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- Al Masri, Mohammad, 2001, et al.
(författare)
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The glymphatic system for neurosurgeons: a scoping review
- 2024
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Ingår i: NEUROSURGICAL REVIEW. - 0344-5607 .- 1437-2320. ; 47:1
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Tidskriftsartikel (refereegranskat)abstract
- The discovery of the glymphatic system has revolutionized our understanding of cerebrospinal fluid (CSF) circulation and interstitial waste clearance in the brain. This scoping review aims to synthesize the current literature on the glymphatic system's role in neurosurgical conditions and its potential as a therapeutic target. We conducted a comprehensive search in PubMed and Scopus databases for studies published between January 1, 2012, and October 31, 2023. Studies were selected based on their relevance to neurosurgical conditions and glymphatic function, with both animal and human studies included. Data extraction focused on the methods for quantifying glymphatic function and the main results. A total of 67 articles were included, covering conditions such as idiopathic normal pressure hydrocephalus (iNPH), idiopathic intracranial hypertension (IIH), subarachnoid hemorrhage (SAH), stroke, intracranial tumors, and traumatic brain injury (TBI). Significant glymphatic dysregulation was noted in iNPH and IIH, with evidence of impaired CSF dynamics and delayed clearance. SAH studies indicated glymphatic dysfunction with the potential therapeutic effects of nimodipine and tissue plasminogen activator. In stroke, alterations in glymphatic activity correlated with the extent of edema and neurological recovery. TBI studies highlighted the role of the glymphatic system in post-injury cognitive outcomes. Results indicate that the regulation of aquaporin-4 (AQP4) channels is a critical target for therapeutic intervention. The glymphatic system plays a critical role in the pathophysiology of various neurosurgical conditions, influencing brain edema and CSF dynamics. Targeting the regulation of AQP4 channels presents as a significant therapeutic strategy. Although promising, the translation of these findings into clinical practice requires further human studies. Future research should focus on establishing non-invasive biomarkers for glymphatic function and exploring the long-term effects of glymphatic dysfunction.
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| 2. |
- Hultegård, Linus, et al.
(författare)
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The risk of ventricular catheter misplacement and intracerebral hemorrhage in shunt surgery for hydrocephalus
- 2019
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Ingår i: Interdisciplinary Neurosurgery. - : Elsevier BV. - 2214-7519. ; 17, s. 23-27
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Tidskriftsartikel (refereegranskat)abstract
- Ventricular shunt insertion is a commonly performed neurosurgical procedure but few studies evaluate the rates of ventricular catheter (VC) misplacement and postoperative intracerebral hemorrhage (ICH) after shunt surgery. In this study, we evaluated the rate of VC misplacement and ICH after shunt insertion in hydrocephalus patients. A consecutive series of adult patients (n=240) that received a ventricular shunt for hydrocephalus were included in the study. Misplacement was defined as tip of the VC located in the contralateral ventricle or intraparenchymal. The event of ICH was based on verification of intraparenchymal blood on an early (<48h) head CT postoperatively. The shunt revision rate within six months postoperatively was compared between patients with and without misplacement of the VC. Misplacement of the VC tip was found in 76 patients (33%); 70 patients with the VC tip in the contralateral ventricle and six patients (3%) with the VC tip intraparenchymal. ICH occurred in 8% of the patients. The shunt revision rate for accurately placed VCs was 17% compared to 21% for misplaced VC (p=0.37). Proximal shunt failure occurred in 11% of the patients with VC misplacement compared to 5% of the patients with accurate VC placement (p=0.07). VC misplacement occurred in one third and ICH was evident in 8% of the patients. However, VC misplacement did not significantly increase the shunt revision rate. Still, measures to optimize VC placement may be important to reduce risks following ventricular shunt placement.
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| 3. |
- Michaëlsson, Isak, et al.
(författare)
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Circulating Brain Injury Biomarkers: A Novel Method for Quantification of the Impact on the Brain After Tumor Surgery.
- 2023
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Ingår i: Neurosurgery. - 0148-396X .- 1524-4040. ; 93:4, s. 847-856
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Tidskriftsartikel (refereegranskat)abstract
- Clinical methods to quantify brain injury related to neurosurgery are scarce. Circulating brain injury biomarkers have recently gained increased interest as new ultrasensitive measurement techniques have enabled quantification of brain injury through blood sampling.To establish the time profile of the increase in the circulating brain injury biomarkers glial fibrillary acidic protein (GFAP), tau, and neurofilament light (NfL) after glioma surgery and to explore possible relationships between these biomarkers and outcome regarding volume of ischemic injury identified with postoperative MRI and new neurological deficits.In this prospective study, 34 adult patients scheduled for glioma surgery were included. Plasma concentrations of brain injury biomarkers were measured the day before surgery, immediately after surgery, and on postoperative days 1, 3, 5, and 10.Circulating brain injury biomarkers displayed a postoperative increase in the levels of GFAP ( P < .001), tau ( P < .001), and NfL ( P < .001) on Day 1 and a later, even higher, peak of NFL at Day 10 ( P = .028). We found a correlation between the increased levels of GFAP, tau, and NfL on Day 1 after surgery and the volume of ischemic brain tissue on postoperative MRI. Patients with new neurological deficits after surgery had higher levels of GFAP and NfL on Day 1 compared with those without new neurological deficits.Measuring circulating brain injury biomarkers could be a useful method for quantification of the impact on the brain after tumor surgery or neurosurgery in general.
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| 4. |
- Michaëlsson, Isak, et al.
(författare)
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Circulating Brain-Injury Markers After Surgery for Craniosynostosis
- 2023
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Ingår i: World Neurosurgery. - : Elsevier BV. - 1878-8750 .- 1878-8769. ; 173
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Historically, there have been few quantitative methods for effectively evaluating outcomes after surgery for craniosynostosis. In this prospective study, we assessed a novel approach for detecting possible postsurgery brain injury in patients with craniosynostosis. Methods: We included consecutive patients operated on for sagittal (pi-plasty or craniotomy combined with springs) or metopic (frontal remodeling) synostosis at the Craniofacial Unit at Sahlgrenska University Hospital, Gothenburg, Sweden, from January 2019 to September 2020. Plasma concentrations of the brain-injury biomarkers neurofilament light (NfL), glial fibrillary acidic protein (GFAP), and tau were measured immediately before induction of anesthesia, immediately before and after surgery, and on the first and the third postoperative days using single-molecule array assays. Results: Of the 74 patients included, 44 underwent craniotomy combined with springs for sagittal synostosis, 10 underwent pi-plasty for sagittal synostosis, and 20 underwent frontal remodeling for metopic synostosis. Compared with baseline, GFAP level showed a maximal significant increase at day 1 after frontal remodeling for metopic synostosis and pi-plasty (P = 0.0004 and P = 0.003, respectively). By contrast, craniotomy combined with springs for sagittal synostosis showed no increase in GFAP. For neurofilament light, we found a maximal significant increase at day 3 after surgery for all procedures, with significantly higher levels observed after frontal remodeling and pi-plasty compared with craniotomy combined with springs (P < 0.001). Conclusions: These represent the first results showing significantly increased plasma levels of brain-injury biomarkers after surgery for craniosynostosis. Furthermore, we found that more extensive cranial vault procedures resulted in higher levels of these biomarkers relative to less extensive procedures.
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