Biomarkers in spinal cord compression: Ethics and perspectives

The phosphorylated form of the high-molecular-weight neurofilament subunit NF-H (pNF-H) in serum or in cerebro-spinal fluid (CSF) is a specific lesional biomarker for spinal cord injury. The lesional biomarkers and the reaction biomarkers are both presented after several hours post-injury. The specific predictive patterns of lesional biomarkers could be used to aid clinicians with making a diagnosis and establishing a prognosis, and evaluating therapeutic interventions. Diagnosis, prognosis, and treatment guidance based on biomarker used as a predictive indicator can determine ethical difficulties by differentiated therapies in patients with spinal cord compression. At this point based on studies until today we cannot take a decision based on biomarker limiting the treatment of neurological recovery in patients with complete spinal cord injury because we do not know the complexity of the biological response to spinal cord compression

New approach based on biomarkers in acute traumatic spinal cord injury

Spinal cord injury (SCI) is one of the most devastating traumas for an individual because the complete traumatic spinal cord injury leads to paraplegia or tetraplegia. The mechanical injuries directly cause axonal destruction in fiber tracts, destruction of the neurons and of the glial cells, and their destruction releases substances whose presence, quantity and dynamics can be lesional biomarkers. The reactions of partially injured cells simultaneously start and the occurring substances and their quantity may be reaction biomarkers. The lesional biomarkers appear immediately post-injury and after several hours there are both lesional biomarkers and reaction biomarkers. The most important lesional biomarkers are the phosphorylated neurofilament subunits resulting from the axonal neurofilament destruction. The heavy phosphorylated neurofilament subunit (pNF-H) is a predictive lesional biomarker because its values pattern can show the reducing or stopping of the secondary lesions and the favorable outcome. The complete SCI patients with a favorable development had a specific pattern of daily values of pNF-H: a sudden increase up to a maximum value then a progressive decrease to normal. The patients with unfavorable outcome or neurological stabilisation had two patterns: an increase to a plateau of pNF-H values or a progressive increase up to a peak followed by a progressive decrease to quasi-normal values

Early therapies for acute traumatic spinal cord injury

Early therapies for acute traumatic spinal cord injury has some key points: 1. Immediately or soon after the injury is recommended a hemodynamic support to maintain mean arterial pressure at 85 – 90 mmHg and monitoring in an intensive care unit for the first week after spinal cord injury. 2. Immediate surgery for spinal cord decompression is of high importance for the prognosis and evolution of spinal cord injury. 3. The recommendation is to treat all patients with spinal cord injury according to the local protocol, methylprednisolone is not standard of care anymore, it is a treatment option that should only be undertaken with knowledge of the potential complications

Normal pressure hydrocephalus: Active and passive pathogenic mechanisms

Normal pressure hydrocephalus (NPH) is characterized by normal CSF pressure, less than 18 cm H2O, classical clinical triad: gait disturbance, dementia and incontinence in patients with communicating hydrocephalus on CT or MRI. We analyzed retrospectively the NPH hospitalized patients in three neurosurgical departments between July 2007 and December 2012. Only the cases who met all diagnostic criteria were selected for this study. There were 47 selected cases of patients with NPH, including 24 patients with secondary NPH and 23 patients with idiopathic NPH. Ventriculo-peritoneal shunt was performed in all 24 patients with secondary NPH and at 11 patients with IdNPH. The short-term and long-term results were good and very good for cases of secondary NPH and good in 60% and poor in 40% in cases of IdNPH. The MR imaging showed the absence of CSF passage through the ventricular wall and the ventricular wall in cases of IdNPH with poor results after shunting: ependyma and glia limitans interna represents a fluid - parenchymal barrier between the brain parenchyma and the ventricles as a glial-ependymal barrier. We can consider that secondary NPH and some cases of idiopathic NPH with repeated small increases of ICP, with transependymal migration of CSF and hydrocephalus causing clinical triad because of the open glial-ependymal barrier, as an Active Normal Pressure Hydrocephalus and the shunt has good results. Other cases of IdNPH have not increases of intracranial pressure, no transependymal migration of CSF and there are periventricular deep lesions, without brain atrophy, causing clinical triad, as a passive hydrocephalus, it is a Passive Normal Pressure Hydrocephalus

Two cases of bone marrow tissue implant into chronic cervical spinal cord injury

Two patients with chronic cervical spinal cord injury and quadriplegia underwent partial resection of the medular scar and implant of bone marrow tissue with a combination of drugs at the site of spinal cord injury. Post-operatively they received a similar treatment in the neuromotor rehabilitation centre and were treated additionally with cerebrolysin . Sensory improvements were noticed, but no significant motor improvements were observed twenty months afterwards

Current applications of 3d printing in neurosurgery

Medical implications of 3-dimensional (3D) printing technology have progressed with increasingly used especially in surgical fields. 3D printing techniques are practical and anatomically accurate methods of producing patient specific models for medical education, surgical planning, training and simulation, and implants production for the assessment and treatment of neurosurgical diseases. This article presents the main directions of 3D printing models application in neurosurgery