Corrigendum: Glycemia Is Related to Impaired Cerebrovascular Autoregulation after Severe Pediatric Traumatic Brain Injury: A Retrospective Observational Study.

[This corrects the article on p. 205 in vol. 5, PMID: 28993802.].

Glycemia Is Related to Impaired Cerebrovascular Autoregulation after Severe Pediatric Traumatic Brain Injury: A Retrospective Observational Study.

INTRODUCTION: A strong association exists between hyperglycemia and outcome in pediatric traumatic brain injury (TBI). Herein, we describe observations of serum markers of glucose metabolism in a cohort of pediatric TBI patients and how these variables are related to parameters of intracranial pathophysiology. METHODS: A retrospective analysis was performed on pediatric severe TBI patients admitted to Addenbrookes Hospital Paediatric Intensive Care Unit (PICU) between January 2001 and December 2013. Demographic, outcome, systemic physiological, and cerebral autoregulatory data were extracted for patients who had received continuous invasive monitoring (ICM+, Cambridge Enterprise, Cambridge, UK). Data were analyzed using a mixed linear model. RESULTS: Forty-four patients with an average age of 12.2 years were admitted to the PICU with a TBI requiring invasive neurosurgical monitoring. Thirty-two patients (73%) survived, with favorable outcomes in 62%. The mean (SD) intracranial pressure (ICP) was 17.6 + 9.0 mmHg, MAP was 89.7 + 9.0 mmHg, and pressure-reactivity index (PRx) was -0.01 + 0.23 a.u. The mean (SD) serum lactate was 2.2 (3.3) mmol/L. and the mean (SD) serum glucose was 6.1 (1.6) mmol/L. Early hyperglycemia was strongly associated with both PRx (Pearson correlation 0.351, p < 0.001) and ICP (Pearson correlation 0.240, p = 0.002) death (p = 0.021) and impaired cerebral autoregulation (p = 0.02). There was a strong association between ICP and serum lactate (p = 0.001). CONCLUSION: Increases in systemic glucose are associated with impaired cerebrovasular autoregulation after severe pediatric TBI. Moreover, deranged blood glucose is a marker of poor prognosis. Further studies are required to delineate putative mechanisms of hyperglycemia induced cerebral harm.

An Evaluation of Styloidectomy as an Adjunct or Alternative to Jugular Stenting in Idiopathic Intracranial Hypertension and Disturbances of Cranial Venous Outflow.

Background The extent to which intracranial venous sinus obstruction contributes to idiopathic intracranial hypertension (IIH) is debated. The extent to which extracranial venous obstruction contributes to IIH is virtually unexplored. This article describes an interventional approach to extracranial venous outflow in a group of patients with severe intractable symptoms. Objective To describe our technique and experience of styloidectomy combined with jugular stenting in the treatment of skull base narrowing of the jugular veins. Methods Retrospective review of all styloidectomies undertaken at our institution (n = 34), as an adjunct or alternative to jugular venous stenting, with a view to improving cranial venous outflow. Results Eleven styloidectomies were for delayed complications of jugular stenting. Of seven with stent dysfunction, three were improved and four unchanged. Of seven with accessory nerve compression (three had both), four resolved and three improved. In 23 instances, styloidectomy preceded or obviated jugular stenting. Two had a virtual resolution of symptoms, 13 were improved, and 8 were unchanged. Conclusion Styloidectomy can replace, salvage, or complement jugular venous stenting in IIH and disturbances of cranial venous outflow.