203 results on '"Lilja-Cyron A"'
Search Results
2. Intracranial pressure following surgery of an unruptured intracranial aneurysm—a model for normal intracranial pressure in humans
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Norager, Nicolas Hernandez, Lilja-Cyron, Alexander, Riedel, Casper Schwartz, Holst, Anders Vedel, Pedersen, Sarah Hornshoej, and Juhler, Marianne
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- 2024
- Full Text
- View/download PDF
3. Predictors of shunt insertion in patients with aneurysmal subarachnoid haemorrhage—a single-centre retrospective analysis
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Capion, Tenna, Lilja-Cyron, Alexander, Olsen, Markus Harboe, Møller, Kirsten, Juhler, Marianne, and Mathiesen, Tiit
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- 2024
- Full Text
- View/download PDF
4. Prompt closure versus gradual weaning of external ventricular drain for hydrocephalus following aneurysmal subarachnoid haemorrhage: a statistical analysis plan for the DRAIN randomised clinical trial
- Author
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Tenna Capion, Alexander Lilja-Cyron, Marianne Juhler, Kirsten Møller, Angelika Sorteberg, Pål André Rønning, Frantz Rom Poulsen, Joakim Wismann, Anders Emil Schack, Celina Ravlo, Jørgen Isaksen, Jane Lindschou, Christian Gluud, Tiit Mathiesen, and Markus Harboe Olsen
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Aneurysm ,Aneurysmal subarachnoid haemorrhage ,Hydrocephalus ,External ventricular drain ,Weaning ,Randomised clinical trial ,Medicine (General) ,R5-920 - Abstract
Abstract Background Insertion of an external ventricular drain (EVD) is a first-line treatment of acute hydrocephalus caused by aneurysmal subarachnoid haemorrhage (aSAH). Once the patient is clinically stable, the EVD is either removed or replaced by a permanent internal shunt. The optimal strategy for cessation of the EVD is unknown. Prompt closure carries a risk of acute hydrocephalus or redundant shunt implantations, whereas gradual weaning may increase the risk of EVD-related infections. Methods DRAIN (Danish RAndomised Trial of External Ventricular Drainage Cessation IN Aneurysmal Subarachnoid Haemorrhage) is an international multicentre randomised clinical trial comparing prompt closure versus gradual weaning of the EVD after aSAH. The primary outcome is a composite of VP-shunt implantation, all-cause mortality, or EVD-related infection. Secondary outcomes are serious adverse events excluding mortality and health-related quality of life (EQ-5D-5L). Exploratory outcomes are modified Rankin Scale, Fatigue Severity Scale, Glasgow Outcome Scale Extended, and length of stay in the neurointensive care unit and hospital. Outcome assessment will be performed 6 months after ictus. Based on the sample size calculation (event proportion 80% in the gradual weaning group, relative risk reduction 20%, alpha 5%, power 80%), 122 participants are required in each intervention group. Outcome assessment for the primary outcome, statistical analyses, and conclusion drawing will be blinded. Two independent statistical analyses and reports will be tracked using a version control system, and both will be published. Based on the final statistical report, the blinded steering group will formulate two abstracts. Conclusion We present a pre-defined statistical analysis plan for the randomised DRAIN trial, which limits bias, p-hacking, and data-driven interpretations. This statistical analysis plan is accompanied by tables with simulated data, which increases transparency and reproducibility. Trial registration ClinicalTrials.gov identifier: NCT03948256. Registered on May 13, 2019.
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- 2024
- Full Text
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5. Intracranial pressure following surgery of an unruptured intracranial aneurysm—a model for normal intracranial pressure in humans
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Nicolas Hernandez Norager, Alexander Lilja-Cyron, Casper Schwartz Riedel, Anders Vedel Holst, Sarah Hornshoej Pedersen, and Marianne Juhler
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Telemetric ICP monitoring ,Intracranial pressure (ICP) ,Unruptured intracranial aneurysm ,Normal ICP reference value ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Abstract Objective Optimizing the treatment of several neurosurgical and neurological disorders relies on knowledge of the intracranial pressure (ICP). However, exploration of normal ICP and intracranial pressure pulse wave amplitude (PWA) values in healthy individuals poses ethical challenges, and thus the current documentation remains scarce. This study explores ICP and PWA values for healthy adults without intracranial pathology expected to influence ICP. Methods Adult patients (age > 18 years) undergoing surgery for an unruptured intracranial aneurysm without any other neurological co-morbidities were included. Patients had a telemetric ICP sensor inserted, and ICP was measured in four different positions: supine, lateral recumbent, standing upright, and 45-degree sitting, at day 1, 14, 30, and 90 following the surgery. Results ICP in each position did not change with time after surgery. Median ICP was 6.7 mmHg and median PWA 2.1 mmHg in the supine position, while in the upright standing position median ICP was − 3.4 mmHg and median PWA was 1.9 mmHg. After standardization of the measurements from the transducer site to the external acoustic meatus, the median ICPmidbrain was 8.3 mmHg in the supine position and 1.2 mmHg in the upright standing position. Conclusion Our study provides insights into normal ICP dynamics in healthy adults following a uncomplicated surgery for an unruptured aneurysm. These results suggest a slightly wider normal reference range for invasive intracranial pressure than previously suggested, and present the first normal values for PWA in different positions. Further studies are, however, essential to enhance our understanding of normal ICP. Trial registration The study was preregistered at www.clinicaltrials.gov (NCT03594136) (11 July 2018)
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- 2024
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- View/download PDF
6. The intracranial pressure–volume relationship following decompressive hinge craniotomy compared to decompressive craniectomy—a human cadaver study
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Søndergaard, Christian Baastrup, Villa, Chiara, Jacobsen, Christina, Lilja-Cyron, Alexander, and Fugleholm, Kåre
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- 2023
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7. Optimal Cerebral Perfusion Pressure Based on Intracranial Pressure-Derived Indices of Cerebrovascular Reactivity: Which One Is Better for Outcome Prediction in Moderate/Severe Traumatic Brain Injury?
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Lilja-Cyron, Alexander, Zeiler, Frederick A., Beqiri, Erta, Cabeleira, Manuel, Smielewski, Peter, Czosnyka, Marek, Steiger, Hans-Jakob, Series Editor, Depreitere, Bart, editor, Meyfroidt, Geert, editor, and Güiza, Fabian, editor
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- 2021
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8. Lumbar puncture position influences intracranial pressure
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Pedersen, Sarah H., Andresen, Morten, Lilja-Cyron, Alexander, Petersen, Lonnie G., and Juhler, Marianne
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- 2021
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9. Endoscopic third ventriculostomy for adults with hydrocephalus: creating a prognostic model for success: protocol for a retrospective multicentre study (Nordic ETV)
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Rahul Raj, Alexander Lilja-Cyron, Marianne Juhler, Jarno Satopää, Jiri Bartek, Jussi Posti, Sami Tetri, Sune Munthe, Sondre Tefre, Lisa Arvidsson, Alba Corell, Axel Forsse, Andreas Nørgaard Glud, Sami Abu Hamdeh, Frederik Lundgaard Hansen, Antti Huotarinen, Conny Johansson, Olli-Pekka Kämäräinen, Tommi Korhonen, Anna Kotkansalo, Nadia Mauland Mansoor, Eduardo Erasmo Mendoza Mireles, Rares Miscov, Henrietta Nittby-Redebrandt, Nina Obad, Lars Kjelsberg Pedersen, Nils Ståhl, and Lovisa Tobieson
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Medicine - Published
- 2022
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10. Discontinuation of External Ventricular Drainage in Patients with Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage - a Scandinavian Multi-institutional Survey
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Capion, Tenna, Lilja-Cyron, Alexander, Bartek, Jr, Jiri, Forsse, Axel, Logallo, Nicola, Juhler, Marianne, and Mathiesen, Tiit
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- 2020
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11. Timing of intraventricular infusion test for diagnosing idiopathic normal pressure hydrocephalus
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Andreasen, Trine Hjorslev, Lilja-Cyron, Alexander, Holst, Anders Vedel, Christoffersen, Dorthe, Johnsen, Sara Duus, and Juhler, Marianne
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- 2020
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12. Telemetric intracranial pressure monitoring in children
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Pedersen, Sarah Hornshøj, Norager, Nicolas Hernandez, Lilja-Cyron, Alexander, and Juhler, Marianne
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- 2020
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13. Long-term functional outcome after decompressive suboccipital craniectomy for space-occupying cerebellar infarction
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Lindeskog, Desirée, Lilja-Cyron, Alexander, Kelsen, Jesper, and Juhler, Marianne
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- 2019
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14. Quality assessment of evidence must be stated in conclusions to avoid conveying questionable recommendations
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Capion, Tenna, Lilja-Cyron, Alexander, Juhler, Marianne, Mathiesen, Tiit, and Wetterslev, Jørn
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- 2022
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15. The Relationship Between Intracranial Pressure and Age—Chasing Age-Related Reference Values
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Pedersen, Sarah Hornshøj, Lilja-Cyron, Alexander, Andresen, Morten, and Juhler, Marianne
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- 2018
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16. Aortic Root Dilatation in Hypertensive Patients with Left Ventricular Hypertrophy–Application of A New Multivariate Predictive Model. The Life Study
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Alexander Lilja-Cyron, Casper N. Bang, Eva Gerdts, Anne C. Larstorp, Sverre E. Kjeldsen, Stevo Julius, Peter M. Okin, Kristian Wachtell, and Richard B. Devereux
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aortic root diameter ,blood pressure ,hypertension ,left ventricular hypertrophy ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background: Available nomograms to predict aortic root (AoR) diameter for body surface area have limitations. The purpose of this study was to evaluate the use of a new multivariate predictive model to identify AoR dilatation in hypertensive patients with left ventricular hypertrophy. Methods: 943 of 961 patients in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiographic sub-study had the necessary baseline characteristics and echocardiographic 2D measurements of AoR size to be included. Results: Predicted AoR (Sinus of Valsalva) diameter was 1.519 + (age [years] × 0.010) + (height [cm] × 0.010) – (gender [1 = M, 2 = F] × 0.247), and a measured AoR diameter exceeding the 97.5-percentile of this estimate was considered dilated. Measured AoR diameter was larger in men than in women (3.75 vs. 3.48 cm, p < 0.001) and AoR diameter predicted by the model was larger than predicted by nomogram (3.52 vs. 3.28 cm, p < 0.001). Using the multivariate model to identify patients with AoR dilatation, the prevalence was 13.7% in men and 12.3% in women (p = 0.537). There was consensus of AoR phenotype (normal/dilated) between model and nomogram in 92.8% of the patients. In multivariate logistic regression, AoR dilatation by model definition was predicted by presence of aortic regurgitation (OR 2.67, p < 0.001) and SD increase in age (OR 0.75, p = 0.023), pulse pressure (OR 0.64, p < 0.001), left ventricular mass index (OR 1.36, p = 0.08) and stroke volume (OR 1.45, p = 0.002), but not by body weight. Conclusions: Using the proposed model the prevalence of AoR dilatation was equal in men and women and the model seems to address the effects of gender, age and body size on AoR size. Clinical Trial Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00338260.
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- 2022
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17. Prompt closure versus gradual weaning of external ventricular drainage for hydrocephalus in adult patients with aneurysmal subarachnoid haemorrhage: a systematic review
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Tenna Capion, Alexander Lilja-Cyron, Marianne Juhler, and Tiit Illimar Mathiesen
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Medicine - Abstract
Objectives To summarise the evidence on benefits and harms of prompt closure versus gradual weaning of external ventricular drainage (EVD) in patients with hydrocephalus following aneurysmal subarachnoid haemorrhage (aSAH) based on randomised clinical trials (RCTs) in humans.Setting RCTs comparing prompt closure versus gradual weaning of EVD in adult patients with hydrocephalus following aSAH were included.Participants Patients aged equal to or greater than 18 years with an EVD due to hydrocephalus following aSAH were eligible for inclusion.Primary and secondary outcome measures Primary outcomes were all-cause mortality, any serious adverse event, rate of ventriculoperitoneal (VP) shunt placement and quality of life. Secondary outcomes were patients with shunt failure, hospital and neuro intensive care unit (NICU) length of stay (LOS) and complications related to treatment with an EVD. Data permitted report of rate of VP shunt placement, and hospital and NICU LOS.Results Six studies were assessed in full text. One RCT with 81 patients was included. Rate of VP shunt placement was 63.4% in the rapid weaning group (ie, prompt closure of the EVD; 41 patients) and 62.5% in the gradual weaning group (40 patients; p=0.932). LOS in hospital and NICU was significantly shorter in the rapidly weaned group compared with the gradually weaned group (mean 19.1 vs 21.5 days in hospital (p=0.03); and mean 14.1 vs 16.9 days in NICU (p=0.0002)). Data were insufficient to conduct meta-analysis, trial sequential analysis or subgroup analysis of heterogeneity and sensitivity. One RCT is currently ongoing.Conclusions We found insufficient evidence to favour any of the two strategies for EVD discontinuation in patients with hydrocephalus following aSAH.PROSPERO registration number CRD42018108801.
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- 2020
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18. Monitoring and Measurement of Intracranial Pressure in Pediatric Head Trauma
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Sarah Hornshøj Pedersen, Alexander Lilja-Cyron, Ramona Astrand, and Marianne Juhler
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intracranial pressure (ICP) ,age-dependent ,reference values ,traumatic brain injury (TBI) ,head trauma ,children ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Purpose of Review: Monitoring of intracranial pressure (ICP) is an important and integrated part of the treatment algorithm for children with severe traumatic brain injury (TBI). Guidelines often recommend ICP monitoring with a treatment threshold of 20 mmHg. This focused review discusses; (1) different ICP technologies and how ICP should be monitored in pediatric patients with severe TBI, (2) existing evidence behind guideline recommendations, and (3) how we could move forward to increase knowledge about normal ICP in children to support treatment decisions.Summary: Current reference values for normal ICP in adults lie between 7 and 15 mmHg. Recent studies conducted in “pseudonormal” adults, however, suggest a normal range below this level where ICP is highly dependent on body posture and decreases to negative values in sitting and standing position. Despite obvious physiological differences between children and adults, no age or body size related reference values exist for normal ICP in children. Recent guidelines for treatment of severe TBI in pediatric patients recommend ICP monitoring to guide treatment of intracranial hypertension. Decision on ICP monitoring modalities are based on local standards, the individual case, and the clinician's choice. The recommended treatment threshold is 20 mmHg for a duration of 5 min. Both prospective and retrospective observational studies applying different thresholds and treatment strategies for intracranial hypertension were included to support this recommendation. While some studies suggest improved outcome related to ICP monitoring (lower rate of mortality and severe disability), most studies identify high ICP as a marker of worse outcome. Only one study applied age-differentiated thresholds, but this study did not evaluate the effect of these different thresholds on outcome. The quality of evidence behind ICP monitoring and treatment thresholds in severe pediatric TBI is low and treatment can potentially be improved by knowledge about normal ICP from observational studies in healthy children and cohorts of pediatric “pseudonormal” patients expected to have normal ICP. Acceptable levels of ICP − and thus also treatment thresholds—probably vary with age, disease and whether the patient has intact cerebral autoregulation. Future treatment algorithms should reflect these differences and be more personalized and dynamic.
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- 2020
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19. Prompt closure versus gradual weaning of external ventricular drainage for hydrocephalus following aneurysmal subarachnoid haemorrhage: a statistical analysis plan for the DRAIN randomised clinical trial
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Capion, Tenna, primary, Lilja-Cyron, Alexander, additional, Juhler, Marianne, additional, Møller, Kirsten, additional, Sorteberg, Angelika, additional, Rønning, Pål André, additional, Poulsen, Frantz Rom, additional, Wismann, Joakim, additional, Schack, Anders Emil, additional, Ravlo, Celina, additional, Isaksen, Jørgen, additional, Lindschou, Jane, additional, Gluud, Christian, additional, Mathiesen, Tiit, additional, and Olsen, Markus Harboe, additional
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- 2023
- Full Text
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20. The intracranial pressure–volume relationship following decompressive hinge craniotomy compared to decompressive craniectomy—a human cadaver study
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Christian Baastrup Søndergaard, Chiara Villa, Christina Jacobsen, Alexander Lilja-Cyron, and Kåre Fugleholm
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Surgery ,Neurology (clinical) - Published
- 2022
21. Prompt closure versus gradual weaning of external ventricular drainage for hydrocephalus following aneurysmal subarachnoid haemorrhage: Protocol for the DRAIN randomised clinical trial
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Capion, Tenna, primary, Lilja‐Cyron, Alexander, additional, Olsen, Markus Harboe, additional, Juhler, Marianne, additional, Møller, Kirsten, additional, Sorteberg, Angelika, additional, Rønning, Pål André, additional, Poulsen, Frantz Rom, additional, Wismann, Joakim, additional, Ravlo, Celina, additional, Isaksen, Jørgen, additional, Lindschou, Jane, additional, Gluud, Christian, additional, and Mathiesen, Tiit, additional
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- 2023
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22. Prompt closure versus gradual weaning of external ventricular drainage for hydrocephalus following aneurysmal subarachnoid haemorrhage:Protocol for the DRAIN randomised clinical trial
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Capion, Tenna, Lilja-Cyron, Alexander, Olsen, Markus Harboe, Juhler, Marianne, Møller, Kirsten, Sorteberg, Angelika, Rønning, Pål André, Poulsen, Frantz Rom, Wismann, Joakim, Ravlo, Celina, Isaksen, Jørgen, Lindschou, Jane, Gluud, Christian, Mathiesen, Tiit, Capion, Tenna, Lilja-Cyron, Alexander, Olsen, Markus Harboe, Juhler, Marianne, Møller, Kirsten, Sorteberg, Angelika, Rønning, Pål André, Poulsen, Frantz Rom, Wismann, Joakim, Ravlo, Celina, Isaksen, Jørgen, Lindschou, Jane, Gluud, Christian, and Mathiesen, Tiit
- Abstract
Background: Aneurysmal subarachnoid haemorrhage (aSAH) is a life-threatening disease caused by rupture of an intracranial aneurysm. A common complication following aSAH is hydrocephalus, for which placement of an external ventricular drain (EVD) is an important first-line treatment. Once the patient is clinically stable, the EVD is either removed or replaced by a ventriculoperitoneal shunt. The optimal strategy for cessation of EVD treatment is, however, unknown. Gradual weaning may increase the risk of EVD-related infection, whereas prompt closure carries a risk of acute hydrocephalus and redundant shunt implantations. We designed a randomised clinical trial comparing the two commonly used strategies for cessation of EVD treatment in patients with aSAH. Methods: DRAIN is an international multi-centre randomised clinical trial with a parallel group design comparing gradual weaning versus prompt closure of EVD treatment in patients with aSAH. Participants are randomised to either gradual weaning which comprises a multi-step increase of resistance over days, or prompt closure of the EVD. The primary outcome is a composite outcome of VP-shunt implantation, all-cause mortality, or ventriculostomy-related infection. Secondary outcomes are serious adverse events excluding mortality, functional outcome (modified Rankin scale), health-related quality of life (EQ-5D) and Fatigue Severity Scale (FSS). Outcome assessment will be performed 6 months after ictus. Based on the sample size calculation (event proportion 80% in the gradual weaning group, relative risk reduction 20%, type I error 5%, power 80%), 122 patients are needed in each intervention group. Outcome assessment for the primary outcome, statistical analyses and conclusion drawing will be blinded. Trial Registration: ClinicalTrials.gov identifier: NCT03948256.
- Published
- 2023
23. Prompt closure versus gradual weaning of external ventricular drainage for hydrocephalus following aneurysmal subarachnoid haemorrhage: Protocol for the DRAIN randomised clinical trial
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Tenna Capion, Alexander Lilja‐Cyron, Markus Harboe Olsen, Marianne Juhler, Kirsten Møller, Angelika Sorteberg, Pål André Rønning, Frantz Rom Poulsen, Joakim Wismann, Celina Ravlo, Jørgen Isaksen, Jane Lindschou, Christian Gluud, and Tiit Mathiesen
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Anesthesiology and Pain Medicine ,General Medicine - Published
- 2023
24. The intracranial pressure–volume relationship following decompressive hinge craniotomy compared to decompressive craniectomy—a human cadaver study
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Søndergaard, Christian Baastrup, primary, Villa, Chiara, additional, Jacobsen, Christina, additional, Lilja-Cyron, Alexander, additional, and Fugleholm, Kåre, additional
- Published
- 2022
- Full Text
- View/download PDF
25. Trends in incidence of oral anticoagulant-related intracerebral hemorrhage and sales of oral anticoagulants in Capital Region of Denmark 2010–2017
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Christina Kruuse, Sverre Rosenbaum, Hanne Christensen, Per Meden, Thorsten Steiner, David Gaist, Josefine Grundtvig, Thomas Christensen, Inger Havsteen, Christian Ovesen, Louisa Christensen, Helle K. Iversen, Jacob Marstrand, Karen Ægidius, and Alexander Lilja-Cyron
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medicine.medical_specialty ,new oral anticoagulants ,Capital region ,030204 cardiovascular system & hematology ,Vitamin k ,Lower risk ,direct oral anticoagulants ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Original Research Articles ,Internal medicine ,medicine ,hemorrhagic stroke ,cardiovascular diseases ,Non-vitamin K-antagonist oral anticoagulants ,Intracerebral hemorrhage ,vitamin K-antagonists ,business.industry ,Incidence (epidemiology) ,medicine.disease ,intracerebral hemorrhage ,nervous system diseases ,Oral anticoagulant ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Abstract
Introduction Non-vitamin K-antagonist oral anticoagulants (NOAC) have become first choice oral anticoagulant (OAC) with decreasing use of vitamin K antagonists (VKA), partly due to lower risk of intracerebral hemorrhage (ICH). Aim: to identify trends in sale of OACs and relate them to trends in OAC-related ICH (OAC-ICH). Patients and methods Study was based on the population in the Capital Region of Denmark (1.8 million inhabitants). We identified all patients admitted with a non-traumatic OAC-ICH in 2010–2017 and ascertained diagnosis and drug use through medical charts. We used information available in the public domain on sale of defined daily doses (DDD) of OAC in the Capital Region of Denmark. Results 453 patients with OAC-ICH out of a total of 2877 ICH-events were identified. From 2010 to 2017 sale of NOAC rose from 0.1 to 11.8 DDD/1000 inhabitants/day (p Discussion In Denmark, the population on OACs has increased; resulting from increased use of NOACs. Parallel to this development, the proportion of OAC-ICH overall has increased based on an increasing trend in NOAC-related ICH. Conclusion Our findings document a need for further research on prevention and treatment of this complication.
- Published
- 2021
26. Aortic Root Dilatation in Hypertensive Patients with Left Ventricular Hypertrophy-Application of A New Multivariate Predictive Model. The Life Study
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Lilja-Cyron, Alexander, Bang, Casper N., Gerdts, Eva, Larstorp, Anne C., Kjeldsen, Sverre E., Julius, Stevo, Okin, Peter M., Wachtell, Kristian, Devereux, Richard B., Lilja-Cyron, Alexander, Bang, Casper N., Gerdts, Eva, Larstorp, Anne C., Kjeldsen, Sverre E., Julius, Stevo, Okin, Peter M., Wachtell, Kristian, and Devereux, Richard B.
- Abstract
Background: Available nomograms to predict aortic root (AoR) diameter for body surface area have limitations. The purpose of this study was to evaluate the use of a new multivariate predictive model to identify AoR dilatation in hypertensive patients with left ventricular hypertrophy. Methods: 943 of 961 patients in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiographic sub-study had the necessary baseline characteristics and echocardiographic 2D measurements of AoR size to be included. Results: Predicted AoR (Sinus of Valsalva) diameter was 1.519 + (age [years] x 0.010) + (height [cm] x 0.010) - (gender [1 = M, 2 = F] x 0.247), and a measured AoR diameter exceeding the 97.5-percentile of this estimate was considered dilated. Measured AoR diameter was larger in men than in women (3.75 vs. 3.48 cm, p < 0.001) and AoR diameter predicted by the model was larger than predicted by nomogram (3.52 vs. 3.28 cm, p < 0.001). Using the multivariate model to identify patients with AoR dilatation, the prevalence was 13.7% in men and 12.3% in women (p = 0.537). There was consensus of AoR phenotype (normal/dilated) between model and nomogram in 92.8% of the patients. In multivariate logistic regression, AoR dilatation by model definition was predicted by presence of aortic regurgitation (OR 2.67, p < 0.001) and SD increase in age (OR 0.75, p = 0.023), pulse pressure (OR 0.64, p < 0.001), left ventricular mass index (OR 1.36, p = 0.08) and stroke volume (OR 1.45, p = 0.002), but not by body weight. Conclusions: Using the proposed model the prevalence of AoR dilatation was equal in men and women and the model seems to address the effects of gender, age and body size on AoR size.
- Published
- 2022
27. Endoscopic third ventriculostomy for adults with hydrocephalus:creating a prognostic model for success: protocol for a retrospective multicentre study (Nordic ETV)
- Author
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Tefre, S. (Sondre), Lilja-Cyron, A. (Alexander), Arvidsson, L. (Lisa), Bartek, J. (Jiri), Corell, A. (Alba), Forsse, A. (Axel), Glud, A. N. (Andreas Nørgaard), Hamdeh, S. A. (Sami Abu), Hansen, F. L. (Frederik Lundgaard), Huotarinen, A. (Antti), Johansson, C. (Conny), Kämäräinen, O.-P. (Olli-Pekka), Korhonen, T. (Tommi), Kotkansalo, A. (Anna), Mansoor, N. M. (Nadia Mauland), Mireles, E. E. (Eduardo Erasmo Mendoza), Miscov, R. (Rares), Munthe, S. (Sune), Nittby-Redebrandt, H. (Henrietta), Obad, N. (Nina), Pedersen, L. K. (Lars Kjelsberg), Posti, J. (Jussi), Raj, R. (Rahul), Satopää, J. (Jarno), Ståhl, N. (Nils), Tetri, S. (Sami), Tobieson, L. (Lovisa), Juhler, M. (Marianne), Tefre, S. (Sondre), Lilja-Cyron, A. (Alexander), Arvidsson, L. (Lisa), Bartek, J. (Jiri), Corell, A. (Alba), Forsse, A. (Axel), Glud, A. N. (Andreas Nørgaard), Hamdeh, S. A. (Sami Abu), Hansen, F. L. (Frederik Lundgaard), Huotarinen, A. (Antti), Johansson, C. (Conny), Kämäräinen, O.-P. (Olli-Pekka), Korhonen, T. (Tommi), Kotkansalo, A. (Anna), Mansoor, N. M. (Nadia Mauland), Mireles, E. E. (Eduardo Erasmo Mendoza), Miscov, R. (Rares), Munthe, S. (Sune), Nittby-Redebrandt, H. (Henrietta), Obad, N. (Nina), Pedersen, L. K. (Lars Kjelsberg), Posti, J. (Jussi), Raj, R. (Rahul), Satopää, J. (Jarno), Ståhl, N. (Nils), Tetri, S. (Sami), Tobieson, L. (Lovisa), and Juhler, M. (Marianne)
- Abstract
Introduction: Endoscopic third ventriculostomy (ETV) is becoming an increasingly widespread treatment for hydrocephalus, but research is primarily based on paediatric populations. In 2009, Kulkarni et al created the ETV Success score to predict the outcome of ETV in children. The purpose of this study is to create a prognostic model to predict the success of ETV for adult patients with hydrocephalus. The ability to predict who will benefit from an ETV will allow better primary patient selection both for ETV and shunting. This would reduce additional second procedures due to primary treatment failure. A success score specific for adults could also be used as a communication tool to provide better information and guidance to patients. Methods and analysis: The study will adhere to the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis reporting guidelines and conducted as a retrospective chart review of all patients≥18 years of age treated with ETV at the participating centres between 1 January 2010 and 31 December 2018. Data collection is conducted locally in a standardised database. Univariate analysis will be used to identify several strong predictors to be included in a multivariate logistic regression model. The model will be validated using K-fold cross validation. Discrimination will be assessed using area under the receiver operating characteristic curve (AUROC) and calibration with calibration belt plots. Ethics and dissemination: The study is approved by appropriate ethics or patient safety boards in all participating countries.
- Published
- 2022
28. Endoscopic third ventriculostomy for adults with hydrocephalus:Creating a prognostic model for success: Protocol for a retrospective multicentre study (Nordic ETV)
- Author
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Tefre, Sondre, Lilja-Cyron, Alexander, Arvidsson, Lisa, Bartek, Jiri, Corell, Alba, Forsse, Axel, Glud, Andreas Nørgaard, Hamdeh, Sami Abu, Hansen, Frederik Lundgaard, Huotarinen, Antti, Johansson, Conny, Kämäräinen, Olli Pekka, Korhonen, Tommi, Kotkansalo, Anna, Mansoor, Nadia Mauland, Mireles, Eduardo Erasmo Mendoza, Miscov, Rares, Munthe, Sune, Nittby-Redebrandt, Henrietta, Obad, Nina, Pedersen, Lars Kjelsberg, Posti, Jussi, Raj, Rahul, Satopää, Jarno, Stahl, Nils, Tetri, Sami, Tobieson, Lovisa, Juhler, Marianne, Tefre, Sondre, Lilja-Cyron, Alexander, Arvidsson, Lisa, Bartek, Jiri, Corell, Alba, Forsse, Axel, Glud, Andreas Nørgaard, Hamdeh, Sami Abu, Hansen, Frederik Lundgaard, Huotarinen, Antti, Johansson, Conny, Kämäräinen, Olli Pekka, Korhonen, Tommi, Kotkansalo, Anna, Mansoor, Nadia Mauland, Mireles, Eduardo Erasmo Mendoza, Miscov, Rares, Munthe, Sune, Nittby-Redebrandt, Henrietta, Obad, Nina, Pedersen, Lars Kjelsberg, Posti, Jussi, Raj, Rahul, Satopää, Jarno, Stahl, Nils, Tetri, Sami, Tobieson, Lovisa, and Juhler, Marianne
- Abstract
Introduction Endoscopic third ventriculostomy (ETV) is becoming an increasingly widespread treatment for hydrocephalus, but research is primarily based on paediatric populations. In 2009, Kulkarni et al created the ETV Success score to predict the outcome of ETV in children. The purpose of this study is to create a prognostic model to predict the success of ETV for adult patients with hydrocephalus. The ability to predict who will benefit from an ETV will allow better primary patient selection both for ETV and shunting. This would reduce additional second procedures due to primary treatment failure. A success score specific for adults could also be used as a communication tool to provide better information and guidance to patients. Methods and analysis The study will adhere to the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis reporting guidelines and conducted as a retrospective chart review of all patients≥18 years of age treated with ETV at the participating centres between 1 January 2010 and 31 December 2018. Data collection is conducted locally in a standardised database. Univariate analysis will be used to identify several strong predictors to be included in a multivariate logistic regression model. The model will be validated using K-fold cross validation. Discrimination will be assessed using area under the receiver operating characteristic curve (AUROC) and calibration with calibration belt plots. Ethics and dissemination The study is approved by appropriate ethics or patient safety boards in all participating countries. Trial registration number NCT04773938; Pre-results.
- Published
- 2022
29. Endoscopic third ventriculostomy for adults with hydrocephalus: creating a prognostic model for success: protocol for a retrospective multicentre study (Nordic ETV)
- Author
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Tefre, Sondre, Lilja-Cyron, Alexander, Arvidsson, Lisa, Bartek, Jiri, Corell, Alba, Forsse, Axel, Glud, Andreas Norgaard, Abu Hamdeh, Sami, Hansen, Frederik Lundgaard, Huotarinen, Antti, Johansson, Conny, Kamarainen, Olli-Pekka, Korhonen, Tommi, Kotkansalo, Anna, Mansoor, Nadia Mauland, Mireles, Eduardo Erasmo Mendoza, Miscov, Rares, Munthe, Sune, Nittby-Redebrandt, Henrietta, Obad, Nina, Pedersen, Lars Kjelsberg, Posti, Jussi, Raj, Rahul, Satopaa, Jarno, Stahl, Nils, Tetri, Sami, Tobieson, Lovisa, Juhler, Marianne, Tefre, Sondre, Lilja-Cyron, Alexander, Arvidsson, Lisa, Bartek, Jiri, Corell, Alba, Forsse, Axel, Glud, Andreas Norgaard, Abu Hamdeh, Sami, Hansen, Frederik Lundgaard, Huotarinen, Antti, Johansson, Conny, Kamarainen, Olli-Pekka, Korhonen, Tommi, Kotkansalo, Anna, Mansoor, Nadia Mauland, Mireles, Eduardo Erasmo Mendoza, Miscov, Rares, Munthe, Sune, Nittby-Redebrandt, Henrietta, Obad, Nina, Pedersen, Lars Kjelsberg, Posti, Jussi, Raj, Rahul, Satopaa, Jarno, Stahl, Nils, Tetri, Sami, Tobieson, Lovisa, and Juhler, Marianne
- Abstract
Introduction Endoscopic third ventriculostomy (ETV) is becoming an increasingly widespread treatment for hydrocephalus, but research is primarily based on paediatric populations. In 2009, Kulkarni et al created the ETV Success score to predict the outcome of ETV in children. The purpose of this study is to create a prognostic model to predict the success of ETV for adult patients with hydrocephalus. The ability to predict who will benefit from an ETV will allow better primary patient selection both for EN and shunting. This would reduce additional second procedures due to primary treatment failure. A success score specific for adults could also be used as a communication tool to provide better information and guidance to patients. Methods and analysis The study will adhere to the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis reporting guidelines and conducted as a retrospective chart review of all patients >= 18 years of age treated with EN at the participating centres between 1 January 2010 and 31 December 2018. Data collection is conducted locally in a standardised database. Univariate analysis will be used to identify several strong predictors to be included in a multivariate logistic regression model. The model will be validated using K-fold cross validation. Discrimination will be assessed using area under the receiver operating characteristic curve (AUROC) and calibration with calibration belt plots. Ethics and dissemination The study is approved by appropriate ethics or patient safety boards in all participating countries., Funding Agencies|Lundbeck FoundationLundbeckfonden [F-22218-19]; Hjerneog Nervekirurgisk Forskningspulje, Rigshospitalet [F23026-02, N497]
- Published
- 2022
- Full Text
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30. Aortic Root Dilatation in Hypertensive Patients with Left Ventricular Hypertrophy–Application of A New Multivariate Predictive Model. The Life Study
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Lilja-Cyron, Alexander, primary, Bang, Casper N., primary, Gerdts, Eva, primary, Larstorp, Anne C., primary, Kjeldsen, Sverre E., primary, Julius, Stevo, primary, Okin, Peter M., primary, Wachtell, Kristian, primary, and Devereux, Richard B., primary
- Published
- 2022
- Full Text
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31. Intracranial pressure before and after cranioplasty: insights into intracranial physiology
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Lonnie G. Petersen, Alexander Lilja-Cyron, Kåre Fugleholm, Trine Hjorslev Andreasen, Morten Andresen, Jesper Kelsen, and Marianne Juhler
- Subjects
Supine position ,Traumatic brain injury ,business.industry ,medicine.medical_treatment ,Physiology ,General Medicine ,medicine.disease ,Cranioplasty ,Hydrocephalus ,03 medical and health sciences ,0302 clinical medicine ,Cerebrospinal fluid ,Cerebral blood flow ,030220 oncology & carcinogenesis ,medicine ,Decompressive craniectomy ,business ,030217 neurology & neurosurgery ,Intracranial pressure - Abstract
OBJECTIVEDecompressive craniectomy (DC) is an emergency neurosurgical procedure used in cases of severe intracranial hypertension or impending intracranial herniation. The procedure is often lifesaving, but it exposes the brain to atmospheric pressure in the subsequent rehabilitation period, which changes intracranial physiology and probably leads to complications such as hydrocephalus, hygromas, and “syndrome of the trephined.” The objective of the study was to study the effect of cranioplasty on intracranial pressure (ICP), postural ICP changes, and intracranial pulse wave amplitude (PWA).METHODSThe authors performed a prospective observational study including patients who underwent DC during a 12-month period. Telemetric ICP sensors were implanted in all patients at the time of DC. ICP was evaluated before and after cranioplasty during weekly measurement sessions including a standardized postural change program.RESULTSTwelve of the 17 patients enrolled in the study had cranioplasty performed and were included in the present investigation. Their mean ICP in the supine position increased from –0.5 ± 4.8 mm Hg the week before cranioplasty to 6.3 ± 2.5 mm Hg the week after cranioplasty (p < 0.0001), whereas the mean ICP in the sitting position was unchanged (–1.2 ± 4.8 vs –1.1 ± 3.6 mm Hg, p = 0.90). The difference in ICP between the supine and sitting positions was minimal before cranioplasty (1.1 ± 1.8 mm Hg) and increased to 7.4 ± 3.6 mm Hg in the week following cranioplasty (p < 0.0001). During the succeeding 2 weeks of the follow-up period, the mean ICP in the supine and sitting positions decreased in parallel to, respectively, 4.6 ± 3.0 mm Hg (p = 0.0003) and –3.9 ± 2.7 mm Hg (p = 0.040), meaning that the postural ICP difference remained constant at around 8 mm Hg. The mean intracranial PWA increased from 0.7 ± 0.7 mm Hg to 2.9 ± 0.8 mm Hg after cranioplasty (p < 0.0001) and remained around 3 mm Hg throughout the following weeks.CONCLUSIONSCranioplasty restores normal intracranial physiology regarding postural ICP changes and intracranial PWA. These findings complement those of previous investigations on cerebral blood flow and cerebral metabolism in patients after decompressive craniectomy.
- Published
- 2020
32. Endoscopic third ventriculostomy for adults with hydrocephalus:Creating a prognostic model for success: Protocol for a retrospective multicentre study (Nordic ETV)
- Author
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Sondre Tefre, Alexander Lilja-Cyron, Lisa Arvidsson, Jiri Bartek, Alba Corell, Axel Forsse, Andreas Nørgaard Glud, Sami Abu Hamdeh, Frederik Lundgaard Hansen, Antti Huotarinen, Conny Johansson, Olli-Pekka Kämäräinen, Tommi Korhonen, Anna Kotkansalo, Nadia Mauland Mansoor, Eduardo Erasmo Mendoza Mireles, Rares Miscov, Sune Munthe, Henrietta Nittby-Redebrandt, Nina Obad, Lars Kjelsberg Pedersen, Jussi Posti, Rahul Raj, Jarno Satopää, Nils Ståhl, Sami Tetri, Lovisa Tobieson, Marianne Juhler, Helsinki University Hospital Area, Clinicum, HUS Neurocenter, and Neurokirurgian yksikkö
- Subjects
Adult ,Epidemiology ,Neurosurgery ,CHILDREN ,TERM ,VALIDATION ,Ventriculostomy ,SCORE ,TOOL ,Humans ,Multicenter Studies as Topic ,Child ,Neuropathology ,Retrospective Studies ,Third Ventricle ,COMPLICATIONS ,OUTCOMES ,Infant ,Ventriculostomy/methods ,General Medicine ,3126 Surgery, anesthesiology, intensive care, radiology ,Prognosis ,Treatment Outcome ,VENTRICULOPERITONEAL SHUNT ,Neuroradiology ,Third Ventricle/surgery ,3121 General medicine, internal medicine and other clinical medicine ,Medicine ,Hydrocephalus/surgery ,Hydrocephalus - Abstract
Introduction Endoscopic third ventriculostomy (ETV) is becoming an increasingly widespread treatment for hydrocephalus, but research is primarily based on paediatric populations. In 2009, Kulkarniet alcreated the ETV Success score to predict the outcome of ETV in children. The purpose of this study is to create a prognostic model to predict the success of ETV for adult patients with hydrocephalus. The ability to predict who will benefit from an ETV will allow better primary patient selection both for ETV and shunting. This would reduce additional second procedures due to primary treatment failure. A success score specific for adults could also be used as a communication tool to provide better information and guidance to patients. Methods and analysis The study will adhere to the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis reporting guidelines and conducted as a retrospective chart review of all patients≥18 years of age treated with ETV at the participating centres between 1 January 2010 and 31 December 2018. Data collection is conducted locally in a standardised database. Univariate analysis will be used to identify several strong predictors to be included in a multivariate logistic regression model. The model will be validated using K-fold cross validation. Discrimination will be assessed using area under the receiver operating characteristic curve (AUROC) and calibration with calibration belt plots. Ethics and dissemination The study is approved by appropriate ethics or patient safety boards in all participating countries. Trial registration number NCT04773938; Pre-results.
- Published
- 2022
33. Aortic root dilatation in hypertensive patients with left ventricular hypertrophy–application of a new multivariate predictive model. The Life Study
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Richard B. Devereux, Kristian Wachtell, Peter M. Okin, Stevo Julius, Sverre E. Kjeldsen, Anne C. Larstorp, Eva Gerdts, Casper N. Bang, and Alexander Lilja-Cyron
- Subjects
Male ,DIMENSIONS ,hypertension ,aortic root diameter ,GEOMETRY ,blood pressure ,Blood Pressure ,General Medicine ,DETERMINANTS ,REGURGITATION ,Dilatation ,RECOMMENDATIONS ,left ventricular hypertrophy ,PREVALENCE ,SIZE ,AGE ,Echocardiography ,Hypertension ,Humans ,Female ,Hypertrophy, Left Ventricular ,Cardiology and Cardiovascular Medicine ,ECHOCARDIOGRAPHY ,POPULATION ,Dilatation, Pathologic - Abstract
Background: Available nomograms to predict aortic root (AoR) diameter for body surface area have limitations. The purpose of this study was to evaluate the use of a new multivariate predictive model to identify AoR dilatation in hypertensive patients with left ventricular hypertrophy. Methods: 943 of 961 patients in the Losartan Intervention For Endpoint reduction in hypertension (LIFE) echocardiographic sub-study had the necessary baseline characteristics and echocardiographic 2D measurements of AoR size to be included. Results: Predicted AoR (Sinus of Valsalva) diameter was 1.519 + (age [years] × 0.010) + (height [cm] × 0.010) – (gender [1 = M, 2 = F] × 0.247), and a measured AoR diameter exceeding the 97.5-percentile of this estimate was considered dilated. Measured AoR diameter was larger in men than in women (3.75 vs. 3.48 cm, p < 0.001) and AoR diameter predicted by the model was larger than predicted by nomogram (3.52 vs. 3.28 cm, p < 0.001). Using the multivariate model to identify patients with AoR dilatation, the prevalence was 13.7% in men and 12.3% in women (p = 0.537). There was consensus of AoR phenotype (normal/dilated) between model and nomogram in 92.8% of the patients. In multivariate logistic regression, AoR dilatation by model definition was predicted by presence of aortic regurgitation (OR 2.67, p < 0.001) and SD increase in age (OR 0.75, p = 0.023), pulse pressure (OR 0.64, p < 0.001), left ventricular mass index (OR 1.36, p = 0.08) and stroke volume (OR 1.45, p = 0.002), but not by body weight. Conclusions: Using the proposed model the prevalence of AoR dilatation was equal in men and women and the model seems to address the effects of gender, age and body size on AoR size. Clinical Trial Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00338260.
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- 2022
34. Endoscopic third ventriculostomy for adults with hydrocephalus: creating a prognostic model for success: protocol for a retrospective multicentre study (Nordic ETV)
- Author
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Tefre, Sondre, primary, Lilja-Cyron, Alexander, additional, Arvidsson, Lisa, additional, Bartek, Jiri, additional, Corell, Alba, additional, Forsse, Axel, additional, Glud, Andreas Nørgaard, additional, Hamdeh, Sami Abu, additional, Hansen, Frederik Lundgaard, additional, Huotarinen, Antti, additional, Johansson, Conny, additional, Kämäräinen, Olli-Pekka, additional, Korhonen, Tommi, additional, Kotkansalo, Anna, additional, Mansoor, Nadia Mauland, additional, Mendoza Mireles, Eduardo Erasmo, additional, Miscov, Rares, additional, Munthe, Sune, additional, Nittby-Redebrandt, Henrietta, additional, Obad, Nina, additional, Pedersen, Lars Kjelsberg, additional, Posti, Jussi, additional, Raj, Rahul, additional, Satopää, Jarno, additional, Ståhl, Nils, additional, Tetri, Sami, additional, Tobieson, Lovisa, additional, and Juhler, Marianne, additional
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- 2022
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35. Lumbar puncture position influences intracranial pressure
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Morten Andresen, Sarah Hornshøj Pedersen, Lonnie G. Petersen, Marianne Juhler, and Alexander Lilja-Cyron
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musculoskeletal diseases ,Supine position ,Lumbar puncture opening pressure (CSF) ,Sitting ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Cerebrospinal fluid ,Lumbar ,Recumbent Position ,Medicine ,Hip flexion ,Neuroradiology ,Intracranial pressure ,integumentary system ,medicine.diagnostic_test ,business.industry ,Lumbar puncture ,musculoskeletal, neural, and ocular physiology ,Lumbar puncture position ,Neck flexion ,Intracranial pressure (ICP) ,Surgery ,Neurology (clinical) ,Nuclear medicine ,business ,030217 neurology & neurosurgery - Abstract
Background: The standard lumbar puncture position involves maximum flexion of both lumbar and cervical spine. The cerebrospinal fluid opening pressure (CSFop) is measured in a horizontal position. This study investigated if flexion of hip and neck both separately and simultaneously influence intracranial pressure (ICP) to a clinically relevant extent. Methods: Thirty-nine patients, undergoing invasive ICP monitoring as part of diagnostic work-up, were included. The patients underwent either a vertical postural examination (n = 24) or a horizontal postural examination (n = 15) to examine a varying degree of spine flexion. Results: The vertical examination showed that ICP decreased by 15.2 mmHg when straightening the neck in a sitting lumbar puncture position (n = 24, IQR − 20.1 to − 9.7). In the horizontal examination, ICP increased in all but one patient when changing from supine position to lateral recumbent position (n = 15, median increase of 6.9 mmHg, IQR 3.1 to 9.9). Straightening the hips alone decreased ICP with 0.2 mmHg (n = 15, IQR − 0.5 to 2.0), while straightening the neck alone decreased ICP by 4.0 mmHg (n = 15, IQR − 5.9 to − 1.7). However, when straightening the hip and neck simultaneously ICP decreased by 6.4 mmHg (n = 6, IQR − 9.5 to − 4.4). Conclusions: Neck flexion alone, and neck flexion and hip flexion in combination, has significant confounding influence on ICP. This may cause patients to shift from a normal ICP range to a pathological ICP range, which will potentially affect treatment decisions. Consensus on guidelines for body position including neck and hip flexion measuring CSFop may be needed.
- Published
- 2021
36. Quality assessment of evidence must be stated in conclusions to avoid conveying questionable recommendations
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Tenna Capion, Alexander Lilja-Cyron, Marianne Juhler, Tiit Mathiesen, and Jørn Wetterslev
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Surgery ,Neurology (clinical) ,General Medicine - Published
- 2022
37. Neurosurgery rounds: questions and answers (2nd edition) (2017) by Mark R. Shaya, Cristian Gragnaniello, and Remi Nader 520 pp., 160 illustrations paperback/softback ISBN: 9781626233461 Thieme Publishers New York/Stuttgart
- Author
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Lilja-Cyron, Alexander
- Published
- 2018
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38. Long-Term Effect of Decompressive Craniectomy on Intracranial Pressure and Possible Implications for Intracranial Fluid Movements
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Marianne Juhler, Trine Hjorslev Andreasen, Jesper Kelsen, Alexander Lilja-Cyron, Kåre Fugleholm, and Morten Andresen
- Subjects
Adult ,Male ,Decompressive Craniectomy ,Supine position ,Intracranial Pressure ,Traumatic brain injury ,medicine.medical_treatment ,03 medical and health sciences ,0302 clinical medicine ,Cerebrospinal fluid ,Germany ,Brain Injuries, Traumatic ,Humans ,Medicine ,Prospective Studies ,Stroke ,Aged ,Monitoring, Physiologic ,Intracranial pressure ,business.industry ,musculoskeletal, neural, and ocular physiology ,Prostheses and Implants ,Middle Aged ,medicine.disease ,nervous system diseases ,Hydrocephalus ,Intensive Care Units ,030220 oncology & carcinogenesis ,Anesthesia ,Intracranial pressure monitoring ,Female ,Surgery ,Decompressive craniectomy ,Neurology (clinical) ,Intracranial Hypertension ,business ,030217 neurology & neurosurgery ,Follow-Up Studies - Abstract
Background Decompressive craniectomy (DC) is used in cases of severe intracranial hypertension or impending intracranial herniation. DC effectively lowers intracranial pressure (ICP) but carries a risk of severe complications related to abnormal ICP and/or cerebrospinal fluid (CSF) circulation, eg, hygroma formation, hydrocephalus, and "syndrome of the trephined." Objective To study the long-term effect of DC on ICP, postural ICP regulation, and intracranial pulse wave amplitude (PWA). Methods Prospective observational study including patients undergoing DC during a 12-mo period. Telemetric ICP sensors (Neurovent-P-tel; Raumedic, Helmbrechts, Germany) were implanted in all patients. Following discharge from the neuro intensive care unit (NICU), scheduled weekly ICP monitoring sessions were performed during the rehabilitation phase. Results A total of 16 patients (traumatic brain injury: 7, stroke: 9) were included (median age: 55 yr, range: 19-71 yr). Median time from NICU discharge to cranioplasty was 48 d (range: 16-98 d) and during this period, mean ICP gradually decreased from 7.8 ± 2.0 mm Hg to -1.8 ± 3.3 mm Hg (P = .02). The most pronounced decrease occurred during the first month. Normal postural ICP change was abolished after DC for the entire follow-up period, ie, there was no difference between ICP in supine and sitting position (P = .67). PWA was markedly reduced and decreased from initially 1.2 ± 0.7 mm Hg to 0.4 ± 0.3 mm Hg (P = .05). Conclusion Following NICU discharge, ICP decreases to negative values within 4 wk, normal postural ICP regulation is lost and intracranial PWA is diminished significantly. These abnormalities might have implications for intracranial fluid movements (eg, CSF and/or glymphatic flow) following DC and warrants further investigations.
- Published
- 2019
39. Long-term functional outcome after decompressive suboccipital craniectomy for space-occupying cerebellar infarction
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Marianne Juhler, Desirée Lindeskog, Alexander Lilja-Cyron, and Jesper Kelsen
- Subjects
Adult ,Male ,Decompressive Craniectomy ,medicine.medical_specialty ,Brain Stem Infarctions ,medicine.medical_treatment ,Time ,03 medical and health sciences ,0302 clinical medicine ,Cerebellar Diseases ,Modified Rankin Scale ,medicine ,Humans ,Cerebellar infarction ,Favorable outcome ,Symptom onset ,Stroke ,Aged ,Retrospective Studies ,business.industry ,Treatment options ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,Median time ,Brain Injuries ,030220 oncology & carcinogenesis ,Female ,Decompressive craniectomy ,Neurology (clinical) ,business ,030217 neurology & neurosurgery - Abstract
Objectives Suboccipital decompressive craniectomy (SDC) is considered the best treatment option in patients with space-occupying cerebellar infarction and clinical signs of deterioration. The primary purpose of this study was to evaluate long-term functional outcome in patients one year after SDC for space-occupying cerebellar infarction, and secondly, to determine factors associated with outcome. Patients and methods All patients treated with SDC due to space-occupying cerebellar infarction between January 2009 and October 2015 were included in the study. Data was retrospectively collected from patient records, CT/MRI scans and surgical protocols. Long-term functional outcome was determined by the modified Rankin Scale (mRS) and mRS ≥ 4 was defined as unfavorable outcome. Results Twenty-two patients (16 male, 6 female) were included in the study. Median age was 53 years. Nine patients were treated with external ventricular drainage as an initial treatment attempt prior to SDC. Median time from symptom onset (stroke ictus) to initiation of the SDC surgery was 48 h (IQR 28–99 hours) and median GCS before SDC was 8 (IQR 5–10). At follow up, median mRS was 3 (IQR 2–6). Outcome was favorable (mRS 0–3) in 12 patients and unfavorable in 10 (3 with major disability, 7 dead). Brainstem infarction and bilateral cerebellar infarction were associated with unfavorable outcome. Conclusions In this small study, functional long-term outcome in patients with space-occupying cerebellar infarction treated by SDC was acceptable and comparable to previously published results (favorable outcome in 54% of patients). Brainstem infarction and bilateral cerebellar infarction were associated with unfavorable outcome.
- Published
- 2019
40. Optimal Cerebral Perfusion Pressure Based on Intracranial Pressure-Derived Indices of Cerebrovascular Reactivity: Which One Is Better for Outcome Prediction in Moderate/Severe Traumatic Brain Injury?
- Author
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Alexander, Lilja-Cyron, Frederick A, Zeiler, Erta, Beqiri, Manuel, Cabeleira, Peter, Smielewski, and Marek, Czosnyka
- Subjects
Intracranial Pressure ,Cerebrovascular Circulation ,Brain Injuries, Traumatic ,Humans ,Arterial Pressure ,Retrospective Studies - Abstract
Intracranial pressure (ICP)-derived indices of cerebrovascular reactivity (e.g., PRx, PAx, and RAC) have been developed to improve understanding of brain status from available neuromonitoring variables. These indices are moving correlation coefficients between slow-wave vasogenic fluctuations in ICP and arterial blood pressure. In this retrospective analysis of neuromonitoring data from 200 patients admitted with moderate/severe traumatic brain injury (TBI), we evaluate the predictive value of CPPopt based on these ICP-derived indices of cerebrovascular reactivity. Valid CPPopt values were obtained in 92.3% (PRx), 86.7% (PAX), and 84.6% (RAC) of the monitoring periods, respectively. In multivariate logistic analysis, a baseline model that includes age, sex, and admission Glasgow Coma Score had an area under the receiver operating curve of 0.762 (P0.0001) for dichotomous outcome prediction (dead vs. good recovery). When adding time/dose of CPP below CPPopt, all multivariate models (based on PRx, PAx, and RAC) predicted the dichotomous outcome measure, but additional value of the prediction was only significantly added by the PRx-based calculations of time spent with CPP below CPPopt and dose of CPP below CPPopt.
- Published
- 2021
41. sj-pdf-1-eso-10.1177_23969873211008770 - Supplemental material for Trends in incidence of oral anticoagulant-related intracerebral hemorrhage and sales of oral anticoagulants in Capital Region of Denmark 2010–2017
- Author
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Grundtvig, Josefine, Ovesen, Christian, Havsteen, Inger, Christensen, Thomas, Gaist, David, Iversen, Helle K, Kruuse, Christina, Lilja-Cyron, Alexander, Ægidius, Karen, Rosenbaum, Sverre, Meden, Per, Marstrand, Jacob, Christensen, Louisa, Steiner, Thorsten, and Christensen, Hanne
- Subjects
FOS: Clinical medicine ,Cardiology ,Medicine ,110904 Neurology and Neuromuscular Diseases - Abstract
Supplemental material, sj-pdf-1-eso-10.1177_23969873211008770 for Trends in incidence of oral anticoagulant-related intracerebral hemorrhage and sales of oral anticoagulants in Capital Region of Denmark 2010–2017 by Josefine Grundtvig, Christian Ovesen, Inger Havsteen, Thomas Christensen, David Gaist, Helle K Iversen, Christina Kruuse, Alexander Lilja-Cyron, Karen Ægidius, Sverre Rosenbaum, Per Meden, Jacob Marstrand, Louisa Christensen, Thorsten Steiner and Hanne Christensen: ; for the PHYS-Stroke study group in European Stroke Journal
- Published
- 2021
- Full Text
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42. Optimal Cerebral Perfusion Pressure Based on Intracranial Pressure-Derived Indices of Cerebrovascular Reactivity: Which One Is Better for Outcome Prediction in Moderate/Severe Traumatic Brain Injury?
- Author
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Manuel Cabeleira, Alexander Lilja-Cyron, Peter Smielewski, Frederick A. Zeiler, Marek Czosnyka, and Erta Beqiri
- Subjects
medicine.medical_specialty ,Multivariate statistics ,Receiver operating characteristic ,Traumatic brain injury ,business.industry ,Glasgow Coma Scale ,medicine.disease ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Cerebrovascular reactivity ,Blood pressure ,Internal medicine ,medicine ,Cardiology ,Cerebral perfusion pressure ,business ,030217 neurology & neurosurgery ,Intracranial pressure - Abstract
Intracranial pressure (ICP)–derived indices of cerebrovascular reactivity (e.g., PRx, PAx, and RAC) have been developed to improve understanding of brain status from available neuromonitoring variables. These indices are moving correlation coefficients between slow-wave vasogenic fluctuations in ICP and arterial blood pressure. In this retrospective analysis of neuromonitoring data from 200 patients admitted with moderate/severe traumatic brain injury (TBI), we evaluate the predictive value of CPPopt based on these ICP-derived indices of cerebrovascular reactivity. Valid CPPopt values were obtained in 92.3% (PRx), 86.7% (PAX), and 84.6% (RAC) of the monitoring periods, respectively. In multivariate logistic analysis, a baseline model that includes age, sex, and admission Glasgow Coma Score had an area under the receiver operating curve of 0.762 (P < 0.0001) for dichotomous outcome prediction (dead vs. good recovery). When adding time/dose of CPP below CPPopt, all multivariate models (based on PRx, PAx, and RAC) predicted the dichotomous outcome measure, but additional value of the prediction was only significantly added by the PRx-based calculations of time spent with CPP below CPPopt and dose of CPP below CPPopt.
- Published
- 2021
43. Trends in incidence of oral anticoagulant-related intracerebral hemorrhage and sales of oral anticoagulants in Capital Region of Denmark 2010–2017
- Author
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Grundtvig, Josefine, Ovesen, Christian, Havsteen, Inger, Christensen, Thomas, Gaist, David, Iversen, Helle K., Kruuse, Christina, Lilja-Cyron, Alexander, Ægidius, Karen, Rosenbaum, Sverre, Meden, Per, Marstrand, Jacob, Christensen, Louisa, Steiner, Thorsten, Christensen, Hanne, Grundtvig, Josefine, Ovesen, Christian, Havsteen, Inger, Christensen, Thomas, Gaist, David, Iversen, Helle K., Kruuse, Christina, Lilja-Cyron, Alexander, Ægidius, Karen, Rosenbaum, Sverre, Meden, Per, Marstrand, Jacob, Christensen, Louisa, Steiner, Thorsten, and Christensen, Hanne
- Abstract
Introduction: Non-vitamin K-antagonist oral anticoagulants (NOAC) have become first choice oral anticoagulant (OAC) with decreasing use of vitamin K antagonists (VKA), partly due to lower risk of intracerebral hemorrhage (ICH). Aim: to identify trends in sale of OACs and relate them to trends in OAC-related ICH (OAC-ICH). Patients and methods: Study was based on the population in the Capital Region of Denmark (1.8 million inhabitants). We identified all patients admitted with a non-traumatic OAC-ICH in 2010–2017 and ascertained diagnosis and drug use through medical charts. We used information available in the public domain on sale of defined daily doses (DDD) of OAC in the Capital Region of Denmark. Results: 453 patients with OAC-ICH out of a total of 2877 ICH-events were identified. From 2010 to 2017 sale of NOAC rose from 0.1 to 11.8 DDD/1000 inhabitants/day (p < 0.001); while VKA sale decreased from 7.6 to 5.2 DDD/1000 inhabitants/day (p < 0.001). The total number of ICH events was stable between 2010 and 2017, but the proportion of OAC-ICH events increased from 13% in 2010 to 22% in 2017 (p < 0.001). The proportion of ICH events related to NOAC had a significant increasing trend (p < 0.001), whereas a decreasing trend was observed for VKA (p = 0.04). Discussion: In Denmark, the population on OACs has increased; resulting from increased use of NOACs. Parallel to this development, the proportion of OAC-ICH overall has increased based on an increasing trend in NOAC-related ICH. Conclusion: Our findings document a need for further research on prevention and treatment of this complication.
- Published
- 2021
44. Trends in incidence of oral anticoagulant-related intracerebral hemorrhage and sales of oral anticoagulants in Capital Region of Denmark 2010–2017
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Grundtvig, Josefine, primary, Ovesen, Christian, additional, Havsteen, Inger, additional, Christensen, Thomas, additional, Gaist, David, additional, Iversen, Helle K, additional, Kruuse, Christina, additional, Lilja-Cyron, Alexander, additional, Ægidius, Karen, additional, Rosenbaum, Sverre, additional, Meden, Per, additional, Marstrand, Jacob, additional, Christensen, Louisa, additional, Steiner, Thorsten, additional, and Christensen, Hanne, additional
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- 2021
- Full Text
- View/download PDF
45. Lumbar puncture position influences intracranial pressure
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Sarah H, Pedersen, Morten, Andresen, Alexander, Lilja-Cyron, Lonnie G, Petersen, and Marianne, Juhler
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Sitting Position ,Intracranial Pressure ,Posture ,Humans ,Intracranial Hypertension ,Range of Motion, Articular ,Spinal Puncture - Abstract
The standard lumbar puncture position involves maximum flexion of both lumbar and cervical spine. The cerebrospinal fluid opening pressure (CSFThirty-nine patients, undergoing invasive ICP monitoring as part of diagnostic work-up, were included. The patients underwent either a vertical postural examination (n = 24) or a horizontal postural examination (n = 15) to examine a varying degree of spine flexion.The vertical examination showed that ICP decreased by 15.2 mmHg when straightening the neck in a sitting lumbar puncture position (n = 24, IQR - 20.1 to - 9.7). In the horizontal examination, ICP increased in all but one patient when changing from supine position to lateral recumbent position (n = 15, median increase of 6.9 mmHg, IQR 3.1 to 9.9). Straightening the hips alone decreased ICP with 0.2 mmHg (n = 15, IQR - 0.5 to 2.0), while straightening the neck alone decreased ICP by 4.0 mmHg (n = 15, IQR - 5.9 to - 1.7). However, when straightening the hip and neck simultaneously ICP decreased by 6.4 mmHg (n = 6, IQR - 9.5 to - 4.4).Neck flexion alone, and neck flexion and hip flexion in combination, has significant confounding influence on ICP. This may cause patients to shift from a normal ICP range to a pathological ICP range, which will potentially affect treatment decisions. Consensus on guidelines for body position including neck and hip flexion measuring CSF
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- 2020
46. Discontinuation of External Ventricular Drainage in Patients with Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage - a Scandinavian Multi-institutional Survey
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Nicola Logallo, Jiri Bartek, Tiit Mathiesen, Axel Forsse, Tenna Capion, Alexander Lilja-Cyron, and Marianne Juhler
- Subjects
Adult ,Male ,medicine.medical_specialty ,Subarachnoid hemorrhage ,Intracranial Pressure ,Closure ,Weaning ,Drain ,Ventriculostomy ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,medicine ,Humans ,Aged ,Intracranial pressure ,Sweden ,medicine.diagnostic_test ,Norway ,business.industry ,Glasgow Coma Scale ,Interventional radiology ,Middle Aged ,Subarachnoid Hemorrhage ,medicine.disease ,Aneurysm ,Discontinuation ,Hydrocephalus ,Emergency medicine ,Drainage ,Female ,Surgery ,Guideline Adherence ,Neurology (clinical) ,Neurosurgery ,business ,030217 neurology & neurosurgery ,External ventricular drain - Abstract
Background: Hydrocephalus requiring external ventricular drainage is common following aneurysmal subarachnoid hemorrhage (aSAH). Timing and strategy for the discontinuation of the external ventricular drain (EVD) are, however, controversial as guidelines are based on limited scientific evidence. A recent similar survey showed that guidelines and recommendations are not being followed. We conducted a questionnaire survey regarding the management of EVD treatment in patients with aSAH and investigated current treatment practice, consensus, and adherence to guidelines within the neurosurgical departments in Scandinavia. Methods: A questionnaire concerning the management of EVD discontinuation in patients with hydrocephalus following aSAH was distributed to all 14 neurosurgical departments in Scandinavia (Norway, Sweden, and Denmark). Neurosurgeons and neurosurgical trainees at all levels were asked to complete the questionnaire individually. A total of 175 completed questionnaires were received between May 2018 and April 2019, resulting in a response rate of 64 %. Results: Eighty-five percent of respondents reported no knowledge of international guidelines regarding EVD discontinuation in patients with hydrocephalus following aSAH. Within every department, respondents disagreed on whether a common discontinuation strategy was followed or not. Seventy-four percent decided upon the EVD discontinuation strategy mainly determined by patients’ clinical condition and drainage volume. Forty-five percent considered Glasgow Coma Score (GCS) the most important clinical variable when assessing the timing of EVD discontinuation. There was general agreement towards the initiation of EVD discontinuation 4–7 days after ictus of aSAH in a stable patient with a drainage volume of < 150 ml/day and intracranial pressure (ICP) < 15 mmHg. Conclusion: Awareness of and adherence to international guidelines regarding EVD discontinuation in patients with hydrocephalus following aSAH were limited in Scandinavia. Internal consensus at department level was absent. Initiation of the discontinuation process appeared to be case dependent and mainly influenced by the patients’ clinical condition and drainage volume. GCS was the clinical variable considered most important when deciding on the initiation of EVD discontinuation.
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- 2020
47. Prompt closure versus gradual weaning of external ventricular drainage for hydrocephalus in adult patients with aneurysmal subarachnoid haemorrhage:A systematic review
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Tiit Mathiesen, Marianne Juhler, Jørn Wetterslev, Alexander Lilja-Cyron, and Tenna Capion
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Adult ,intensive & critical care ,medicine.medical_specialty ,Pediatrics ,Subgroup analysis ,Weaning ,law.invention ,Randomized controlled trial ,law ,medicine ,Humans ,neurosurgery ,Retrospective Studies ,business.industry ,neurology ,General Medicine ,Subarachnoid Hemorrhage ,medicine.disease ,Intensive care unit ,Discontinuation ,Hydrocephalus ,Clinical trial ,Neurology ,Quality of Life ,Drainage ,Medicine ,Neurosurgery ,business - Abstract
ObjectivesTo summarise the evidence on benefits and harms of prompt closure versus gradual weaning of external ventricular drainage (EVD) in patients with hydrocephalus following aneurysmal subarachnoid haemorrhage (aSAH) based on randomised clinical trials (RCTs) in humans.SettingRCTs comparing prompt closure versus gradual weaning of EVD in adult patients with hydrocephalus following aSAH were included.ParticipantsPatients aged equal to or greater than 18 years with an EVD due to hydrocephalus following aSAH were eligible for inclusion.Primary and secondary outcome measuresPrimary outcomes were all-cause mortality, any serious adverse event, rate of ventriculoperitoneal (VP) shunt placement and quality of life. Secondary outcomes were patients with shunt failure, hospital and neuro intensive care unit (NICU) length of stay (LOS) and complications related to treatment with an EVD. Data permitted report of rate of VP shunt placement, and hospital and NICU LOS.ResultsSix studies were assessed in full text. One RCT with 81 patients was included. Rate of VP shunt placement was 63.4% in the rapid weaning group (ie, prompt closure of the EVD; 41 patients) and 62.5% in the gradual weaning group (40 patients; p=0.932). LOS in hospital and NICU was significantly shorter in the rapidly weaned group compared with the gradually weaned group (mean 19.1 vs 21.5 days in hospital (p=0.03); and mean 14.1 vs 16.9 days in NICU (p=0.0002)). Data were insufficient to conduct meta-analysis, trial sequential analysis or subgroup analysis of heterogeneity and sensitivity. One RCT is currently ongoing.ConclusionsWe found insufficient evidence to favour any of the two strategies for EVD discontinuation in patients with hydrocephalus following aSAH.PROSPERO registration numberCRD42018108801.
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- 2020
48. Lower body negative pressure to safely reduce intracranial pressure
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Justin S. Lawley, William K. Cornwell, Louis A. Whitworth, Erin J. Howden, Satyam Sarma, Alexander Lilja-Cyron, Michael A. Williams, Johan Petersen, Benjamin D. Levine, Lonnie G. Petersen, Rong Zhang, and Marianne Juhler
- Subjects
Adult ,Male ,0301 basic medicine ,medicine.medical_specialty ,Supine position ,Intracranial Pressure ,Physiology ,Traumatic brain injury ,Posture ,Spaceflight ,law.invention ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,law ,Internal medicine ,Humans ,Medicine ,Cerebral perfusion pressure ,Aged ,Intracranial pressure ,Lower Body Negative Pressure ,Weightlessness ,business.industry ,musculoskeletal, neural, and ocular physiology ,Brain ,Middle Aged ,Space Flight ,medicine.disease ,Treatment Outcome ,030104 developmental biology ,medicine.anatomical_structure ,Blood pressure ,Ventricle ,Cardiology ,Female ,business ,030217 neurology & neurosurgery ,Gravitation ,Neuroscience - Abstract
KEY POINTS: During long‐term missions, some astronauts experience structural and functional changes of the eyes and brain which resemble signs/symptoms experienced by patients with intracranial hypertension. Weightlessness prevents the normal cerebral volume and pressure ‘unloading’ associated with upright postures on Earth, which may be part of the cerebral and ocular pathophysiology. By placing the lower body in a negative pressure device (LBNP) that pulls fluid away from cranial compartments, we simulated effects of gravity and significantly lowered pressure within the brain parenchyma and ventricle compartments. Application of incremental LBNP demonstrated a non‐linear dose–response curve, suggesting 20 mmHg LBNP as the optimal level for reducing pressure in the brain without impairing cerebral perfusion pressure. This non‐invasive method of reducing pressure in the brain holds potential as a countermeasure in space as well as having treatment potential for patients on Earth with traumatic brain injury or other pathology leading to intracranial hypertension. ABSTRACT: Patients with elevated intracranial pressure (ICP) exhibit neuro‐ocular symptoms including headache, papilloedema and loss of vision. Some of these symptoms are also present in astronauts during and after prolonged space‐flight where lack of gravitational stress prevents daily lowering of ICP associated with upright posture. Lower body negative pressure (LBNP) simulates the effects of gravity by displacing fluid caudally and we hypothesized that LBNP would lower ICP without compromising cerebral perfusion. Ten cerebrally intact volunteers were included: six ambulatory neurosurgical patients with parenchymal ICP‐sensors and four former cancer patients with Ommaya‐reservoirs to the frontal horn of a lateral ventricle. We applied LBNP while recording ICP and blood pressure while supine, and during simulated intracranial hypertension by 15° head‐down tilt. LBNP from 0 to 50 mmHg at increments of 10 mmHg lowered ICP in a non‐linear dose‐dependent fashion; when supine (n = 10), ICP was decreased from 15 ± 2 mmHg to 14 ± 4, 12 ± 5, 11 ± 4, 10 ± 3 and 9 ± 4 mmHg, respectively (P
- Published
- 2018
49. Monitoring and Measurement of Intracranial Pressure in Pediatric Head Trauma
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Pedersen, Sarah Hornshøj, Lilja-Cyron, Alexander, Astrand, Ramona, Juhler, Marianne, Pedersen, Sarah Hornshøj, Lilja-Cyron, Alexander, Astrand, Ramona, and Juhler, Marianne
- Abstract
Purpose of Review: Monitoring of intracranial pressure (ICP) is an important and integrated part of the treatment algorithm for children with severe traumatic brain injury (TBI). Guidelines often recommend ICP monitoring with a treatment threshold of 20 mmHg. This focused review discusses; (1) different ICP technologies and how ICP should be monitored in pediatric patients with severe TBI, (2) existing evidence behind guideline recommendations, and (3) how we could move forward to increase knowledge about normal ICP in children to support treatment decisions. Summary: Current reference values for normal ICP in adults lie between 7 and 15 mmHg. Recent studies conducted in "pseudonormal" adults, however, suggest a normal range below this level where ICP is highly dependent on body posture and decreases to negative values in sitting and standing position. Despite obvious physiological differences between children and adults, no age or body size related reference values exist for normal ICP in children. Recent guidelines for treatment of severe TBI in pediatric patients recommend ICP monitoring to guide treatment of intracranial hypertension. Decision on ICP monitoring modalities are based on local standards, the individual case, and the clinician's choice. The recommended treatment threshold is 20 mmHg for a duration of 5 min. Both prospective and retrospective observational studies applying different thresholds and treatment strategies for intracranial hypertension were included to support this recommendation. While some studies suggest improved outcome related to ICP monitoring (lower rate of mortality and severe disability), most studies identify high ICP as a marker of worse outcome. Only one study applied age-differentiated thresholds, but this study did not evaluate the effect of these different thresholds on outcome. The quality of evidence behind ICP monitoring and treatment thresholds in severe pediatric TBI is low and treatment can potentially be improved
- Published
- 2020
50. Prompt closure versus gradual weaning of external ventricular drainage for hydrocephalus in adult patients with aneurysmal subarachnoid haemorrhage:A systematic review
- Author
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Capion, Tenna, Lilja-Cyron, Alexander, Juhler, Marianne, Mathiesen, Tiit Illimar, Wetterslev, Jørn, Capion, Tenna, Lilja-Cyron, Alexander, Juhler, Marianne, Mathiesen, Tiit Illimar, and Wetterslev, Jørn
- Abstract
Objectives To summarise the evidence on benefits and harms of prompt closure versus gradual weaning of external ventricular drainage (EVD) in patients with hydrocephalus following aneurysmal subarachnoid haemorrhage (aSAH) based on randomised clinical trials (RCTs) in humans. Setting RCTs comparing prompt closure versus gradual weaning of EVD in adult patients with hydrocephalus following aSAH were included. Participants Patients aged equal to or greater than 18 years with an EVD due to hydrocephalus following aSAH were eligible for inclusion. Primary and secondary outcome measures Primary outcomes were all-cause mortality, any serious adverse event, rate of ventriculoperitoneal (VP) shunt placement and quality of life. Secondary outcomes were patients with shunt failure, hospital and neuro intensive care unit (NICU) length of stay (LOS) and complications related to treatment with an EVD. Data permitted report of rate of VP shunt placement, and hospital and NICU LOS. Results Six studies were assessed in full text. One RCT with 81 patients was included. Rate of VP shunt placement was 63.4% in the rapid weaning group (ie, prompt closure of the EVD; 41 patients) and 62.5% in the gradual weaning group (40 patients; p=0.932). LOS in hospital and NICU was significantly shorter in the rapidly weaned group compared with the gradually weaned group (mean 19.1 vs 21.5 days in hospital (p=0.03); and mean 14.1 vs 16.9 days in NICU (p=0.0002)). Data were insufficient to conduct meta-Analysis, trial sequential analysis or subgroup analysis of heterogeneity and sensitivity. One RCT is currently ongoing. Conclusions We found insufficient evidence to favour any of the two strategies for EVD discontinuation in patients with hydrocephalus following aSAH. PROSPERO registration number CRD42018108801.
- Published
- 2020
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