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Therapeutic clinical trials for the treatment of traumatic brain injury (TBI) have consumed medical and financial resources with few positive results. Current arguments as to why so many trials failed include heterogeneity in the TBI population, delay in instituting therapy, poor penetration of the brain with pharmacological agents, and a lack of understanding regarding the pathophysiological mechanisms involved. This article examines the major trials that have failed, possible reasons for their failure, and possible modifications to improve future TBI trials. [ABSTRACT FROM AUTHOR]

Concussion and mild traumatic brain injury (TBI) account for the majority of TBIs treated. Traditional management of these injuries involves diagnosis and classification, computed tomography to identify traumatic lesions, and neuropsychological studies in those with persistent symptoms. Long-term treatment involves management of postconcussive symptoms with the goal of resuming normal cognitive and physical activities. This review summarizes the diagnosis and management of this disease. [ABSTRACT FROM AUTHOR]

The detail and information obtained from neuroimaging have improved greatly over the last two decades with the advent of magnetic resonance imaging (MRI) and angiography (MRA). In the last decade, advances in computer technology and tomography have produced angiographic images from computed tomography (CTA). Despite these advances, the basic evaluation of traumatic vascular injury relies on catheter angiography. With advances in critical care and neuroimaging techniques, it has become feasible to have critically ill patients undergo MR and CT imaging. MRA and CTA provide the ability to diagnose rapidly and noninvasively vascular injuries that may predispose to stroke. The purpose of this article is to review briefly these advances and their relevance to traumatic brain injury for the neurosurgical practitioner. [ABSTRACT FROM AUTHOR]

Cervical spinal kyphotic deformities are common sequelae of degenerative disease and/or prior posterior decompressive surgery. Patients may present with myelopathy, radiculopathy, cervicalgia, dysphagia, or a combination thereof. Treatment of cervical kyphotic deformities involves decompression of the spinal cord at regions of stenosis followed by reconstruction of the spine to reduce the deformity and to reconstruct and stabilize the spine. We prospectively studied a cohort of 78 patients who underwent decompression and reconstruction of the cervical spine for kyphotic deformities. Common etiologies included degenerative disease, trauma, osteomyelitis, and postlaminectomy angulation. Decompression and reconstruction were done by vertebrectomy/strut graft (51%), multilevel interbody arthrodesis (40%), posterior decompression and reconstruction with arthrodesis (4%), or combined ventral and dorsal procedures (5%). Fourteen patients (18%) had failure of their initial reconstruction graft and/or fixation requiring surgical revision via a combined approach. For those patients requiring revision, the average degree of pretreatment kyphosis was -25.1 ± 16.6 degrees compared with -12.4 ± 10.0 degrees preoperative angulation for those patients who were effectively treated via their primary procedure (p < 0.001, unpaired t-test). In those patients whose pretreatment kyphotic deformity was more severe than -15 degrees, 10 of 27 required revision compared with only 4 of 51 patients whose initial deformities were less than -15 degrees (p < 0.005, Fisher exact test). Overall, myelopathy improved in 83% of treated patients, radiculopathy improved in 94%, and cervicalgia improved in 70%. The mean preoperative kyphosis was -14.6 degrees, which was improved to a mean postoperative lordosis of +5.3 degrees. For patients with symptomatic cervical kyphotic deformity, consideration should be given to treatment by decompression, stabilization, and arthrodesis. In those patients with a pretreatment deformity of -15 degrees or greater, strong consideration should be given to a combined ventral/dorsal decompression-internal fixation-fusion procedure. [ABSTRACT FROM AUTHOR]