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1.
Clin Neurol Neurosurg ; 243: 108394, 2024 Jun 13.
Article in English | MEDLINE | ID: mdl-38908321

ABSTRACT

AIM: Advanced neuroimaging strategies may provide new insights into the underlying mechanisms of trigeminal neuralgia (TN). The objective of this study is to measure central pain centers in patients with long-standing trigeminal neuralgia and compare them to those of normal individuals. The findings of this study could improve the understanding of central region changes related to pain and improve the diagnosis and management of chronic trigeminal pain. MATERIAL AND METHODS: We examined radiologic data from 20 patients with trigeminal neuralgia and 28 healthy controls who underwent 3D iso T1-weighted brain MRI at our university hospital between 2018 and 2023. Patients with a minimum pain duration of 5 years were included and compared with healthy controls. Additionally, patients were categorized into groups based on the presence of vascular compression. The pain-related subcortical structures, such as the cingulate cortex and insula, were analyzed volumetrically using volBrain software. The results were evaluated statistically. RESULTS: Significant differences were observed in the measurement of the posterior insula (p = 0.014) when comparing patients with trigeminal neuralgia and healthy subjects. Additionally, group comparisons based on the presence of vascular compression revealed significant differences in the Middle Cingulate Cortex (0.036) and Posterior Cingulate Cortex (0.031) between groups, which may be related to the etiological factor. CONCLUSION: Understanding changes in central regions related to pain can aid in the diagnosis and management of chronic trigeminal pain.

2.
J Clin Monit Comput ; 36(5): 1341-1346, 2022 10.
Article in English | MEDLINE | ID: mdl-34705168

ABSTRACT

Oxygen reserve index, available as part of Masimo Rainbow SET pulse oximetry, is a noninvasive and continuous variable intended to provide insight into a patient's oxygen status in the moderate hyperoxic range (PaO2 > 100 and ≤ 200 mm Hg), defined as a patient's oxygen "reserve". When used in conjunction with pulse oximetry, ORi extends the knowledge on a patient's oxygen status providing clinically important information helping to prevent hyperoxemia and hypoxemia. There are limited data on patients undergoing craniosynostosis surgery. Our primary goal was to evaluate the effects of different concentrations of inspiratory oxygen (FiO2) on patient oxygenation status by monitoring ORi. Thirty patients scheduled for craniosynostosis were included in this observational cohort study. Patients were randomized into two equal groups: Group 1 received a fraction of inspired oxygen of 0.8 and group 2 received a FiO2 of 0.6 during induction of anaesthesia. In addition to standard haemodynamic variables with ORi were recorded at baseline 1 min, 5 min, 60 min, and 120 min after intubation. Postoperative complications, length of stay in the intensive care unit and hospital were recorded. In total, 14 patients were evaluated in each group. Gender, age, BMI, ASA scores were similar between groups (p > 0.05). In Group 1, ORi values were significantly higher when compared to group 2 at baseline (0.86 ± 0.21 vs 0.45 ± 0.32, p = 0.001), one minute (0.61 ± 0.24 vs 0.27 ± 0.21, p = 0.001), and 5 min (0.34 ± 0.31 vs 0.10 ± 0.13, p = 0.033). High inspired oxygen concentration during induction of anesthesia in pediatric patients is associated with higher levels of ORi. Therefore, ORi may provide the means to safely reduce the inspired oxygen fraction during inhalational induction in paediatric patients.


Subject(s)
Craniosynostoses , Oximetry , Anesthesia, General/adverse effects , Craniosynostoses/complications , Humans , Hypoxia/prevention & control , Oximetry/adverse effects , Oxygen
3.
Pediatr Neurosurg ; 56(2): 152-156, 2021.
Article in English | MEDLINE | ID: mdl-33691329

ABSTRACT

INTRODUCTION: Although penetrating cranial injuries are rare in pediatric patients, these injuries can lead to morbidity and mortality. Removal of a gigantic foreign body from the cranium requires proper management as it has high risk of further brain damage and seizures. CASE PRESENTATION: We report the case of a patient with cranial injury caused by hitting the head to the hook of a school desk. Due to the extreme nature of the injury, the following additional steps were necessary: taking help from a local firefighter team to cut the desk, surgical removal of the foreign body, and cranioplasty after 6 months. Following this, he was discharged without neurological deficits. DISCUSSION/CONCLUSION: Neurotrauma is one of the major causes of death in children. The damage and effect of the injuring foreign body depends on its size, shape, velocity, trajectory, and entry point. It should be kept in mind that any high-frequency processes applied on the extracranial parts of conductive objects, such as metal bars, may trigger seizures. Preoperative extracranial intervention for huge penetrating foreign bodies should be performed under anticonvulsant administration and intubation to decrease the risk of epileptic seizures and its complications.


Subject(s)
Brain Injuries , Foreign Bodies , Head Injuries, Penetrating , Child , Foreign Bodies/diagnostic imaging , Foreign Bodies/surgery , Head Injuries, Penetrating/diagnostic imaging , Head Injuries, Penetrating/surgery , Humans , Male , Preoperative Care , Schools
4.
Spinal Cord Ser Cases ; 2: 16009, 2016.
Article in English | MEDLINE | ID: mdl-28053753

ABSTRACT

Stab wound injuries to the spinal cord are rare, although they commonly cause complete or incomplete neurological deficits. Normal neurological examination with a knife traversing the spinal canal is extremely rare. Here we report on a patient with a knife lodged in the thoracic spine with normal neurological examination and describe direct withdrawal of the knife with excellent results that have not been reported to date. A 50-year-old male patient was admitted to the emergency service because of his sustaining a stab wound to thoracic 3-4 level due to a knife traversing the spinal canal and still lodged in the vertebral bodies. His neurological examination was normal. The knife was withdrawn in the operating room under general anesthesia without bleeding or cerebrospinal fluid leakage. After withdrawal neurological examination was normal and control magnetic resonance imaging showed no abnormalities. Surgical exploration is suggested for spinal stab wounds if there is a retained body. Some authors recommend exploration even no foreign body is detected. Incomplete or complete cord injuries deserve surgical exploration, but in a patient with normal neurological examination direct withdrawal can be a safe option. Exploration of the wound surgically may have risks associated with enlarging the incision, muscle dissection, enlarging dural tear and bony removal, which may have long-term adverse effects. The operation team must be ready for urgent exploration. Cerebrospinal fluid leakage, excessive bleeding or any neurological deficit after removal must mandate surgical exploration. Long-term close follow-up of the patient has paramount importance for late complications such as infection and pseudomeningocele development.

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