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1. Vibrational spectroscopy for the triage of traumatic brain injury computed tomography priority and hospital admissions

Author

Theakstone, AG, Brennan, PM, Ashton, K, Czeiter, E, Jenkinson, MD, Syed, K, Reed, MJ, Baker, MJ, Åkerlund, C, Amrein, K, Andelic, N, Andreassen, L, Anke, A, Antoni, A, Audibert, G, Azouvi, P, Azzolini, ML, Bartels, R, Barzó, P, Beauvais, R, Beer, R, Bellander, B-M, Belli, A, Benali, H, Berardino, M, Beretta, L, Blaabjerg, M, Bragge, P, Brazinova, A, Brinck, V, Brooker, J, Brorsson, C, Buki, A, Bullinger, M, Cabeleira, M, Caccioppola, A, Calappi, E, Calvi, MR, Cameron, P, Lozano, GC, Carbonara, M, Cavallo, S, Chevallard, G, Chieregato, A, Citerio, G, Clusmann, H, Coburn, M, Coles, J, Cooper, JD, Correia, M, Amra Čović, A, Curry, N, Czosnyka, M, Dahyot-Fizelier, C, Dark, P, Dawes, H, Keyser, VD, Degos, V, Corte, FD, Boogert, HD, Depreitere, B, Đilvesi, Đ, Dixit, A, Donoghue, E, Dreier, J, Dulière, G-L, Ercole, A, Esser, P, Ezer, E, Fabricius, M, Feigin, VL, Foks, K, Frisvold, S, Furmanov, A, Gagliardo, P, Galanaud, D, Gantner, D, Gao, G, George, P, Ghuysen, A, Giga, L, Glocker, B, Golubovic, J, Gomez, PA, Gratz, J, Gravesteijn, B, Grossi, F, Gruen, RL, Gupta, D, Haagsma, JA, Haitsma, I, Helbok, R, Helseth, E, Horton, L, Huijben, J, Hutchinson, PJ, Jacobs, B, Jankowski, S, Jarrett, M, Jiang, J-Y, Johnson, F, Jones, K, Karan, M, Kolias, AG, Kompanje, E, Kondziella, D, Kornaropoulos, E, Koskinen, L-O, Kovács, N, Kowark, A, Lagares, A, Lanyon, L, Laureys, S, Lecky, F, Ledoux, D, Lefering, R, Legrand, V, Lejeune, A, Levi, L, Lightfoot, R, Lingsma, H, Maas, AIR, Castaño-León, AM, Maegele, M, Majdan, M, Manara, A, Manley, G, Martino, C, Maréchal, H, Mattern, J, McMahon, C, Melegh, B, Menon, D, Menovsky, T, Mikolic, A, Misset, B, Muraleedharan, V, Murray, L, Negru, A, Nelson, D, Newcombe, V, Nieboer, D, Nyirádi, J, Olubukola, O, Oresic, M, Ortolano, F, Palotie, A, Parizel, PM, Payen, J-F, Perera, N, Perlbarg, V, Persona, P, Peul, W, Piippo-Karjalainen, A, Pirinen, M, Pisica, D, Ples, H, Polinder, S, Pomposo, I, Posti, JP, Puybasset, L, Radoi, A, Ragauskas, A, Raj, R, Rambadagalla, M, Helmrich, IR, Rhodes, J, Richardson, S, Richter, S, Ripatti, S, Rocka, S, Roe, C, Roise, O, Rosand, J, Rosenfeld, JV, Rosenlund, C, Rosenthal, G, Rossaint, R, Rossi, S, Rueckert, D, Rusnák, M, Sahuquillo, J, Sakowitz, O, Sanchez-Porras, R, Sandor, J, Schäfer, N, Schmidt, S, Schoechl, H, Schoonman, G, Schou, RF, Schwendenwein, E, Sewalt, C, Singh, RD, Skandsen, T, Smielewski, P, Sorinola, A, Stamatakis, E, Stanworth, S, Stevens, R, Stewart, W, Steyerberg, EW, Stocchetti, N, Sundström, N, Takala, R, Tamás, V, Tamosuitis, T, Taylor, MS, Ao, BT, Tenovuo, O, Theadom, A, Thomas, M, Tibboel, D, Timmers, M, Tolias, C, Trapani, T, Tudora, CM, Unterberg, A, Vajkoczy, P, Vallance, S, Valeinis, E, Vámos, Z, Jagt, MVD, Steen, GVD, Naalt, JVD, van Dijck, JTJM, van Erp, IA, van Essen, TA, Van Hecke, W, van Heugten, C, Van Praag, D, van Veen, E, Vyvere, TV, van Wijk, RPJ, Vargiolu, A, Vega, E, Velt, K, Verheyden, J, Vespa, PM, Vik, A, Vilcinis, R, Volovici, V, Steinbüchel, NV, Voormolen, D, Vulekovic, P, Wang, KKW, Whitehouse, D, Wiegers, E, Williams, G, Wilson, L, Winzeck, S, Wolf, S, Yang, Z, Ylén, P, Younsi, A, Zeiler, FA, Zelinkova, V, Ziverte, A, and Zoerle, T

Abstract

Computed tomography (CT) brain imaging is routinely used to support clinical decision-making in patients with traumatic brain injury (TBI). Only 7% of scans, however, demonstrate evidence of TBI. The other 93% of scans contribute a significant cost to the healthcare system and a radiation risk to patients. There may be better strategies to identify which patients, particularly those with mild TBI, are at risk of deterioration and require hospital admission. We introduce a blood serum liquid biopsy that utilizes attenuated total reflectance (ATR)-Fourier transform infrared (FTIR) spectroscopy with machine learning algorithms as a decision-making tool to identify which patients with mild TBI will most likely present with a positive CT scan. Serum samples were obtained from patients (n = 298) patients who had acquired a TBI and were enrolled in CENTER-TBI and from asymptomatic control patients (n = 87). Injury patients (all severities) were stratified against non-injury controls. The cohort with mild TBI was further examined by stratifying those who had at least one CT abnormality against those who had no CT abnormalities. The test performed exceptionally well in classifications of patients with mild injury versus non-injury controls (sensitivity = 96.4% and specificity = 98.0%) and also provided a sensitivity of 80.2% when stratifying mild patients with at least one CT abnormality against those without. The results provided illustrate the test ability to identify four of every five CT abnormalities and show great promise to be introduced as a triage tool for CT priority in patients with mild TBI.

Published
2022

2. Health-related quality of life after traumatic brain injury : deriving value sets for the QOLIBRI-OS for Italy, The Netherlands and The United Kingdom

Author

Voormolen, DC, Polinder, S, von Steinbuechel, N, Feng, Y, Wilson, L, Oppe, M, Haagsma, JA, Åkerlund, C, Adams, H, Amrein, K, Andelic, N, Andreassen, L, Anke, A, Antoni, A, Audibert, G, Azouvi, P, Azzolini, ML, Bartels, R, Barzó, P, Beauvais, R, Beer, R, Bellander, B-M, Belli, A, Benali, H, Berardino, M, Beretta, L, Blaabjerg, M, Bragge, P, Brazinova, A, Brinck, V, Brooker, J, Brorsson, C, Buki, A, Bullinger, M, Cabeleira, M, Caccioppola, A, Calappi, E, Calvi, MR, Cameron, P, Lozano, GC, Carbonara, M, Castaño-León, AM, Chevallard, G, Chieregato, A, Citerio, G, Cnossen, M, Coburn, M, Coles, J, Cooper, JD, Correia, M, Čović, A, Curry, N, Czeiter, E, Czosnyka, M, Dahyot-Fizelier, C, Dawes, H, De Keyser, V, Degos, V, Corte, FD, Boogert, HD, Depreitere, B, Đilvesi, Đ, Dixit, A, Donoghue, E, Dreier, J, Dulière, G-L, Ercole, A, Esser, P, Ezer, E, Fabricius, M, Feigin, VL, Foks, K, Frisvold, S, Furmanov, A, Gagliardo, P, Galanaud, D, Gantner, D, Gao, G, George, P, Ghuysen, A, Giga, L, Glocker, B, Golubovic, J, Gomez, PA, Gratz, J, Gravesteijn, B, Grossi, F, L.Gruen, R, Gupta, D, Haitsma, I, Helbok, R, Helseth, E, Horton, L, Huijben, J, Hutchinson, PJ, Jacobs, B, Jankowski, S, Jarrett, M, Jiang, J-Y, Jones, K, Karan–, M, Kolias, AG, Kompanje, E, Kondziella, D, Koskinen, L-O, Kovács, N, Lagares, A, Lanyon, L, Laureys, S, Lecky, F, Lefering, R, Legrand, V, Lejeune, A, Levi, L, Lightfoot, R, Lingsma, H, Maas, AIR, Maegele, M, Majdan, M, Manara, A, Manley, G, Martino, C, Maréchal, H, Mattern, J, McFadyen, C, McMahon, C, Melegh, B, Menon, D, Menovsky, T, Mulazzi, D, Muraleedharan, V, Murray, L, Nair, N, Negru, A, Nelson, D, Newcombe, V, Nieboer, D, Noirhomme, Q, Nyirádi, J, Olubukola, O, Oresic, M, Ortolano, F, Palotie, A, Parizel, PM, Payen, J-F, Perera, N, Perlbarg, V, Persona, P, Peul, W, Piippo-Karjalainen, A, Pirinen, M, Ples, H, Pomposo, I, Posti, JP, Puybasset, L, Radoi, A, Ragauskas, A, Raj, R, Rambadagalla, M, Real, R, Rhodes, J, Richardson, S, Richter, S, Ripatti, S, Rocka, S, Roe, C, Roise, O, Rosand, J, Rosenfeld, JV, Rosenlund, C, Rosenthal, G, Rossaint, R, Rossi, S, Rueckert, D, Rusnák, M, Sahuquillo, J, Sakowitz, O, Sanchez-Porras, R, Sandor, J, Schäfer, N, Schmidt, S, Schoechl, H, Schoonman, G, Schou, RF, Schwendenwein, E, Sewalt, C, Skandsen, T, Smielewski, P, Sorinola, A, Stamatakis, E, Stanworth, S, Stevanovic, A, Stevens, R, Stewart, W, Steyerberg, EW, Stocchetti, N, Sundström, N, Synnot, A, Takala, R, Tamás, V, Tamosuitis, T, Taylor, MS, Ao, BT, Tenovuo, O, Theadom, A, Thomas, M, Tibboel, D, Timmers, M, Tolias, C, Trapani, T, Tudora, CM, Vajkoczy, P, Vallance, S, Valeinis, E, Vámos, Z, Van der Steen, G, van der Naalt, J, van Dijck, JTJM, van Essen, T, Van Hecke, W, van Heugten, C, Van Praag, D, Vyvere, TV, Vanhaudenhuyse, A, van Wijk, RPJ, Vargiolu, A, Vega, E, Velt, K, Verheyden, J, Vespa, PM, Vik, A, Vilcinis, R, Volovici, V, von Steinbüchel, N, Voormolen, D, Vulekovic, P, Wang, KKW, Wiegers, E, Williams, G, Wolf, S, Yang, Z, Ylén, P, Younsi, A, Zeiler, FA, Zelinkova, V, Ziverte, A, Zoerle, T, Voormolen, D. C., Polinder, S., von Steinbuechel, N., Feng, Y., Wilson, L., Oppe, M., Haagsma, J. A., Akerlund, C., Adams, H., Amrein, K., Andelic, N., Andreassen, L., Anke, A., Antoni, A., Audibert, G., Azouvi, P., Azzolini, M. L., Bartels, R., Barzo, P., Beauvais, R., Beer, R., Bellander, B. -M., Belli, A., Benali, H., Berardino, M., Beretta, L., Blaabjerg, M., Bragge, P., Brazinova, A., Brinck, V., Brooker, J., Brorsson, C., Buki, A., Bullinger, M., Cabeleira, M., Caccioppola, A., Calappi, E., Calvi, M. R., Cameron, P., Lozano, G. C., Carbonara, M., Castano-Leon, A. M., Chevallard, G., Chieregato, A., Citerio, G., Cnossen, M., Coburn, M., Coles, J., Cooper, J. D., Correia, M., Covic, A., Curry, N., Czeiter, E., Czosnyka, M., Dahyot-Fizelier, C., Dawes, H., De Keyser, V., Degos, V., Corte, F. D., Boogert, H., Depreitere, B., Dilvesi, D., Dixit, A., Donoghue, E., Dreier, J., Duliere, G. -L., Ercole, A., Esser, P., Ezer, E., Fabricius, M., Feigin, V. L., Foks, K., Frisvold, S., Furmanov, A., Gagliardo, P., Galanaud, D., Gantner, D., Gao, G., George, P., Ghuysen, A., Giga, L., Glocker, B., Golubovic, J., Gomez, P. A., Gratz, J., Gravesteijn, B., Grossi, F., L. Gruen, R., Gupta, D., Haitsma, I., Helbok, R., Helseth, E., Horton, L., Huijben, J., Hutchinson, P. J., Jacobs, B., Jankowski, S., Jarrett, M., Jiang, J. -Y., Jones, K., Karan-, M., Kolias, A. G., Kompanje, E., Kondziella, D., Koskinen, L. -O., Kovacs, N., Lagares, A., Lanyon, L., Laureys, S., Lecky, F., Lefering, R., Legrand, V., Lejeune, A., Levi, L., Lightfoot, R., Lingsma, H., Maas, A. I. R., Maegele, M., Majdan, M., Manara, A., Manley, G., Martino, C., Marechal, H., Mattern, J., Mcfadyen, C., Mcmahon, C., Melegh, B., Menon, D., Menovsky, T., Mulazzi, D., Muraleedharan, V., Murray, L., Nair, N., Negru, A., Nelson, D., Newcombe, V., Nieboer, D., Noirhomme, Q., Nyiradi, J., Olubukola, O., Oresic, M., Ortolano, F., Palotie, A., Parizel, P. M., Payen, J. -F., Perera, N., Perlbarg, V., Persona, P., Peul, W., Piippo-Karjalainen, A., Pirinen, M., Ples, H., Pomposo, I., Posti, J. P., Puybasset, L., Radoi, A., Ragauskas, A., Raj, R., Rambadagalla, M., Real, R., Rhodes, J., Richardson, S., Richter, S., Ripatti, S., Rocka, S., Roe, C., Roise, O., Rosand, J., Rosenfeld, J. V., Rosenlund, C., Rosenthal, G., Rossaint, R., Rossi, S., Rueckert, D., Rusnak, M., Sahuquillo, J., Sakowitz, O., Sanchez-Porras, R., Sandor, J., Schafer, N., Schmidt, S., Schoechl, H., Schoonman, G., Schou, R. F., Schwendenwein, E., Sewalt, C., Skandsen, T., Smielewski, P., Sorinola, A., Stamatakis, E., Stanworth, S., Stevanovic, A., Stevens, R., Stewart, W., Steyerberg, E. W., Stocchetti, N., Sundstrom, N., Synnot, A., Takala, R., Tamas, V., Tamosuitis, T., Taylor, M. S., Ao, B. T., Tenovuo, O., Theadom, A., Thomas, M., Tibboel, D., Timmers, M., Tolias, C., Trapani, T., Tudora, C. M., Vajkoczy, P., Vallance, S., Valeinis, E., Vamos, Z., Van der Steen, G., van der Naalt, J., van Dijck, J. T. J. M., van Essen, T., Van Hecke, W., van Heugten, C., Van Praag, D., Vyvere, T. V., Vanhaudenhuyse, A., van Wijk, R. P. J., Vargiolu, A., Vega, E., Velt, K., Verheyden, J., Vespa, P. M., Vik, A., Vilcinis, R., Volovici, V., von Steinbuchel, N., Voormolen, D., Vulekovic, P., Wang, K. K. W., Wiegers, E., Williams, G., Wolf, S., Yang, Z., Ylen, P., Younsi, A., Zeiler, F. A., Zelinkova, V., Ziverte, A., Zoerle, T., Centre of Excellence in Complex Disease Genetics, Research Programs Unit, Aarno Palotie / Principal Investigator, Institute for Molecular Medicine Finland, Genomics of Neurological and Neuropsychiatric Disorders, HUS Neurocenter, Neurokirurgian yksikkö, Helsinki Institute for Information Technology, Statistical and population genetics, Department of Mathematics and Statistics, Biostatistics Helsinki, Clinicum, Helsinki University Hospital Area, Department of Public Health, Samuli Olli Ripatti / Principal Investigator, Complex Disease Genetics, Section Neuropsychology, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, RS: FPN NPPP I, Psychiatrie & Neuropsychologie, Ragauskas, Arminas, Ročka, Saulius, Tamošuitis, Tomas, Vilcinis, Rimantas, Rocka, Saulius, Tamosuitis, Tomas, „Springer' grupė, Molecular Neuroscience and Ageing Research (MOLAR), Public Health, Voormolen, Daphne C [0000-0003-0449-0708], Apollo - University of Cambridge Repository, Voormolen, D, Polinder, S, von Steinbuechel, N, Feng, Y, Wilson, L, Oppe, M, Haagsma, J, Akerlund, C, Adams, H, Amrein, K, Andelic, N, Andreassen, L, Anke, A, Antoni, A, Audibert, G, Azouvi, P, Azzolini, M, Bartels, R, Barzo, P, Beauvais, R, Beer, R, Bellander, B, Belli, A, Benali, H, Berardino, M, Beretta, L, Blaabjerg, M, Bragge, P, Brazinova, A, Brinck, V, Brooker, J, Brorsson, C, Buki, A, Bullinger, M, Cabeleira, M, Caccioppola, A, Calappi, E, Calvi, M, Cameron, P, Lozano, G, Carbonara, M, Castano-Leon, A, Chevallard, G, Chieregato, A, Citerio, G, Cnossen, M, Coburn, M, Coles, J, Cooper, J, Correia, M, Covic, A, Curry, N, Czeiter, E, Czosnyka, M, Dahyot-Fizelier, C, Dawes, H, De Keyser, V, Degos, V, Corte, F, Boogert, H, Depreitere, B, Dilvesi, D, Dixit, A, Donoghue, E, Dreier, J, Duliere, G, Ercole, A, Esser, P, Ezer, E, Fabricius, M, Feigin, V, Foks, K, Frisvold, S, Furmanov, A, Gagliardo, P, Galanaud, D, Gantner, D, Gao, G, George, P, Ghuysen, A, Giga, L, Glocker, B, Golubovic, J, Gomez, P, Gratz, J, Gravesteijn, B, Grossi, F, L. Gruen, R, Gupta, D, Haitsma, I, Helbok, R, Helseth, E, Horton, L, Huijben, J, Hutchinson, P, Jacobs, B, Jankowski, S, Jarrett, M, Jiang, J, Jones, K, Karan-, M, Kolias, A, Kompanje, E, Kondziella, D, Koskinen, L, Kovacs, N, Lagares, A, Lanyon, L, Laureys, S, Lecky, F, Lefering, R, Legrand, V, Lejeune, A, Levi, L, Lightfoot, R, Lingsma, H, Maas, A, Maegele, M, Majdan, M, Manara, A, Manley, G, Martino, C, Marechal, H, Mattern, J, Mcfadyen, C, Mcmahon, C, Melegh, B, Menon, D, Menovsky, T, Mulazzi, D, Muraleedharan, V, Murray, L, Nair, N, Negru, A, Nelson, D, Newcombe, V, Nieboer, D, Noirhomme, Q, Nyiradi, J, Olubukola, O, Oresic, M, Ortolano, F, Palotie, A, Parizel, P, Payen, J, Perera, N, Perlbarg, V, Persona, P, Peul, W, Piippo-Karjalainen, A, Pirinen, M, Ples, H, Pomposo, I, Posti, J, Puybasset, L, Radoi, A, Ragauskas, A, Raj, R, Rambadagalla, M, Real, R, Rhodes, J, Richardson, S, Richter, S, Ripatti, S, Rocka, S, Roe, C, Roise, O, Rosand, J, Rosenfeld, J, Rosenlund, C, Rosenthal, G, Rossaint, R, Rossi, S, Rueckert, D, Rusnak, M, Sahuquillo, J, Sakowitz, O, Sanchez-Porras, R, Sandor, J, Schafer, N, Schmidt, S, Schoechl, H, Schoonman, G, Schou, R, Schwendenwein, E, Sewalt, C, Skandsen, T, Smielewski, P, Sorinola, A, Stamatakis, E, Stanworth, S, Stevanovic, A, Stevens, R, Stewart, W, Steyerberg, E, Stocchetti, N, Sundstrom, N, Synnot, A, Takala, R, Tamas, V, Tamosuitis, T, Taylor, M, Ao, B, Tenovuo, O, Theadom, A, Thomas, M, Tibboel, D, Timmers, M, Tolias, C, Trapani, T, Tudora, C, Vajkoczy, P, Vallance, S, Valeinis, E, Vamos, Z, Van der Steen, G, van der Naalt, J, van Dijck, J, van Essen, T, Van Hecke, W, van Heugten, C, Van Praag, D, Vyvere, T, Vanhaudenhuyse, A, van Wijk, R, Vargiolu, A, Vega, E, Velt, K, Verheyden, J, Vespa, P, Vik, A, Vilcinis, R, Volovici, V, von Steinbuchel, N, Vulekovic, P, Wang, K, Wiegers, E, Williams, G, Wolf, S, Yang, Z, Ylen, P, Younsi, A, Zeiler, F, Zelinkova, V, Ziverte, A, and Zoerle, T

Subjects
Male, CONJOINT-ANALYSIS, Neurologi, VALUATION, Health-related quality of life, Discrete choice experiment, 0302 clinical medicine, Traumatic brain injury, Surveys and Questionnaires, Brain Injuries, Traumatic, SCALE, media_common, Netherlands, 030503 health policy & services, Health utilities, Health-related quality of life, Quality of life after brain injury overall scale (QOLIBRI-OS), Traumatic brain injury, Value set, Art, Middle Aged, STATE, 3142 Public health care science, environmental and occupational health, 3. Good health, Neurology, Italy, Female, 0305 other medical science, Quality of life after brain injury overall scale (QOLIBRI-OS), Adult, Value set, Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi, DISCRETE-CHOICE EXPERIMENTS, Adolescent, media_common.quotation_subject, Article, 03 medical and health sciences, Kingdom, Young Adult, SDG 3 - Good Health and Well-being, Inigo, Humans, Quality of Life Research, Aged, Health related quality of life, Public Health, Environmental and Occupational Health, Health Care Service and Management, Health Policy and Services and Health Economy, EUROQOL, United Kingdom, 3141 Health care science, health utilities, health-related quality of life, quality of life after brain injury overall scale (QOLIBRI-OS), traumatic brain injury, value set, Health utilities, PREFERENCE-BASED MEASURES, Quality of Life, Humanities, 030217 neurology & neurosurgery
Abstract

PURPOSE: The Quality of Life after Brain Injury overall scale (QOLIBRI-OS) measures health-related quality of life (HRQoL) after traumatic brain injury (TBI). The aim of this study was to derive value sets for the QOLIBRI-OS in three European countries, which will allow calculation of utility scores for TBI health states. METHODS: A QOLIBRI-OS value set was derived by using discrete choice experiments (DCEs) and visual analogue scales (VAS) in general population samples from the Netherlands, United Kingdom and Italy. A three-stage procedure was used: (1) A selection of health states, covering the entire spectrum of severity, was defined; (2) General population samples performed the health state valuation task using a web-based survey with three VAS questions and an at random selection of sixteen DCEs; (3) DCEs were analysed using a conditional logistic regression and were then anchored on the VAS data. Utility scores for QOLIBRI-OS health states were generated resulting in estimates for all potential health states. RESULTS: The questionnaire was completed by 13,623 respondents. The biggest weight increase for all attributes is seen from "slightly" to "not at all satisfied", resulting in the largest impact on HRQoL. "Not at all satisfied with how brain is working" should receive the greatest weight in utility calculations in all three countries. CONCLUSION: By transforming the QOLIBRI-OS into utility scores, we enabled the application in economic evaluations and in summary measures of population health, which may be used to inform decision-makers on the best interventions and strategies for TBI patients., Hannelore Kohl Stiftung (Germany) OneMind (USA) Integra LifeSciences Corporation (USA)

Published
2020
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3. Pathogenesis of spinal intramedullary lipomas: two case reports.

Author

Moreno Gómez LM, García-Pérez D, González-León PJ, Munarriz PM, and Castaño-León AM

Subjects
Male, Female, Humans, Adolescent, Young Adult, Adult, Neurosurgical Procedures, Treatment Outcome, Lipoma diagnostic imaging, Lipoma surgery, Lipoma pathology, Spinal Cord Neoplasms diagnostic imaging, Spinal Cord Neoplasms surgery
Abstract

Background: Spinal lipomas not associated with dysraphism are rare and have an unknown natural history. In this report, we describe two cases; they showed recurrence during long-term follow-up, which makes us doubt a benign malformative etiology., Case Reports: Two patients, a 19-year-old South American woman and a 14-year-old boy with spinal lipomas, underwent surgical resection. The lipomas were not associated with dysraphism and were located in the cervicothoracic and craniocervical junctions. In both cases, we decided to operate due to clinical progression; the former had a progressive natural course, and the latter experienced clinical worsening after recurrence from previous surgeries. The surgery took place with the assistance of neurophysiological monitoring and intraoperative ultrasound; a partial resection and medullary decompression were done, following the more recent recommendations., Discussion: The natural history of these lesions is currently unknown due to their rarity and the heterogeneity in the long-term follow-up of previously reported cases. Although previous reports describe good outcomes after surgical resection, long follow-ups, especially in young subjects, may show differences in these outcomes with progression and recurrence. We contribute to this last piece of evidence by describing two more cases of progression and recurrence., Lessons: Long-term close follow-up should be done in young subjects with spinal lipomas, as they are more prone to an aggressive course. Metabolism and hormonal changes may be behind this progression. Reoperation must be considered if neurological decline is detected., (© 2023. The Author(s).)

Published
2023
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4. Dexamethasone for the treatment of traumatic brain injured patients with brain contusions and pericontusional edema: Study protocol for a prospective, randomized and double blind trial.

Author

Pérez-Bárcena J, Castaño-León AM, Lagares Gómez-Abascal A, Barea-Mendoza JA, Navarro Maín B, Pomar Pons J, Periañez Párraga LDM, Ibáñez Domínguez J, Chico-Fernández M, Llompart-Pou JA, and Frontera Juan G

Subjects
Brain Contusion complications, Brain Edema etiology, Double-Blind Method, Humans, Outcome Assessment, Health Care, Prospective Studies, Randomized Controlled Trials as Topic, Anti-Inflammatory Agents therapeutic use, Brain Contusion drug therapy, Brain Edema drug therapy, Dexamethasone therapeutic use
Abstract

Background: Traumatic brain injury (TBI) constitutes a leading cause of death and disability. Patients with TBI and cerebral contusions developing pericontusional edema are occasionally given dexamethasone on the belief that this edema is similar to that of tumors, in which the beneficial effect of dexamethasone has been demonstrated., Methods: The DEXCON TBI trial is a multicenter, pragmatic, randomized, triple-blind, placebo controlled trial to quantify the effects of dexamethasone on the prognosis of TBI patients with brain contusions and pericontusional edema. Adult patients who fulfill the elegibility criteria will be randomized to dexamethasone/placebo in a short and descending course: 4 mg/6 h (2 days); 4 mg/8 hours (2 days); 2 mg/6 hours (2 days); 2 mg/8 hours (2 days); 1 mg/8 hours (2 days); 1 mg/12 hours (2 days). The primary outcome is the Glasgow Scale Outcome Extended (GOSE) performed 1 month and 6 months after TBI. Secondary outcomes are: number of episodes of neurological deterioration; symptoms associated with TBI; adverse events; volume of pericontusional edema before and after 12 days of treatment; results of the neuropsychological tests one month and 6 months after TBI. The main analysis will be on an "intention-to-treat" basis. Logistic regression will estimate the effect of dexamethasone/placebo on GOSE at one month and at 6 months, dichotomized in unfavorable outcome (GOSE 1-6) and favorable outcome (GOSE 7-8). Efficacy will also be analyzed using the 'sliding dichotomy'. An interim and safety analysis will be performed including patients recruited during the first year to calculate the conditional power. A study with 600 patients would have 80% power (2 sided alpha = 5%) to detect a 12% absolute increase (from 50% to 62%) in good recovery., Discussion: This is a confirmative trial to elucidate the therapeutic efficacy of dexamethasone in a very specific group of TBI patients: patients with brain contusions and pericontusional edema. This trial could become an important milestone for TBI patients as nowadays there is no effective treatment in this type of patients., Trial Registration: eudraCT: 2019-004038-41; Clinical Trials.gov: NCT04303065., Competing Interests: The authors report no conflicts of interest., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Published
2021
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5. Reduction in the infection rate of cranioplasty with a tailored antibiotic prophylaxis: a nonrandomized study.

Author

Paredes I, Lagares A, San-Juan R, Castaño-León AM, Gómez PA, Jimenez-Roldán L, Panero I, Eiriz C, García-Perez D, Moreno LM, Perez-Nuñez A, Gonzalez-León P, and Alén JAF

Subjects
Adult, Female, Humans, Male, Middle Aged, Anti-Bacterial Agents administration & dosage, Anti-Bacterial Agents pharmacology, Anti-Bacterial Agents therapeutic use, Cefazolin administration & dosage, Cefazolin pharmacology, Cefazolin therapeutic use, Methicillin-Resistant Staphylococcus aureus drug effects, Methicillin-Resistant Staphylococcus aureus pathogenicity, Skull surgery, Antibiotic Prophylaxis methods, Neurosurgical Procedures adverse effects, Neurosurgical Procedures methods, Plastic Surgery Procedures adverse effects, Plastic Surgery Procedures methods, Staphylococcal Infections drug therapy, Staphylococcal Infections microbiology, Staphylococcal Infections prevention & control, Surgical Wound Infection drug therapy, Surgical Wound Infection microbiology, Surgical Wound Infection prevention & control
Abstract

Background: Cranioplasty carries a high risk of surgical site infections (SSIs) for a scheduled procedure, particularly with antibiotic-resistant bacteria., Methods: The goal of this retrospective study was to measure the effect of tailored antibiotic prophylaxis on SSIs resulting from cranioplasties. The authors collected a prospective database of cranioplasties from 2009 to 2018. Risk factors for SSI were registered, as well as infection occurring during the first year postoperatively. A new protocol was initiated in 2016 consisting of antibiotic prophylaxis tailored to the colonizing flora of the skin of the scalp and decolonization of patients who were nasal carriers of methicillin-resistant S. aureus (MRSA); infection rates were compared., Results: One hundred nine cranioplasties were identified, 64 in the old protocol and 45 in the new protocol. Of the 109 cranioplasties, 16 (14.7%) suffered an infection, 14 (21.9%) in the old protocol group and 2 (4.4%) in the new protocol group (OR for the new protocol 0.166, 95% CI 0.036-0.772). Multiple surgeries (OR 3.44), Barthel ≤ 70 (OR 3.53), and previous infection (OR 3.9) were risk factors for SSI. Of the bacteria identified in the skin of the scalp, 22.2% were resistant to routine prophylaxis (cefazoline). Only one patient was identified as a nasal carrier of MRSA and was decolonized., Conclusions: A high percentage of bacteria resistant to routine prophylaxis (cefazoline) was identified in the skin of these patients' scalps. The use of tailored antibiotic prophylaxis reduced significantly the infection rate in this particular set of patients.

Published
2020
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6. Spinal cord injury after blunt cervical spine trauma: correlation of soft-tissue damage and extension of lesion.

Author

Martínez-Pérez R, Paredes I, Cepeda S, Ramos A, Castaño-León AM, García-Fuentes C, Lobato RD, Gómez PA, and Lagares A

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Cervical Vertebrae diagnostic imaging, Cervical Vertebrae pathology, Female, Humans, Ligaments diagnostic imaging, Ligaments pathology, Magnetic Resonance Imaging, Male, Middle Aged, Soft Tissue Injuries diagnosis, Spinal Cord Injuries diagnosis, Spinal Fractures diagnosis, Statistics as Topic, Tomography, X-Ray Computed, Wounds, Nonpenetrating diagnosis, Young Adult, Cervical Vertebrae injuries, Ligaments injuries, Soft Tissue Injuries etiology, Spinal Cord Injuries etiology, Spinal Fractures complications, Wounds, Nonpenetrating complications
Abstract

Background and Purpose: In patients with spinal cord injury after blunt trauma, several studies have observed a correlation between neurologic impairment and radiologic findings. Few studies have been performed to correlate spinal cord injury with ligamentous injury. The purpose of this study was to retrospectively evaluate whether ligamentous injury or disk disruption after spinal cord injury correlates with lesion length., Materials and Methods: We retrospectively reviewed 108 patients diagnosed with traumatic spinal cord injury after cervical trauma between 1990-2011. Plain films, CT, and MR imaging were performed on patients and then reviewed for this study. MR imaging was performed within 96 hours after cervical trauma for all patients. Data regarding ligamentous injury, disk injury, and the extent of the spinal cord injury were collected from an adequate number of MR images. We evaluated anterior longitudinal ligaments, posterior longitudinal ligaments, and the ligamentum flavum. Length of lesion, disk disruption, and ligamentous injury association, as well as the extent of the spinal cord injury were statistically assessed by means of univariate analysis, with the use of nonparametric tests and multivariate analysis along with linear regression., Results: There were significant differences in lesion length on T2-weighted images for anterior longitudinal ligaments, posterior longitudinal ligaments, and ligamentum flavum in the univariate analysis; however, when this was adjusted by age, level of injury, sex, and disruption of the soft tissue evaluated (disk, anterior longitudinal ligaments, posterior longitudinal ligaments, and ligamentum flavum) in a multivariable analysis, only ligamentum flavum showed a statistically significant association with lesion length. Furthermore, the number of ligaments affected had a positive correlation with the extension of the lesion., Conclusions: In cervical spine trauma, a specific pattern of ligamentous injury correlates with the length of the spinal cord lesion in MR imaging studies. Ligamentous injury detected by MR imaging is not a dynamic finding; thus it proved to be useful in predicting neurologic outcome in patients for whom the MR imaging examination was delayed., (© 2014 by American Journal of Neuroradiology.)

Published
2014
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