BACKGROUND: Atherosclerotic intracranial arterial stenosis is an important cau se of stroke. Warfarin is commonly used in preference to aspirin for this disord er, but these therapies have not been compared in a randomized trial. METHODS: W e randomly assigned patients with transient ischemic attack or stroke caused by angiographically verified 50 to 99 percent stenosis of a major intracranial arte ry to receive warfarin (target international normalized ratio, 2.0 to 3.0) or as pirin (1300 mg per day) in a double-blind, multicenter clinical trial. The prim ary end point was ischemic stroke, brain hemorrhage, or death from vascular caus es other than stroke. RESULTS: After 569 patients had undergone randomization, e nrollment was stopped because of concerns about the safety of the patients who h ad been assigned to receive warfarin. During a mean follow-up period of 1.8 yea rs, adverse events in the two groups included death (4.3 percent in the aspirin group vs. 9.7 percent in the warfarin group; hazard ratio for aspirin relative t o warfarin, 0.46; 95 percent confidence interval, 0.23 to 0.90; P=0.02), major h emorrhage (3.2 percent vs. 8.3 percent, respectively; hazard ratio, 0.39; 95 per cent confidence interval, 0.18 to 0.84; P=0.01), and myocardial infarction or su dden death (2.9 percent vs. 7.3 percent, respectively; hazard ratio, 0.40; 95 pe rcent confidence interval, 0.18 to 0.91; P=0.02). The rate of death from vascula r causes was 3.2 percent in the aspirin group and 5.9 percent in the warfarin gr oup (P=0.16); the rate of death from nonvascular causes was 1.1 percent and 3.8 percent, respectively (P=0.05). The primary end point occurred in 22.1 percent o f the patients in the aspirin group and 21.8 percent of those in the warfarin gr oup (hazard ratio, 1.04; 95 percent confidence interval, 0.73 to 1.48; P=0.83). CONCLUSIONS: Warfarin was associated with significantly higher rates of adverse events and provided no benefit over aspirin in this trial. Aspirin should be use d in preference to warfarin for patients with intracranial arterial stenosis.

Comparison of warfarin and aspirin for symptomatic intracranial arterial stenosis

OBJECT The factors that contribute to periprocedural complications following cranioplasty, including patient-specific and surgery-specific factors, need to be thoroughly assessed. The aim of this study was to evaluate risk factors that predispose patients to an increased risk of cranioplasty complications and death. METHODS The authors conducted a retrospective review of all patients at their institution who underwent cranioplasty following craniectomy for stroke, subarachnoid hemorrhage, epidural hematoma, subdural hematoma, and trauma between January 2000 and December 2011. The following predictors were tested: age, sex, race, diabetic status, hypertensive status, tobacco use, reason for craniectomy, urgency status of the craniectomy, graft material, and location of cranioplasty. The cranioplasty complications included reoperation for hematoma, hydrocephalus postcranioplasty, postcranioplasty seizures, and cranioplasty graft infection. A multivariate logistic regression analysis was performed. Confidenc...

Complications following cranioplasty: incidence and predictors in 348 cases.

Decompressive craniectomy (DC) has been used for many years in the management of patients with elevated intracranial pressure and cerebral edema. Ongoing clinical trials are investigating the clinical and cost effectiveness of DC in trauma and stroke. While DC has demonstrable efficacy in saving life, it is accompanied by a myriad of non-trivial complications that have been inadequately highlighted in prospective clinical trials. Missing from our current understanding is a comprehensive analysis of all potential complications associated with DC. Here, we review the available literature, we tabulate all reported complications, and we calculate their frequency for specific indications. Of over 1500 records initially identified, a final total of 142 eligible records were included in our comprehensive analysis. We identified numerous complications related to DC that have not been systematically reviewed. Complications were of three major types: (1) Hemorrhagic (2) Infectious/Inflammatory, and (3) Disturbances of the CSF compartment. Complications associated with cranioplasty fell under similar major types, with additional complications relating to the bone flap. Overall, one of every ten patients undergoing DC may suffer a complication necessitating additional medical and/or neurosurgical intervention. While DC has received increased attention as a potential therapeutic option in a variety of situations, like any surgical procedure, DC is not without risk. Neurologists and neurosurgeons must be aware of all the potential complications of DC in order to properly advise their patients.

Complications Associated with Decompressive Craniectomy: A Systematic Review

Melt processing is routinely used to fabricate medical polymeric devices/implants for clinical reconstruction and can be incorporated into quality systems procedures for medical device manufacture. As additive manufacturing (AM) becomes increasingly used for biomaterials and biofabrication, the translation of new, customizable, medical devices to the clinic becomes paramount. Melt processing is therefore a distinguishable group within AM that provides an avenue to manufacture scaffolds/implants with a clinical end-point. Three key melt processing AM technologies are highlighted in this review: melt micro-extrusion, selective laser sintering and melt electrospinning writing. The in vivo (including clinical) outcomes of medical devices and scaffolds made with these processes are reviewed. Together, they encompass the melt AM of scaffold architectures with feature sizes and resolutions ranging from 800 nm up to 700 μm.

https://iopscience.iop.org/article/10.1088/1758-5090/aa5766/pdf

Additive manufacturing of polymer melts for implantable medical devices and scaffolds.

An osteochondral scaffold has a chondrogenic spiral scaffold in one end of an outer shell made of sintered microspheres, and an osteogenic spiral scaffold in the other end of the outer shell. Each spiral scaffold has nanofibers of a composition selected to promote attachment and proliferation of the desired types of cells. The nanofibers for the chondrogenic spiral scaffold have a different composition than the nanofibers for the osteogenic spiral scaffold. The nanofibers of each spiral scaffold are aligned to orient the attached cells so as to recreate the structure of the native tissue.

Biphasic osteochondral scaffold for reconstruction of articular cartilage

Introduction. Cranial reconstruction with a cranioplasty is performed to repair skull defects after decompressive craniectomies. Aims. To retrospectively review all cranioplasties performed in our institution over 10 years and analyse the complications and the factors that cause complications. Patient and methods. Two hundred and forty-three cranioplasties were performed from 2000 to 2010, with a follow-up of at least 1 year. Age, sex, comorbidities, material, site of skull defect, time between decompression and cranioplasty, and rate of complications were collected from our database. Fischer's T-test and direct logistical regression were performed to identify factors that contributed to the rate of complications. p < 0.05 was considered significant. Results. Post-cranioplasty seizures (14.81%), infection and exposed implant (9.05%), haemorrhage (1.65%) and others (0.82%) were identified complications. Total percentage of complications was 25.92%. Previous trauma (p = 0.034) and intracranial haemo...

A retrospective analysis and review of an institution's experience with the complications of cranioplasty

OBJECT Both the older and the recent extracranial-intracranial (EC-IC) bypass trials for symptomatic carotid occlusion failed to demonstrate a reduction in stroke recurrence. However, the role of superficial temporal artery (STA)-middle cerebral artery (MCA) bypass in patients with symptomatic intracranial stenoocclusive disease has been rarely evaluated. The authors evaluated serial changes in various cerebral hemodynamic parameters in patients with severe stenoocclusive disease of the intracranial internal carotid artery (ICA) or middle cerebral artery (MCA) and impaired cerebral vasodilatory reserve (CVR), treated by STA-MCA bypass surgery or medical treatment. METHODS Patients with severe stenoocclusive disease of the intracranial ICA or MCA underwent transcranial Doppler (TCD) ultrasonography and CVR assessment using the breath-holding index (BHI). Patients with impaired BHI (< 0.69) were further evaluated with acetazolamide-challenge technitium-99m hexamethylpropyleneamine oxime (99mTc HMPAO) SPECT....

/pdf/improvement-in-cerebral-hemodynamic-parameters-and-outcomes-24nnm5yeiv.pdf

Improvement in cerebral hemodynamic parameters and outcomes after superficial temporal artery-middle cerebral artery bypass in patients with severe stenoocclusive disease of the intracranial internal carotid or middle cerebral arteries

INTRODUCTION External ventricular drain (EVD) infections can cause serious complications We performed an audit of EVD infections within our neurosurgical unit Through this study, we aimed to reduce the incidence of external ventricular drain-related infection, including ventriculities in neurosurgical patients METHODS We conducted an audit of the EVD infections in our institution observed over a one-and-a-half year period This was conducted in three phases A baseline EVD infection rate was determined for Phase I, from January to June 2007 We introduced the following measures to reduce EVD infection rate in Phase II, from July to December 2007: (1) For Neurosurgery doctors: performing proper surgical techniques to minimise intra-operative infections; educating junior doctors on proper CSF sampling from the EVD; and minimising the number of days the EVD is maintained in situ; (2) For Neurosurgery nurse clinicians: developing Standard Operating Procedures on nursing management of EVDs; conducting EVD care workshops for nurses working in neurosurgical wards; and competency skill checks on the management of EVDs for nurses working in the neurosurgical wards Silver-coated EVDs were introduced in Phase III of the study from January to June 2008 RESULTS The EVD infection rate decreased from a baseline of 61% to 38% in Phase II; a further reduction from 38% to 0% was achieved during Phase III CONCLUSION Good teamwork among doctors and nurses is essential for reducing EVD infection rate We managed to reduce EVD infections substantially and would continue to strive to remain infection-free in the future

/pdf/external-ventricular-drain-infections-successful-bgls106flr.pdf

External ventricular drain infections: successful implementation of strategies to reduce infection rate.

A 1-year-old boy with a history of exomphalos and hydrocephalus had surgeries to correct these pathologies the ventriculopleural (VP L ) shunt inserted for hydrocephalus was complicated by pleural effusion, for which a ventriculoperitoneal (VP) shunt was inserted on the contralateral side He subsequently presented with protrusion of the distal VP shunt tip from the mouth due to perforation through the gastrointestinal tract the child also had a history of peritonitis post-exomphalos repair, which may have predisposed him to this relatively uncommon shunt complication Probable causes and risk factors of the perforation are discussed

/pdf/migration-of-the-abdominal-catheter-of-a-26a707nuyd.pdf

Migration of the abdominal catheter of a ventriculoperitoneal shunt into the mouth: a rare presentation.

A bioabsorbable plug implant, suitable for bone tissue regeneration, comprising a first portion, and a second portion extending outwardly from the first portion, the first and second portions formed from expandable material. A method for bone tissue regeneration comprising the steps of: providing a bioabsorbable plug implant, wherein the implant comprises a first portion and a second portion extending outwardly from the first portion, the first and second portions formed from expandable material; inserting the second portion into a defect or gap of a bone, the first surface engaging the outside contour of the defect or gap; allowing the plug implant to contact body fluids, thereby expanding the size of the plug implant so that the plug fits into the defect or gap.

Ning Chou

Papers

A retrospective analysis and review of an institution's experience with the complications of cranioplasty

Improvement in cerebral hemodynamic parameters and outcomes after superficial temporal artery-middle cerebral artery bypass in patients with severe stenoocclusive disease of the intracranial internal carotid or middle cerebral arteries

External ventricular drain infections: successful implementation of strategies to reduce infection rate.

Migration of the abdominal catheter of a ventriculoperitoneal shunt into the mouth: a rare presentation.

Bioabsorbable plug implants and method for bone tissue regeneration