Management of Mild Brain Trauma in the Elderly: Literature Review.

PURPOSE: The world population is aging. As direct consequence, geriatric trauma is increasing both in absolute number and in the proportion of annual admissions causing a challenge for the health-care system worldwide. The aim of this review is to delineate the specific and practice rules for the management of mild brain trauma in the elderly. METHODS: Systematic review of the last 15 years literature on mild traumatic brain injury (nTBI) in elderly patients. RESULTS: A total of 68 articles met all eligibility criteria and were selected for the systematic review. We collected 29% high-quality studies and 71% low-quality studies. CONCLUSION: Clinical advices for a comprehensive management are provided. Current outcome data from mTBIs in the elderly show a condition that cannot be sustained in the future by families, society, and health-care systems. There is a strong need for more research on geriatric mild brain trauma addressed to prevent falls, to reduce the impact of polypharmacy, and to define specific management strategies.

Endoscope-Assisted Microneurosurgery for Neurovascular Compression Syndromes: Basic Principles, Methodology, and Technical Notes.

BACKGROUND: Microscopic microvascular decompression (MVD) has a low but not negligible failure rate due to some missed conflicts, especially in case of multiple offending vessels. The reported study is aimed to assess the principles, methodology, technical notes, and effectiveness of the endoscope-assisted (EA) MVD for neurovascular compression syndromes (NVCS) in the posterior fossa. MATERIALS AND METHODS: A series of 43 patients suffering from an NVCS and undergone to an EA MVD were retrospectively reviewed. Syndromes were trigeminal neuralgia in 25 cases, hemifacial spasm in nine cases, positional vertigo in six cases, glossopharyngeal neuralgia in two cases, and spasmodic torticollis in one case. In all cases, a 0°-30° specially designed endoscope was inserted into the surgical field to find/treat those conflicts missed by the microscopic exploration. Each procedure was judged in terms of the effectiveness of the adjunct of the endoscope according to a three types classification system: Type I - improvement in the visualization of the nerve's root entry/exit zone; Type II - endoscopic detection of one or more conflicts involving the ventral aspects of the nerve and missed by the microscope; Type III - endoscope-controlled release of the neurovascular conflict otherwise difficult to treat under the only microscopic view. RESULTS: A total of 55 conflicts were found and treated. Twenty-eight procedures were classified as Type I, nine as Type II, and six as Type III. All the patients had a full recovery from their symptoms. CONCLUSIONS: In selected cases, EA MVD offers some advantages in the detection and treatment of neurovascular conflicts in the posterior fossa.

Minimally Invasive Transforaminal Lumbar Interbody Fusion with Percutaneous Bilateral Pedicle Screw Fixation for Lumbosacral Spine Degenerative Diseases. A Retrospective Database of 40 Consecutive Cases and Literature Review.

AIM: To report our results about minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) with bilateral pedicle screw fixation, in patients with degenerative lumbosacral spine disease. To describe the indications, surgical technique and results of a consecutive series of 40 patients who had undergone MI-TLIF. Despite the limited number of clinical studies, published data suggest tremendous potential advantages of this technique. MATERIAL AND METHODS: Forty patients with radiological findings of degenerative lumbosacral spine disease had undergone MI-TLIF between July 2012 and January 2015. Clinical outcomes were assessed by means of Oswestry Disability Index (ODI) and Health Survey Scoring (SF36) before surgery and at first year follow-up. Furthermore, the following parameters were retrospectively reviewed: age, sex, working activity, body mass index (BMI), type of degenerative disease, number of levels of fusion, operative time, blood loss, length of hospital stay. RESULTS: Average operative time was 230 minutes, mean estimated blood loss 170 mL, average length of hospital stay 5 days. The ODI improved from a score of 59, preoperatively, to post-operative score of 20 at first year follow-up. Average SF36 score increased from 36 to 54 (Physical Health) and from 29 to 50 (Mental Health) at first year outcome evaluation. CONCLUSION: MI-TLIF with bilateral pedicle screw fixation is an excellent choice for selected patients suffering from symptomatic degenerative lumbosacral spine disease, especially secondary to recurrent disc herniations.

Hydrogel for cell housing in the brain and in the spinal cord.

PURPOSE: Neurons in the adult mammalian central nervous system do not proliferate or renew themselves and consequently strong interest in cell replacement therapies to repair brain and spinal cord damages has emerged in the last decade. METHODS: An injectable resorbable hydrogel with a controlled nanostructure, specifically designed for neural cell housing, was developed together with a new protocol for building three-dimensional (3D) biohybrid cell/hydrogel constructs: cells are housed within the polymeric matrix which is directly built with a specific cell culture media. This matrix was tested with standard glial populations, primary astrocytes and mesenchymal stem cells. RESULTS: Physico-chemical characterization of the hydrogel matrix confirmed a 2- week (+ 2 days) stability before massive degradation; mean mesh size of about 5 nm and thixotropic behavior with transition yield stress at 60+5 Pa. Cell survival within the hydrogel resulted in about 55 ± 5% (minimum value) survivals, data also confirmed by optical assessments. Cell viability also remained high after extraction from the gel, indicating survival to inclusion latency period. CONCLUSIONS: Since the intimate structure of the gel mimics extracellular matrix cells as would be expected to be found in an in vivo context, this polymeric formulation is a promising base for building 3D constructs for neural cell housing, in which cells are embedded and kept alive directly from the time of polycondensation.