[Trends in computed tomography characteristics, intracranial pressure monitoring and surgical management in severe traumatic brain injury: Analysis of a data base of the past 25 years in a neurosurgery department]. / Evolución temporal en las características de la tomografía computarizada, presión intracraneal y tratamiento quirúrgico en el traumatismo craneal grave: análisis de la base de datos de los últimos 25 años en un servicio de neurocirugía.

OBJECTIVE: To describe the radiological characteristics, surgical indications, procedures, and intracranial pressure monitoring of a representative cohort of severe traumatic brain injury (sTBI) cases collected over the past 25years, and to analyse the changes that have occurred by dividing the period into 3 equal time periods. METHODS: An observational cohort study was conducted on consecutive adult patients (>14years of age) with severe closed TBI (Glasgow Coma Scale score [GCS]≤8) who were admitted during the first 48hours after injury to the Hospital 12 de Octubre from 1987 to 2012. The most relevant radiological findings, surgical procedures, and intracranial monitoring indications reported in the literature were defined and compared in 3 equal time periods (1987-1995, 1996-2004, and 2005-2014). RESULTS: A significant increase was observed in subdural haematomas with lesions over 25cc, and midline shift in the last period of time. The incidence of subarachnoid haemorrhage increased significantly with time. There was a progression to a worse computed tomography (CT) classification from the initial CT scan in 33% of cases. Surgery was performed on 721 (39.4%) patients. Early surgery (<12hours) was performed on 585 (81.1%) patients, with the most frequent being for extra-cerebral mass lesions (subdural and epidural haematomas), whereas delayed surgery (>12hours) was most frequently performed due to an intracerebral haematoma. Surgical treatment, both early and late was significantly lower with respect to the first time period. Decompressive craniectomy with evacuation of the mass lesion was the preferred procedure in the last time period. Intracranial pressure monitoring (ICP) was carried out on 1049 (57.3%) patients, with a significantly higher frequency in the second period of time. There was adherence to Guidelines in 64.4% of cases. Elevated/uncontrolled ICP was more significant in the first time period. CONCLUSIONS: As a result of the epidemiological changes seen in traumatic brain injury, a different pattern of morphological injury is described, as depicted in the CT, leading to a difference in practice during this period of observation.

[Idiopathic intracranial hypertension and spontaneous cerebrospinal fluid fistula. Usefulness of intracranial pressure monitoring]. / Hipertensión intracraneal idiopática y fístula espontánea de líquido cefalorraquídeo. Utilidad de la monitorización de la presión intracraneal.

Spontaneous cerebrospinal fluid (CSF) fistulas are rather common in daily practice. The aim of the surgical treatment is closure of the leak, but recurrences are quite frequent. The association between spontaneous CSF fistulas and idiopathic intracranial hypertension (IIH) is not uncommon, and this is probably the cause of the low rate of success of the surgical treatment. Symptoms of IIH associated with spontaneous CSF fistula are atypical, and diagnosis is often missed. Continuous intracranial pressure monitoring is very useful in the diagnosis of chronic IIH and in patients with spontaneous CSF fistula, as it helps in making decisions on the treatment of these patients.

[Long-term prognosis of idiopathic chronic adult hydrocephalus: I. The University Hospital Marqués de Valdecilla diagnostic and therapeutic protocol]. / Pronóstico a largo plazo de la hidrocefalia crónica del adulto idiopática: I. Protocolo diagnóstico-terapéutico del Hospital Universitario Marqués de Valdecilla.

INTRODUCTION: Despite the existence of published guidelines for more than a decade, there is still a substantial variation in the management of idiopathic normal pressure hydrocephalus due to its diagnostic and therapeutic complexity. DEVELOPMENT: The diagnostic and therapeutic protocol for the management of idiopathic normal pressure hydrocephalus in use at the Department of Neurosurgery of the University Hospital Marqués de Valdecilla is presented. The diagnostic process includes neuropsychological testing, phase contrast cine MRI, urodynamic evaluation, continuous intracranial pressure monitoring, cerebrospinal fluid hydrodynamics by means of lumbar infusion testing, and intra-abdominal pressure measurement. A patient is considered a surgical candidate if any of the following criteria is met: mean intracranial pressure >15mmHg, or B-waves present in >10% of overnight recording; pressure-volume index <15ml, or resistance to cerebrospinal fluid outflow (ROUT) >4.5mmHg/ml/min in bolus infusion test; ROUT >12mmHg/ml/min, intracranial pressure >22mmHg, or high amplitude B-waves in the steady-state of the continuous rate infusion test; or a clinical response to high-volume cerebrospinal fluid withdrawal. CONCLUSIONS: The implementation of a diagnostic and therapeutic protocol for idiopathic normal pressure hydrocephalus management could improve various aspects of patient care. It could reduce variability in clinical practice, optimise the use of health resources, and help in identifying scientific uncertainty areas, in order to direct research efforts in a more appropriate way.

[Monitoring intracranial pressure in severe traumatic brain injury]. / Monitorización de la presión intracraneal en traumatismo craneoencefálico severo.

INTRODUCTION: Severe traumatic brain injury (TBI) is a serious condition. Intracranial pressure (ICP) monitoring can be used to direct treatment, which is of limited access in developing countries. OBJECTIVE: To describe the clinical experience of pediatric patients with severe TBI. PATIENTS AND METHOD: A clinical experience in patients with severe TBI was conducted. Age was 1-17 years, exclusion criteria were chronic illness and psicomotor retardation. Informed consent was obtained in each case. Two groups were formed based on the criterion of neurosurgeons: with and without intracraneal pressure (ICP) monitoring. PIC monitoring was performed through a 3PN Spiegelberg catheter and a Spiegelberg HDM 26 monitor. Patients were treated according international pediatric guides. The characteristics of both groups are described at 6 months of follow-up. RESULTS: Forty-two patients (CM=14 and SM=28). Those in the CM Group had lower Glasgow coma scale score and Marshall classification with poorer prognosis. Among them survival rate was lower, although the outcome was from moderate to good. No complications were reported with the use of the ICP catheter. CONCLUSION: Patients with ICP monitoring had greater severity at admission and an increased mortality; however, the outcome for the survivors was from moderate to good. It is necessary to conduct randomized clinical trials to define the impact of ICP monitoring on survival and quality of life in severe TBI patients.

Basic concepts about brain pathophysiology and intracranial pressure monitoring.

INTRODUCTION: Many brain processes that cause death are mediated by intracranial hypertension (ICH). The natural course of this condition inevitably leads to brain death. The objective of this study is to carry out a systematic review of cerebral pathophysiology and intracranial pressure (ICP) monitoring. DEVELOPMENT: Studying, monitoring, and recording ICP waves provide data about the presence of different processes that develop with ICH. CONCLUSIONS: Correct monitoring of ICP is fundamental for diagnosing ICH, and even more importantly, providing appropriate treatment in a timely manner.

[Usefulness of intracranial pressure continuous monitoring in pseudotumor cerebri]. / Utilidad de la monitorización de la presión intracraneal en pacientes con sospecha de hipertensión intracraneal benigna.

OBJECTIVES: To analyse the usefulness of intracranial pressure (ICP) monitoring in pseudotumor cerebri (PTC). MATERIAL AND METHODS: Ten patients with suspected PTC, but having incomplete criteria for the syndrome, on whom ICP monitoring was performed. Demographic, clinical and radiological data were collected, as well as ICP monitoring data and related complications. Results were evaluated 6 months after surgery. RESULTS: In relation to demographics, all patients were young females. Mean ICP was less than 250 mmH2O in 5 of 8 patients with pathological monitoring. Most patients (62.5%) showed A waves; these were related with higher mean ICP, but not always with papilloedema. All recordings showed high amplitude B waves. Most pathological recordings showed wave amplitudes superior to 5 mmHg. There were no complications related to the monitoring technique. CONCLUSIONS: Clinical and lumbar opening pressure data are not enough to establish PTC diagnosis correctly, especially if patient has been treated previously. Monitoring using ICP is a valuable, safe tool, and very useful in this syndrome. Mean ICP could be normal even with pathological recordings. Morphological analysis is necessary to establish diagnosis. A and B waves are highly related to shunt response. Wave amplitude is related to brain compliance and to shunt response as well.

[Usefulness of continuous intracranial pressure monitoring in long-standing overt ventriculomegaly in adults]. / Utilidad de la monitorización de la presión intracraneal en pacientes con ventriculomegalia marcada de larga evolución.

OBJECTIVES: To analyze the usefulness of intracranial pressure (ICP) monitoring in overt long-standing ventriculomegaly patients. MATERIAL AND METHODS: There were 22 patients with ventriculomegaly and neurological symptoms. Demographic, clinical and radiological data were collected, as well as ICP monitoring data and complications related to the procedure. Results were evaluated 6 months after surgery. RESULTS: Mean age was 44 years (22-70). Mean Evans index was 0.47 (0.35-0.66). Aqueductal stenosis was present in more than half of the patients (55%). Mean ICP was higher than 12 mmHg in only 9% of patients. Morphological analysis of ICP recordings was abnormal in 64% of patients. "Pre-plateau" A waves were seen in 7 patients, with B waves seen in 20 patients (high amplitude B waves in 14). Twelve patients were operated on the basis of ICP recordings (CSF shunt or ventriculostomy). Seventy per cent of treated patients had improved at 6 months. There were no complications related to the monitoring technique. CONCLUSIONS: ICP monitoring is a valuable, safe tool, very useful in these cases. Selection of surgical candidates on the basis of ICP monitoring seems to be advisable. Mean ICP may be normal even with pathological recordings. Morphological analysis is essential to establish a correct diagnosis. The presence of A and B waves in the recording is highly related to good shunt response.

[Intracranial pressure monitoring in severe traumatic brain injury: A different perspective of the BestTrip trial]. / Monitorización de la presión intracraneal en el traumatismo craneoencefálico grave: otra visión del Best Trip trial.

The present study outlines a series of questions and reflections upon the recent publication of Chesnut et al., who compared 2 approaches to the treatment of intracranial hypertension (ICH) in severe head injuries: one with and the other without intracranial pressure monitoring (ICP). The authors concluded that no improved outcome was observed in the treatment group guided by ICP monitoring. The main concerns relate to the degree of training of the physicians involved in the monitoring and management of ICH in the ICP group, as well as to the possible inter-observer variability in interpreting the CT scans, the capacity of clinical signs to guide the treatment of ICH, and the suitability of randomization. The analysis of this trial should not be taken to suggest the futility of ICP monitoring but rather the need to correctly use the information afforded by ICP monitoring, with emphasis on the importance of the definition of alternative methods for non-invasive monitoring.

Effects of PEEP on intracranial pressure in patients with acute brain injury: An observational, prospective and multicenter study.

OBJECTIVE: To analyze the impact of positive end-expiratory pressure (PEEP) changes on intracranial pressure (ICP) dynamics in patients with acute brain injury (ABI). DESIGN: Observational, prospective and multicenter study (PEEP-PIC study). SETTING: Seventeen intensive care units in Spain. PATIENTS: Neurocritically ill patients who underwent invasive neuromonitorization from November 2017 to June 2018. INTERVENTIONS: Baseline ventilatory, hemodynamic and neuromonitoring variables were collected immediately before PEEP changes and during the following 30 min. MAIN VARIABLES OF INTEREST: PEEP and ICP changes. RESULTS: One-hundred and nine patients were included. Mean age was 52.68 (15.34) years, male 71 (65.13%). Traumatic brain injury was the cause of ABI in 54 (49.54%) patients. Length of mechanical ventilation was 16.52 (9.23) days. In-hospital mortality was 21.1%. PEEP increases (mean 6.24-9.10 cmH2O) resulted in ICP increase from 10.4 to 11.39 mmHg, P < .001, without changes in cerebral perfusion pressure (CPP) (P = .548). PEEP decreases (mean 8.96 to 6.53 cmH2O) resulted in ICP decrease from 10.5 to 9.62 mmHg (P = .052), without changes in CPP (P = .762). Significant correlations were established between the increase of ICP and the delta PEEP (R = 0.28, P < .001), delta driving pressure (R = 0.15, P = .038) and delta compliance (R = -0.14, P = .052). ICP increment was higher in patients with lower baseline ICP. CONCLUSIONS: PEEP changes were not associated with clinically relevant modifications in ICP values in ABI patients. The magnitude of the change in ICP after PEEP increase was correlated with the delta of PEEP, the delta driving pressure and the delta compliance.

Relación entre la medición por tomografía y ecografía del diámetro de la vaina del nervio óptico como estimador no invasivo de la presión intracraneal.

OBJECTIVE: To compare the ONSD measured by ultrasound and tomography in patients with a diagnosis of intracranial hypertension. METHOD: Prospective, transversal, observational, analytical study. 105 patients were included, divided into two groups: healthy (control group) and patients presenting clinical data of intracranial hypertension (study group). ONSD was measured by ultrasound and tomography. The Kruskal-Wallis test was used to compare the ONSD between the patients, and the Spearman test was used to assess the correlation between USG and CT. A value of p <0.05 was considered statistically significant. RESULTS: Of the 105 patients, 58.1% were men and 41.9% women. The study group included 14 patients with TBI, CVD, intracranial neoplasia, or neuroinfection. The highest median of ONSD by Ultrasound was in the CVD group, followed by TBI, neoplasia and neuroinfection and the lowest was in the control group (7.5, 7.0, 6.8, 6.8 and 5.2 mm respectively); these differences being statistically significant (p < 0.001). In the correlation analysis between Ultrasound and CT, a good statistically significant positive correlation was found (rho = 0.893, p < 0.001). CONCLUSIONS: The ultrasound evaluation of ONSD has proven to be a reliable test for the diagnosis and non-invasive monitoring of intracranial hypertension.

OBJETIVO: Comparar el diámetro de la vaina del nervio óptico (DVNO) medido por ultrasonografía (USG) y tomografía computarizada (TC) en pacientes con diagnóstico de hipertensión intracraneal. MÉTODO: Estudio prospectivo, transversal, observacional y analítico. Se incluyeron 105 pacientes divididos en dos grupos: sanos (grupo control) y pacientes que presentaran datos clínicos de hipertensión intracraneal (grupo de estudio). Se midió el DVNO por USG y TC. Para comparar el DVNO entre los pacientes se utilizó la prueba de Kruskal-Wallis, y para evaluar la correlación entre USG y TC se utilizó la prueba de Spearman. Un valor de p < 0.05 fue considerado estadísticamente significativo. RESULTADOS: De los 105 pacientes, el 58.1% eran hombres y el 41.9% mujeres. El grupo de estudio incluyó 14 pacientes con traumatismo craneoencefálico (TCE), evento vascular cerebral (EVC), neoplasia intracraneal o neuroinfección. La mayor mediana de DVNO por USG la tuvo el grupo de EVC, seguido de los pacientes con TCE, neoplasia y neuroinfección, y la menor la tuvo el grupo control (7.5, 7.0, 6.8, 6.8 y 5.2 mm, respectivamente), siendo estas diferencias estadísticamente significativas (p < 0.001). En el análisis de correlación entre USG y TC se encontró una buena correlación positiva estadísticamente significativa (rho = 0.893, p < 0.001). CONCLUSIONES: La evaluación por USG del DVNO ha demostrado ser una prueba confiable para el diagnóstico y el monitoreo no invasivo de la hipertensión intracraneal.

Optic nerve sheath diameter with intracranial pressure monitoring: a non-invasive method to follow children with craniosynostosis.

Craniosynostosis (CS) is associated with increased intracranial pressure (ICP) and this elevation is of vital importance in children. Bedside optic nerve sheath diameter (ONSD) on ocular ultrasonography has begun to be increasingly used in recently. A patient who was diagnosed with CS, standard anesthesia monitoring and anesthesia were performed. Before and after the surgery, ONSD measurement was performed to follow the changes in ICP. ONSD measurement can be used as an effective, non-invasive, repeated, and easy-to-apply method to monitor the changes in the ICP in pediatric patients with CS who are planned to undergo craniectomy.

La craneosinostosis (SC) se asocia con un aumento de la presión intracraneal (PIC) y esta elevación es de vital importancia en los niños. El diámetro de la vaina del nervio óptico al lado de la cama (ONSD) en la ecografía ocular ha comenzado a usarse cada vez más recientemente. A un paciente al que se le diagnosticó SC, se le realizó seguimiento anestésico estándar y anestesia. Antes y después de la cirugía, se realizó la medición ONSD para seguir los cambios en la PIC. La medición ONSD se puede utilizar como un método eficaz, no invasivo, repetido y fácil de aplicar para monitorear los cambios en la PIC en pacientes pediátricos con SC que se planea someter a craniectomía.

Neuromonitoring in the severe traumatic brain injury. Spanish Trauma ICU Registry (RETRAUCI). / Neuromonitorización en el traumatismo craneoencefálico grave. Datos del Registro español de Trauma en UCI (RETRAUCI).

OBJECTIVES: To analyze the use of intracranial pressure (ICP) and cerebral oximetry monitoring in patients with severe traumatic brain injury (TBI) according to the Spanish Trauma ICU Registry (RETRAUCI). METHODS: We included TBI patients with Glasgow Coma Scale score ≤ 8. Hypotheses were tested using the Student-T or Wilcoxon tests (quantitative variables) and the Chi-square test (categorical variables). Multivariate analysis using logistic regression was performed to analyze the variables associated with the use of ICP monitoring. RESULTS: We analyzed 1463 patients. Age 49.1 years. Males 1130 (77.3%). Mechanism of injury: falls in 350 cases (23.9%). Injury Severity Score 27.9. Uni- or bilateral mydriasis was present in 39.3% of the patients. Neurosurgical intervention within 24hours was performed in 331 patients (22.7%). ICP was monitored in 635 patients (45.1%), pbtO2 in 122 patients (8.6%), SjVO2 in 19 patients (1.34%) and NIRS was used in 25 cases (1.77%). In the multivariate analysis, age, bilateral mydriasis at admission and previous use of antiplatelets or anticoagulants was inversely related with ICP monitoring. Severity of injury and the need of neurosurgical intervention increased the probability of ICP monitoring. CONCLUSIONS: Our study shows a picture of ICP monitoring in severe TBI patients in our environment. Use of cerebral oximetry techniques is very limited.

Ultrasonografía del diámetro de la vaina del nervio óptico en voluntarios sanos

Fundamento: La ultrasonografía del diámetro de la vaina del nervio óptico ha sido utilizada como medidor no invasivo de la presión intracraneal. Una de las deficiencias enunciadas resulta, la no existencia de un valor estándar, que sugiera el límite entre la normalidad y la hipertensión intracraneal. Objetivo: Determinar el diámetro de la vaina del nervio óptico mediante ecografía en voluntarios sanos. Métodos: Se realizó un estudio ecológico de poblaciones múltiples en 160 voluntarios sanos que cumplieron con los criterios de inclusión. Se realizaron 3 mediciones ultrasonográficas en modo B en cada ojo, se tomó como valor final el promedio. Las variables estudiadas fueron: edad, sexo, color de la piel y diámetro de la vaina del nervio óptico. Se calculó el porcentaje, media, mediana, límite y estándar. Con un valor de referencia al 95 % del intervalo de confianza. La relación entre las variables se determinó mediante análisis de regresión logística simple con el paquete estadístico de SPSS 22.0. Resultados: El diámetro de la vaina del nervio óptico, en los sujetos, se cuantificó entre 4,62 - 4,80 mm y 4,66 - 4,83 mm para los ojos derecho e izquierdo respectivamente. Al análisis de regresión lineal simple, solo el sexo se asoció al valor del diámetro de la vaina del nervio óptico (p= 0,000). Conclusiones: En una población de voluntarios sanos el valor del diámetro de la vaina del nervio óptico fue similar a otras descripciones, con diferencias entre el sexo, lo cual sugiere tomar en consideración esta variable al hacer la medición.

Foundation: Ultrasonography of the diameter of the optic nerve sheath has been used as a non-invasive measure of intracranial pressure. One of the deficiencies stated is the non-existence of a standard value that suggests the limit between normality and intracranial hypertension. Objective: Determine the diameter of the optic nerve sheath using ultrasound in healthy volunteers. Methods: A multi-population ecological study was conducted on 160 healthy volunteers who met the inclusion criteria. Three ultrasonographic measurements were performed in B mode in each eye, the average was taken as the final value. The variables studied were: age, sex, skin color and diameter of the optic nerve sheath. The percentage, mean, median, limit and standard were calculated. With a reference value at the 95% confidence interval. The relationship between the variables was determined by simple logistic regression analysis with the SPSS 22.0 statistical package. Results: That diameter of the optic nerve sheath, in the subjects, was quantified between 4.62 - 4.80 mm and 4.66 - 4.83 mm for the right and left eyes respectively. In the simple linear regression analysis, only sex was associated with the value of the diameter of the optic nerve sheath (p= 0.000). Conclusions: In a population of healthy volunteers, the value of the diameter of the optic nerve sheath was similar to other descriptions, with differences between sex, which suggests taking this variable into consideration when making the measurement.

Craniectomía descompresiva como alternativa terapéutica en la hipertensión intracraneal pediátrica incontrolable por traumatismo craneoencefálico grave / Decompressive craniectomy as a therapeutic alternative in uncontrollable intracranial hypertension in pediatric severe head injury

Introducción: El traumatismo craneoencefálico grave presenta una elevada incidencia en pacientes pediátricos. Es una importante causa de muerte y discapacidad. Sus causas más comunes en este grupo etario son los accidentes domésticos y de tránsito, caídas, violencia y actividades deportivas. Se realizó una revisión bibliográfica en julio y agosto de 2023 con un total de 38 bibliografías en idioma español, inglés y portugués en las bases de datos de SciElo, Elsevier, Pubmed y el motor de búsqueda Google Académico. Se consideró como criterio de selección aquella literatura publicada con mayor actualidad en concordancia con lo novedoso de esta enfermedad. Objetivo: Describir la craniectomía descompresiva como una alternativa a la hipertensión intracraneal pediátrica producida por traumatismo craneoencefálico grave. Desarrollo: Ante un traumatismo craneoencefálico grave, la presión intracraneal aumenta, lo que causa hipertensión intracraneal. Cuando esta hipertensión no se logra controlar, se convierte en refractaria, se requieren otros tratamientos más agresivos como la craniectomía descompresiva. Este procedimiento es invasivo, consiste en remover parte del cráneo para disminuir la presión dentro de la cavidad craneana. Conclusiones: Es necesario continuar los estudios de craniectomía descompresiva en el manejo de la hipertensión craneal pediátrica en la población infanto-juvenil, pues los estudios enfocados en ellos no abundan; estos constituyen una intervención de rescate. A pesar de los adelantos científicos, logros terapéuticos alcanzados y conocimientos de la hipertensión craneal pediátrica, se considera la craniectomía descompresiva como una elección terapéutica óptima, con una justa predicción y no brindarla cuando las opciones reales de éxito sean insuficientes(AU)

Introduction: Severe head trauma has a high incidence in pediatric patients. It is a major cause of death and disability. Its most common causes in this age group are domestic and traffic accidents, falls, violence and sports activities. A bibliographic review was carried out in July and August 2023 with a total of 38 bibliographies in Spanish, English and Portuguese from the SciElo, Elsevier, Pubmed databases and the Google Scholar search engine. The most recent published literature in accordance with the novelty of this disease was considered as a selection criterion. Objective: To describe decompressive craniectomy as an alternative to pediatric intracranial hypertension caused by severe head trauma. Development: In the event of severe head trauma, intracranial pressure increases, causing intracranial hypertension. When this hypertension cannot be controlled, it becomes refractory, other more aggressive treatments such as decompressive craniectomy are required. This procedure is invasive, it consists of removing part of the skull to reduce the pressure inside the cranial cavity. Conclusions: It is necessary to continue studies of decompressive craniectomy in the management of pediatric cranial hypertension in the child and adolescent population, since studies focused on them are not abundant; these constitute a rescue intervention. Despite scientific advances, therapeutic achievements and knowledge of pediatric cranial hypertension, decompressive craniectomy is considered an optimal therapeutic choice, with fair prediction and not provided when the real options for success are insufficient(AU)

Conocimiento de enfermería en el traumatismo craneoencefálico grave y monitorización de la presión intracraneal

Introducción: El traumatismo craneoencefálico grave es una importante causa de mortalidad e incapacidades en todo el mundo, y la causa más común es el traumatismo cerrado; algunos lo consideran una "epidemia silenciosa". La monitorización de la presión intracraneal, su adecuado registro, y la correcta interpretación de los valores, permiten un diagnóstico y un tratamiento precoz, sin llegar a la hipertensión intracraneal. Objetivo: Identificar el nivel de conocimiento de enfermería en el traumatismo craneoencefálico grave y monitorización de la presión intracraneal. Métodos: Se realizó un estudio analítico observacional, descriptivo y transversal, de desarrollo tecnológico, en la Unidad de Cuidados Intensivos del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, en el período de enero de 2022 a julio de 2023. El universo estuvo conformado por los 62 enfermeros a los que fueron aplicados el criterio de inclusión (voluntad de participar en el estudio) y de exclusión (enfermeros de estancia transitoria). Se utilizaron la planilla de recolección de datos y un cuestionario. Resultados: El mayor porciento de los enfermeros estudiados fue asistencial a pie de cama; entre los años de experiencia prevaleció de 0-1 año, y las edades de 20-29 años. La aplicación del cuestionario exploró el estado de conocimientos en el nivel Bajo. En la etapa de diagnóstico se constató la necesidad de fortalecer los conocimientos de enfermería en el actuar del paciente con traumatismo craneoencefálico grave y monitorización de la presión intracraneal. Conclusiones: Se diagnosticó la necesidad de fortalecer los conocimientos para el afrontamiento de los cuidados con el paciente con traumatismo craneoencefálico grave.

Introduction: Severe traumatic brain injury is an important cause of mortality and disability worldwide and the most common cause is blunt trauma; some consider it a "silent epidemic." The monitoring of intracranial pressure, its adequate recording, and the correct interpretation of the values allow early diagnosis and treatment, without reaching intracranial hypertension. Objective: To identify the level of nursing knowledge on severe traumatic brain injury and intracranial pressure monitoring. Methods: An observational, descriptive and cross-sectional analytical study of technological development was carried out in the Intensive Care Unit of the Clinical Surgical University Hospital Comandante Faustino Pérez Hernandez, in the period from January 2022 to July 2023. The universe was made up of the 62 nurses to whom the inclusion criteria (the willingness to participate in the study) and exclusion criteria (temporary stay nurses) were applied. The data collection form and a questionnaire were used. Results: The highest percentage of the nurses studied provided care at the bedside; among the years of experiences prevailed from 0-1 year and ages were 20-29 years. The application of the questionnaire explored the level of knowledge at the Low level. In the diagnosis stage, the need to strengthen nursing knowledge on the actions of patient with severe traumatic brain injury and intracranial pressure monitoring was confirmed. Conclusions: It was diagnosed the need to strengthen knowledge to cope with care for patients with traumatic brain injury.

Preliminary Study on Application of Combined Monitoring of Neuroelectrophysiology-Intracranial Pressure-Cerebral Perfusion Pressure in Craniotomy for Intracranial Aneurysm Clipping: An Anatomical and Clinical Study

SUMMARY: Intracranial aneurysm is a common cerebrovascular disease with high mortality. Neurosurgical clipping for the treatment of intracranial aneurysms can easily lead to serious postoperative complications. Studies have shown that intraoperative monitoring of the degree of cerebral ischemia is extremely important to ensure the safety of operation and improve the prognosis of patients. Aim of this study was to probe the application value of combined monitoring of intraoperative neurophysiological monitoring (IONM)-intracranial pressure (ICP)-cerebral perfusion pressure (CPP) in craniotomy clipping of intracranial aneurysms. From January 2020 to December 2022, 126 patients in our hospital with intracranial aneurysms who underwent neurosurgical clipping were randomly divided into two groups. One group received IONM monitoring during neurosurgical clipping (control group, n=63), and the other group received IONM-ICP-CPP monitoring during neurosurgical clipping (monitoring group, n=63). The aneurysm clipping and new neurological deficits at 1 day after operation were compared between the two groups. Glasgow coma scale (GCS) score and national institutes of health stroke scale (NIHSS) score were compared before operation, at 1 day and 3 months after operation. Glasgow outcome scale (GOS) and modified Rankin scale (mRS) were compared at 3 months after operation. All aneurysms were clipped completely. Rate of new neurological deficit at 1 day after operation in monitoring group was 3.17 % (2/63), which was markedly lower than that in control group of 11.11 % (7/30) (P0.05). Combined monitoring of IONM-ICP-CPP can monitor the cerebral blood flow of patients in real time during neurosurgical clipping, according to the monitoring results, timely intervention measures can improve the consciousness state of patients in early postoperative period and reduce the occurrence of early postoperative neurological deficits.

El aneurisma intracraneal es una enfermedad cerebrovascular común con alta mortalidad. El clipaje neuroquirúrgico para el tratamiento de aneurismas intracraneales puede provocar complicaciones posoperatorias graves. Los estudios han demostrado que la monitorización intraoperatoria del grado de isquemia cerebral es extremadamente importante para garantizar la seguridad de la operación y mejorar el pronóstico de los pacientes. El objetivo de este estudio fue probar el valor de la aplicación de la monitorización combinada de la monitorización neurofisiológica intraoperatoria (IONM), la presión intracraneal (PIC) y la presión de perfusión cerebral (CPP) en el clipaje de craneotomía de aneurismas intracraneales. Desde enero de 2020 hasta diciembre de 2022, 126 pacientes de nuestro hospital con aneurismas intracraneales que se sometieron a clipaje neuroquirúrgico se dividieron aleatoriamente en dos grupos. Un grupo recibió monitorización IONM durante el clipaje neuroquirúrgico (grupo de control, n=63) y el otro grupo recibió monitorización IONM-ICP-CPP durante el clipaje neuroquirúrgico (grupo de monitorización, n=63). Se compararon entre los dos grupos el recorte del aneurisma y los nuevos déficits neurológicos un día después de la operación. La puntuación de la escala de coma de Glasgow (GCS) y la puntuación de la escala de accidentes cerebrovasculares de los institutos nacionales de salud (NIHSS) se compararon antes de la operación, 1 día y 3 meses después de la operación. La escala de resultados de Glasgow (GOS) y la escala de Rankin modificada (mRS) se compararon 3 meses después de la operación. Todos los aneurismas fueron cortados por completo. La tasa de nuevo déficit neurológico 1 día después de la operación en el grupo de seguimiento fue del 3,17 % (2/63), que fue notablemente inferior a la del grupo de control del 11,11 % (7/30) (P 0,05). La monitorización combinada de IONM-ICP-CPP puede controlar el flujo sanguíneo cerebral de los pacientes en tiempo real durante el corte neuroquirúrgico; de acuerdo con los resultados de la monitorización, las medidas de intervención oportunas pueden mejorar el estado de conciencia de los pacientes en el período postoperatorio temprano y reducir la aparición de problemas postoperatorios tempranos y déficits neurológicos.

Comparison between the parietal foramina observed in samples of African and European population groups / Comparación entre los forámenes parietales observados en muestras de grupos de población africanos y europeos

SUMMARY: Parietal foramina of the human skull act as a passageway for emissary veins, connecting the superior sagittal sinus to the veins of the scalp. This passageway can lead to the spread of infection from the scalp to the dural venous sinuses, but may also assist in relieving intracranial pressure. However, variation in the prevalence of parietal foramina has been noted among population groups. This observational and descriptive study aimed to determine the incidence, size and location of parietal foramina by using osteological specimens of 252 African skulls from the Sefako Makgatho Health Sciences University, South Africa and 95 European skulls from the University of Leipzig, Germany. Parietal foramina were significantly more common in the African sample (61.9 %) compared to the European sample (55.8 %). Moreover, the Central European sample displayed more unilateral foramina (29.5 %), while the African sample exhibited more bilateral foramina (40.8 %). The diameter of the parietal foramen average 1.98 mm and 1.88 mm for the European and African samples, respectively. In this study, a median foramen on the sagittal suture was observed in 14 of the overall skull caps (4 %). This study demonstrated that parietal foramina are more prevalent than anticipated in both population groups. Findings of this study, indicating an increased prevalence, and the subsequent possibility of more emissary veins encountered, can be used to improve the understanding of the variations in the prevalence and clinical implications of the parietal foramen among various population groups located world-wide.

Los forámenes parietales del cráneo humano actúan como una vía para las venas emisarias, conectando el seno sagital superior con las venas del cuero cabelludo. Este pasaje puede conducir a la propagación de infecciones desde el epicráneo (calva) hasta los senos venosos durales, pero también puede ayudar a aliviar la presión intracraneal. Sin embargo, se ha observado una variación en la prevalencia de los forámenes parietales entre los grupos de población. Este estudio observacional y descriptivo tuvo como objetivo determinar la incidencia, el tamaño y la ubicación de los forámenes parietales mediante el uso de muestras osteológicas de 252 cráneos africanos de la Universidad de Ciencias de la Salud Sefako Makgatho, Sudáfrica, y 95 cráneos europeos de la Universidad de Leipzig, Alemania. Los forámenes parietales fueron significativamente más comunes en la muestra africana (61,9 %) en comparación con la muestra europea (55,8 %). Además, la muestra centroeuropea mostró más forámenes unilaterales (29,5 %), mientras que la muestra africana mostró más forámenes bilaterales (40,8 %). El diámetro del foramen parietal promedió 1,98 mm y 1,88 mm para las muestras europeas y africanas, respectivamente. En este estudio, se observó un foramen medio en la sutura sagital en 14 de los cráneos en general (4 %). El estudio demostró que los forámenes parietales son más frecuentes de lo previsto en ambos grupos de población. Los hallazgos de este estudio, que indican una mayor prevalencia y la subsiguiente posibilidad de que se encuentren más venas emisarias, pueden ser útiles para mejorar la comprensión de las variaciones en la prevalencia y las implicaciones clínicas del foramen parietal entre varios grupos de población ubicados en el mundo.

Relationship between prehospital clinical status intracranial pressure and outcomes in pediatric patients with severe head trauma

Introduction: The prehospital phase of the management of pediatric severe traumatic brain injury may have a direct influence on the results. Objective: To evaluate the influence of prehospital variables on intracranial pressure and the results in pediatric patients with severe TBI. Method: A descriptive study of 41 pediatric patients who were admitted to the medical emergency department and later admitted to the pediatric intensive care unit due to severe head trauma was carried out between January 2003 and December 2018. Results: children aged 5-17 years predominate, and the highest number of cases were received between 0-3h at the neurotrauma center. Of the 41 cases, 27 arrived with a non-expedited airway and hypoxia was verified upon arrival by pulse oximetry. A correlation was observed between arterial hypotension on admission and elevated intracranial pressure in 9 of 15 children (60%) and in the deceased (40%). Discussion: Clinical conditions, oxygenation, arterial hypotension, and treatment in the prehospital phase may influence the state of intracranial pressure and other intracranial variables in pediatric patients with severe head injury.

Introducción: La fase prehospitalaria del manejo del traumatismo craneoencefálico grave pediátrico puede tener una influencia directa en los resultados. Objetivo: Evaluar la influencia de variables prehospitalarias sobre la presión intracraneal y los resultados en pacientes pediátricos con TCE grave. Metodología: Se realizó un estudio descriptivo de 41 pacientes pediátricos que ingresaron al servicio de urgencias médicas y posteriormente ingresaron a la unidad de cuidados intensivos pediátricos por traumatismo craneoencefálico severo entre enero de 2003 y diciembre de 2018. Resultados: predominan los niños de 5 a 17 años, y el mayor número de casos se recibieron entre las 0-3h en el centro de neurotrauma. De los 41 casos, 27 llegaron con vía aérea no acelerada y se verificó hipoxia al llegar mediante oximetría de pulso. Se observó correlación entre hipotensión arterial al ingreso y presión intracraneal elevada en 9 de 15 niños (60%) y en los fallecidos (40%). Discusión: Las condiciones clínicas, la oxigenación, la hipotensión arterial y el tratamiento en la fase prehospitalaria pueden influir en el estado de la presión intracraneal y otras variables intracraneales en pacientes pediátricos con traumatismo craneoencefálico grave.

Manuel Balado y las diferenciasde presión craneal y espinal / Manuel Balado and the cranial and spinal pressure differences

Manuel Balado (1897-1942), pionero de la neurocirugía argentina, es más conocido por sus estudios sobre la vía óptica y la sistematización de la iodoventriculografía. Sus inquietudes, sin embargo, abarcaron numerosos otros campos, siendo uno de ellos la existencia de diferencias de presión entre compartimientos craneales y espinales. En sus Lecciones de Cirugía Neurológica, el primer texto exclusivo de la especialidad en la Argentina, hizo una descripción original de los mismos. Reproducimos aquí varios de los mismos, la mayoría aún válidos, y los analizamos en su contexto y a la luz de los conocimientos actuales. No hemos hallado descripciones similares en la bibliografía de su tiempo(AU)

Manuel Balado (1897-1942), a pioneer of Argentinian neurosurgery, is best known for his studies on the optic pathway and iodoventriculography. Their concerns, however, encompassed numerous other fields, one of them being the pressure differences between the cranial and spinal compartments. In his Lessons on Neurological Surgery, the first exclusive text of the specialty in Argentina, he made an original description of them. We reproduce here several of his schemes, most of them still valid, and we analyze them in their context and in the light of current knowledge. We did not find similar descriptions in the bibliography of his time(AU)

Ecografía de nervio óptico para estimar hipertensión intracraneal en pacientes adultos con neurotrauma / Optic Nerve Ultrasound to Estimate Intracranial Hypertension in Adult Patients with Neurotrauma

Introducción: El neurotrauma es una condición que puede dar paso a una hipertensión intracraneana, situación que es muy grave. Los métodos diagnósticos de elección son los invasivos, aun así, los no invasivos y entre ellos la ecografía del nervio óptico, ofrecen muchísimas ventajas. Objetivo: Describir elementos esenciales de la ecografía de nervio óptico como método para diagnosticar hipertensión intracraneal en pacientes adultos con neurotrauma. Métodos: Se hizo una revisión de la literatura más reciente sin restricción lingüística o geográfica en las bases de datos PubMed y SciELO, se usaron términos afines al tema del artículo y se realizó una valoración crítica sobre la bibliografía consultada. Resultados: La literatura disponible sobre la ecografía del nervio óptico en la determinación de la hipertensión intracraneal es abundante y la mayoría apunta a sus beneficios como método no invasivo. La principal debilidad del mismo es que no es capaz de dar un valor exacto y esto se debe a que el valor normal del diámetro de la vaina del nervio óptico por cada persona puede variar significativamente. La proporción directa entre el diámetro de la vaina del nervio óptico y la presión intracraneal es un hecho que ningún autor intenta invalidar. Conclusiones: La ecografía del nervio óptico es un método seguro, accesible económicamente, no invasivo, fácil de usar y con un valor predictivo confiable para determinar la hipertensión intracraneal(AU)

Introduction: Neurotrauma is a condition that can lead to intracranial hypertension, which is a very serious situation. The diagnostic methods of choice are the invasive ones, even so, the non-invasive ones offer many advantages, the ultrasound of the optic nerve is among them. Objective: To describe essential elements of optic nerve ultrasound as a method to diagnose intracranial hypertension in adult patients with neurotrauma. Methods: A review of the most recent literature was made without linguistic or geographical restrictions in databases such as PubMed and SciELO, terms related to the theme of the manuscript were used. A critical assessment of the consulted bibliography was made. Results: The available literature on optic nerve ultrasound in the determination of intracranial hypertension is abundant and most points to the benefits as a non-invasive method. However, its main weakness lies in the fact that it is not capable of giving an exact value, due to the fact that the normal value of the diameter of the optic nerve sheath for each person can vary significantly. The direct relationship between optic nerve sheath diameter and intracranial pressure is a fact that no author attempts to invalidate. Conclusions: Optic nerve ultrasound is a safe, affordable, non-invasive, easy-to-use method with a reliable predictive value to determine intracranial hypertension(AU)