Induced mild hypothermia in children

The objective of this study was to measure outcomes and to determine the safety and effectiveness of mild induced hypothermia in children after traumatic and posthypoxic brain injury. Methods. Forty patients, following traumatic or posthypoxic brain injury, were involved in the study. Mean age was 10.7 ± 0.8 years. Median GCS (Glasgow Coma Scale) was 6.0 (4-7) and mean PIM2 (Pediatric Index of Mortality) 14.6 ± 3.8 %. Results. GOS (Glasgow Outcome Scale) of 5 was assigned for 15 (37.5%) patients, GOS 4 for 14 (35.0%), GOS 3 for 7 (17.5%) and GOS 2 for 4 (10%) patients. The average GOS in patients after severe head trauma was 3.6 ± 0.9 points and in patients with posthypoxic brain injury 5 points, (p < 0.05). No life threatening complications occurred. Conclusion. Mild induced hypothermia can be safely used in pediatric patents after severe traumatic or posthypoxic brain injury. This method may be of benefit while improving outcomes in children

Introduction of Novel Semiquantitative Evaluation of 99mTc-MIBI SPECT Before and After Treatment of Glioma

Background and Objective. There is a need for objective semiquantitative indexes for the evaluation of results of single-photon emission tomography (SPECT) in patients with brain glioma. The aim of this study was to validate the total size index (TSI) and total intensity index (TII) based on technetium-99m-methoxyisobutylisonitrile (99mTc-MIBI) SPECT scans to discriminate the patients with high-grade glioma versus low-grade glioma and to evaluate the changes of viable glioma tissue by the means of TSI and TII after surgery and after radiation treatment. Material and Methods. Thirty-two patients (mean age, 55 years [SD, 18]; 20 men) underwent a 99mTc-MIBI-SPECT scan before surgery. Of these patients, 27 underwent a postoperative 99mTc- MIBI-SPECT scan and 7 patients with grade IV glioma underwent a third 99mTc-MIBI-SPECT scan after radiation treatment. TII that corresponds to the area and intensity of tracer uptake and TSI that corresponds to the area of tracer uptake were calculated before surgery, after surgery, and after radiation treatment. Results. The TII and TSI were found to be valid in discriminating the patients with high-grade versus low-grade glioma with optimal cutoff values of 3.0 and 2.5, respectively. Glioma grade correlated with the preoperative TSI score (r=0.76, P&lt;0.001) and preoperative TII score (r=0.64, P&lt;0.001). There was a significant decrease in the TII and TSI after surgery in patients with grade IV glioma. After radiation treatment, there was a significant increase in the TII in patients with grade IV glioma. Conclusions. TSI and TII were found to be reliable in discriminating the patients with high-grade versus low-grade glioma and allowed for the semiquantitative evaluation of change in viable glioma tissue after surgery and after radiation treatment in patients with grade IV glioma

Induced mild hypothermia in children

The objective of this study was to measure outcomes and to determine the safety and effectiveness of mild induced hypothermia in children after traumatic and posthypoxic brain injury. Methods. Forty patients, following traumatic or posthypoxic brain injury, were involved in the study. Mean age was 10.7 ± 0.8 years. Median GCS (Glasgow Coma Scale) was 6.0 (4-7) and mean PIM2 (Pediatric Index of Mortality) 14.6 ± 3.8 %. Results. GOS (Glasgow Outcome Scale) of 5 was assigned for 15 (37.5%) patients, GOS 4 for 14 (35.0%), GOS 3 for 7 (17.5%) and GOS 2 for 4 (10%) patients. The average GOS in patients after severe head trauma was 3.6 ± 0.9 points and in patients with posthypoxic brain injury 5 points, (p < 0.05). No life threatening complications occurred. Conclusion. Mild induced hypothermia can be safely used in pediatric patents after severe traumatic or posthypoxic brain injury. This method may be of benefit while improving outcomes in children

Management of cerebrospinal fluid leak after surgical removal of pituitary adenomas

Objectives. The aim of the study was to evaluate the frequency and the causes of the intra- and postoperative cerebrospinal fluid (CSF) leaks and to discuss the sella closure methods. Methods. During the period from 1995 to 2005, 313 patients underwent 356 transsphenoidal operations for pituitary adenoma. Microadenoma was found in 80 (22.5%) cases, and in 276 (77.5%) cases, macroadenoma was removed. Two different methods to close the sella were used. The first one consisted packing the sella turcica and sphenoidal sinus with autologous fat and restoring the defect of sella turcica with autologous bone. In more resent practice, the regenerated oxidized cellulose (Surgicel®) and collagen sponge with human fibrin (TachoSil®) were used to cover the sella membrane defect, followed by packing the sella with autologous fat and covering the dural defect with Surgicel® and TachoSil®. Results. Adenoma was totally removed in 198 (55.6%) cases out of 356. Microadenoma was totally removed in 91.3% and macroadenoma in 45.3% of cases, respectively. Postoperative complications were noted in 40 (11.2%) patients. Two (0.6%) patients died after surgery. Intraoperative CSF leakage was observed in 58 (16.3%) cases. Postoperative CSF leakages were observed in 3 cases, when the method of packing the sella with just autologous fat was used, whereas in 29 cases when the sella fat packing was used together with Surgicel® and TachoSil® to cover the sella membrane and dural defects, no postoperative CSF leakages were observed. Conclusions. The technique of covering the sella membrane and dural defects with Surgicel® and TachoSil® in the presence of intraoperative CSF leakage appeared to be the most reliable one, as no postoperative CSF leakage applying this technique has been observed