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Progress in Brain Research 2024The purpose of this chapter is to present how past surgeons have viewed the pericranium and how they have reacted to its appearances. In ancient times, the membrane was...
The purpose of this chapter is to present how past surgeons have viewed the pericranium and how they have reacted to its appearances. In ancient times, the membrane was considered formed by the dura through the sutures and it retained a relationship with the dura via vessels in the sutures. It was considered advisable to strip it totally from any area to be examined for fissure fractures and also for any area to be trepanned, as pericranial injury was thought to lead to fever and inflammation. In the 18th century, a new idea arose that posttraumatic spontaneous separation of the pericranium from the bone was a reliable indicator of the development of intracranial suppuration. This idea was subsequently refuted. For over two millennia, the pericranium was considered to be an important membrane requiring the close attention of the surgeon. It is no longer required to receive more than minimal attention.
Topics: Humans; Dura Mater; History, 15th Century; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, 20th Century; History, Ancient; History, Medieval
PubMed: 38705714
DOI: 10.1016/bs.pbr.2024.02.021 -
Progress in Brain Research 2024The dura was first described in ancient Egypt. Hippocrates insisted that it should be protected and not penetrated. Celsus proposed an association between clinical... (Review)
Review
The dura was first described in ancient Egypt. Hippocrates insisted that it should be protected and not penetrated. Celsus proposed an association between clinical findings and meningeal damage. Galen proposed that the dura was attached only at the sutures, and he was the first to describe the pia in humans. In the Middle Ages, new interest in the management of meningeal injuries arose, with renewed interest in relating clinical changes to intracranial injuries. These associations were neither consistent nor accurate. The Renaissance brought little change. It was in the 18th century that it became clear that the indication for opening the cranium following trauma was to relieve pressure from hematomas. Moreover, the important clinical findings on which to base an indication for intervention were changes in the level of consciousness.
Topics: Humans; Meninges; History, Ancient; History, 19th Century; History, 18th Century; History, 17th Century; History, Medieval; History, 16th Century; History, 15th Century; History, 20th Century
PubMed: 38705713
DOI: 10.1016/bs.pbr.2024.02.020 -
Medicine May 2024Subdural hematoma is defined as blood collection in the subdural space between the dura mater and arachnoid. Subdural hematoma is a condition that neurosurgeons... (Observational Study)
Observational Study
How artificial intelligence can provide information about subdural hematoma: Assessment of readability, reliability, and quality of ChatGPT, BARD, and perplexity responses.
Subdural hematoma is defined as blood collection in the subdural space between the dura mater and arachnoid. Subdural hematoma is a condition that neurosurgeons frequently encounter and has acute, subacute and chronic forms. The incidence in adults is reported to be 1.72-20.60/100.000 people annually. Our study aimed to evaluate the quality, reliability and readability of the answers to questions asked to ChatGPT, Bard, and perplexity about "Subdural Hematoma." In this observational and cross-sectional study, we asked ChatGPT, Bard, and perplexity to provide the 100 most frequently asked questions about "Subdural Hematoma" separately. Responses from both chatbots were analyzed separately for readability, quality, reliability and adequacy. When the median readability scores of ChatGPT, Bard, and perplexity answers were compared with the sixth-grade reading level, a statistically significant difference was observed in all formulas (P < .001). All 3 chatbot responses were found to be difficult to read. Bard responses were more readable than ChatGPT's (P < .001) and perplexity's (P < .001) responses for all scores evaluated. Although there were differences between the results of the evaluated calculators, perplexity's answers were determined to be more readable than ChatGPT's answers (P < .05). Bard answers were determined to have the best GQS scores (P < .001). Perplexity responses had the best Journal of American Medical Association and modified DISCERN scores (P < .001). ChatGPT, Bard, and perplexity's current capabilities are inadequate in terms of quality and readability of "Subdural Hematoma" related text content. The readability standard for patient education materials as determined by the American Medical Association, National Institutes of Health, and the United States Department of Health and Human Services is at or below grade 6. The readability levels of the responses of artificial intelligence applications such as ChatGPT, Bard, and perplexity are significantly higher than the recommended 6th grade level.
Topics: Humans; Cross-Sectional Studies; Artificial Intelligence; Comprehension; Hematoma, Subdural; Reproducibility of Results
PubMed: 38701313
DOI: 10.1097/MD.0000000000038009 -
Neurosurgical Focus May 2024The mainstay of treatment for skull base chordoma (SBC) is maximal safe resection followed by radiotherapy. However, even after gross-total resection (GTR), the...
OBJECTIVE
The mainstay of treatment for skull base chordoma (SBC) is maximal safe resection followed by radiotherapy. However, even after gross-total resection (GTR), the recurrence rate is high due to microscopic disease in the resection margins. Therefore, supramarginal resection (SMR) could be beneficial, as has been shown for sacral chordoma. The paradigm of postoperative radiation therapy for every patient has also begun to change, as molecular profiling has shown variability in the risk of recurrence. The aim of this study was to present the concept of SMR applied to SBC, along with an individualized decision for postoperative radiation therapy.
METHODS
This is a retrospective analysis of all SBCs operated on by the senior author between 2018 and 2023. SMR was defined as negative histological margins of bone and/or dura mater, along with evidence of bone resection beyond the tumor margins in the craniocaudal and lateral planes on postoperative imaging. Tumors were classified into 3 molecular recurrence risk groups (group A, low risk; group B, intermediate risk; and group C, high risk). Postoperative radiation therapy was indicated in group C tumors, in group B chordomas without SMR, or in cases of patient preference.
RESULTS
Twenty-two cases of SBC fulfilled the inclusion criteria. SMR was achieved in 12 (55%) cases, with a mean (range) amount of bone resection beyond the tumor margins of 10 (2-20) mm (+40%) in the craniocaudal axis and 6 (1-15) mm (+31%) in the lateral plane. GTR and near-total resection were each achieved in 5 (23%) cases. Three (19%) tumors were classified as group A, 12 (75%) as group B, and 1 (6%) as group C. Although nonsignificant due to the small sample size, the trends showed that patients in the SMR group had smaller tumor volumes (13.9 vs 19.6 cm3, p = 0.35), fewer previous treatments (33% vs 60% of patients, p = 0.39), and less use of postoperative radiotherapy (25% vs 60%, p = 0.19) compared to patients in the non-SMR group. There were no significant differences in postoperative CSF leak (0% vs 10%, p = 0.45), persistent cranial nerve palsy (8% vs 20%, p = 0.57), and tumor recurrence (8% vs 10%, p = 0.99; mean follow-up 15 months) rates between the SMR and non-SMR groups.
CONCLUSIONS
In select cases, SMR of SBC appears to be feasible and safe. Larger cohorts and longer follow-up evaluations are necessary to explore the benefit of SMR and individualized postoperative radiation therapy on progression-free survival.
Topics: Humans; Chordoma; Skull Base Neoplasms; Male; Female; Middle Aged; Adult; Retrospective Studies; Aged; Treatment Outcome; Neurosurgical Procedures; Neoplasm Recurrence, Local; Young Adult; Margins of Excision
PubMed: 38691859
DOI: 10.3171/2024.2.FOCUS23909 -
Neurology India Mar 2024Dural closure is an important part of neurosurgery, failure which may lead to wound infection, pseudomeningoceles, meningitis, severe morbidity to a patient, and even...
INTRODUCTION
Dural closure is an important part of neurosurgery, failure which may lead to wound infection, pseudomeningoceles, meningitis, severe morbidity to a patient, and even mortality. In cases where primary dura closure is not possible, a bovine pericardial patch is a good alternative with the benefits of suturability and the ability to provide watertight closure, hence preventing Cerebrospinal Fluid (CSF) leak. The present study demonstrates the use of the bovine pericardial patch in both cranial and spinal disorders for dural closure as well as for transposition technique in microvascular decompression.
OBJECTIVES
The aim of our study is to understand the advantages and feasibility of a bovine pericardial patch in various neurosurgical procedures.
MATERIAL METHODS
Fifty-one patients were analyzed prospectively and followed up in which glutaraldehyde-free bovine pericardial patch was used in various cranial and spinal disorders.
RESULTS
The most common indications where a bovine pericardial patch was used, in decreasing order of frequency, were meningioma excision surgery (47%), followed by Chiari malformation operated for foramen magnum decompression (17.6%), meningomyelocele (7.8%), spinal dural defects (7.8%), trigeminal neuralgia (5.8%), traumatic decompression with lax duraplasty (4%), glioma (4%), encephalocele (4%), and skull base defects (2%). Two patients had complications, one with CSF leak and the other had superficial wound infection, which were managed appropriately.
CONCLUSIONS
The use of a bovine pericardial patch as a dural substitute in various cranial and spinal disorders is feasible with good outcomes, and it can be considered an ideal dural substitute.
Topics: Humans; Pericardium; Cattle; Male; Female; Adult; Middle Aged; Neurosurgical Procedures; Animals; Dura Mater; Aged; Adolescent; Young Adult; Prospective Studies; Child
PubMed: 38691472
DOI: 10.4103/ni.ni_327_22 -
In Vivo (Athens, Greece) 2024Dural reconstruction is a critical process after neurosurgical procedures. Improper dural repair leads to serious side-effects, such as cerebrospinal fluid leakage or...
BACKGROUND/AIM
Dural reconstruction is a critical process after neurosurgical procedures. Improper dural repair leads to serious side-effects, such as cerebrospinal fluid leakage or infection. This is why it is important to properly repair the dura using a dural substitute, and research into dural substitutes is ongoing. The ideal dural substitute should be non-toxic, biocompatible, and capable of maintaining adequate tension and preventing cerebrospinal fluid leakage for extended periods in vivo. This study evaluated the biocompatibility and healing properties of Safe-Seal, poly-L-lactic acid synthetic bioabsorbable dural substitute produced by electrospinning technology.
MATERIALS AND METHODS
Safe-Seal, was created by electrospinning, which is a technique for nanofiberizing polymers into three-dimensional structures, and its cytotoxicity was evaluated. The animal study used 30 rats, divided into three groups assessed at two time points (4 and 12 weeks). The study groups were a negative control group with no treatment, an experimental group with Safe-Seal (TDM Co. Ltd., Gwangju, Republic of Korea) implantation, and a positive control group with a commercial product, Redura (Medprin Biotech, Frankfurt, Germany) implantation.
RESULTS
Safe-Seal exhibited no cytotoxic or adverse effects in the in vivo animal study. Histologically, Safe-Seal displayed less inflammatory cell infiltration, less adhesion to brain tissue, and connectivity with the surrounding dura mater as compared to the negative control group and without any significant differences from Redura in all evaluation criteria.
CONCLUSION
Safe-Seal presented adequate biocompatibility in vivo and contributed to the healing of the dura mater at a similar level to that of Redura when applied to dural defects.
Topics: Animals; Dura Mater; Biocompatible Materials; Rats; Materials Testing; Wound Healing; Polyesters; Male; Absorbable Implants; Polymers
PubMed: 38688638
DOI: 10.21873/invivo.13546 -
Brain Sciences Mar 2024Migraine, recognized as a severe headache disorder, is widely prevalent, significantly impacting the quality of life for those affected. This article aims to provide a... (Review)
Review
Migraine, recognized as a severe headache disorder, is widely prevalent, significantly impacting the quality of life for those affected. This article aims to provide a comprehensive review of the application of animal model technologies in unraveling the pathomechanism of migraine and developing more effective therapies. It introduces a variety of animal experimental models used in migraine research, emphasizing their versatility and importance in simulating various aspects of the condition. It details the benefits arising from the utilization of these models, emphasizing their role in elucidating pain mechanisms, clarifying trigeminal activation, as well as replicating migraine symptoms and histological changes. In addition, the article consciously acknowledges the inherent limitations and challenges associated with the application of animal experimental models. Recognizing these constraints is a fundamental step toward fine-tuning and optimizing the models for a more accurate reflection of and translatability to the human environment. Overall, a detailed and comprehensive understanding of migraine animal models is crucial for navigating the complexity of the disease. These findings not only provide a deeper insight into the multifaceted nature of migraine but also serve as a foundation for developing effective therapeutic strategies that specifically address the unique challenges arising from migraine pathology.
PubMed: 38671969
DOI: 10.3390/brainsci14040317 -
Cells Apr 2024Subarachnoid hemorrhage (SAH) remains a major cause of cerebrovascular morbidity, eliciting severe headaches and vasospasms that have been shown to inversely correlate...
Subarachnoid hemorrhage (SAH) remains a major cause of cerebrovascular morbidity, eliciting severe headaches and vasospasms that have been shown to inversely correlate with vasodilator calcitonin gene-related peptide (CGRP) levels. Although dura mater trigeminal afferents are an important source of intracranial CGRP, little is known about the effects of SAH on these neurons in preclinical models. The present study evaluated changes in CGRP levels and expression in trigeminal primary afferents innervating the dura mater 72 h after experimentally induced SAH in adult rats. SAH, eliciting marked damage revealed by neurological examination, significantly reduced the density of CGRP-immunoreactive nerve fibers both in the dura mater and the trigeminal caudal nucleus in the medulla but did not affect the total dural nerve fiber density. SAH attenuated ex vivo dural CGRP release by ~40% and in the trigeminal ganglion, reduced both CGRP mRNA levels and the number of highly CGRP-immunoreactive cell bodies. In summary, we provide novel complementary evidence that SAH negatively affects the integrity of the CGRP-expressing rat trigeminal neurons. Reduced CGRP levels suggest likely impaired meningeal neurovascular functions contributing to SAH complications. Further studies are to be performed to reveal the importance of impaired CGRP synthesis and its consequences in central sensory processing.
Topics: Animals; Calcitonin Gene-Related Peptide; Dura Mater; Male; Rats; Subarachnoid Hemorrhage; Neurons; Rats, Sprague-Dawley; Trigeminal Ganglion; RNA, Messenger; Trigeminal Nerve
PubMed: 38667268
DOI: 10.3390/cells13080653 -
Trends in Immunology May 2024It is increasingly clear that the central nervous system (CNS) relies significantly on both adaptive and innate immune cells for its repair and lifelong maintenance.... (Review)
Review
It is increasingly clear that the central nervous system (CNS) relies significantly on both adaptive and innate immune cells for its repair and lifelong maintenance. These interactions hold profound implications for brain aging and neurodegeneration. Recent work by Smyth et al. describes newfound anatomical connections between the brain and dura mater, which they named the arachnoid cuff exit points.
Topics: Humans; Brain; Animals; Immune System; Immunity, Innate; Dura Mater; Aging; Adaptive Immunity
PubMed: 38658220
DOI: 10.1016/j.it.2024.04.006