Page 49 - NNS 2014 Program & Abstract Book

Poster Abstracts
A1-01
THE SURGICAL STRATEGY OF PENETRATING ORBITO-
CRANIAL COMBINED INJURIES FROM HIGH TEMPERA-
TURE LIQUID PLASTIC: CASE REPORT
Yu, M.K.
Shanghai Changzheng Hospital, Department of Neurosurgery,
Shanghai, China
The objective is to report the surgical experience for one case with
penetrating orbito-cranial combined injuries from high temperature
plastic, we discuss the surgical key points and some announcements.
By imaging examination and physical examination, we found that the
plastic foreign bodies were inserted into the patient’s right eye socket,
which passed across orbital medial penetrating orbital plate into the
supraorbital fissure and anterior skull base. Using the right fronto-
temporal joint approach, the intracranial wound track was fully exposed
in operation. Due to the larger volume tip of foreign bodies which were
fixed in the orbit and could not be removed directly by cranial or orbital
department, intracranial foreign body could be only disconnected from
the orbital plate first, and then a thorough debridement was done. The
tissue spaces around the orbital foreign bodies were then separated out,
and the residual plastic foreign bodies incarcerated in upper eyelid,
intraorbital and outside the orbit were taken out. Finally, the recon-
struction of the skull base was implemented by neurosurgery.
After joint surgery by neurosurgeon and ophthalmology, removal of
orbital cranial foreign bodies, orbital-cranial wound debridement, and
the reconstruction of the skull base were finished during the same
period. The patient was cured through an operation with intact eye
ball at the injury side.
The state of these penetrating orbito-cranial wounds is complicated,
which will be difficult to handle and may directly endanger life.
Methods of dealing with orbital cranial penetrating injury have their
particularity. Based on the application of effective broad spectrum
antibiotics, the situation of foreign bodies and the wounded, and their
correlation with orbital or cranial injury should be clearly detected as
early as possible. According to the traumatic condition, it is the key to
take the appropriate surgical strategy for cure of this combined injury.
Because of complex structure and wide range around the injury, the
operation often needs multidisciplinary collaboration.
Key words
combined injury, cranium, high temperature plastic, orbit, penetrating
injury, surgery
A1-02
THE INTRATHORACIC PRESSURE REGULATOR LOWERS
INTRACRANIAL PRESSURE IN PATIENTS WITH ALTERED
INTRACRANIAL ELASTANCE: A PILOT
Naik, B.I., Huffmyer, J.L., Shaffrey, M.E., Nemergut, E.C.
University of Virginia, Charlottesville, USA
Intrathoracic pressure regulator (ITPR) is a noninvasive device designed
to improve hemodynamics. Application of negative pressure during the
expiratory phase of ventilation decreases intrathoracic pressure and
enhances venous return. ITPR can potentially decrease intracranial
pressure (ICP) and increase cerebral perfusion pressure (CPP) in brain-
injured patients. We conducted an open-label study of the ITPR in
patients with an ICP monitor and altered intracranial elastance.
Baseline hemodynamic variables and ICP were recorded prior to in-
serting one of the two ITPRs into the ventilator circuit based on a ran-
domization scheme. Depending on the device, activation provided either
- 5 or - 9mmHg endotracheal tube pressure. Hemodynamic and ICP
data were recorded sequentially every 2 minutes for 10 minutes. The first
device was turned off for 10 minutes, removed and the second device
was applied, and the procedure was repeated for the second device.
Ten patients were enrolled. Baseline ICP ranged from 12 to 38mm Hg.
With device application, a decrease in ICP was observed in 16 of
20 applications. During treatment with the - 5mmHg device, there was
a mean maximal decrease of 3.3 mmHg in ICP (21.7 vs. 18.4mm Hg,
p = 0.003), which was associated with an increase in CPP of 6.5mmHg
(58.2 vs. 64.7 mmHg, p = 0.019). During treatment with the - 9mmHg
device, there was a mean maximal decrease of 2.4mmHg in ICP (21.1
vs. 18.7mmHg, p = 0.044), which was associated with an increase in
CPP of 6.5mmHg (59.2 vs. 65.7mmHg, p = 0.001).
This pilot study demonstrates that use of the ITPR in patients with
altered intracranial elastance is feasible. This data strongly suggest
that the ITPR may be used to rapidly lower ICP and increase CPP
without apparent adverse effects. Additional studies will be needed to
assess longitudinal changes in ICP when the device is in use and to
delineate treatment parameters.
Key words
cerebral perfusion pressure, intrathoracic pressure regulator, negative
intrathoracic pressure, traumatic brain injury
A1-03
EARLY AND LATE TRACHEOSTOMY AFTER DECOM-
PRESSIVE CRANIECTOMY FOR SEVERE TRAUMATIC
BRAIN INJURY
Yang, S.H.
Department of Neurosurgery, St. Vincent’s Hospital, The Catholic
University of Korea, Suwon, Korea
The purpose of the study was to retrospectively compare the early and
late tracheostomy in terms of ventilator days, intensive care unit (ICU)
days, pneumonia, and clinical outcomes in patients with a severe trau-
matic brain injury (TBI) who underwent a decompressive craniectomy.
Patients who had a TBI and a Glasgow coma scale (GCS) score £ 8,
and were treated with a unilateral or bilateral decompressive cra-
niectomy were enrolled. Between January 2006 and December 2008,
37 patients were enrolled in the retrospective study. Percutaneous
tracheostomies were performed by trained residents. According to the
timing of the tracheostomy, the subjects were classified as the early
( £ 7 days; N = 20) or late group ( > 7 days; N = 17).
The average time of the tracheostomy was 3.2 – 1.4 days in the
early group and 9.7 – 0.9 days in the late group. There was no sta-
tistically significant difference between the early and late groups with
respect to total days of mechanical ventilation, ICU stay, Glasgow
outcome score (GOS), and pneumonia incidence. The duration of
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