Improved strategy for post-traumatic hydrocephalus following decompressive craniectomy: Experience of a single center

BackgroundPatients with head trauma may develop hydrocephalus after decompressive craniectomy. Many studies have referred one-stage cranioplasty (CP) and ventriculoperitoneal shunt (VPS) was applied to treat cranial defect with post-traumatic hydrocephalus (PTH), but the safety and efficiency of the procedure remain controversial.MethodsThis is a retrospective cohort study including 70 patients of PTH following decompressive craniectomy who underwent simultaneous (50) and separated (20) procedures of cranioplasty and VPS from March 2014 to March 2021 at the authors’ institution with at least 30 days of follow-up. Patient characteristics, clinical findings, and complications were collected and analyzed.ResultsFifty patients with PTH underwent improved simultaneous procedures and 20 patients underwent staged surgeries. Among the cases, the overall complication rate was 22.86%. Complications suffered by patients who underwent one-stage procedure of CP and VPS did not differ significantly, compared with patients in the group of staged procedures (22% vs. 25%, p = 0.763). The significant difference was not observed in the two groups, regarding the complications of subdural/epidural fluid collection (4%/6% vs. 0/2%, p = 1.000/1.000), epidural hemorrhage (6% vs. 4%, p = 0.942), dysfunction of shunting system (0 vs. 2%, p = 0.286), postoperative seizure (8% vs. 4%, p = 1.000), and reoperation case (0 vs. 2%, p = 0.286). No case of subdural hemorrhage, incision/intracranial/abdominal infection, shunting system dysfunction, or reoperation was observed in the group of simultaneous procedure. Complications including subdural/epidural fluid collection, subdural hemorrhage, and incision/intracranial infection were not shown in the case series of the staged procedure group.ConclusionThe improved simultaneous procedure of cranioplasty and VPS is effective and safe to treat cranial defect and post-traumatic hydrocephalus with low risk of complications

Polymeric immunoglobulin receptor expression is predictive of poor prognosis in glioma patients

Abstract: Although there have been recent advances in surgery, radiotherapy, and chemotherapy, the survival of patient with glioma remains poor. Increased expression of polymeric immunoglobulin receptor (pIgR) in tumor tissue has been detected in various cancer forms. However, the clinical relevance of pIgR in glioma remains unclear. The aim of this study was to assess the prognostic value of pIgR in patients with glioma after surgical resection. pIgR expression was evaluated by immunohistochemistry in paraffin-embedded glioma tissues from 146 patients. The relation between pIgR expression and clinicopathologic factors and long-term prognosis in these 146 patients was retrospectively examined. The prognostic significance of negative or positive pIgR exspression in glioma was assessed using Kaplan-Meier survival analysis and log-rank tests. Positive expression of pIgR was statistically significantly associated with poor prognosis of patients with glioma. Our results indicated that pIgR could be a novel predictor for poor prognosis of patients with glioma after surgical resection

Usage of neuronavigation system to treat a case of traumatic acute subdural hematoma after two-side ventriculoperitoneal shunt

Traumatic acute subdural hematoma is one of the most lethal causes of head injuries, which leads to high mortality. While combined diseases always make it more intractable for the treatment. We present a case of a 68-year-old female patient with traumatic acute subdural hematoma combined with hydrocephalus after ventriculoperitoneal shunt assisted by the neuronavigation system in January 12, 2017. She was undergone ventriculoperitoneal shunt 6 years and 5 months ago on two sides respectively because of hydrocephalus, with the ventriculoperitoneal shunt device on the right side out of work. The initial neurological examination showed a Glasgow Coma Scale of E2V1M5 with no papillary defect. A CT scan of the head revealed a left homogeneously hyperdense and subdural hematoma, with compression of the lateral ventricle (2.6 cm thick) and a 0.5 cm midline shift. To protect the ventriculoperitoneal shunt device, we used neuronavigation system to precisely mark the relative location of the device and “invisible” subdural hematoma, thus to design a perfect incision preoperatively. Subsequently, evacuation of the subdural hematoma was performed via craniotomy without damaging the ventriculoperitoneal shunt device. Postoperative CT of the head showed totally removing of the subdural hematoma. The patient recovered three months later. With the assistant of neuronavigation system, it is much easier for the preoperative planning and to reduce the surgical risk. Our case gives a clue that more approaches can be considered when encountering acute head trauma with the complicated combined diseases. Keywords: Neuronavigation, Acute subdural hematoma, Hydrocephalus, Ventriculoperitoneal shun

Astaxanthin as a Potential Neuroprotective Agent for Neurological Diseases

Neurological diseases, which consist of acute injuries and chronic neurodegeneration, are the leading causes of human death and disability. However, the pathophysiology of these diseases have not been fully elucidated, and effective treatments are still lacking. Astaxanthin, a member of the xanthophyll group, is a red-orange carotenoid with unique cell membrane actions and diverse biological activities. More importantly, there is evidence demonstrating that astaxanthin confers neuroprotective effects in experimental models of acute injuries, chronic neurodegenerative disorders, and neurological diseases. The beneficial effects of astaxanthin are linked to its oxidative, anti-inflammatory, and anti-apoptotic characteristics. In this review, we will focus on the neuroprotective properties of astaxanthin and explore the underlying mechanisms in the setting of neurological diseases