Treatment Of Neurosurgical Patients Research Articles

Predictors and surgical outcome of hemorrhagic metastatic brain malignancies.

Intracerebral metastases present a substantial risk of tumor-associated intracerebral hemorrhage (ICH). This study aimed to investigate the risk of hemorrhagic events in brain metastases (BM) from various primary tumor sites and evaluate the safety and outcomes of surgical tumor removal. A retrospective, single-center review of medical records was conducted for patients who underwent BM removal between January 2016 and December 2017. Patients with hemorrhagic BM were compared to those with non-hemorrhagic BM. Data on preoperative predictors, perioperative management, and postoperative outcomes were collected and analyzed. A total of 229 patients met the inclusion criteria. Melanoma metastases were significantly associated with preoperative hemorrhage, even after adjusting for confounding factors (p = 0.001). Poor clinical status (p = 0.001), larger tumor volume (p = 0.020), and unfavorable prognosis (p = 0.001) independently predicted spontaneous hemorrhage. Importantly, preoperative use of anticoagulant medications was not linked to increased hemorrhagic risk (p = 0.592). Surgical removal of hemorrhagic BM, following cessation of blood-thinning medication, did not significantly affect intraoperative blood loss, surgical duration, or postoperative rebleeding risk (p > 0.096). However, intra-tumoral hemorrhage was associated with reduced overall survival (p = 0.001). This study emphasizes the safety of anticoagulation in patients with BM and highlights the safety of neurosurgical treatment in patients with hemorrhagic BM when blood-thinning medication is temporarily paused. The presence of intra-tumoral hemorrhage negatively impacts survival, highlighting its prognostic significance in BM patients. Further research with larger cohorts is warranted to validate these findings and elucidate underlying mechanisms.

Abstract 6 Combined Umbilical Cord Mesenchymal Stromal/Stem Cell Application For Primary Torsion Dystonia Treatment (Case Report)

Abstract Introduction Primary torsion dystonia (PTD) is a neurological disorder characterized by sustained or intermittent muscle contractions causing abnormal movements and/or postures with severe disability of young patients. Traditional therapies for PTD include oral anti-parkinsonism drugs, botulinum neurotoxin, pallidotomy and deep brain stimulation. Stem cell therapy is another promising treatment option, due to its neuroregenerative properties. Objectives The objective of the study was to investigate the effect of combined (intrathecal and intravenous) administration of umbilical cord derive stromal/stem cells (UC-MCS) on PTD reduction. Methods Patient M, born on 25.06.2004, fell ill gradually, 8 years ago developed signs of muscle dystonia, especially in right hand. Genetic tests were carried out, which revealed mutations in the DYT-1 gene. The diagnosis of primary torsion dystonia was established. Conservative treatment was not effective. The patient was offered treatment in the frame of research scientific program "To investigate the effectiveness of regenerative cell technologies in the neurosurgical treatment of patients with demyelinating diseases of the CNS and cerebral palsy. № 0119U000112" UC-MSCs for this study were isolated from healthy human umbilical cord and prepared due to the minimal criteria established by the Mesenchymal and Tissue Stem Cell Committee of the International Society for Cellular Therapy. 3 injections of UC-MSC were performed with time interval of 6 month (intravenously and intrathecally in a dose of 6 × 107at each injection). Intrathecal administration was performed according to the typical method of performing lumbar puncture in compliance with the rules of asepsis and antiseptics in the operation room using local anesthesia. Results Prior to stem cells injection, the patient's Unified Dystonia Rating Scale (UDRS) dystonia movement score was 15, which progressively decreased after procedure to 13, 10, 7 and 4 after 6, 12, 18 and 24 months respectively. There was a significant improvement in the patient's quality of life. Discussion UC-MSC significantly reduce dystonia in patient. This result is probably achieved due to the neuroregenerative and neurotrophic effects of UC-MSCs. Study results suggest the need to provide larger multicenter randomized studies with more sophisticated methods of investigations.

Neurosurgical Treatment of Patients with Posterior Fossa Acute Subdural Hematoma Right after Cardiac Surgery.

As posterior fossa acute subdural hematoma (ASDH) right after cardiac surgery is extremely rare, the clinical course and optimal treatment strategy remain undetermined. We performed a retrospective analysis of patients with posterior fossa ASDH right after cardiac surgery requiring neurosurgical treatment at our institution over a 7-year period and, in this study, discussed the neurosurgical strategy and clinical course. Collected data included clinical history, laboratory results, time course, symptoms, neurosurgical treatment, outcome at discharge, and imaging studies. All six patients were women who had no history of head trauma and had received antithrombotic therapy during the perioperative period of cardiac surgery. All patients showed lower platelets count and were diagnosed with ASDH within 3 days (longest time 64 h) right after cardiac surgery. After discontinuation of anticoagulation therapy and administration of reversal agents, they underwent emergency hematoma evacuation craniotomy (n = 5) or burr hole drainage surgery (n = 1), which were performed in the prone (n = 4) or lateral (n = 2) positions. Four of these patients showed favorable outcomes, and two showed poor outcomes. One of the poor-outcome patients received three antithrombotic therapies, and another developed rapidly progressive ASDH. Posterior fossa ASDH associated with antithrombotic therapy right after cardiac surgery is frequently found in women, and emergent neurosurgical treatment with anticoagulation discontinuation and reversal agent administration can be performed safely. Burr hole drainage surgery might be acceptable in nonsevere cases. By contrast, we must pay attention to cases receiving both anticoagulant and antiplatelet drugs and rapid progression cases.

Cognitive, emotional and motor disorders and their impact on the postoperative rehabilitation of neurosurgical patients

Pathological post-anesthetic changes can be determined by the type and duration of anesthesia, the somatic and neurological status of the patient in the preoperative period, age, etc.Objective: to assess the severity of cognitive (CI), emotional and motor impairments in patients who underwent spinal surgery.Patients and methods. The clinical study included 60 patients aged 30-74 years who underwent spinal surgery under general anesthesia. The neuropsychological, emotional, somatic, and neurological status were assessed at the baseline and one week, 3, and 6 months after the surgery. Thirty patients underwent a course of cognitive training (main group), and 30 patients were included in a comparison group.Results and discussion. In the postoperative period, pain indicators decreased in both groups. There was an improvement in cognitive functions, emotional state, and quality of life (QoL) in the main group 3 and 6 months after surgery. The inclusion of cognitive training in the rehabilitation program for patients undergoing neurosurgical spinal surgery improved cognitive and motor functions and the QoL of patients. Evaluation and treatment of neurosurgical patients are discussed, which are helpful to improve the results of rehabilitation and QoL in the postoperative period.Conclusion. Additional positive impact of cognitive-motor training for pain regression in patients after spinal surgery was observed.

The factors of the outcome of neurosurgical treatment in traumatic brain injury

The purpose of the research: to improve the results of neurosurgical treatment in patients with traumatic brain injury by detecting an optimal way of craniotomy. Material and methods. The study includes the analysis of 127 patients operated on in the Department of Neurosurgery. The examination sample consisted of 109 (85.8%) male and 18 (14.2%) female patients. Patients’ ages varied from 16 to 85 years. The average age of the patients was 43.8 ± 4.2 years. Results. Not depending on craniotomy method, there was not a statistically significant difference in outcome in patients with traumatic brain injury. Using of trephination, craniectomy and osteoplastic craniotomy revealed no significant differences in outcomes in patients with traumatic brain injury. Patients’ age over 60 years, consciousness degree 4-6 scores according to Glasgow Coma Scale, and dislocation syndrome are unfavorable prognostic factors. Resection craniotomy in traumatic brain injury may be effective even in deep coma consciousness level and dislocation syndrome, but in absence of intraoperative brain edema. Conclusion. During the planning of craniotomy method in traumatic brain injury, 4-9 score consciousness degree according to Glasgow Coma Scale, brain contusion foci, acute subdural and intracerebral hematomas, brain compression volume of 30-150 cm³, patient’ age and dislocation syndrome should be considered, which, in total, predicts an outcome.

Variation in medical management and neurosurgical treatment of patients with supratentorial spontaneous intracerebral haemorrhage.

IntroductionThe role of surgery in spontaneous intracerebral haemorrhage (sICH) remains controversial. This leads to variation in the percentage of patients who are treated with surgery between countries.Patients and methodsWe sent an online survey to all neurosurgeons (n = 140) and to a sample of neurologists (n = 378) in Dutch hospitals, with questions on management in supratentorial sICH in general, and on treatment in six patients, to explore current variation in medical and neurosurgical management. We assessed patient and haemorrhage characteristics influencing treatment decisions.ResultsTwenty-nine (21%) neurosurgeons and 92 (24%) neurologists responded. Prior to surgery, neurosurgeons would more frequently administer platelet-transfusion in patients on clopidogrel (64% versus 13%; p = 0.000) or acetylsalicylic acid (61% versus 11%; p = 0.000) than neurologists. In the cases, neurosurgeons and neurologists were similar in their choice for surgery as initial treatment (24% and 31%; p = 0.12), however variation existed amongst physicians in specific cases. Neurosurgeons preferred craniotomy with haematoma evacuation (74%) above minimally-invasive techniques (5%). Age, Glasgow Coma Scale score and ICH location were important factors influencing decisions on treatment for neurosurgeons and neurologists. 69% of neurosurgeons and 80% of neurologists would randomise patients in a trial evaluating the effect of minimally-invasive surgery on functional outcome.DiscussionOur results reflect the lack of evidence about the right treatment strategy in patients with sICH.ConclusionNew high quality evidence is needed to guide treatment decisions for patients with ICH. The willingness to randomise patients into a clinical trial on minimally-invasive surgery, contributes to the feasibility of such studies in the future.

Changes in treatment paradigm for neurosurgical patients in the era of stereotactic irradiation. By the 15th anniversary of the Neuroradiosurgery in Russia

INTRODUCTION Stereotactic method and new irradiation techniques ensured radiosurgical treatment with high precision and conformity and significantly expanded the indications for stereotactic irradiation in neurosurgery. MATERIAL AND METHODS Over 15-year period, 29 976 patients underwent irradiation in various modes of fractionation on linear accelerators and Gamma Knife system at the first national radiosurgery center. RESULTS Stereotactic radiotherapy and radiosurgery are followed by minimal number of complications and side reactions. At the same time, 5-year control of tumor growth for skull base meningioma was 96.8%, neuroma - 97%, glomus tumor - 94%, pituitary adenoma - 96-98%, craniopharyngioma - 95% in overall 10-year survival 86%, pilocytic astrocytoma - 97.5% in overall 5-year survival 99%. In intracranial metastases, median overall survival after radiosurgery was 10.1 months, 24- and 36-month overall survival - 25.9% and 19.2%, respectively. In patients with recurrent high-grade glioma, overall survival was 27.4 months. In case of metastatic spine lesions, control of tumor growth within 1 year was achieved in 90% of patients, pain relief - in more than 50% of cases. Obliteration of AVM and dural fistula was found in more than 80% of patients in years after treatment. Reduction or disappearance of pain was also observed in 80% of patients with trigeminal neuralgia. CONCLUSION Stereotactic irradiation is effective and safe in patients with various pathologies of the central nervous system and characterized by high socio-economic indicators. Our own data indicate more significant role of stereotactic irradiation in the treatment of neurosurgical patients and make it possible to revise the existing treatment standards.

Changes in treatment paradigm for neurosurgical patients in the era of stereotactic irradiation. By the 15th anniversary of the Neuroradiosurgery in Russia

Stereotactic method and new irradiation techniques ensured radiosurgical treatment with high precision and conformity and significantly expanded the indications for stereotactic irradiation in neurosurgery. Over 15-year period, 29 976 patients underwent irradiation in various modes of fractionation on linear accelerators and Gamma Knife system at the first national radiosurgery center. Stereotactic radiotherapy and radiosurgery are followed by minimal number of complications and side reactions. At the same time, 5-year control of tumor growth for skull base meningioma was 96.8%, neuroma - 97%, glomus tumor - 94%, pituitary adenoma - 96-98%, craniopharyngioma - 95% in overall 10-year survival 86%, pilocytic astrocytoma - 97.5% in overall 5-year survival 99%. In intracranial metastases, median overall survival after radiosurgery was 10.1 months, 24- and 36-month overall survival - 25.9% and 19.2%, respectively. In patients with recurrent high-grade glioma, overall survival was 27.4 months. In case of metastatic spine lesions, control of tumor growth within 1 year was achieved in 90% of patients, pain relief - in more than 50% of cases. Obliteration of AVM and dural fistula was found in more than 80% of patients in years after treatment. Reduction or disappearance of pain was also observed in 80% of patients with trigeminal neuralgia. Stereotactic irradiation is effective and safe in patients with various pathologies of the central nervous system and characterized by high socio-economic indicators. Our own data indicate more significant role of stereotactic irradiation in the treatment of neurosurgical patients and make it possible to revise the existing treatment standards.

Epilepsy and cognitive deterioration as postoperative complications of the arachnoid cyst fenestration. Case report

Objective With the aim of contributing to the discussion on treatment of patients with arachnoid cysts (AC) and their neuropsychological functioning, we present the case of a patient who has undergone surgery of AC located in the left Sylvian fissure. Case description: The patient had no cognitive deficits and no seizures before the cyst’s fenestration. After the procedure, however, occurrences of seizures have been observed. Along with the concomitant epileptic seizures, aphasia and serious memory problems also developed. The initial pharmacological treatment of the seizures brought about unsatisfactory results. The treatment was therefore modified a number of times and ultimately, seizures were brought under control to some extent. Despite the varied efforts at neuropsychological rehabilitation, cognitive impairment was still persistent up to a year after the surgery. Conclusions: 1) While referring patients with AC for surgery, one should always consider both the positive outcomes and the unintended and deleterious consequences. A cyst fenestration could in some cases lead to epilepsy and cause neuropsychological symptoms such as anomic aphasia and cognitive deterioration with memory function impairment. 2) Neurological patients, especially the ones qualified for surgery, should always undergo neuropsychological examination. The lack of data from presurgical neuropsychological examination may impact further treatment of neurosurgical patients.

Relationship of psychoalgological status and results of neurosurgical treatment of patients with discogenic radiculopathy

The OBJECTIVE was to improve the results of surgical treatment of patients with discogenic radiculopathy by preoperative neuropsychological examination of patients with an increased risk of unsatisfactory outcome of the operation.METHODS AND MATERIALS. Neuropsychological status of 77 patients with discogenic radiculopathy in the preoperative period was studied. For this purpose, we assessed the intensity of pain, levels of personal and situational anxiety and the presence and severity of depression. The obtained data were compared with postoperative results of quality of life assessment for the main parameters, which include the level of pain and adaptation to daily activities.RESULTS. Data from neuropsychological tests were revealed, the presence of which in patients with discogenic pain syndrome suggests the risk of an unsatisfactory assessment of the operation performed by the patient. According to the long-term results of neurosurgical treatment, patients were divided into three groups: 1 – with a good result; 2 – patients with a number of preserved complaints, who rated the result of the operation as satisfactory; 3 – unsatisfactory outcome. In patients with unsatisfactory results of surgical treatment of discogenic radiculopathies with pain syndrome, patterns of psychological indices were found that were significantly associated with the outcome of treatment.CONCLUSION. Conducting a neuropsychological examination prior to surgery with the identification of predictors of chronic discogenic pain and patient dissatisfaction with the results of treatment can influence the surgical tactics and optimize the process of further treatment.

Effects of using different software packages for BOLD analysis in planning a neurosurgical treatment in patients with brain tumours

BackgroundThe authors of the present thesis carried out a comparative analysis of three different computer software packages – FSL, SPM and FuncTool – for the processing of fMRI scans. PurposeThe aim of the thesis was the analysis of the volume of regions functionally active during the stimulation of the centres evaluated as well as the location of those regions in relation to the tumour boundaries, and then the comparison of the results. Material and methodsThirty eight patients with a diagnosed tumour of the left hemisphere, qualified for a neurosurgical operation, underwent fMRI. The functions of speech, motion and sensation were evaluated. Imaging data were processed for all the acquired scans with the use of each of the three software packages assessed. ResultsFor the FuncTool software package the calculated differences in the distances were several times greater than those calculated using FSL and SPM. The differences in the volume of the functionally active regions derived from the calculations with the use of the FSL and SPM software packages were statistically different for four out of the six functions evaluated. ConclusionsThe conclusions of the analysis in question showed that the FSL and SPM packages could be used interchangeably in the functional mapping of the brain with the purpose of the planning of neurosurgical operations. The FuncTool software package is less precise than FSL and SPM.

Outcomes of neurosurgical treatment of patients with non-visualized adenoma and microadenoma of the pituitary gland and with Cushing’s disease

The study objective is to compare pre- and intraoperative characteristics, and the results of neurosurgical treatment in patients with Cushing’s disease, non-visualized adenoma and microadenoma of the pituitary gland.Materials and methods. The results of transsphenoidal adenomectomy were analyzed in 102 patients with non-visualized corticotropinomas and 360 patients with microcorticotropinomas. The pituitary genesis of endogenous ACTH-dependent hypercorticism in 182 patients was proved by the results of selective blood sampling from inferior petrosal sinus with stimulation desmopressin. The study included 369 women and 93 men aged 16 to 64 years. All patients were operated by transnasal approach using endoscopic techniques.Results. The group with non-visualized adenoma was dominated by men (p = 0.005) and patients with severe hypercorticism (p = 0.021). When comparing intraoperative characteristics in this group, invasive growth was statistically significantly more frequent (53 % vs 39 %) (p = 0.017), which in turn led to more aggressive intraoperative tactics (p <0.001) and more frequent development of hypothyroidism (11 % vs 4 %) (p = 0.028) in the early postoperative period. Early postoperative remission occurred in 73 (72 %) of 102 patients with non-visualized adenoma and in 314 (87 %) of 360 patients with microadenoma (p <0.001).Conclusion. Early results of primary transsphenoidal adenomectomy in patients with non-visualized pituitary adenoma were significantly worse in comparison with patients with microadenoma detected by 1.5 T magnetic resonance imaging, which have more frequently invasive growth, what leads to an increase in the volume of surgery and a possible increase in postoperative hypopituitarism.

The changes of standard DXA measurements and TBS depending on outcomes of neurosurgical treatment in patients with Cushing's disease

BACKGROUND: Patients with endogenous hypercortisolism have reduced bone mineral density (BMD) and trabecular bone score (TBS) that are the causes of secondary osteoporosis and low-traumatic fractures. It is well known that radical treatment (neurosurgery or radiosurgery) of Cushing’s disease leads to a decline of cortisol levels in all body fluids to normal values. However, it is still uncertain whether bone tissue structure, and particularly its microarchitecture, does recover in remission of the disease.
 AIMS: To evaluate an influence of hormone activity (presence or absence of remission) in patients with Cushing's disease on changes of bone structure measurements in accordance with DXA values (TBS, BMD, T- and Z-scores), as well as significance of such changes in 12 and 24 months after neurosurgical treatment.
 MATERIALS AND METHODS: In patients with confirmed active Cushing's disease (ACTH-producing pituitary adenoma) (n = 44) and in control group of healthy volunteers (n = 40), BMD in lumbar spine (L1-L4) and simultaneously TBS, in cut-off points before neurosurgical treatment (in both groups) and in 12 and 24 months after it (only in patients), were assessed. We diagnosed presence or absence of disease remission at cut-offs. All measurements were performed using a GE iDXA device (GE Healthcare Lunar, Madison, Wisconsin, USA). The TBS was calculated simultaneously from taken BMD scans, blinded to clinical outcome using TBS iNsight software v2.1 (Medimaps, Merignac, France). The activity of Cushing’s disease was evaluated using late-night salivary cortisol (LNSC, at 23:00). To determine the differences in DXA and TBS values before and after neurosurgical intervention depending on remission occurrence, covariate analysis (ANCOVA) was applied.
 RESULTS: There were found significant changes in TBS, BMD and T-score values in 12 months after neurosurgical treatment associated with presence or absence of disease remission (p = 0.039, 0.046 and 0.048, respectively). No differences in Z-score as well as in all measurements in 24 months, that might be associated with remission occurrence, were revealed. The gain in all DXA measurements (including TBS) during 24 months of observation period was statistically significant when analyzing data using Student’s paired t-test. However, the values corresponding to the age references had not been achieved for the specified time interval.
 CONCLUSIONS: Patients with Cushing’s disease have lower TBS values. In remission conditions TBS is getting significantly higher. The increase in BMD and TBS occurs during 24 months after achieving remission of Cushing’s disease but doesn’t lead to a full restoration of normal bone mass and microstructure throughout observation period of 24 months.

Intracranial Pressure Monitor Based on Wireless

During the treatment of neurosurgical patients, the changing of intracranial pressure (ICP) monitoring is the main monitoring objects, while most of the clinical equipment are wireline. With the rapid development of transducer and wireless network, miniaturization, micromation and wireless transmission become one of the research hotspots. This paper designed a wireless ICP monitoring system based on ZigBee technology, which can continuously measure the patient's intracranial pressure and temperature, and send monitoring data of patients of different ward to nurse station through the wireless network, and save it. Then we can inquiry the intracranial pressure and temperature using the intracranial pressure monitoring and management software we designed. The wireless system can be installed in the hospital very conveniently, which can reduce the work intensity of medical staff. The system is very useful in clinical work.

Lung cancer brain metastases – the role of neurosurgery

Lung cancer is mostly common occurring oncological disease in the developed countries. Currently lung cancers are subdivided into nonsmall-cell (adenocarcinoma, large-cell, squamous cell) and small-cell. The difference in the clinical and morphological picture leads to the necessity of choosing therapeutic approaches to patients of various groups. Lung cancer should be referred to encephalotropic diseases since metastatic lesion of the central nervous system is sufficiently common complication. Successes of complex treatment of primary tumor result in increase of total longlivety currently ther is ageing of patients suffering lung cancer. These factors increase the risk of metastatic lesions of the brain. Interest to the problem of neurosurgical treatment of patients suffering lung cancer is determined by frequency of lesion, varicosity of morphological variants of the disease, requiring various algorithms of treatment and diagnosis. The main role of neurosurgical intervention in cerebral metastases of lung cancer consist in creation of the paled of carrying out combined therapy. Ideally, a neurosurgical operation should be carried out with clearcut observance of oncological principles of ablasty. Adequate comprehensive approach to treatment or patients with cerebral metastases of various forms of lung cancer with the developed of optimal tactics of and stages of treatment would make it possible to increase duration and quality of life of patients.

The study of the improved complex neurosurgical treatment in patients with posttraumatic chronic subdural hematomas and hygromas

The study of the improved complex neurosurgical treatment in patients with posttraumatic chronic subdural hematomas and hygromas

The study of the improved complex neurosurgical treatment in patients with posttraumatic chronic subdural hematomas and hygromas

The study of the improved complex neurosurgical treatment in patients with posttraumatic chronic subdural hematomas and hygromas

Resident-led Implementation of a Standardized Handoff System to Facilitate Transfer of Postoperative Neurosurgical Patients to the ICU

Transitions in care are pivotal moments for patient safety. Although many strategies have been suggested for handoff improvement in the healthcare realm, little focus has been placed on patient safety during the transition from the operative to the postoperative setting. Many surgical trainees have received limited instruction, if any, on how to conduct comprehensive handoffs that ensure the safe transition of care and optimize continuity of care. Therefore, structured transfers of patient care can be invaluable. Here, we describe the implementation of a standardized handoff system developed by residents in an academic neurosurgery department to communicate key perioperative data via both electronic documentation and in-person discussion as a means of reinforcement. Our results are part of a comprehensive effort to strengthen the culture of safety surrounding the care and treatment of neurosurgical patients at our institution.

Neurosurgical treatment of cerebrovascular complications of heart surgeries and interventions.

Intracerebral haematoma and brain ischaemia are rare life-threatening complications of cardiovascular surgery. The aim of this study is to present the experience with the neurosurgical treatment of patients with cerebrovascular complications of heart surgery. Patients with brain ischaemia or intracerebral haematoma in the acute phase after heart surgery or invasive intervention operated on between 2002 and 2011 were reviewed. There were 3 patients with middle cerebral artery infarction requiring decompressive craniectomy (2 males, 1 female; mean age 54.3 years) and 5 patients with intracerebral haematoma (3 males, 2 females; mean age 55 years). The type of surgery for intracerebral haematoma was selected individually preferring minimally invasive techniques: stereotactic aspiration (2 patients), neuroendoscopy (1 patient), stereotactic craniotomy (1 patient) or classical craniotomy (1 patient). The results of decompressive craniectomy were unsatisfactory: GOS 1, 3 and 4 in 1 patient each. The results of surgery for intracerebral haematoma were GOS 5 in 1 patient, GOS 4 in 2 patients, and lethal in 2 patients. Minimally invasive neurosurgery techniques appear to be beneficial for selected patients with intracerebral haematoma after heart surgeries even when considering the limited number of patients. Decompressive craniectomy should be considered strictly individually.

The Role of Hypertonic Saline in Neurosurgery

he first reported experiments with hypertonic saline (HS) were performed in 1919 whereby intravenous injections T of 30% sodium chloride or saturated sodium bicarbonate were found to result in marked decrease in brain size and intracranial pressure (22). Since this time, extensive experimental and clinical studies have been conducted to assess the alterations in physiology after HS infusions and the possible beneficial effects after the treatment of patients. HS is commonly used as part of a number of therapeutic modalities in the treatment of hemorrhagic shock, hyponatremia, and intracranial hypertension. Within the field of neurosurgery, HS has been used extensively in preoperative, intraoperative, and postoperative patient management. It has been extensively assessed in neurosurgery because of its ability to reduce intracranial pressure by moving water from the interstitial and intracellular spaces to the intravascular areas within the nervous system as a result of osmotic gradients. The primary beneficial roles include a reduction in intracranial pressure and cerebral edema without compromising intravascular volume, blood pressure, and cerebral perfusion pressure. These beneficial properties may result in improved outcomes in the treatment of neurosurgical patients, but currently there are no consensus guidelines on therapeutic indications, dose, or timing. Potential alternative therapies as well as overall benefits and side effects also have not been completely defined.