Korean Journal of Neurotrauma最新文献

Spinal cord injury (SCI) frequently results in persistent motor, sensory, or autonomic dysfunction, and the outcomes are largely determined by the location and severity of the injury. Despite significant technological progress, the intricate nature of the spinal cord anatomy and the difficulties associated with neuroregeneration make full recovery from SCI uncommon. This review explores the potential of artificial intelligence (AI), with a particular focus on machine learning, to enhance patient outcomes in SCI management. The application of AI, specifically machine learning, has revolutionized the diagnosis, treatment, prognosis, and rehabilitation of patients with SCI. By leveraging large datasets and identifying complex patterns, AI contributes to improved diagnostic accuracy, optimizes surgical procedures, and enables the personalization of therapeutic interventions. AI-driven prognostic models provide accurate predictions of recovery, facilitating improved planning and resource allocation. Additionally, AI-powered rehabilitation systems, including robotic devices and brain-computer interfaces, increase the effectiveness and accessibility of therapy. However, realizing the full potential of AI in SCI care requires ongoing research, interdisciplinary collaboration, and the development of comprehensive datasets. As AI continues to evolve, it is expected to play an increasingly vital role in enhancing the outcomes of patients with SCI.

A growing skull fracture (GSF) is a fracture that gradually widens as the arachnoid membrane or brain parenchyma herniates into the fractured space in a skull fracture accompanied by dural injury. GSF has a good prognosis if diagnosed early and treated surgically. However, it is generally a chronic complication with low incidence, making diagnosis difficult. Here, we present the case of a 13-month-old female infant who underwent surgical intervention for a GSF that grew rapidly within 3 weeks with a good outcome.

Tuberculous (TB) spondylitis, also known as Pott's disease, was first described by Percivall Pott in 1779. The diagnosis of TB spondylitis is often delayed because of the non-specific nature of the infection, which can lead to severe consequences. Differential diagnosis is especially critical in cancer patients undergoing chemotherapy who present with lymph node or bone metastasis. We present the case of a 76-year-old female with advanced gastric cancer, who was initially suspected of having a metastatic spinal tumor and bacterial spondylitis. The patient presented with lower limb paralysis and was diagnosed with metastatic cancer, resulting in a loss of hope for recovery. However, following the subsequent diagnosis of TB spondylitis and multiple surgical interventions, the patient achieved complete remission and significant improvement, ultimately regaining the ability to walk independently. This case highlights the importance of accurate diagnosis and timely intervention in cases where the initial presentations may mimic metastatic disease.

This case report describes a rare presentation of antineutrophil cytoplasmic antibodies-associated hypertrophic pachymeningitis in a 49-year-old woman with cranial and spinal lesions. Initial management comprised decompressive laminectomy and steroid therapy, with the subsequent addition of immunosuppressant therapy following symptom recurrence. After a ten-year follow-up, significant symptom improvement and return of motor function were noted. This case emphasizes the crucial role of early diagnosis, a multidisciplinary approach, and combined medical therapy in managing this rare condition.

Objective: This randomized controlled trial (RCT) aimed to compare the short-, mid-, and long-term outcomes in patients with malignant intracranial hypertension undergoing either decompressive craniectomy (DC) or hinge craniotomy (HC).

Methods: In this prospective RCT, 38 patients diagnosed with malignant intracranial hypertension due to ischemic infarction, traumatic brain injury, or non-lesional spontaneous intracerebral hemorrhage, who required cranial decompression, were randomly allocated to the DC and HC groups.

Results: The need for reoperation, particularly cranioplasty, in the DC group was significantly different from that in the HC group. The percentage of brain expansion was higher in the DC group versus the HC group; however, the difference was not significant. There was no significant intergroup difference in the functional outcome according to the modified Rankin Scale or the Glasgow Outcome Scale. Additionally, no significant intergroup differences were observed in the rates of in-hospital complications.

Conclusion: The HC and DC groups did not significantly differ in the rate of hospital complications such as infection, need for reoperation owing to the lack of intracranial pressure control, wound healing problems, or bone infection. Our results suggest that by performing HC, the probability of the need for major surgery (cranioplasty) is reduced, thereby removing financial burden from the patient and the health system.

Trial registration: Iranian Registry of Clinical Trials Identifier: IRCT20180515039678N1.

Objective: The goal of a decompressive craniectomy (DC) or a hinge craniotomy (HC), is to treat intracranial hypertension and reduce mortality. Traditionally, the decompression procedure has been performed with cranial bone removal. However, decompression and repositioning the cranial bone, named HC, has been presented as an alternative for certain cases. Our objective is to describe the neuroradiological and clinical preoperative factors and outcomes in traumatic brain injury (TBI) cases treated with both techniques in 2 centers in a Middle-Income country.

Methods: This is a retrospective cross-sectional study of adult patients who underwent decompression surgical treatment for TBI, either with a traditional DC or HC, in 2 centers in Bogotá, Colombia between 2016-2020.

Results: This study involved 30 cases that underwent HC and 20 that underwent DC. 78% were male with an overall mean age of 50.2 years. 66% cases had traumatic subarachnoid hemorrhage (tSAH) and 60% had evidence of acute subdural hematoma ≥10 mm in thickness. The overall mortality rate during hospitalization was 20%. Preoperative pupil impairment differences between the 2 groups were statistically significant (p=0.026).

Conclusion: This study reveals that using a traditional DC or HC depends on the neurosurgeon's intraoperative case-by-case assessment according to the intraoperative brain's vitality and the presence of diffuse edema in the brain parenchyma at the time of surgical closure. Each case requires an individualized evaluation before and during surgery. The preoperative pupil condition can serve as a marker for HC or DC selection.

Intracranial hypertension (IH) is a critical neurological emergency that requires prompt intervention because failure to treat it properly can lead to severe outcomes, including secondary brain injury. Traditionally, mannitol (MNT) has been the cornerstone of hyperosmolar therapy. However, the use of hypertonic saline (HTS) has become increasingly important because of its unique advantages. Both HTS and MNT effectively reduce intracranial pressure by creating an osmotic gradient that draws fluid from brain tissue. However, unlike MNT, HTS does not induce diuresis or significantly lower blood pressure, making it more favorable for maintaining cerebral perfusion. Additionally, HTS does not cause rebound edema and carries a lower risk of renal injury than MNT. However, it is important to note that the use of HTS comes with potential risks, such as hypernatremia, hyperchloremia, and fluid overload. Due to its unique properties, HTS is a crucial agent in the management of IH, and understanding its appropriate use is essential to optimize patient outcomes.