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ICP monitoring is standard of care in most developed countries for
patient with severe TBI. Over the last decade or more other modalities
have been monitored in these patients: cerebral blood flow, partial
brain oxygenation pressure, seizures, spreading depression, and brain
metabolites, just to name a few. The efficacy of such will be discussed
in this presentation.
Keywords: Multimodality monitoring, Brain oxygenation, In-
tracranial pressure, EEG
AANS02-02
PRECISION MEDICINE FOR ICP TREATMENT: TCD IN-
DIVIDUALIZES TARGETING COMPLIANCE AND/OR PER-
FUSION AMELIORATION
Gregory Kapinos
1–3
, Ali Sadoughi
2
, Jamie Ullman
1–3
, Raj Narayan
1–3
1
North Shore-LIJ Health System, Neurosurgery, Manhasset, NY, USA
2
Hofstra North Shore-LIJ School of Medicine, Medicine, Hempstead,
NY, USA
3
Cushing Neuroscience Institute, Neurosurgery, Manhasset, NY, USA
Transcranial Doppler (TCD)-derived parameters can classify patients
into four categories: a group of patients at risk of raised intracranial
pressure (ICP) could benefit from ICP reduction by osmotherapy
alone, another group could benefit from blood pressure augmentation
alone, a third group would benefit from dual-targeted treatment, while
a fourth group with normal physiology could receive no treatment.
TCD was performed for non-invasive ICP monitoring in 5 patients
in our ICU with cerebral edema and risk for ICP-related ischemia, but
who were non-surgical or at high bleeding risk for ventriculostomy.
Cases were 1 hepatic failure and 1 meningitis, both with global ce-
rebral edema (GCE) and hemispheric hematoma with midline shift
(MLS), 1 moderate traumatic brain injury (TBI) and 2 hypertensive
hematomas with mass effect. TCD was used to derive pulsatility index
(PI) as a surrogate marker for brain compliance and end-diastolic
velocity (EDV) reflecting adequacy of cerebral perfusion pressure
(CPP). We applied therapeutic choices according to the 4 described
categories to specifically address the cerebral needs of each group.
One patient had no change in management because of normal PI
and EDV. Two received hypertonic saline along with induced hy-
pertension. One patient received mannitol and had vasopressors ta-
pered off to address break-through pressure edema. One patient
received hemodynamic augmentation for CPP amelioration. All pa-
tients had normalization of PI and EDV within our target range within
an hour of the tailored therapy. No patient had neurological deterio-
ration, worsening of GCE, MLS, new hemorrhage or developed in-
farcts within 48h of our repeated interventions.
TCD was helpful to tailor a better suited therapeutic intervention
within this novel treatment paradigm. We propose to refine goal-
directed therapies for the pleiomorphic entity of cerebral blood flow
compromise instead of focusing solely on elevated ICP.
Keywords: Transcranial doppler, Brain Compliance, Cerebral per-
fusion, Goal-directed therapy
AANS02-03
MANAGEMENT OF ACUTE NEUROVASCULAR INJURY
Soren Singel
1
, Patrick Noonan
2
, Jason Huang
2
1
University of California San Francisco, Neurological Surgery, San
Francisco, USA
2
Baylor Scott&White Neuroscience Institute, Neurological Surgery,
Temple, USA
Background:
Arterial and venous structures are frequently involved
in neurotrauma. Risks of surgical complications and overall morbidity
and mortality are high. Objectives: Demonstrate neurovascular in-
juries and principles of management.
Methods:
Case studies are used to illustrate critical injuries, tech-
nical nuances of the interventions and outcomes.
Results:
Penetrating injury at the superior sagittal sinus was man-
aged conservatively. Traumatic carotid-cavernous sinus fistula was
successfully closed endovascularly. Laceration of the torcular was
managed with angiography in the hybrid endovascular surgical suite
and open surgical repair. Lacerations of meningeal and cortical ves-
sels were repaired surgically in open depressed skull fracture.
Transection of the vertebral artery was managed with endovascular
vessel sacrifice. Good functional outcomes were achieved in all cases
with no surgical morbidity or mortality.
Conclusions:
Recognition of neurovascular anatomy at the site of
injury is crucial for the choice of treatment strategy. Good outcomes
and low surgical morbidity can be achieved.
Keywords: neurovascular, carotid cavernous fistula, vertebral artery
transection, torcular laceration, interventional treatment, surgical
management
AANS03 Outcomes after Spine Trauma
AANS03-01
DOES TIMING MATTER?
Aruna Ganju
Northwestern University Feinberg School of Medicine, Neurological
Surgery, Chicago, USA
Neurologic function, spinal column stability, or both may be affected
by spine trauma. Historically, the timing of surgical treatment of these
conditions has been controversial. In this session, the history of and
the more recent evidence supporting early surgery following spine
trauma will be reviewed. Specifically, the Surgical Trial in Acute
Spinal Cord Injury Study (STASCIS) data will be presented. Early
decompression (within 24 hours) should be considered as part of the
therapeutic management of any patient with spinal cord injury (SCI).
Very early decompression (within 12 hours) should be considered for
any patient with an incomplete cervical SCI.
Keywords: spinal column stability, acute SCI
AANS03-02
LUMBOSACRAL SPINAL CORD EPIDURAL STIMULATION
FOR STANDING AFTER CHRONIC COMPLETE PARALYSIS
IN HUMANS
Enrico Rejc
, Claudia Angeli, Susan Harkema
University of Louisville, Kentucky Spinal Cord Injury Research
Center, Louisville, USA
Motor complete spinal cord injury has been considered functionally
complete resulting in permanent paralysis with no recovery of vol-
untary movement, standing or walking. In this study, we showed that
two clinically sensory and motor complete participants were able to
stand over-ground bearing full body-weight without any external as-
sistance, using their hands to assist balance. The other two clinically
motor complete participants also used minimal external assistance for
hip extension. The combination of stand training and improvement of
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