Aman Deep

Hypertonic saline for treating raised intracranial pressure: literature review with meta-analysis

OBJECT Currently, mannitol is the recommended first choice for a hyperosmolar agent for use in patients with elevated intracranial pressure (ICP). Some authors have argued that hypertonic saline (HTS) might be a more effective agent; however, there is no consensus as to appropriate indications for use, the best concentration, and the best method of delivery. To answer these questions better, the authors performed a review of the literature regarding the use of HTS for ICP reduction. METHODS A PubMed search was performed to locate all papers pertaining to HTS use. This search was then narrowed to locate only those clinical studies relating to the use of HTS for ICP reduction. RESULTS A total of 36 articles were selected for review. Ten were prospective randomized controlled trials (RCTs), 1 was prospective and nonrandomized, 15 were prospective observational trials, and 10 were retrospective trials. The authors did not distinguish between retrospective observational studies and retrospective comparison trials. Prospective studies were considered observational if the effects of a treatment were evaluated over time but not compared with another treatment. CONCLUSIONS The available data are limited by low patient numbers, limited RCTs, and inconsistent methods between studies. However, a greater part of the data suggest that HTS given as either a bolus or continuous infusion can be more effective than mannitol in reducing episodes of elevated ICP. A meta-analysis of 8 prospective RCTs showed a higher rate of treatment failure or insufficiency with mannitol or normal saline versus HTS.

The intracranial arachnoid mater: A comprehensive review of its history, anatomy, imaging, and pathology

IntroductionThe arachnoid mater is a delicate and avascular layer that lies in direct contact with the dura and is separated from the pia mater by the cerebrospinal fluid-filled subarachnoid space. The subarachnoid space is divided into cisterns named according to surrounding brain structures.MethodsThe medical literature on this meningeal layer was reviewed in regard to historical aspects, etymology, embryology, histology, and anatomy with special emphasis on the arachnoid cisterns. Cerebrospinal fluid dynamics are discussed along with a section devoted to arachnoid cysts.ConclusionKnowledge on the arachnoid mater and cerebrospinal fluid dynamics has evolved over time and is of great significance to the neurosurgeon in clinical practice.

The choroid plexus: a comprehensive review of its history, anatomy, function, histology, embryology, and surgical considerations

IntroductionThe role of the choroid plexus in cerebrospinal fluid production has been identified for more than a century. Over the years, more intensive studies of this structure has lead to a better understanding of the functions, including brain immunity, protection, absorption, and many others. Here, we review the macro- and microanatomical structure of the choroid plexus in addition to its function and embryology.MethodThe literature was searched for articles and textbooks for data related to the history, anatomy, physiology, histology, embryology, potential functions, and surgical implications of the choroid plexus. All were gathered and summarized comprehensively.ConclusionWe summarize the literature regarding the choroid plexus and its surgical implications.

Treatment of spinal cord injury: a review of engineering using neural and mesenchymal stem cells.

Over time, various treatment modalities for spinal cord injury have been trialed, including pharmacological and nonpharmacological methods. Among these, replacement of the injured neural and paraneural tissues via cellular transplantation of neural and mesenchymal stem cells has been the most attractive. Extensive experimental studies have been done to identify the safety and effectiveness of this transplantation in animal and human models. Herein, we review the literature for studies conducted, with a focus on the human‐related studies, recruitment, isolation, and transplantation, of these multipotent stem cells, and associated outcomes. Clin. Anat. 28:37–44, 2015.

The arcade of Struthers: An anatomical study with potential neurosurgical significance.

Background: Significant controversy exists regarding the existence of the so-called arcade of Struthers and whether this structure is involved in some cases of proximal ulnar nerve entrapment. Therefore, the aim of the present study was to further elucidate this anatomy. Methods: Fifteen cadavers (30 sides) underwent dissection of the medial arm with special attention to the course of the ulnar nerve and its relationships to the soft tissues of this region. Results: We identified a thickening in the inferior medial arm that crosses the ulnar nerve and is consistent with the so-called arcade of Struthers in 86.7% of sides. On 57.7% of the sides, the arcade was found to be due to a thickening of the brachial fascia and was classified as a type I arcade. On 19.2% of the sides, the arcade was due to the internal brachial ligament and these were classified as type II arcades. On 23.1% of the sides, the arcade was due to a thickened medial intermuscular septum and these were classified as type III arcades. The mean length of the arcade was 4.3 cm and the distal end of the arcade was, on average, 6.8 cm above the medial epicondyle. Although the presence of an arcade of Struthers was slightly more common in female specimens, this did not reach statistical significance. However, arcades were found more often on right side (P < 0.001). Conclusions: Based on our findings, the arcade of Struthers is an anatomical band of connective tissue in the medial distal arm that crosses the ulnar nerve. This structure was found in the majority of our specimens and may need to be evaluated in proximal ulnar neuropathies. We believe that past studies that have not observed the arcade and past studies with varied findings are due to the various definitions used for this anatomical structure. Using the classification system as demonstrated in the present study may make future communications regarding the arcade of Struthers more exact.

The pia mater: a comprehensive review of literature

IntroductionThe pia mater has received less attention in the literature compared to the dura and arachnoid maters. However, its presence as a direct covering of the nervous system and direct relation to the blood vessels gives it a special importance in neurosurgery.MethodA comprehensive review of the literature was conducted to study all that we could find relating to the pia mater, including history, macro- and microanatomy, embryology, and a full description of the related structures.ConclusionThe pia mater has an important anatomic position, rich history, complicated histology and embryology, and a significant contribution to a number of other structures that may stabilize and protect the nervous system.

Lateral cephaloceles: case-based update

BackgroundMasses of the lateral skull are not uncommon and include lipomas and epidermoids. However, meningoceles of the lateral skull are very rare and are often misdiagnosed. Even rarer are atretic encephaloceles of this region.Illustrative caseWe report a newborn with a right atretic encephalocele of the asterion. Lesions of the anterolateral and posterolateral fontanelles should include lateral cephaloceles/encephaloceles in the differential diagnosis. The literature and embryology of these rare entities are discussed.

Gabriele Fallopio (1523–1562) and his contributions to the development of medicine and anatomy

IntroductionGabriele Fallopio was one of the greatest anatomists of the sixteenth century. He discovered and named numerous parts of the human body. His name survives to this day as it is associated with several anatomical structures including the Fallopian canal, Fallopian hiatus, Fallopian valve, Fallopian muscle, and the Fallopian tube.ConclusionsOur current knowledge of human anatomy is based on giants such as Fallopio. His contributions to neuroanatomy laid the foundations for the development of this discipline.

Comparison of Parkinson Disease Patients Who Fell Once with Patients Who Fell More than Once (Recurrent Fallers)

Falls are a major risk for Parkinson disease patients (PD). Single falls, in older peoplemay be related to the underlying disease or may be accidental. Recurrent falls are more likely to be related to the underlying disease. We followed 401persons with PD for a year, 205 of whom, 51.0%, fell: 161 fell once and 44 fell more than once (recurrent fallers). Recurrent fallers had PD significantly longer, 12.6 ± 7.0 versus 5.9 + 4.5 years, had significantly higher, worse, motor Unified Parkinson Disease Rating Scale (UPDRS) scores” 31.2 ± 12.7 versus 19.7 + 8.3. The major difference between recurrent and single fallers was an inability of recurrent fallers to stand on one leg for < 3 seconds: 95% versus 11%, odds ratio 178 CI 95% 39.5 – 801.2 single fallers who are unable to stand on one foot for < 3 seconds may be at risk for recurrent falls. Gait and balance training focused on improving a patient’s ability to stand on one leg may decrease the risk of recurrent falls in PD.

Chemical priming for spinal cord injury: a review of the literature part II—potential therapeutics

IntroductionSpinal cord injury is a complex cascade of reactions secondary to the initial mechanical trauma that puts into action the innate properties of the injured cells, the circulatory, inflammatory, and chemical status around them, into a non-permissive and destructive environment for neuronal function and regeneration. Priming means putting a cell, in a state of “arousal” towards better function. Priming can be mechanical as trauma is known to enhance activity in cells.Materials and methodsA comprehensive review of the literature was performed to better understand the possible chemical primers used for spinal cord injuries.ConclusionsTaken together, many studies have shown various promising results using the substances outlined herein for treating SCI.