Discapacidad grave tras daño cerebral traumático: posibilidades terapéuticas de la administración subaracnoidea de células estromales / Severe disability after traumatic brain injury: therapeutic posibilities of subarachnoid administration of stromal cells

Objetivo: Estudiar el efecto terapéutico de la administración de células madre mesenquimales (CMM) para tratar secuelas neurológicas crónicas producidas tras una lesión cerebral. Material y método: En 20 ratas Wistar adultas y dos meses después de una lesión cerebral traumática, se realizó la administración subaracnoidea de CMM o suero. Se valoró la respuesta funcional de los animales y se hizo un análisis histológico del tejido cerebral. Resultados: No se obtuvieron mejoras significativas en la respuesta funcional de animales con CMM. Se localizaron CMM dentro del tejido cerebral, obteniéndose diferencias estadísticamente significativas en el tamaño de la lesión pero no en la expresión de marcadores neurales. Conclusión: El tratamiento subaracnoideo con CMM no tiene efecto en la respuesta neurológica de animales lesionados, aunque las células migraron y se integraron en el tejido cerebral, afectando a la morfología del mismo (AU)

Objective: To study the therapeutic effect of administration of mesenchymal stem cells (MSCs) to treat chronic neurological sequelae produced after traumatic brain injury (TBI). Material and method: In 20 adult Wistar rats and two months after TBI, subarachnoid administration of CMM or saline were performed. Functional response of the animals was assessed and a histological analysis of brain tissue was conducted. Results: There was no significant improvement in the functional response in animals with MSCs. MSCs were located within the brain tissue obtained statistically significant difference in lesion size but not in the expression of neural markers. Conclusion: Subarachnoid treatment with MSCs has no effect on neurological response of injured animals, although the cells migrated and integrated into the brain tissue affecting their morphology (AU)

The current role of decompressive craniectomy in the management of neurological emergencies.

Decompressive craniectomy has been used as a lifesaving procedure for many neurological emergencies, including traumatic brain injury, ischaemic stroke, subarachnoid haemorrhage, cerebrovenous thrombosis, severe intracranial infection, inflammatory demyelination and encephalopathy. The evidence to support using decompressive craniectomy in these situations is, however, limited. Decompressive craniectomy has only been evaluated by randomized controlled trials in traumatic brain injury and ischaemic stroke and, even so, its benefits and risks in these situations remain elusive. If one considers a modified Rankin Scale of 4 or 5 or dependency in daily activity as an unfavourable outcome, decompressive craniectomy is associated with an increased risk of survivors with unfavourable outcome (relative risk [RR] = 2.9, 95% confidence interval [CI] = 1.5-5.8, p = 0.002, I(2 )= 0%; number needed to operate to increase an unfavourable outcome = 3.5, 95% CI = 2.4-7.4), but not the number of survivors with a favourable outcome (RR = 1.5, 95% CI = 0.9-2.6, p = 0.13, I(2 )= 0%).

Damage control neurosurgery.

Damage control neurosurgery (DCNS) is abbreviated urgent neurosurgery performed on the injured patient which helps to prevent secondary brain injury, assists in stabilising the patient and improves survival and outcome. It may be urgent surgery done by the neurosurgeon in a trauma centre, but it has particular application in the remote, rural or military environment where the surgery can be performed by a generalist. This surgery should always be done in collaboration with the trauma team caring for the overall needs of the patient. The Definitive Surgery Trauma Course (DSTC) is an ideal educational vehicle to disseminate the principles of DCNS.

The structural basis of moderate disability after traumatic brain damage.

The objective was to discover the nature of brain damage in survivors of head injury who are left with moderate disability. Macroscopic and microscopic examination was carried out on the brains of 20 persons who had died long after a head injury that had been treated in a neurosurgical unit. All had become independent but had various disabilities (moderate disability on the Glasgow outcome scale) Most deaths had been sudden, which had led to their referral from forensic pathologists. Post-traumatic epilepsy was a feature in 75%. An intracranial haematoma had been evacuated in 75%, and in 11 of the 15 with epilepsy. Diffuse axonal injury was found in six patients, five of the mildest type (grade 1) and one of grade 2. No patient had diffuse thalamic damage but one had a small focal ischaemic lesion in the thalamus. No patient had severe ischaemic brain damage, but three had moderate lesions which were bilateral in only one. No patient had severe cortical contusions. In conclusion, the dominant lesion was focal damage from an evacuated intracranial haematoma. Severe diffuse damage was not found, with diffuse axonal injury only mild and thalamic damage in only one patient.