Causes and risk factors of an unplanned second craniotomy in patients with traumatic brain injury

Fu, Shilong; Hou, Pengwei; Wang, Guofeng; Wang, Shousen

doi:10.1186/s12893-023-01977-w

Cited by 2 publications

(3 citation statements)

References 17 publications

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“…Several stepwise intracranial decompression techniques, such as pre-craniotomy hole drilling, slow cutting of the dura mater, and gradual decompression via external ventricular drainage or ICP monitoring, have been reported to effectively decrease the occurrence of secondary brain bulge to a certain extent. 12 However, these measures may not sufficiently prevent primary brain bulge in clinical practice. In this study, nearly all surgical patients who experienced primary brain bulge succumbed to refractory elevated ICP shortly after surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Under the GOS rating system, a score of 1 signifies death, 2 signifies persistent vegetative state, 3 signifies severe disability, 4 signifies moderate disability, and 5 signifies good recovery. 12 In terms of functional prognosis, a GOS score of 1–3 indicates an unfavorable prognosis, while a score of 4–5 indicates a favorable prognosis. The secondary outcome measure was the proportion of surgical patients who experienced intraoperative malignant brain bulge.…”

Section: Methodsmentioning

confidence: 99%

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Incidence, risk factors, and clinical outcomes of acute brain swelling associated with traumatic acute subdural hematoma: a retrospective study utilizing novel diagnostic criteria

Fu,

Liu,

Wang

et al. 2024

Ther Adv Neurol Disord

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Background: Post-traumatic acute brain swelling (ABS) is a major cause of elevated intracranial pressure and thus mortality. The current definition of post-traumatic ABS has certain limitations, and there is limited information available regarding ABS associated with traumatic acute subdural hematoma (ASDH). Objectives: To investigate the incidence, risk factors, and clinical outcomes of ABS associated with traumatic ASDH. Design: Retrospective study. Methods: Data for 161 patients diagnosed with traumatic ASDH were retrospectively collected. Novel computed tomography-based criteria were proposed for diagnosing ABS in patients with ASDH and determining its incidence. Univariate and multivariate logistic regression analyses were performed to explore the risk factors of post-traumatic ABS. The Glasgow Outcome Scale (GOS) score, mortality, and functional prognosis of all patients at discharge and the proportion of intraoperative malignant brain bulge in surgical patients were taken as clinical outcome measures. Results: A total of 45 (28%) patients experienced post-traumatic ABS, exhibiting significantly lower Glasgow Coma Scale scores on admission ( p < 0.001). The incidence of hemispheric and whole-brain swelling was 8.1% and 19.9%, respectively. Risk factors independently associated with post-traumatic ABS were: (1) age [odds ratio (OR) = 0.917, p < 0.001]; (2) platelet to white blood cell ratio (PWR) (OR = 0.887, p = 0.012); and (3) traumatic subarachnoid hemorrhage (SAH) (OR = 4.346, p = 0.005). The ABS cohort had a lower GOS score [2 (1–3) versus 4 (3–5); p < 0.001], higher mortality (46.7% versus 6.9%; p < 0.001), and higher proportion of unfavorable functional prognosis (75.6% versus 34.5%; p < 0.001) upon discharge compared to the no ABS cohort, along with higher proportion of intraoperative malignant brain bulge (43.8% versus 0%; p < 0.001). Conclusion: The incidence of ABS associated with ASDH is significantly high overall. Patients with ASDH who have young age, low PWR, and traumatic SAH are at an increased risk of developing post-traumatic ABS, and therefore of poor clinical outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Incidence, risk factors, and clinical outcomes of acute brain swelling associated with traumatic acute subdural hematoma: a retrospective study utilizing novel diagnostic criteria

Fu,

Liu,

Wang

et al. 2024

Ther Adv Neurol Disord

Self Cite

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“…Under this circumstance, comprehensive and continuous monitoring following a TBI is critical for avoiding the clinical deterioration of the brain status. For example, blood pressure medication and hemostasis are necessary after hemorrhage occurred, and surgical intervention will be mandatory when the pharmacological interventions fail to reduce intracranial pressure. , Therefore, it is necessary to develop a reliable monitoring strategy for the surgical management of TBI. This involves evaluating if external head injuries coincide with internal damage, detecting any secondary injuries early on, ensuring precise removal of any blood clots during surgery, etc.…”

Section: Introductionmentioning

confidence: 99%

Aqueous Grown Quantum Dots with Robust Near-Infrared Fluorescence for Integrated Traumatic Brain Injury Diagnosis and Surgical Monitoring

Jiao,

Li,

Liu

et al. 2024

ACS Nano

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Surgical intervention is the most common first-line treatment for severe traumatic brain injuries (TBIs) associated with high intracranial pressure, while the complexity of these surgical procedures often results in complications. Surgeons often struggle to comprehensively evaluate the TBI status, making it difficult to select the optimal intervention strategy. Here, we introduce a fluorescence imaging-based technology that uses high-quality silver indium selenide-based quantum dots (QDs) for integrated TBI diagnosis and surgical guidance. These engineered, poly(ethylene glycol)capped QDs emit in the near-infrared region, are resistant to phagocytosis, and importantly, are ultrastable after the epitaxial growth of an aluminum-doped zinc sulfide shell in the aqueous phase that renders the QDs resistant to long-term light irradiation and complex physiological environments. We found that intravenous injection of QDs enabled both the precise diagnosis of TBI in a mouse model and, more importantly, the comprehensive evaluation of the TBI status before, during, and after an operation to distinguish intracranial from superficial hemorrhages, provide real-time monitoring of the secondary hemorrhage, and guide the decision making on the evacuation of intracranial hematomas. This QD-based diagnostic and monitoring system could ultimately complement existing clinical tools for treating TBI, which may help surgeons improve patient outcomes and avoid unnecessary procedures.

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Causes and risk factors of an unplanned second craniotomy in patients with traumatic brain injury

Cited by 2 publications

References 17 publications

Incidence, risk factors, and clinical outcomes of acute brain swelling associated with traumatic acute subdural hematoma: a retrospective study utilizing novel diagnostic criteria

Incidence, risk factors, and clinical outcomes of acute brain swelling associated with traumatic acute subdural hematoma: a retrospective study utilizing novel diagnostic criteria

Aqueous Grown Quantum Dots with Robust Near-Infrared Fluorescence for Integrated Traumatic Brain Injury Diagnosis and Surgical Monitoring

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