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| 2. |
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| 3. |
- Eneling, Johanna, et al.
(författare)
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Sphenopalatine arteriovenous fistula complicating transsphenoidal pituitary surgery: A rare cause of delayed epistaxis treatable by endovascular embolization.
- 2016
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Ingår i: Surgical Neurology International. - : Medknow Publications. - 2229-5097 .- 2152-7806. ; 7:Suppl 41, s. S1053-S1056
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Vascular injuries in transsphenoidal surgery for pituitary adenomas are uncommon but can result in serious disability or death.CASE DESCRIPTION:A 46-year-old man, who underwent resection of a pituitary adenoma with suprasellar extension via a transsphenoidal approach, presented with massive epistaxis five days postoperatively. Angiography revealed an arteriovenous fistula (AVF) between the right sphenopalatine artery and a deep vein draining to the right internal jugular vein, as well as contrast agent extravasation at the fistula point. The AVF was catheterized and successfully occluded with N-butyl-2-cyanoacrylate.CONCLUSIONS:Transsphenoidal pituitary surgery can be complicated by massive epistaxis from a lesion of a small branch of the external carotid artery. Airway protection through intubation and investigation with conventional digital subtraction angiography is recommended. The treatment of choice is endovascular embolization because it can be done immediately at the angiography suite.
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| 4. |
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| 5. |
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| 6. |
- Gustafsson, O., et al.
(författare)
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MR imaging of experimentally induced intracranial hemorrhage in rabbits during the first 6 hours
- 1999
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Ingår i: Acta Radiologica. - 0284-1851. ; 40:4, s. 360-8
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To evaluate the MR appearance of intracranial, especially intraparenchymal, hemorrhage during the first 6 hours after bleeding with various pulse sequences in an animal model. MATERIAL AND METHODS: Intracerebral hematomas and subarachnoid hemorrhage were created by injecting autologous blood in 9 rabbits. MR studies were performed using a 1.5 T scanner with pixel size and slice thickness comparable to those used in clinical practice before blood injection, immediately after injection, and at regular intervals during 6 hours. The images were compared with the hematoma sizes on formalin-fixed brain slices. RESULTS: In every animal, susceptibility-weighted gradient-echo (GRE) pulse sequences depicted the intraparenchymal hematomas and blood escape in the ventricles or subarachnoid space best as areas of sharply defined, strong hypointensity. The findings remained essentially unchanged during follow-up. The sizes corresponded well to the post-mortem findings. Gradient- and spin-echo (GRASE) imaging revealed some hypointensities, but these were smaller and less well defined. Spin-echo (SE) sequences (proton density-, T1- and T2-weighted) as well as a fluid-attenuated inversion recovery turbo spin-echo sequence (fast FLAIR) depicted the hemorrhage sites as mostly isointense to brain. CONCLUSION: Susceptibility-weighted GRE imaging at 1.5 T is highly sensitive to both hyperacute hemorrhage in the brain parenchyma and to subarachnoid and intraventricular hemorrhage.
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| 7. |
- Maria Marreiros, Filipe Miguel
(författare)
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Guidance and Visualization for Brain Tumor Surgery
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Image guidance and visualization play an important role in modern surgery to help surgeons perform their surgical procedures. Here, the focus is on neurosurgery applications, in particular brain tumor surgery where a craniotomy (opening of the skull) is performed to access directly the brain region to be treated. In this type of surgery, once the skull is opened the brain can change its shape, and this deformation is known as brain shift. Moreover, the boundaries of many types of tumors are difficult to identify by the naked eye from healthy tissue. The main goal of this work was to study and develop image guidance and visualization methods for tumor surgery in order to overcome the problems faced in this type of surgery.Due to brain shift the magnetic resonance dataset acquired before the operation (preoperatively) no longer corresponds to the anatomy of the patient during the operation (intraoperatively). For this reason, in this work methods were studied and developed to compensate for this deformation. To guide the deformation methods, information of the superficial vessel centerlines of the brain was used. A method for accurate (approximately 1 mm) reconstruction of the vessel centerlines using a multiview camera system was developed. It uses geometrical constraints, relaxation labeling, thin plate spline filtering and finally mean shift to find the correct correspondences between the camera images.A complete non-rigid deformation pipeline was initially proposed and evaluated with an animal model. From these experiments it was observed that although the traditional non-rigid registration methods (in our case coherent point drift) were able to produce satisfactory vessel correspondences between preoperative and intraoperative vessels, in some specific areas the results were suboptimal. For this reason a new method was proposed that combined the coherent point drift and thin plate spline semilandmarks. This combination resulted in an accurate (below 1 mm) non-rigid registration method, evaluated with simulated data where artificial deformations were performed.Besides the non-rigid registration methods, a new rigid registration method to obtain the rigid transformation between the magnetic resonance dataset and the neuronavigation coordinate systems was also developed.Once the rigid transformation and the vessel correspondences are known, the thin plate spline can be used to perform the brain shift deformation. To do so, we have used two approaches: a direct and an indirect. With the direct approach, an image is created that represents the deformed data, and with the indirect approach, a new volume is first constructed and only after that can the deformed image be created. A comparison of these two approaches, implemented for the graphics processing units, in terms of performance and image quality, was performed. The indirect method was superior in terms of performance if the sampling along the ray is high, in comparison to the voxel grid, while the direct was superior otherwise. The image quality analysis seemed to indicate that the direct method is superior.Furthermore, visualization studies were performed to understand how different rendering methods and parameters influence the perception of the spatial position of enclosed objects (typical situation of a tumor enclosed in the brain). To test these methods a new single-monitor-mirror stereoscopic display was constructed. Using this display, stereo images simulating a tumor inside the brain were presented to the users with two rendering methods (illustrative rendering and simple alpha blending) and different levels of opacity. For the simple alpha blending method an optimal opacity level was found, while for the illustrative rendering method all the opacity levels used seemed to perform similarly.In conclusion, this work developed and evaluated 3D reconstruction, registration (rigid and non-rigid) and deformation methods with the purpose of minimizing the brain shift problem. Stereoscopic perception of the spatial position of enclosed objects was also studied using different rendering methods and parameter values.
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| 8. |
- Maria Marreiros, Filipe Miguel, 1978-, et al.
(författare)
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Multi-view 3D vessel tracking using near-infrared cameras
- 2014
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Ingår i: Proceedings of the 27th International Congress and Exhibition on Computer Assisted Radiology and Surgery. - : Springer. ; , s. S165-S165
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)
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| 9. |
- Maria Marreiros, Filipe Miguel, 1978-, et al.
(författare)
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Non-rigid Deformation Pipeline for Compensation of Superficial Brain Shift
- 2013
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Ingår i: Medical Image Computing and Computer-Assisted Intervention, MICCAI 2013. - Berlin, Heidelberg : Springer Berlin/Heidelberg. - 9783642407628 - 9783642407635 ; , s. 141-148
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Konferensbidrag (refereegranskat)abstract
- The correct visualization of anatomical structures is a critical component of neurosurgical navigation systems, to guide the surgeon to the areas of interest as well as to avoid brain damage. A major challenge for neuronavigation systems is the brain shift, or deformation of the exposed brain in comparison to preoperative Magnetic Resonance (MR) image sets. In this work paper, a non-rigid deformation pipeline is proposed for brain shift compensation of preoperative imaging datasets using superficial blood vessels as landmarks. The input was preoperative and intraoperative 3D image sets of superficial vessel centerlines. The intraoperative vessels (obtained using 3 Near-Infrared cameras) were registered and aligned with preoperative Magnetic Resonance Angiography vessel centerlines using manual interaction for the rigid transformation and, for the non-rigid transformation, the non-rigid point set registration method Coherent Point Drift. The rigid registration transforms the intraoperative points from the camera coordinate system to the preoperative MR coordinate system, and the non-rigid registration deals with local transformations in the MR coordinate system. Finally, the generation of a new deformed volume is achieved with the Thin-Plate Spline (TPS) method using as control points the matches in the MR coordinate system found in the previous step. The method was tested in a rabbit brain exposed via craniotomy, where deformations were produced by a balloon inserted into the brain. There was a good correlation between the real state of the brain and the deformed volume obtained using the pipeline. Maximum displacements were approximately 4.0 mm for the exposed brain alone, and 6.7 mm after balloon inflation.
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| 10. |
- Maria Marreiros, Filipe Miguel, 1978-, et al.
(författare)
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Non-rigid point set registration of curves : registration of the superficial vessel centerlines of the brain
- 2016
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Ingår i: MEDICAL IMAGING 2016. - : SPIE - International Society for Optical Engineering. - 9781510600218
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Konferensbidrag (refereegranskat)abstract
- In this study we present a non-rigid point set registration for 3D curves (composed by 3D set of points). The method was evaluated in the task of registration of 3D superficial vessels of the brain where it was used to match vessel centerline points. It consists of a combination of the Coherent Point Drift (CPD) and the Thin-Plate Spline (TPS) semilandmarks. The CPD is used to perform the initial matching of centerline 3D points, while the semilandmark method iteratively relaxes/slides the points. For the evaluation, a Magnetic Resonance Angiography (MRA) dataset was used. Deformations were applied to the extracted vessels centerlines to simulate brain bulging and sinking, using a TPS deformation where a few control points were manipulated to obtain the desired transformation (T-1). Once the correspondences are known, the corresponding points are used to define a new TPS deformation(T-2). The errors are measured in the deformed space, by transforming the original points using T-1 and T-2 and measuring the distance between them. To simulate cases where the deformed vessel data is incomplete, parts of the reference vessels were cut and then deformed. Furthermore, anisotropic normally distributed noise was added. The results show that the error estimates (root mean square error and mean error) are below 1 mm, even in the presence of noise and incomplete data.
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| 11. |
- Maria Marreiros, Filipe Miguel, 1978-, et al.
(författare)
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Superficial vessel reconstruction with a multiview camera system
- 2016
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Ingår i: Journal of Medical Imaging. - : SPIE - International Society for Optical Engineering. - 2329-4302 .- 2329-4310. ; 3:1
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Tidskriftsartikel (refereegranskat)abstract
- We aim at reconstructing superficial vessels of the brain. Ultimately, they will serve to guide the deformation methods to compensate for the brain shift. A pipeline for three-dimensional (3-D) vessel reconstruction using three mono-complementary metal-oxide semiconductor cameras has been developed. Vessel centerlines are manually selected in the images. Using the properties of the Hessian matrix, the centerline points are assigned direction information. For correspondence matching, a combination of methods was used. The process starts with epipolar and spatial coherence constraints (geometrical constraints), followed by relaxation labeling and an iterative filtering where the 3-D points are compared to surfaces obtained using the thin-plate spline with decreasing relaxation parameter. Finally, the points are shifted to their local centroid position. Evaluation in virtual, phantom, and experimental images, including intraoperative data from patient experiments, shows that, with appropriate camera positions, the error estimates (root-mean square error and mean error) are similar to 1 mm.
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| 12. |
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| 13. |
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| 14. |
- Rossitti, Sandro, et al.
(författare)
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Absence of the common carotid artery in a patient with a persistent trigeminal artery variant
- 2001
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Ingår i: Clinical Radiology. - : Elsevier BV. - 0009-9260 .- 1365-229X. ; 56:1, s. 79-81
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Tidskriftsartikel (refereegranskat)abstract
- We found the present case when retrospectively reviewing the files of patients with intracranial aneurysm in our institution. It concerns the coexistence of a rare developmental anomaly of the aortic arch vessels and a persistent carotid-vertebrobasilar communication variant. Since no common embryologic basis is known, this association was probably fortuitous. Each of these particular anomalies can pose unique diagnostic and therapeutic difficulties.
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| 15. |
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| 16. |
- Rossitti, Sandro, 1962-
(författare)
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Endovascular coiling of intracranial aneurysms using bioactive coils : A single-center study
- 2007
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Ingår i: Acta Radiologica. - : SAGE Publications. - 0284-1851 .- 1600-0455. ; 48:5, s. 565-576
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Tidskriftsartikel (refereegranskat)abstract
- Background: Some degree of recanalization is reported in up to one-third of intracranial aneurysms treated with endovascular coiling. A technical development potentially effective in avoiding recanalization is the Matrix Detachable Coil (MDC), which is covered with a biodegradable polymeric material that enhances intra-aneurysmal clot organization and fibrosis. Purpose: To report the initial clinical experience of MDC for endovascular aneurysm coiling in a single-center, single-operator, and well-defined population setting. Material and Methods: 118 aneurysms in 104 patients (73 with subarachnoid hemorrhage, SAH) were embolized with MDC alone (n=52) or combined with bare platinum coils (n=66). Results: Initial aneurysm obliteration was class 1 (complete obliteration) in 45 aneurysms (38.1%), class 2 (residual neck) in 44 (37.3%), and class 3 (residual aneurysm) in 29 (24.6%). Procedure-related morbidity was 4.8%, and mortality 0.96%. Clinical follow-up of 61 patients with SAH (mean 5.9 months, range 1-17 months) showed good outcome (Glasgow Outcome Scale, GOS 4-5) in 39 (63.9%), and poor outcome or death (GOS 1-3) in 22 (36.1%). Imaging follow-up of 73 aneurysms (average 6.5 months, range 1-17 months) showed class 1 in 47 (64.4%), class 2 in 18 (24.7%), and class 3 in eight (10.9%). Recanalization occurred in 11 aneurysms (15%), of which four (5.5%) required re-treatment. Conclusion: This study confirms that aneurysm coiling with MDC is feasible, effective, and safe. © 2007 Taylor and Francis.
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| 23. |
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| 24. |
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| 25. |
- Rossitti, Sandro, 1962-
(författare)
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Preoperative embolization of lower-falx meningiomas with ethylene vinyl alcohol copolymer : Technical and anatomical aspects
- 2007
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Ingår i: Acta Radiologica. - : SAGE Publications. - 0284-1851 .- 1600-0455. ; 48:3, s. 321-326
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To report the feasibility of using ethylene vinyl alcohol copolymer (EVAC) for embolization of lower-falx meningiomas. Material and Methods: Three patients were treated. The procedures were done under general anesthesia. A terminal branch of the middle cerebral artery in the proximity of the tumor was catheterized as near as possible or into the pre-falcine arterial anastomotic network around the superior sagittal sinus, and embolization with EVAC was performed with a standard injection technique. Results: This technique resulted in filling of the tumor-supplying dural arteries including all collaterals from both sides, filling of the dural territory of the tumor circulation, and some obliteration of the tumor's pial supply. On later operation, the tumors could be removed from the inside out with minimal brain retraction. Conclusion: Effective preoperative embolization of lower-falx meningiomas using EVAC is feasible. This technique has a sound anatomical basis, and it can be used with benefit even in falx meningiomas with predominantly pial vascular supply. © 2007 Taylor & Francis.
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| 26. |
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| 27. |
- Rossitti, Sandro, et al.
(författare)
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Regulation of vascular tone
- 1995
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Ingår i: Canadian Journal of Physiology and Pharmacology. ; 73, s. 544-
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Tidskriftsartikel (refereegranskat)
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| 28. |
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| 29. |
- Rossitti, Sandro
(författare)
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Transarterial Embolization of Intracranial Dural Arteriovenous Fistulas with Direct Cortical Venous Drainage using Ethylene Vinyl Alcohol Copolymer (Onyx)
- 2009
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Ingår i: CLINICAL NEURORADIOLOGY-KLINISCHE NEURORADIOLOGIE. - : Springer Science and Business Media LLC. - 0939-7116. ; 19:2, s. 122-128
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This communication concerns the new possibilities and technical aspects of using ethylene vinyl alcohol copolymer ( Onyx, EVAC) for endovascular treatment of intracranial dural arteriovenous fistulas with direct cortical venous drainage (DAVF-CVs). Patients and Methods: Five patients with symptomatic DAVF-CVs were treated primarily with transarterial embolization using Onyx. Results: All patients had complete obliteration of their DAVFs with a single Onyx injection that resulted in passage of embolic agent to the draining vein. One asymptomatic technical adverse event occurred ( a broken microcatheter on retrieval). On clinical follow-up ( mean 12.6 months, range 1-27 months), two patients with intracranial hemorrhage and one patient with cerebellar symptoms improved significantly after treatment, with residual symptoms that did not affect independence. One patient had remission of tinnitus and headache but developed seizures, and one patient was asymptomatic. Imaging follow-up ( mean 4 months, range 1-7 months) did not show any revascularization. Conclusion: Embolization with Onyx represents a significant improvement in the endovascular treatment of DAVF-CVs. Cases that would not be effectively treated with cyanoacrylate or particles can be cured by embolization alone.
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| 30. |
- Sandborg, Michael, 1961-, et al.
(författare)
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Local skin and eye lens equivalent odses in interventional neuroradiology
- 2010
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Ingår i: European Radiology. - : Springer Science and Business Media LLC. - 0938-7994 .- 1432-1084. ; 20:3, s. 725-733
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Tidskriftsartikel (refereegranskat)abstract
- Purpose To assess patient skin and eye lens doses in interventional neuroradiology and to assess both stochastic and deterministic radiation risks. Methods Kerma–area product (P KA) was recorded and skin doses measured using thermoluminescence dosimeters. Estimated dose at interventional reference point (IRP) was compared with measured absorbed doses. Results The average and maximum fluoroscopy times were 32 and 189 min for coiling and 40 and 144 min for embolisation. The average and maximum P KA for coiling were 121 and 436 Gy cm2, respectively, and 189 and 677 Gy cm2 for embolisation. The average and maximum values of the measured maximum absorbed skin doses were 0.72 and 3.0 Sv, respectively, for coiling and 0.79 and 2.1 Sv for embolisation. Two out of the 52 patients received skin doses in excess of 2 Sv. The average and maximum doses to the eye lens (left eye) were 51 and 515 mSv (coiling) and 71 and 289 mSv (embolisation). Conclusion The ratio between the measured dose and the dose at the IRP was 0.44 ± 0.18 mSv/mGy indicating that the dose displayed by the x-ray unit overestimates the maximum skin dose but is still a valuable indication of the dose. The risk of inducing skin erythema and lens cataract during our hospital procedures is therefore small.
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| 31. |
- Sandborg, Michael, et al.
(författare)
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Patient Organ Radiation Doses During Treatment for Aneurysmal Subarachnoid Hemorrhage
- 2012
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Ingår i: Clinical neuroradiology. - : Springer. - 1869-1447 .- 1869-1439. ; 22:4, s. 315-325
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The aim of this retrospective study was to estimate risk organ doses and to estimate radiation risks during the imaging work-up and treatment for aneurysmal subarachnoid hemorrhage (SAH). METHODS: The imaging procedures comprised computed tomography and digital subtraction angiography studies for diagnosis or endovascular interventional procedures in 50 consecutive patients. Equivalent organ doses (H(T)) to skin, brain, eye lens, salivary glands, thyroid and oral mucosa were measured using thermoluminescence dosimeters in an anthropomorphic head phantom. Picture archiving and communication system (PACS) and radiological information system (RIS) records were analyzed and the frequency of each imaging procedure was recorded as well as the registered individual kerma-length product (P(KL)) and the kerma-area product (P(KA)). The doses were computed by multiplying the recorded P(KL) and P(KA) values by the conversion coefficients H(T)/P(KL) and H(T)/P(KA) from the head phantom. RESULTS: The mean fluoroscopy time, P(KL) and P(KA) were 38 min, 7269 mGy cm and 286 Gy cm(2), respectively. The estimated mean equivalent doses were as follows: skin 2.51 Sv, brain 0.92 Sv, eye lens 0.43 Sv and salivary glands 0.23 Sv. Maximum organ doses were 2.3-3.5 times higher than the mean. Interventional procedures contributed 66 % to skin dose, 55 % to brain dose and 25 % to eye lens dose. Of the patients with an estimated skin dose exceeding 6 Sv, only 1 developed temporary epilation. CONCLUSION: The risk for radiation-induced cancer for SAH patients is low (2-3 cases per 1,000 patients, of which 90 % are expected to be benign types) compared with the risk of tissue reactions on the head such as skin erythema and epilation (1 temporary epilation per 50 patients).
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| 32. |
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| 33. |
- Tobieson, Lovisa, et al.
(författare)
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Dynamic protein changes in the perihaemorrhagic zone of Surgically Treated Intracerebral Haemorrhage Patients
- 2019
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- The secondary injury cascades exacerbating the initial brain injury following intracerebral haemorrhage (ICH) are incompletely understood. We used dual microdialysis (MD) catheters placed in the perihaemorrhagic zone (PHZ) and in seemingly normal cortex (SNX) at time of surgical ICH evacuation in ten patients (range 26-70 years). Routine interstitial MD markers (including glucose and the lactate/pyruvate ratio) were analysed and remaining microdialysate was analysed by two-dimensional gel electrophoresis (2-DE) and nano-liquid chromatography tandem mass spectrometry (nLC-MS/MS). Two time intervals were analysed; median 2-10 hours post-surgery (time A) and median 68-76 hours post-ICH onset (time B). Using 2-DE, we quantified 232 ± 31 different protein spots. Two proteins differed between the MD catheters at time A, and 12 proteins at time B (p < 0.05). Thirteen proteins were significantly altered between time A and time B in the SNX and seven proteins in the PHZ, respectively. Using nLC-MS/MS ca 800 proteins were identified out of which 76 were present in all samples. At time A one protein was upregulated and two downregulated, and at time B, seven proteins were upregulated, and four downregulated in the PHZ compared to the SNX. Microdialysis-based proteomics is feasible for study of secondary injury mechanisms and discovery of biomarkers after ICH.
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| 34. |
- Tobieson, Lovisa, et al.
(författare)
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Persistent Metabolic Disturbance in the Perihemorrhagic Zone Despite a Normalized Cerebral Blood Flow Following Surgery for Intracerebral Hemorrhage
- 2019
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Ingår i: Neurosurgery. - : Ovid Technologies (Wolters Kluwer Health). - 0148-396X .- 1524-4040. ; 84:6, s. 1269-1279
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: We hypothesized that reduced cerebral blood flow (CBF) and/or energy metabolic disturbances exist in the tissue surrounding a surgically evacuated intracerebral hemorrhage (ICH). If present, such CBF and/or metabolic impairments may contribute to ongoing tissue injury and the modest clinical efficacy of ICH surgery.OBJECTIVE: To conduct an observational study of CBF and the energy metabolic state in the perihemorrhagic zone (PHZ) tissue and in seemingly normal cortex (SNX) by microdialysis (MD) following surgical ICH evacuation.METHODS: We evaluated 12 patients (median age 64; range 26-71 yr) for changes in CBF and energy metabolism following surgical ICH evacuation using Xenon-enhanced computed tomography (n = 10) or computed tomography perfusion (n = 2) for CBF and dual MD catheters, placed in the PHZ and the SNX at ICH surgery.RESULTS: CBF was evaluated at a mean of 21 and 58 h postsurgery. In the hemisphere ipsilateral to the ICH, CBF improved between the investigations (36.6 ± 20 vs 40.6 ± 20 mL/100 g/min; P < .05). In total, 1026 MD samples were analyzed for energy metabolic alterations including glucose and the lactate/pyruvate ratio (LPR). The LPR was persistently elevated in the PHZ compared to the SNX region (P < .05). LPR elevations in the PHZ were predominately type II (pyruvate normal-high; indicating mitochondrial dysfunction) as opposed to type I (pyruvate low; indicating ischemia) at 4 to 48 h (70% vs 30%) and at 49 to 84 h (79% vs 21%; P < .05) postsurgery.CONCLUSION: Despite normalization of CBF following ICH evacuation, an energy metabolic disturbance suggestive of mitochondrial dysfunction persists in the perihemorrhagic zone.
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| 35. |
- Tobieson, Lovisa
(författare)
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Surgically Treated Intracerebral Haemorrhage : Pathophysiology and Clinical Aspects
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Mortality and morbidity of intracerebral haemorrhage (ICH) is excessively high, and the case fatality rate has not improved in the last decades. Although surgery for ICH can be life-saving, no positive effect on functional outcome has been found in large cohorts of ICH patients. Increased understanding of the pathophysiology of ICH is needed to develop improved treatment strategies.In 17 ICH patients, paired cerebral microdialysis (CMD) catheters were inserted in the perihaemorrhagic zone (PHZ) and in normal uninjured cortex at time of surgery. Despite normalisation of cerebral blood flow, a persistent metabolic crisis indicative of mitochondrial dysfunction was detected in the PHZ. This metabolic pattern was not observed in the uninjured cortex.CMD was also used to sample proteins for proteomic analysis. A distinct proteome profile that changed over time was found in the PHZ when compared to the seemingly normal, uninjured cortex. However, protein adsorption to CMD membranes, which may interfere with concentration measurements, was substantial.Surgical treatment of 578 ICH patients was analysed in a nation-wide retrospective multi-centre study in Sweden over five years. Patients selected for surgery had similar age, pre-operative level of consciousness and co-morbidity profiles, but ICH volume and the proportion of deep-seated ICH differed among the six neurosurgical centres. Furthermore, there was variability in the post-operative care, including the use and duration of intracranial pressure monitoring, cerebrospinal fluid drainage and mechanical ventilation.In conclusion, the results of this thesis show that:(i) Despite surgical removal of an ICH a metabolic crisis caused by mitochondrial dysfunction, a potential future therapeutic target, persists in the perihaemorrhagic zone.(ii-iii) CMD is a valuable tool in ICH research for sampling novel biomarkers using proteomics, which may aid in the development of improved therapeutic interventions. However, caveats of the technique, such as protein adsorption to the CMD membrane, must be considered.(iv) The nation-wide study illustrates similar clinical features in patients selected for ICH surgery, but substantial variability in ICH volume and location as well as neurocritical care strategies among Swedish neurosurgical centres. Development of refined clinical guidelines may reduce such intercentre variability and lead to improved functional outcome for ICH patients.
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