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Neurocritical care has emerged as a specialized field addressing the complex needs of patients with acute neurological disorders, such as stroke, brain tumor and traumatic brain injury. The clinical management of these patients necessitates precise, individualized nutritional support due to the significant variability in neurological deficits and resting energy expenditure (REE) based on factors including stroke phase, type (hemorrhagic or ischemic), and intracranial pressure and activity of neuronal cells. This emphasizes the need for accurate, patient-specific nutritional recommendations, achievable through indirect calorimetry. Traditional predictive equations may not accurately capture the diverse nutritional requirements of neurocritical patients. Indirect calorimetry offers a more reliable, personalized approach to determining patients' nutritional needs, crucial for this heterogeneous population. Furthermore, clinical practice often inadequately addresses nutritional needs in neurocritical patients, highlighting the importance of optimizing nutritional support to enhance patient outcomes. Indirect calorimetry also plays a critical role in assessing patients with non-normal body temperatures. Hypothermia affects the body's metabolic rate and overall energy expenditure, making it challenging to evaluate energy requirements during hypothermia treatment. Indirect calorimetry can provide more accurate assessments under such conditions. In conclusion, employing indirect calorimetry in neurocritical care is essential for accurate, individualized nutritional support. By accounting for factors such as stroke type, location, intracranial pressure and body temperature, indirect calorimetry offers valuable insights and improved patient care, emphasizing its indispensability in managing neurocritical patients.

Postoperative ischemic complication results in neurological sequelae and longer hospitalization after unruptured middle cerebral artery (MCA) aneurysm clipping surgery. We evaluated the radiological and patient-related factors associated with ischemic complications after unruptured MCA aneurysm clipping surgery. Patient demographics, radiological findings, and intraoperative factors were compared between patients with and without postoperative ischemic complications. The clinical courses and outcomes of postoperative ischemic complications were compared according to the types of ischemic complication. Forty-two out of 2227 patients (1.9%) developed postoperative ischemic complications after MCA aneurysm clipping. Multivariate analysis revealed that diabetes mellitus (DM) was a patient-related factor. Intraarterial (IA) calcification of the distal internal carotid artery (ICA), preoperative M1 stenosis, and M1 aneurysm were radiological factors that increased the risk of postoperative ischemic complications. DM was significantly associated with divisional branch territory infarction (P = 0.04). The time to first presentation of ischemic complication was significantly longer in divisional branch territory infarction than perforator territory infarction (67.8 ± 75.9 h vs. 22 ± 20.7, P = 0.023). Twelve out of 42 patients with ischemic complications (28.6%) had unfavorable outcome (mRS > 3). Perforator territory infarction was significantly associated with an unfavorable outcome (mRS > 3, P = 0.019). IA calcification of the distal ICA, M1 stenosis and aneurysms, and DM were significantly associated with postoperative ischemic complications after unruptured MCA aneurysm clipping. Patients with DM should be closely monitored postoperatively to detect delayed occurrence of divisional branch infarction. Trial registration number: 2019-1002, Date of registration: January 1, 2005, "retrospectively registered".

Laminectomy followed by posterolateral fusion (PLF) is a standard procedure for thoracic and thoracolumbar (TL) compressive lesions. However, it is challenging to apply sufficient bone chips as the spinal cord is exposed after the laminectomy. Therefore, we performed posterior thoracic cage interbody fusion (PTCIF) as an alternative technique. A total of 25 patients operated with PTCIF technique between 2012 and 2017 were analyzed in our study. These patients required a posterior decompression and fusion in thoracic and TL spine for traumatic injury or degenerative disease. To evaluate the outcome of bone fusion, computed tomography (CT) was performed at least 3–4 months after PTCIF. The surgery was performed through insertion of screws and cages packed with autologous bone chips in a similar fashion to the posterior lumbar interbody fusion technique. Among 25 patients who underwent PTCIF, 22 patients were involved in our study. The mean age and follow-up interval were 58.6 (28–78) years and 27.1 (6–60) months, respectively. Traumatic spinal injury was diagnosed in 6 patients and degenerative disease in 16 patients. One level PTCIF was performed in 12 patients and 2 levels in 8 patients. After the operation, patients with degenerative disease showed neurological improvement, and trauma cases showed no neurological aggravation. Successful bone fusion was confirmed on CT for all patients. PTCIF is an effective treatment thereby we suggest this approach to be considered as an alternative procedure to decompression and fusion surgery in the thoracic and TL spine.