Traumatic axolemmal and cytoskeletal derangement in myelinated axons of human oedematous cerebral cortex and loss of consciousness. An electron microscopic study using cortical biopsies.

Cortical biopsies of 7 patients with clinical diagnosis of severe head trauma and complicated brain trauma with subdural and epidural hematoma, and loss of consciousness were examined with the transmission electron microscope to study axolemmal and cytoskeletal damage in myelinated axons. Granular disintegration of microtubules and misaligned and fragmented neurofilaments, and fragmentation of axolemmal membrane were observed in most patients studied. In some cases a differential response characterized by increased number of neurofilaments and decreased number or disappearance of microtubules was found. In few cases apparently intact microtubules coexisting with fragmented ones were found. These findings are discussed in relation with traumatic brain edema and associated anoxic-ischemic conditions, the Hameroff-Penrose hypothesis relating microtubules and consciousness, and the existing and contemporary knowledge on neural correlates of consciousness.

Minimally invasive approach to traumatic intracerebral hematomas.

Trauma is one of the leading causes of death in Brazil. We report on 28 cases of traumatic intracerebral hematomas operated on via a minimally invasive approach. A simplified method of localization and right placement of the burr hole is described in details, as well as the technique used in all cases. Every patient was submitted to pre- and postoperative CT scan (computerized tomography) and had the volume of the hematoma measured before the surgical procedure to compare the efficacy of the treatment. No patient needed a second operation, even though in some cases there were residual hematomas. We believe that this approach can be done with safety and replace a standard craniotomy in selected cases.