein 43 (TDP-43), glial fibrillary acidic protein (GFAP), and tumor necrosis factor (TNF)-α.

Results: rTBI significantly increased the levels of inflammatory markers, such as TNF-α and GFAP. A substantial decrease of TNF-α expression was observed in the treatment group. A distinct trend was observed for GFAP expression, which was markedly decreased after the rest period compared to that in the trauma group. Phosphorylated tau expression decreased in both the treatment and pretreatment groups relative to that in the trauma and rest groups. TDP-43 expression was also significantly decreased in the treatment and pretreatment groups.

Conclusion: In conclusion, Turmeric demonstrates significant potential as a neuroprotective and anti-inflammatory agent in rTBI, especially when used as a preventive measure. Our findings challenge the significance of rest in concussion management.

Intradiscal electrothermal therapy (IDET) is a minimally invasive procedure that alleviates chronic discogenic pain by delivering controlled heat to modify collagen and destroy pain-conducting nerve endings. While IDET offers a less invasive alternative to surgery, it carries risks such as nerve damage, infection, vertebral osteonecrosis, and, rarely, spinal cord injury. This report presents the case of a 36-year-old woman who developed left-sided hemiparesis following IDET for cervical disc herniation at the C5/6 level. Magnetic resonance imaging revealed cervical cord edema, and examination revealed neurological deficits, including reduced proprioception, motor strength, and senses of pain and temperature. Anterior cervical discectomy and fusion led to thermal injury on the left ventral spinal cord, and postoperative recovery resulted in significant neurological improvement, although some sensory deficits persisted. This case underscores the importance of appropriate patient selection and meticulous procedural technique to prevent severe complications, emphasizing the importance to reserve IDET for specific cases and to consider alternatives for more complex spinal conditions.

Objective: The new diagnosis-related group (NDRG) payment combines the original diagnosis-related group (DRG) and the fee-for-service (FFS) system, covering basic hospital services through fixed hospitalization costs based on the DRG assigned to the patient, while separate fees were applied for surgical and procedural interventions by physicians. This study aimed to evaluate the impact of payment methodology on medical costs and outcomes in patients with mild traumatic brain injury (TBI).

Methods: This retrospective study included 1,247 patients who underwent inpatient neurosurgical treatment at a single regional trauma center from January 2016 to December 2022. Since the implementation of the NDRG payment system in 2019, patients were classified into the FFS and NDRG payment groups. Outcomes were evaluated using the Extended Glasgow Outcome Scale (GOS-E) at discharge and 3 months post-traumatic event; admission days were also assessed. Total medical and out-of-pocket expenses incurred at the time of discharge were also analyzed.

Results: The NDRG payment group demonstrated poorer results in GOS-E at discharge and 3 months post-TBI. However, the admission days were notably shorter. Out-of-pocket expenses were significantly lower in the NDRG payment group. While age, total medical expenses, and out-of-pocket expenses were significantly associated with the GOS-E at discharge, the NDRG payment did not correlate with the GOS-E at discharge. Notably, only the NDRG payment was significantly correlated with lower out-of-pocket expenses.

Conclusion: Implementing the NDRG payment system for patients with mild TBI does not impact total medical costs but effectively reduces out-of-pocket expenses, without adversely affecting the GOS-E.

Objective: This study aimed to describe the incidence and status of acute management of traumatic brain injuries (TBIs) in Korea.

Methods: We utilized nationwide administrative data from the National Emergency Department Information System (2016-2018), focusing on patients with TBIs who visited emergency medical centers within 7 days of injury and were treated in neurosurgery.

Results: The study included 117,830 patients, indicating an annual crude incidence of 79.4 TBIs per 100,000 persons. The highest incidence was in the age groups 0-4 and 75-79 years, with men experiencing TBIs more often than women (79.3 vs. 60.4). Traffic accidents were the most common cause (34.2%). Ambulance transport accounted for 65.4% of cases, with a median hospital arrival time of 62 minutes. Only 7.6% of patients were admitted to trauma care units, showing significant regional variations. Craniotomy or craniectomy was performed in 4.8% of cases. Normal discharge occurred in 69.3% of patients, and the overall in-hospital mortality rate was 5.3%, higher in men (3.9% vs. 1.5%).

Conclusion: In Korea, the incidence of TBIs vary by age, sex, and regions. Current status of management of TBIs also differs by regions, especially between metropolitan city and province. Tailored strategies for TBI management are needed based on these differences.

Objective: The aim of this study was to investigate the efficacy of additional surgical decompression with antibiotics to treat pyogenic spinal epidural abscess (SEA) with no neurological deficits.

Methods: We retrospectively reviewed the data of patients diagnosed with spontaneous pyogenic SEA in the thoracolumbosacral area who presented with sciatica and no motor deficits in the lower extremities. The treatment took place in a single tertiary hospital. The effects of additional surgical decompression (decompressive laminectomy) and other clinical variables on functional outcome were assessed using the short form 36 (SF-36).

Results: Fifty-nine patients (49 men and 10 women, mean age 65.73±12.29 [41-89] years) were included in the analysis. Surgical decompression had been performed in 31 patients (Group S, treated with additional surgical decompression and antibiotics). There were five (15.2%, 5/33) unplanned operations to control leg sciatica among the patients with initially non-surgical plans, and 28 patients were finally treated with only antibiotics (group N-S). Group S showed a statistically significant increased cost of hospitalization compared to group N-S (15,856.37±7,952.83 vs. 10,672.62±4,654.17 US dollars, p=0.004) with no superiority of 6-month functional outcome after the completion of antibiotic treatment (53.65±4.74 vs. 51.75±7.96 SF-36 scores, p=0.266).

Conclusion: Although there is a possibility of requiring an unplanned operation to control leg sciatica during conservative antibiotic treatment, overall, additional surgical decompression in pyogenic SEA presenting with no motor deficit of the lower extremity showed increased medical burden and no greater benefit in terms of functional outcomes.

This article aimed to assess and discuss the current diagnostic and treatment approaches for post-hemorrhagic hydrocephalus (PHH) in preterm infants with the goal of enhancing their quality of life and minimizing long-term complications. This literature review used a multilevel analysis of contemporary studies on intraventricular hemorrhage (IVH) and PHH in preterm neonates from PubMed, Scopus, and Web of Science databases, applying strict selection criteria and double independent assessments to ensure the reliability and relevance of the findings. This review emphasizes the complexity of IVH and PHH in preterm neonates and highlights diverse approaches in diagnosis, treatment, and rehabilitation. Recent studies have highlighted the importance of advanced neuroimaging for accurate diagnosis and the potential of neuroendoscopic lavage in reducing shunt dependency and the risk of infections; however, there is a clear need for further research into long-term outcomes and the development of less invasive treatments. The efficacy of combined techniques using temporary manipulation followed by permanent drainage systems, which ensure normal positioning of the postnasal drainage system and provides time for specialists to consider the optimal strategy, has also been demonstrated. This study will aid health professionals in making timely decisions, reducing neurological complications, and improving patient prognoses and quality of life.

Objective: This study aimed to compare the complications and outcomes of macroscopic and microscopic anterior cervical discectomy.

Methods: In this single-blind randomized clinical trial, 47 patients referred for anterior cervical discectomy and fusion were randomly assigned to two groups: microscopic (n=23) and macroscopic (n=24). Both groups were evaluated and compared regarding 1) complications, including neurological deficits, dural damage, and dysphagia; 2) the amount of intra- and postoperative bleeding; 3) the amount of analgesic administered; 4) length of hospitalization; 5) quality of life before and one month after surgery, using the 12-item short form questionnaire; and 6) time required to return to daily activities.

Results: Complications and neurological deficits were not significantly different between the two groups. Although the preoperative quality of life was not significantly different between the two groups (p=0.458), the microscopic groups had a greater improvement in quality of life after surgery than the macroscopic group (43.04±3.67 vs. 37.84±2.30; p<0.001). However, the microscopic group had a longer surgical duration than the macroscopic group (75.86±9.78 vs. 57.12±2.81 minutes; p<0.001).

Conclusion: Anterior cervical discectomy with an intraoperative microscope increases the surgical duration but is not significantly different from the macroscopic method in terms of neurological deficits and complications. However, the microscopic method may improve the quality of life of patients compared to the macroscopic method during the short-term follow-up.

Spinal cord injury (SCI) remains a significant clinical challenge, with no fully effective treatment available despite advancements in various therapeutic approaches. This review examines the emerging role of induced neural stem cells (iNSCs) as promising candidates for SCI treatment, highlighting their potential for direct neural regeneration and integration with host tissue. We explore the biology of iNSCs, their mechanisms of action, and their interactions with host tissue, including modulating inflammatory responses, promoting axonal growth, and reconstructing neural circuits. Additionally, the importance of administration route, optimal timing for transplantation, and potential adverse events are discussed to address key challenges in translating these therapies to clinical applications. The review also emphasizes recent innovations, such as combining iNSC transplantation with rehabilitative training and the integration of biomaterials and growth factors to enhance therapeutic efficacy. Although preclinical studies have demonstrated positive outcomes, larger, controlled trials and standardized protocols are essential for validating the safety and effectiveness of iNSC-based therapies for SCI patients.

Spinal cord injury (SCI) following high-energy trauma often leads to lasting neurologic deficits and severe socioeconomic impact. Effective neurointensive care, particularly in the early stages post-injury, is essential for optimizing outcomes. This review discusses the role of neurointensive care in managing SCI, emphasizing early assessment, stabilization, and intervention strategies based on recent evidence-based practices. SCI results from primary mechanical damage to the spinal cord, triggering secondary injuries involving vascular and cellular dysfunction. Early neurointensive care focuses on stabilizing airway, breathing, and circulation while preventing further spinal damage. Imaging and neurologic assessments, including the ASIA scale, guide the management plan. Early decompressive surgery within 24 hours is widely supported for patients with spinal instability or cord compression. Pharmacologic strategies aim to reduce secondary injury, though standardization remains limited. Prophylaxis for deep vein thrombosis and pulmonary embolism, intensive pulmonary support, and monitoring for pressure sores are critical in early-phase SCI. Early neurointensive care and surgical interventions play a pivotal role in mitigating SCI progression. Optimal care requires a multifaceted approach addressing both neurologic and systemic complications, significantly influencing recovery and long-term quality of life. Further research is needed to standardize pharmacologic treatments and optimize surgical timing.