Intraoperative Targeted Temperature Management in Acute Brain and Spinal Cord Injury

Abstract

Acute brain and spinal cord injuries affect hundreds of thousands of people worldwide. Though advances in pre-hospital and emergency and neurocritical care have improved the survival of some to these devastating diseases, very few clinical trials of potential neuro-protective strategies have produced promising results. Medical therapies such as targeted temperature management (TTM) have been trialed in traumatic brain injury (TBI), spinal cord injury (SCI), acute ischemic stroke (AIS), subarachnoid hemorrhage (SAH), and intracranial hemorrhage (ICH), but in no study has a meaningful effect on outcome been demonstrated. To this end, patient selection for potential neuro-protective therapies such as TTM may be the most important factor to effectively demonstrate efficacy in clinical trials. The use of TTM as a strategy to treat and prevent secondary neuronal damage in the intraoperative setting is an area of ongoing investigation. In this review we will discuss recent and ongoing studies that address the role of TTM in combination with surgical approaches for different types of brain injury.

Combination of RNA Interference and Stem Cells for Treatment of Central Nervous System Diseases

“…Approximately 1.7 million individuals worldwide suffer from SCI each year [94], with increases health care and living expenses [95]. It has been suggested that miRNAs regulate gene expression and are associated with the pathogenic processes of SCI, such as inflammation, oxidation, demyelination, and apoptosis [96].…”

“…Currently, standard therapies only have limited effects on secondary neuronal injury [94]. Thus, strategies for treatment and prevention of secondary neuronal damage are necessary.…”