Systemic inflammatory effects of traumatic brain injury, femur fracture, and shock: an experimental murine polytrauma model.

OBJECTIVE: Despite broad research in neurotrauma and shock, little is known on systemic inflammatory effects of the clinically most relevant combined polytrauma. Experimental investigation in an animal model may provide relevant insight for therapeutic strategies. We describe the effects of a combined injury with respect to lymphocyte population and cytokine activation. METHODS: 45 male C57BL/6J mice (mean weight 27 g) were anesthetized with ketamine/xylazine. Animals were subjected to a weight drop closed traumatic brain injury (WD-TBI), a femoral fracture and hemorrhagic shock (FX-SH). Animals were subdivided into WD-TBI, FX-SH and combined trauma (CO-TX) groups. Subjects were sacrificed at 96 h. Blood was analysed for cytokines and by flow cytometry for lymphocyte populations. RESULTS: Mortality was 8%, 13% and 47% for FX-SH, WD-TBI and CO-TX groups (P < 0.05). TNFα (11/13/139 for FX-SH/WD-TBI/CO-TX; P < 0.05), CCL2 (78/96/227; P < 0.05) and IL-6 (16/48/281; P = 0.05) showed significant increases in the CO-TX group. Lymphocyte populations results for FX-SH, WD-TBI and CO-TX were: CD-4 (31/21/22; P = n.s.), CD-8 (7/28/34, P < 0.05), CD-4-CD-8 (11/12/18; P = n.s.), CD-56 (36/7/8; P < 0.05). CONCLUSION: This study shows that a combination of closed TBI and femur-fracture/ shock results in an increase of the humoral inflammation. More attention to combined injury models in inflammation research is indicated.

Histopathological features of the brain, liver, kidney and spleen following an innovative polytrauma model of the mouse.

OBJECT: Among the various introduced experimental traumatic brain injury models, there is a clear paucity of proper experimental polytrauma models. To overcome this experimental gap we introduced such a polytrauma model in the mouse including traumatic brain injury. Here, we report on the histopathological features of the brain, lung, kidney, spleen and liver. MATERIALS AND METHODS: 20 male C57BL mice with a mean weight of 23 g were anesthetized with ketamine and xylazine. The anaesthetized animals were subjected to a controlled cortical impact (CCI) over the left parieto-temporal cortex using rounded-tip impounder for application of a standardized brain injury. Following fracture of the right femur using a guillotine, a volume-controlled hemorrhagic shock was induced. The control groups included animals with CCI only (n=20) and animals with femur fracture plus hemorrhagic shock without CCI (n=20). Subjects were sacrified at 96 h following trauma. Brain, lung, kidney, spleen and liver of the animals underwent histopathological examinations. RESULTS: The mortality rate at 96 h was 25% in the polytrauma group versus 10% in the control groups. Within the histopathological investigations, polytraumatized animals differ from those with a single trauma (traumatic brain injury or femur fracture with hemorrhagic shock) with various severity. CONCLUSION: The findings of this study show that such a polytrauma model can be standardized resulting in a reproducible damage. This model fulfills the requirements of a standardized animal model. It allows adequate analogies and inferences to the clinical situation of a polytrauma in humans.

Systemic effects of isolated brain injury: an experimental animal study.

OBJECTIVE: Although various experimental works of neurotrauma research are performed, little attention has been paid to the concomitant systemic changes following isolated traumatic brain injury (TBI). Such investigations seem to be a prerequisite condition for evaluation of experimental drugs, which may diminish the secondary damage following TBI. We describe histopathologic findings of the lung, liver, spleen and kidney 96 hours following an experimental TBI. METHODS: Ten male C57BI/6 mice were subjected to a controlled cortical impact (CCI) over the left parietotemporal cortex using rounded-tip impounder for application of a standardized brain injury. Subjects were killed 96 hours following trauma. Brain, lung, liver, kidney and spleen were preserved for morphologic examinations. RESULTS: Moderate histopathologic changes were evident in the lung and liver. The kidney and spleen seem not to be affected by the trauma regarding our examination. CONCLUSION: The findings of this study show that even isolated TBI can lead to a migration of immunocompetent cells to peripheral organs potentially leading to dysfunctions of peripheral organs to various extents. More attention to peripheral organs during experimental TBI research is indicated.

The use of high-frequency electromagnetics in brain tumour surgery.

OBJECTIVE: The first commercially available high-frequency electromagnetic field (EMF) system promises additional functionality for neurosurgical procedures. In a prospective study, we evaluated the optimal use as well as the limitations of this system designed for vaporizing tissue and for coagulation in brain tumour surgery. METHODS: For the microsurgical treatment of 63 consecutive patients with various intracranial tumours, the EMF system was used in addition to the standard neurosurgical instrumentarium. The system was assessed with respect to its compatibility with the operating room environment. Furthermore, attention was given to the particular techniques required to use the system most effectively. The efficiency of the investigated tool was monitored throughout the study. RESULTS: The EMF system functioned properly in all procedures and did not cause any complications. Specific handling techniques and electrode tip configurations could be defined for optimal use of high-frequency electromagnetics for vaporization and coagulation in different intraoperative settings. Thereby, the efficiency of the device could be increased throughout the study while ineffective use decreased from 7 to 2 cases. Although this tool is designed ergonomically and offers high tactile control, it cannot be used submerged in cerebrospinal fluid or under continuous irrigation, which makes it necessary to use it in tandem with suction devices to obtain a clear view on the surgical field. CONCLUSION: Maneuvering with the EMF system was substantially different to both monopolar and bipolar systems, clearly necessitating a learning curve for the surgeon. This device was found to be a valuable complementary tool to standard electrosurgical instruments when applied effectively and with elaborated techniques.

Image-guided craniotomy for frontal sinus preservation during meningioma surgery.

OBJECTIVE: Preservation of the frontal sinus (FS) during the frontolateral approach to the skull base reduces morbidity, enhances patient comfort, and speeds up the surgical procedure. Due to its irregular outline, mental reconstruction of the borders of FS from two-dimensional images is challenging during surgery. This study was designed to evaluate the impact of neuronavigation on identification and preservation of the FS during frontolateral craniotomies. METHODS: Forty-five patients with pathologies located in the anterior skull base and in the parasellar region were included. A standard computed tomography (CT) sequence was obtained from each patient and uploaded onto an image-guidance system for volumetric rendering of 3D images. The outline of the FS was visualized and the distance between its lateral border and the mid-pupillary line (MPL) was measured. The results were used for navigated craniotomies and compared to the intra-operative findings. RESULTS: The FS was located medial, on and lateral to the MPL in 32, 4 and 9 cases, respectively. The individual outline of the FS could be identified with a mean target registration error of 1.4mm (+/-0.7 mm). The craniotomy could be custom-tailored for each patient according to the individualized landmarks while visualizing the lesion and the surgical landmarks simultaneously. Unintended opening of the frontal sinus or orbit did not occur in any of these cases. CONCLUSION: Image-guided craniotomies based on 3D volumetric image rendering allow for fast and reliable demarcation of complex anatomical structures hidden from direct view in frontolateral approaches. The outline of the frontal sinus and the orbit can be appraised at a glance providing additional safety and precision during craniotomy.

Osteolytic intra-osseous meningiomas: illustrated review.

While bone invasion and hyperostosis are frequent phenomena in meningiomas, primary intra-osseous meningiomas are rare. With only 15 reported cases, the osteolytic form of primary intra-osseous meningiomas is most uncommon. Its occurrence in the skull base is an extra-ordinary exception. We have reviewed and categorized the pertinent literature on intra-osseus meningiomas with special emphasis on osteolytic tumours and discuss their clinical implications on the basis of a new case located in the petrous bone without contact with the meninges. It is concluded that due to their different clinical, radiological and pathological features, hyperostotic and osteolytic variants of intra-osseus meningiomas should be distinguished from tumours with soft tissue components and from en-plaque lesions.

Prognostic parameters for flare in systemic lupus erythematosus.

OBJECTIVE: To characterize prognostic parameters for systemic lupus erythematosus (SLE) flares. METHODS: In a prospective study, 120 SLE patients attending our out-patient clinic were evaluated every 3 months for 2 yr. At every visit clinical manifestations and laboratory parameters were assessed and the SLE disease activity index (SLEDAI) was determined. A correlation analysis of the number of flares in the first year and SLEDAI as a marker of disease activity after 1 and 2 yr with several parameters determined at the start of the study was performed. RESULTS: Flares were predicted by erythrocyte sedimentation rate (P=0.001), anaemia (P=0.006) and lymphopenia (P=0.005). The SLEDAI after 1 yr was predicted by the titre of antinuclear antibodies (P=0.009), antibodies against double-stranded DNA (P=0.007), lymphopenia (P=0.007), anaemia (P=0.0002) and SLEDAI determined at the start of the study (P=0.001). CONCLUSIONS: Anaemia and lymphopenia predict both flares and SLEDAI within the next year of follow-up.