Neurosurgery Blog: December 2014

Saturday, December 27, 2014

Smartphone-related finger, thumb movements may influence sensory processing

Neurology News & Neuroscience News from Medical News Today

Activity in the sensory processing region of the brain may be influenced by finger and thumb movements from use of smartphones, according to new research.

Original Article: http://www.medicalnewstoday.com/articles/287461.php

Separating Spondyloarthritis From Back Pain Still Problematic

MedPage Today Neurology

(MedPage Today) -- Spinal MRI criteria don't help differentiate SpA from nonspecific pain.

Original Article: http://www.medpagetoday.com/Rheumatology/Arthritis/49303

Thursday, December 25, 2014

Trial of Antiamyloid Agent in Prodromal Alzheimer's Halted

Medscape NeurologyHeadlines

The decision to halt the phase 3 trial of gantenerumab was based on a preplanned futility analysis, but the DIAN-TU trial, studying the agent in volunteers with an AD risk mutation, will continue.
Medscape Medical News

Original Article: http://www.medscape.com/viewarticle/837202?src=rss

Scientific American Editor’s Picks for the Top Tech Stories of 2014

Scientific American Editor's Picks for the Top Tech Stories of 2014

Scientific American: Mind and Brain

Wallets, wreckage and digital coin. Before the new year appears, let's look at some of the most important technology stories Scientific American covered over the past 12 months.

-- Read more on ScientificAmerican.com

Original Article: http://www.scientificamerican.com/blog/post/scientific-american-editor-s-picks-for-the-top-tech-stories-of-2014/

Wednesday, December 24, 2014

Validation of the Supplemented Spetzler-Martin Grading System for Brain Arteriovenous Malformations in a Multicenter Cohort of 1009 Surgical Patients

Neurosurgery - Most Popular Articles

BACKGROUND: The supplementary grading system for brain arteriovenous malformations (AVMs) was introduced in 2010 as a tool for improving preoperative risk prediction and selecting surgical patients. OBJECTIVE: To demonstrate in this multicenter validation study that supplemented Spetzler-Martin (SM-Supp) grades have greater predictive accuracy than Spetzler-Martin (SM) grades alone. METHODS: Data collected from 1009 AVM patients who underwent AVM resection were used to compare the predictive powers of SM and SM-Supp grades. Patients included the original 300 University of California, San Francisco patients plus those treated thereafter (n = 117) and an additional 592 patients from 3 other centers. RESULTS: In the combined cohort, the SM-Supp system performed better than SM system alone: area under the receiver-operating characteristics curve (AUROC) = 0.75 (95% confidence interval, 0.71-0.78) for SM-Supp and AUROC = 0.69 (95% confidence interval, 0.65-0.73) for SM (P < .001). Stratified analysis fitting models within 3 different follow-up groupings (<6 months, 6 months-2 years, and >2 years) demonstrated that the SM-Supp system performed better than SM system for both medium (AUROC = 0.71 vs 0.62; P = .003) and long (AUROC = 0.69 vs 0.58; P = .001) follow-up. Patients with SM-Supp grades ≤6 had acceptably low surgical risks (0%-24%), with a significant increase in risk for grades >6 (39%-63%). CONCLUSION: This study validates the predictive accuracy of the SM-Supp system in a multicenter cohort. An SM-Supp grade of 6 is a cutoff or boundary for AVM operability. Supplemented grading is currently the best method of estimating neurological outcomes after AVM surgery, and we recommend it as a starting point in the evaluation of AVM operability. ABBREVIATIONS: AUROC, area under the receiver-operating characteristic curve AVM, arteriovenous malformation mRS, modified Rankin Scale SM, Spetzler-Martin SM-Supp, supplemented Spetzler-Martin UCSF, University of California, San Francisco

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2015/01000/Validation_of_the_Supplemented_Spetzler_Martin.3.aspx

Scientists uncover potential to restore lost memories in patients with early Alzheimer's

Neurology News & Neuroscience News from Medical News Today

A new study by researchers from UCLA claims lost memories may be restored by triggering regrowth of previously destroyed synaptic connections.

Original Article: http://www.medicalnewstoday.com/articles/287360.php

Traumatic Brain Injuries: The Influence of the Direction of Impact

Neurosurgery Blog

Traumatic Brain Injuries: The Influence of the Direction of Impact

Post, Andrew PhD^*; Hoshizaki, T.B. PhD^*; Gilchrist, Michael D. PhD^*,‡; Brien, Susan MD^*,§; Cusimano, Michael MD^¶; Marshall, Shawn MD^‖

BACKGROUND: Head impact direction has been identified as an influential risk factor in the risk of traumatic brain injury (TBI) from animal and anatomic research; however, to date, there has been little investigation into this relationship in human subjects. If a susceptibility to certain types of TBI based on impact direction was found to exist in humans, it would aid in clinical diagnoses as well as prevention methods for these types of injuries.

OBJECTIVE: To examine the influence of impact direction on the presence of TBI lesions, specifically, subdural hematomas, subarachnoid hemorrhage, and parenchymal contusions.

METHODS: Twenty reconstructions of falls that resulted in a TBI were conducted in a laboratory based on eyewitness, interview, and medical reports. The reconstructions involved impacts to a Hybrid III anthropometric dummy and finite element modeling of the human head to evaluate the brain stresses and strains for each TBI event.

RESULTS: The results showed that it is likely that increased risk of incurring a subdural hematoma exists from impacts to the frontal or occipital regions, and parenchymal contusions from impacts to the side of the head. There was no definitive link between impact direction and subarachnoid hemorrhage. In addition, the results indicate that there is a continuum of stresses and strain magnitudes between lesion types when impact location is isolated, with subdural hematoma occurring at lower magnitudes for frontal and occipital region impacts, and contusions lower for impacts to the side.

CONCLUSION: This hospital data set suggests that there is an effect that impact direction has on TBI depending on the anatomy involved for each particular lesion.

Neurosurgery:

January 2015 – Volume 76 – Issue 1 – p 81–91

doi: 10.1227/NEU.0000000000000554

Research-Laboratory

http://journals.lww.com/neurosurgery/Abstract/2015/01000/Traumatic_Brain_Injuries___The_Influence_of_the.9.aspx

The post Traumatic Brain Injuries: The Influence of the Direction of Impact appeared first on NEUROSURGERY BLOG.

Original Article: http://neurocirurgiabr.com/traumatic-brain-injuries-the-influence-of-the-direction-of-impact/?utm_source=rss&utm_medium=rss&utm_campaign=traumatic-brain-injuries-the-influence-of-the-direction-of-impact

AHA: 30% of All US Deaths Are From Heart Disease, Stroke

Medscape NeurologyHeadlines

In its annual statistical update, the AHA for the first time includes a global snapshot on heart health and stroke. Worldwide and in the US, CVD remains the leading cause of death.
Heartwire

Original Article: http://www.medscape.com/viewarticle/837133?src=rss

Eating More Carbs May Signal Frontotemporal Dementia

Medscape NeurologyHeadlines

Changes in eating patterns toward more sugar and carbs, weight gain, and deteriorating table manners may point to a diagnosis of frontotemporal dementia, a new study suggests.
Medscape Medical News

Original Article: http://www.medscape.com/viewarticle/837070?src=rss

Saturday, December 20, 2014

Future Smartphone Could Fall Smartly Too

Scientific American: Mind and Brain

Apple got a patent for a system to adjust your falling device in flight to minimize the damage upon landing. Larry Greenemeier reports.

-- Read more on ScientificAmerican.com

Original Article: http://www.scientificamerican.com/podcast/episode/future-smartphone-could-fall-smartly-too/

Errors in Neurosurgery

Neurosurgery Clinics of North America

Medical errors are common and dangerous, estimated to cause over 400,000 deaths per year in the United States alone. The field of neurosurgery is not immune to these errors, and many studies have begun analyzing the frequency and types of errors that neurosurgical patients experience, along with their effects and causes. Fortunately, these data are guiding new innovations to reduce and prevent errors, like checklists, computerized order entry, and an increased appreciation for volume–outcome relationships. This article describes the epidemiology of errors, their classification, methods for identifying and discovering errors, and new strategies for error prevention.

Original Article: http://www.neurosurgery.theclinics.com/article/S1042-3680(14)00146-6/abstract?rss=yes

Friday, December 19, 2014

A Systematic Review of Risk Factors for Delirium in the ICU*

Critical Care Medicine - Current Issue

Objective: Although numerous risk factors for delirium in the ICU have been proposed, the strength of evidence supporting each risk factor remains unclear. This study systematically identifies risk factors for delirium in critically ill adults where current evidence is strongest. Data Sources: CINAHL, EMBASE, MEDLINE, the Cochrane Central Register for Controlled Trials, and the Cochrane Database of Systematic Reviews. Study Selection: Studies published from 2000 to February 2013 that evaluated critically ill adults, not undergoing cardiac surgery, for delirium, and used either multivariable analysis or randomization to evaluate variables as potential risk factors for delirium. Data Extraction: Data were abstracted in duplicate, and quality was scored using Scottish Intercollegiate Guidelines Network checklists (i.e., high, acceptable, and low). Using a best-evidence synthesis each variable was evaluated using 3 criteria: the number of studies investigating it, the quality of these studies, and whether the direction of association was consistent across the studies. Strengths of association were not summarized. Strength of evidence was defined as strong (consistent findings in ≥2 high quality studies), moderate (consistent findings in 1 high quality study and ≥1 acceptable quality studies), inconclusive (inconsistent findings or 1 high quality study or consistent findings in only acceptable quality/low quality studies) or no evidence available. Data Synthesis: Among 33 studies included, 70% were high quality. There was strong evidence that age, dementia, hypertension, pre-ICU emergency surgery or trauma, Acute Physiology and Chronic Health Evaluation II score, mechanical ventilation, metabolic acidosis, delirium on the prior day, and coma are risk factors for delirium, that gender is not associated with delirium, and that use of dexmedetomidine is associated with a lower delirium prevalence. There is moderate evidence that multiple organ failure is a risk factor for delirium. Conclusions: Only 11 putative risk factors for delirium are supported by either strong or moderate level of evidence. These factors should be considered when designing delirium prevention strategies or controlling for confounding in future etiologic studies.

Original Article: http://journals.lww.com/ccmjournal/Fulltext/2015/01000/A_Systematic_Review_of_Risk_Factors_for_Delirium.6.aspx

Xenon Improves Neurologic Outcome and Reduces Secondary Injury Following Trauma in an In Vivo Model of Traumatic Brain Injury*

Critical Care Medicine - Current Issue

Objectives: To determine the neuroprotective efficacy of the inert gas xenon following traumatic brain injury and to determine whether application of xenon has a clinically relevant therapeutic time window. Design: Controlled animal study. Setting: University research laboratory. Subjects: Male C57BL/6N mice (n = 196). Interventions: Seventy-five percent xenon, 50% xenon, or 30% xenon, with 25% oxygen (balance nitrogen) treatment following mechanical brain lesion by controlled cortical impact. Measurements and Main Results: Outcome following trauma was measured using 1) functional neurologic outcome score, 2) histological measurement of contusion volume, and 3) analysis of locomotor function and gait. Our study shows that xenon treatment improves outcome following traumatic brain injury. Neurologic outcome scores were significantly (p < 0.05) better in xenon-treated groups in the early phase (24 hr) and up to 4 days after injury. Contusion volume was significantly (p < 0.05) reduced in the xenon-treated groups. Xenon treatment significantly (p < 0.05) reduced contusion volume when xenon was given 15 minutes after injury or when treatment was delayed 1 or 3 hours after injury. Neurologic outcome was significantly (p < 0.05) improved when xenon treatment was given 15 minutes or 1 hour after injury. Improvements in locomotor function (p < 0.05) were observed in the xenon-treated group, 1 month after trauma. Conclusions: These results show for the first time that xenon improves neurologic outcome and reduces contusion volume following traumatic brain injury in mice. In this model, xenon application has a therapeutic time window of up to at least 3 hours. These findings support the idea that xenon may be of benefit as a neuroprotective treatment in patients with brain trauma.

Original Article: http://journals.lww.com/ccmjournal/Fulltext/2015/01000/Xenon_Improves_Neurologic_Outcome_and_Reduces.18.aspx

Electroencephalogram Predicts Outcome in Patients With Postanoxic Coma During Mild Therapeutic Hypothermia*

Critical Care Medicine - Current Issue

Objective: To assess the value of electroencephalogram for prediction of outcome of comatose patients after cardiac arrest treated with mild therapeutic hypothermia. Design: Prospective cohort study. Setting: Medical ICU. Patients: One hundred forty-two patients with postanoxic encephalopathy after cardiac arrest, who were treated with mild therapeutic hypothermia. Measurements and Main Results: Continuous electroencephalogram was recorded during the first 5 days of ICU admission. Visual classification of electroencephalogram patterns was performed in 5-minute epochs at 12 and 24 hours after cardiac arrest by two independent observers, blinded for patients' conditions and outcomes. Patterns were classified as isoelectric, low voltage, epileptiform, burst-suppression, diffusely slowed, or normal. Burst-suppression was subdivided into patterns with and without identical bursts. Primary outcome measure was the neurologic outcome based on each patient's best achieved Cerebral Performance Category score within 6 months after inclusion. 67 patients (47%) had favorable outcome (Cerebral Performance Category, 1–2). In patients with favorable outcome, electroencephalogram patterns improved within 24 hours after cardiac arrest, mostly toward diffusely slowed or normal. At 24 hours after cardiac arrest, the combined group of isoelectric, low voltage, and "burst-suppression with identical bursts" was associated with poor outcome with a sensitivity of 48% (95% CI, 35–61) and a specificity of 100% (95% CI, 94–100). At 12 hours, normal or diffusely slowed electroencephalogram patterns were associated with good outcome with a sensitivity of 56% (95% CI, 41–70) and a specificity of 96% (95% CI, 86–100). Conclusions: Electroencephalogram allows reliable prediction of both good and poor neurologic outcome of patients with postanoxic encephalopathy treated with mild therapeutic hypothermia within 24 hours after cardiac arrest.

Original Article: http://journals.lww.com/ccmjournal/Fulltext/2015/01000/Electroencephalogram_Predicts_Outcome_in_Patients.19.aspx

Development and Implementation of Guidelines in Neurosurgery

Neurosurgery Clinics of North America

Although it is intuitive that any neurosurgeon would seek to consistently apply the best available evidence to patient management, the application of evidence-based medicine (EBM) principles and clinical practice guidelines (CPGs) remains variable. This article reviews the origin and process of EBM, and the development, assessment, and applicability of EBM and CPGs in neurosurgical care, aiming to demonstrate that CPGs are one of the valid available options that exist to improve quality of care. CPGs are not intended to define the standard of care but to compile dynamic advisory statements, which need to be updated as new evidence emerges.

Original Article: http://www.neurosurgery.theclinics.com/article/S1042-3680(14)00140-5/abstract?rss=yes

A Faster Way to Diagnose Antibiotic Resistance

Scientific American: Mind and Brain

Novel test could slash wait time and curb inappropriate prescriptions

-- Read more on ScientificAmerican.com

Original Article: http://www.scientificamerican.com/article/a-faster-way-to-diagnose-antibiotic-resistance/

Primary Complex Motor Stereotypies in Older Children and Adolescents: Clinical Features and Longitudinal Follow-Up

Pediatric Neurology

Complex motor stereotypies (CMS) are rhythmic, repetitive, fixed, and purposeless movements that stop with distraction. Once believed to occur only in children with autism spectrum or other developmental disorders, their presence in otherwise typically developing children (primary) has been well established. In primary CMS, little information is available about the long-term outcome of the movements or existing comorbidities. Forty-nine healthy participants (31 boys), ages 9 to 20 years with primary CMS who were previously diagnosed at a pediatric movements disorder clinic, were identified from medical records.

Original Article: http://www.pedneur.com/article/S0887-8994(14)00667-5/abstract?rss=yes

A Systematic Review of Risk Factors for Delirium in the ICU*

Critical Care Medicine - Most Popular Articles

Intracranial Pressure After Subarachnoid Hemorrhage*

Critical Care Medicine - Most Popular Articles

Objectives: To describe mean intracranial pressure after aneurysmal subarachnoid hemorrhage, to identify clinical factors associated with increased mean intracranial pressure, and to explore the relationship between mean intracranial pressure and outcome. Design: Analysis of a prospectively collected observational database. Setting: Neuroscience ICU of an academic hospital. Patients: One hundred sixteen patients with subarachnoid hemorrhage and intracranial pressure monitoring. Interventions: None. Measurements and Main Results: Episodes of intracranial pressure greater than 20 mm Hg lasting at least 5 minutes and the mean intracranial pressure for every 12-hour interval were analyzed. The highest mean intracranial pressure was analyzed in relation to demographic characteristics, acute neurologic status, initial radiological findings, aneurysm treatment, clinical vasospasm, and ischemic lesion. Mortality and 6-month outcome (evaluated using a dichotomized Glasgow Outcome Scale) were also introduced in multivariable logistic models. Eighty-one percent of patients had at least one episode of high intracranial pressure and 36% had a highest mean intracranial pressure more than 20 mm Hg. The number of patients with high intracranial pressure peaked 3 days after subarachnoid hemorrhage and declined after day 7. Highest mean intracranial pressure greater than 20 mm Hg was significantly associated with initial neurologic status, aneurysmal rebleeding, amount of blood on CT scan, and ischemic lesion within 72 hours from subarachnoid hemorrhage. Patients with highest mean intracranial pressure greater than 20 mm Hg had significantly higher mortality. When death, vegetative state, and severe disability at 6 months were pooled, however, intracranial pressure was not an independent predictor of unfavorable outcome. Conclusions: High intracranial pressure is a common complication in the first week after subarachnoid hemorrhage in severe cases admitted to ICU. Mean intracranial pressure is associated with the severity of early brain injury and with mortality.

Original Article: http://journals.lww.com/ccmjournal/Fulltext/2015/01000/Intracranial_Pressure_After_Subarachnoid.20.aspx

Choosing Wisely: A Neurosurgical Perspective on Neuroimaging for Headaches

Neurosurgery - Current Issue

Multiple national initiatives seek to curb spending to address increasing healthcare costs in the United States. The Choosing Wisely initiative is a popular initiative that focuses on reducing healthcare spending by setting guidelines to limit tests and procedures requested by patients and ordered by physicians. To reduce spending on neuroimaging, the Choosing Wisely initiative and other organizations have offered guidelines to limit neuroimaging for headaches. Although the intentions are laudable, these guidelines are inconsistent with the neurosurgeon's experience with patients with brain tumor. If adopted by governing or funding organizations, these guidelines threaten to negatively affect the care and outcomes of patients with brain tumors, who frequently present with minimal symptoms or isolated headaches syndromes. As physicians grapple with the difficult conflict between evidence-based cost-cutting guidelines and individualized patient-tailored medicine, they must carefully balance the costs and benefits of discretionary services such as neuroimaging for headaches. By participating in the development of validated clinical decision rules on neuroimaging for headaches, neurosurgeons can advocate for their patients and improve their patients' outcomes.

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2015/01000/Choosing_Wisely___A_Neurosurgical_Perspective_on.1.aspx

Validation of the Supplemented Spetzler-Martin Grading System for Brain Arteriovenous Malformations in a Multicenter Cohort of 1009 Surgical Patients

Neurosurgery - Current Issue

Rates and Predictors of 5-Year Survival in a National Cohort of Asymptomatic Elderly Patients Undergoing Carotid Revascularization

Neurosurgery - Current Issue

BACKGROUND: Current American Heart Association guidelines recommend carotid revascularization for asymptomatic patients on the basis of life expectancy. OBJECTIVE: To determine the rates and predictors of 5-year survival in elderly patients with asymptomatic carotid artery stenosis who underwent either carotid artery stent placement (CAS) or carotid endarterectomy (CEA). METHODS: The rates of 5-year survival were determined by use of Kaplan-Meier survival methods in a representative sample of fee-for-service Medicare beneficiaries ≥65 years of age who underwent CAS or CEA for asymptomatic carotid artery stenosis with postprocedural follow-up of 3.4 ± 1.7 years. Cox proportional hazards analysis was used to assess the relative risk of all-cause mortality for patients in the presence of selected comorbidities, including ischemic heart disease, chronic renal failure, and atrial fibrillation, after adjustment for potential confounders such as age, sex, race/ethnicity, and procedure type. RESULTS: A total of 22 177 patients with asymptomatic carotid artery stenosis were treated with either CAS (n = 2144) or CEA (n = 20 033). The overall estimated 5-year survival rate (±SE) was 95.3 ± 0.00149; it was 95.5% and 93.8% in patients treated with CEA and CAS, respectively. After adjustment for potential confounders, relative risk of all-cause 5-year mortality was significantly higher among patients with atrial fibrillation (relative risk, 1.8; 95% confidence interval, 1.5-2.1) and those with chronic renal failure (relative risk, 2.1; 95% confidence interval, 1.7-2.6). CONCLUSION: Risks and benefits must be carefully weighed before carotid revascularization in elderly patients with asymptomatic carotid artery stenosis who have concurrent atrial fibrillation or chronic renal failure. ABBREVIATIONS: CAS, carotid artery stent placement CEA, carotid endarterectomy CI, confidence interval ICD-9-CM,International Classification of Diseases, 9th Revision, Clinical Modification RR, relative risk

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2015/01000/Rates_and_Predictors_of_5_Year_Survival_in_a.4.aspx

Endovascular Treatment of 346 Middle Cerebral Artery Aneurysms: Results of a 16-Year Single-Center Experience

Neurosurgery - Current Issue

BACKGROUND: The endovascular treatment of middle cerebral artery (MCA) aneurysms has been controversial because of the frequency of complex anatomy and the relative ease of surgical clipping in this location. OBJECTIVE: To present a large single-center experience with the endovascular treatment of MCA aneurysms. METHODS: The neurointerventional database at our institution was reviewed for all endovascular treatments of MCA aneurysms. Demographics, aneurysm characteristics, treatment modality, intraprocedural hemorrhagic and thromboembolic events, 30-day neurological events, and follow-up angiographic studies were recorded. RESULTS: From December 1996 to April 2013, 292 patients underwent endovascular treatment of 346 MCA aneurysms. Of these, 341 (98.6%) were successfully completed. Balloon neck remodeling was used in 230 procedures (66.5%). Ninety-five procedures (27.4%) were for ruptured aneurysms. The rate of intraprocedural hemorrhage was 2.6% (9 of 346). The overall rate of intraprocedural thromboembolic events was 13.6% (47 of 346), significantly more common in patients with acute subarachnoid hemorrhage (27.4%; P < .001). The 30-day major (modified Rankin Scale score > 2) neurological event rate was 2.9% (10 of 346), significantly more common in patients with subarachnoid hemorrhage (8.4%) compared with those without (0.8%; P < .001). The rate of complete or near-complete aneurysm occlusion at was 90.6% ≥ 6 months and 91.8% at ≥ 2 years, with an average of 24 months of follow-up available for 247 procedures. CONCLUSION: Endovascular treatment of MCA aneurysms can be safe and effective. However, it is associated with a high asymptomatic thromboembolic event rate that is more frequent in the setting of acute subarachnoid hemorrhage. ABBREVIATIONS: ISAT, International Subarachnoid Aneurysm Trial MCA, middle cerebral artery mRS, modified Rankin Scale SAH, subarachnoid hemorrhage TIA, transient ischemic attack

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2015/01000/Endovascular_Treatment_of_346_Middle_Cerebral.6.aspx

Effect of Vascular Anatomy on the Formation of Basilar Tip Aneurysms

Neurosurgery - Current Issue

BACKGROUND: The pathogenesis of intracranial aneurysms is multifactorial and includes genetic, environmental, and anatomic influences. Hemodynamic stress plays a particular role in the formation of intracranial aneurysms, which is conditioned by the geometry and morphology of the vessel trees. OBJECTIVE: To identify image-based morphological parameters that correlated with the formation of basilar artery tip aneurysms (BTAs) in a location-specific manner. METHODS: Morphological parameters obtained from computed tomographic angiographies of 33 patients with BTAs and 33 patients with aneurysms at other locations were evaluated with Slicer, an open-source image analysis software, to generate 3-dimensional models of the aneurysms and surrounding vascular architecture. We examined the diameters and vessel-to-vessel angles of the main vessels at the basilar bifurcation in patients with and without BTAs. To control for genetic and other risk factors, only patients with at least 1 aneurysm were included. Univariate and multivariate analyses were performed to determine statistical significance. RESULTS: Sixty-six patients (33 with BTAs, 33 with other aneurysms) who were evaluated from 2008 to 2013 were analyzed. Multivariate logistic regression revealed that a larger angle between the posterior cerebral arteries (odds ratio, 1.04; P = 1.42 × 10−3) and a smaller basilar artery diameter (odds ratio, 0.23; P = .02) were most strongly associated with BTA formation after adjustment for other morphological and clinical variables. CONCLUSION: Larger posterior cerebral artery angles and smaller basilar artery diameters are associated with the formation of basilar tip aneurysms. These parameters are easily measurable by the clinician and will aid in screening strategies in high-risk patients. ABBREVIATIONS: BTA, basilar tip aneurysm CI, confidence interval IA, intracranial aneurysms OR, odds ratio PCA, posterior cerebral artery WSS, wall shear stress

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2015/01000/Effect_of_Vascular_Anatomy_on_the_Formation_of.7.aspx

Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI): A Prospective Longitudinal Observational Study

Neurosurgery - Current Issue

BACKGROUND: Current classification of traumatic brain injury (TBI) is suboptimal, and management is based on weak evidence, with little attempt to personalize treatment. A need exists for new precision medicine and stratified management approaches that incorporate emerging technologies. OBJECTIVE: To improve characterization and classification of TBI and to identify best clinical care, using comparative effectiveness research approaches. METHODS: This multicenter, longitudinal, prospective, observational study in 22 countries across Europe and Israel will collect detailed data from 5400 consenting patients, presenting within 24 hours of injury, with a clinical diagnosis of TBI and an indication for computed tomography. Broader registry-level data collection in approximately 20 000 patients will assess generalizability. Cross sectional comprehensive outcome assessments, including quality of life and neuropsychological testing, will be performed at 6 months. Longitudinal assessments will continue up to 24 months post TBI in patient subsets. Advanced neuroimaging and genomic and biomarker data will be used to improve characterization, and analyses will include neuroinformatics approaches to address variations in process and clinical care. Results will be integrated with living systematic reviews in a process of knowledge transfer. The study initiation was from October to December 2014, and the recruitment period was for 18 to 24 months. EXPECTED OUTCOMES: Collaborative European NeuroTrauma Effectiveness Research in TBI should provide novel multidimensional approaches to TBI characterization and classification, evidence to support treatment recommendations, and benchmarks for quality of care. Data and sample repositories will ensure opportunities for legacy research. DISCUSSION: Comparative effectiveness research provides an alternative to reductionistic clinical trials in restricted patient populations by exploiting differences in biology, care, and outcome to support optimal personalized patient management.

Original Article: http://journals.lww.com/neurosurgery/Fulltext/2015/01000/Collaborative_European_NeuroTrauma_Effectiveness.8.aspx