Natriuretic Peptides, Antidiuretic Hormone and Hyponatraemia after Acute Craniocerebral Injury

We investigated the physiological mechanisms involved in central hyponatraemia in patients with acute craniocerebral injury (ACI). We measured blood concentrations of natriuretic peptides, antidiuretic hormone (ADH), and endogenous digitalis-like substance (EDLS), blood and urine sodium concentrations, and the plasma and urine osmolality in 68 patients with ACI and 24 healthy control subjects. A total of 27 ACI patients were hyponatraemic and the majority of these had grievous or severely grievous craniocerebral injuries. Blood concentrations of EDLS and ADH in hyponatraemic ACI patients were significantly higher compared with normonatraemic ACI patients and control subjects. Blood EDLS and sodium concentrations were negatively correlated with each other, whereas EDLS was positively correlated with urine sodium concentration and with urine osmotic pressure. Hyponatraemic ACI patients require different treatment based on the cause of their central hyponatraemia, so it is important to undertake a comprehensive analysis of each patient's physiological status

Complex reconstructive surgery following removal of extra-intracranial meningiomas, including the use of autologous fibrin glue and a pedicled muscle flap

Background: Skull reconstructive surgery is critical to prevent cerebrospinal fluid (CSF) fistulas and infections, and to ensure good aesthetic results in meningiomas surgery. Methods: A 65-year-old woman was surgically treated for a bilateral parasagittal meningioma with complete superior sagittal sinus (SSS) involvement, and an intra-extracranial extension, determining a significant cranial defect at the vertex. A Simpson I resection was achieved. Postoperatively a considerable and not conservatively repairable CSF leak was detected. Surgical revision of the wound with repair of the fistula and complex reconstructive operation was performed including a combination of techniques and devices such as autologous fibrin glue and reparation of the extracranial planes by an autologous vascularized vastus lateralis pedicled muscle flap. Results: No postoperative complications, infections or new neurological deficits were detected, and the CSF leak definitively ceased after surgery; the aesthetic results were satisfactory. Conclusions: Reparation of CSF fistulas that arise after meningioma surgery can require a complex reconstructive surgery of the superficial layers; when cranioplasty is not feasible or indicated, a meticulous reconstruction of the extracranial soft tissues is possible also by using vascularized autologous distal muscular tissue, with close interdisciplinary cooperation

Neuromodulation of Vegetative State through Spinal Cord Stimulation: Where Are We Now and Where Are We Going?

Background: Vegetative state (VS) is a complex condition that represents a challenging frontier for medicine and neuroscience research. Nowadays there is no scientifically validated treatment for VS patients, and their chronic long-term assistance is very demanding for healthcare systems worldwide. Objectives: The present paper is a systematic review of the role of spinal cord stimulation (SCS) as a treatment of patients with VS. Methods: Published literature on this topic was analyzed systematically. Clinical and epidemiological characteristics of VS, present therapeutic options and social costs of VS were also evaluated. Results: Only 10 papers have been published since 1988, and overall 308 VS patients have been treated with SCS worldwide; 51.6% displayed a clinical improvement and an amelioration of the environmental interaction. These effects are probably mediated by the stimulation of the reticular formation-thalamus-cortex pathway and by cerebral blood flow augmentation induced by SCS. Conclusions: The experience on this topic is still very limited, and on this basis it is still hard to make any rigorous assessment. However, the most recent experiments represent significant progress in the research on this topic and display SCS as a possible therapeutic tool in the treatment of VS

Considerazioni su \u201cApproccio endoscopico endonasale alla cerniera craniocervicale: Il ruolo della preservazione dell\u2019arco anteriore di C1 o della sua ricostruzione\u201d

NO ABSTRACT AVAILABL

Commentary: Effect of Spinal Cord Stimulation on Early Disability Pension in 198 Failed Back Surgery Syndrome Patients: Case-Control Study

Commentary: Effect of Spinal Cord Stimulation on Early Disability Pension in 198 Failed Back Surgery Syndrome Patients: Case-Control Study

Advances in videoassisted anterior surgical approach to the craniovertebral junction

At the present time, an update to the classical microsurgical transoral decompression is supported by the most recent literature dealing with the introduction of the endoscopy in spine surgery. In this paper, we present all the reported experience on the surgical approaches to anterior cranioveretebral junction (CVJ) compressive pathology managed by endoscopy. Surgical strategies dealing with decompressive procedures by using an open access, microsurgical technique, neuronavigation and endoscopy are summarized.Endoscopy represents a useful complement to the standard microsurgical approach to the anterior CVJ. Endoscopy can be used via transnasal, transoral and transcervical routes; it facilitates visualisation and better decompression without the need for soft palate splitting, hard palate resection, or extended maxillotomy. Although neuronavigation enhances orientation within the surgical field, intraoperative fluoroscopy helps to recognize residual compression.Under normal anatomical conditions, there appear to be no surgical limitations for the endoscopically assisted transoral approach compared with the pure endonasal and transcervical endoscopic approaches.The endoscope has a clear role as "support" to the standard transoral microsurgical approach since 30\ub0 angulated endoscopy increases the surgical area exposed over the posterior pharyngeal wall and the extent of the clivus

Expert\u2019s Comment concerning Grand Rounds case entitled \u201cAcute non-traumatic idiopathic spinal subdural hematoma: radiographic findings and surgical results with a literature review\u201d by K. Kobayashi, S. Imagama, K. Ando, Y. Nishida, N. Ishiguro (Eur Spine J; 2017)

Expert\u2019s Comment concerning Grand Rounds case entitled \u201cAcute non-traumatic idiopathic spinal subdural hematoma: radiographic findings and surgical results with a literature revie

Nuances of Microsurgical and Endoscope Assisted Surgical Techniques to the Cranio-Vertebral Junction: Review of the Literature

Purpose: An update of the technical nuances of microsurgical - endoscopic assisted approaches to the craniocervical junction (transnasal, transoral and transcervical) if provided from the literature in order to better contribute to identify the best strategy.Methods: A non-systematic update of the review and reporting on the anatomical and clinical results of endoscopic assisted and microsurgical approaches to the craniocervical junction (CVJ) is performed.Results: Pure endonasal and cervical endoscopic approaches still have some disadvantages,including the learning curve and the deeper surgical fi eld. Endoscopically assisted transoral surgery with 30° endoscopes represents an emerging option to standard microsurgical techniques for transoral approaches to the anterior CVJ. This approach should be considered as complementary rather than an alternative to the traditional transoral-transpharyngeal approach.Conclusions: Transoral (microsurgical or video-assisted) approach with sparing of the soft palate still remains the gold standard compared to the ‘‘pure’’ transnasal and transcervical approaches due to the wider working channel provided by the former technique. Transnasal endoscopic approach alone appearsto be superior when the CVJ lesion exceeds the upper limit of the inferior third of the clivus. Of particularinterest the evidence that advancement in reduction techniques can avoid ventral approach.</p