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Thermography by Specialty
Published in James Stewart Campbell, M. Nathaniel Mead, Human Medical Thermography, 2023
James Stewart Campbell, M. Nathaniel Mead
Major neurosurgical procedures on the brain are often started by partially or totally removing the calvarium, exposing the brain tissue to the temperature and humidity of the operating theatre. Within the brain, an even outflow of heat is maintained by a 0.5°C (0.9°F) temperature difference between the deeper tissues and the cooler superficial layer.225 With the brain exposed to room air, evaporative heat losses additionally cool the surface, providing thermal contrast between blood vessels and the brain tissue. During craniotomy procedures, the arteries and veins of the brain can be qualitatively visualized with properly-scaled images. In an operating theatre at an ambient temperature of 20°C (68°F), the surface of the brain can be expected to be up to 4°C (7.2°F) lower than the normal body core temperature (37°C).226 In experiments on exposed primate brains, areas of reduced blood perfusion due to arterial occlusion cooled rapidly by 0.3 to 1.3°C (0.5–2.3°F) and then rewarmed equally rapidly upon the resumption of blood flow.227 This cerebral rewarming can be seen in patients undergoing cerebral artery anastomosis for Moyamoya disease. An increase in brain surface temperature can be observed and graft patency monitored with thermography. Brain hyperperfusion can also be observed and treated accordingly.228
Adult skull fractures
Published in Helen Whitwell, Christopher Milroy, Daniel du Plessis, Forensic Neuropathology, 2021
If the dura/meninges are still intact, the location of a haematoma can be readily assessed and compared with the location of the fracture site and underlying brain injury. After removal of the brain, the dura around the base of the brain and inside the remaining calvarium should be removed carefully. In younger individuals, traction with soft tissue paper can do most of the stripping. In elderly individuals, the dura mater tends to adhere more to the skull and dural strippers may be employed. Once all the dura has been removed, the inside of the cranium should be carefully examined and again the fracture lines documented and photographed. Gentle traction on the skull will open up any fracture lines and make them more readily visible.
L-2-hydroxyglutaric aciduria
Published in William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop, Atlas of Inherited Metabolic Diseases, 2020
William L. Nyhan, Georg F. Hoffmann, Aida I. Al-Aqeel, Bruce A. Barshop
Progressive deterioration was documented in one patient [8] after a number of years of relative stability; by 16 years, she was unable to walk and had repeated seizures. Progression was also reported in two patients by Divry and colleagues [10], who emphasized ataxia, brisk tendon reflexes, and positive Babinski as extrapyramidal signs and first reported macrocephaly in both patients. Macrocephaly was also observed by Wilcken et al. [11] in three Australian patients of Serbian, Iranian, and Iraqi parents; one demonstrated rapid neurologic deterioration over five months and died; the others did not. One had strabismus and myopia. Two adult Japanese patients had seizures in childhood and psychomotor impairment, but began progressive degeneration after 25 years of age [12]. Nocturnal myoclonus was a feature. In addition to typical white matter disease on magnetic resonance imaging (MRI), the calvarium was thickened. Another 15-year-old boy [13] was wheelchair-bound and had impaired mental development epilepsy, optic atrophy, spastic tetraparesis, and dystonia. Six Iranian children, 4–16 years of age, had macrocephaly, ataxia, and progressive neurologic dysfunction [14].
Balancing the short-term benefits and long-term outcomes of decompressive craniectomy for severe traumatic brain injury
Published in Expert Review of Neurotherapeutics, 2020
A contemporary example of these issues is seen when considering the role of decompressive craniectomy in the management of severe traumatic brain injury [3]. Temporarily removing a large section of the calvarium provides extra space into which the injured brain can expand. The short-term goal of surgical intervention is to reduce mortality in the context of intracranial hypertension and many retrospective cohort studies have emphasized the lifesaving nature of the surgical intervention and the reduction in intracranial pressure (ICP) that can be achieved. What is less clear is the degree to which the reduction in ICP and the improvement in cerebral perfusion leads to the long-term goals of a good functional outcome that is acceptable to those that survive. These concerns have prompted researchers to conduct a number of large multicentre randomized controlled trials investigating the efficacy of surgical decompression, initially in the context of ischaemic stroke [4–8] and more recently in the context of severe traumatic brain injury [9,10].
Neuro-Ophthalmic Literature Review
Published in Neuro-Ophthalmology, 2019
David Bellows, Noel Chan, John Chen, Hui-Chen Cheng, Peter MacIntosh, Jenny Nij Bijvank, Michael Vaphiades, Konrad Weber, Sui Wong
This is a good review paper illustrating that the associated comorbidities of obesity (obstructive sleep apnoea and idiopathic intracranial hypertension) are risk factors of spontaneous cerebrospinal fluid (CSF) leaks. The paper highlights that the calvarium bone (best viewed axially at the level of the optic canal) is thinner in patients with spontaneous CSF leak and also in patients with obstructive sleep apnoea, and that obesity alone does not independently affect skull thickness. The tegmen at the skull base is also thinner in OSA and spontaneous CSF leaks. This paper is a reminder that patients who develop spontaneous CSF leaks should be screened, and treated, for ongoing risk factors for raised intracranial pressure. This is important because repair of CSF leak without treatment of the underlying cause may cause it to recur, putting patients at risk of meningitis from CSF leaks.
Role of growth factors and biomaterials in wound healing
Published in Artificial Cells, Nanomedicine, and Biotechnology, 2018
Farshad Zarei, Maryam Soleimaninejad
Clinical application of ASCs as a therapeutic alternative is widely adopted because it’s easy to harvest fat tissue, abundant and ethical concerns does not in fact exist [27]. Recently, ASCs have been reported to be efficient in preclinical studies of chronic wounds and as such ASCs studies have progressed from translational phase into clinical trials [28]. Table 3 shows the use of ASCs in various available clinical trials [29]. Lendeckel et al. [30] were among the first researchers to report the clinical use of ASCs using stromal vascular fraction (SVF) in a case report to treat calvaria defect after head injury. In their report, they used fibrin glue combined with SVF [31]. They concluded that there was newly formed cranial bone after three months post-surgical treatment and there were also clear evidences of near total healing of calvaria defect. Mesimäki et al. in their study, reported that ASCs combined with bone morphogenic protein (BMP-2) and tricalcium phosphate scaffold resulted in effective healing of osteogenic defect [32]. The management and treatment of Crohn’s disease has been reported to be achieved via the administration of ASCs [33].