Brain bleed surgery
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Brain Bleed Surgery: Insights from Recent Research
Incidence and Risk Factors of Intracranial Bleeding in Deep Brain Stimulation Surgery
Deep brain stimulation (DBS) surgery, a treatment for movement disorders, carries a risk of intracranial bleeding. A systematic review and meta-analysis found that the incidence of intracranial bleeding in DBS surgery is 2.5% per patient and 1.4% per implanted lead 1. The study highlighted that older patients are at a higher risk of hemorrhage, with an average age difference of five years between those who experienced bleeding and those who did not 1. Additionally, there was a nonsignificant trend suggesting that patients with hypertension might have a higher risk of bleeding 1. The use of microelectrode recording did not significantly affect the bleeding rate 1.
Predicting the Need for Surgery in Head Injury: The Bleed to Brain Ratio
In head trauma cases, determining the need for surgical intervention can be challenging. A study introduced the bleed to brain ratio (BBR) as a more accurate predictor of the need for surgery compared to bleed volume alone 2. The BBR is calculated by comparing the total volume of blood clots to the volume of normal brain tissue. A BBR cutoff value of 0.0535 was found to have a sensitivity of 90.6% and a specificity of 52.6% for predicting the need for surgery 2. This method is particularly useful for patients with multiple irregular-sized bleeds where surgical decisions are uncertain 2.
Tranexamic Acid in Traumatic Brain Injury: Reducing Mortality and Hemorrhage Growth
Tranexamic acid (TXA) has been studied extensively for its effects on traumatic brain injury (TBI). The CRASH-3 trial demonstrated that TXA reduces head injury-related death when administered within three hours of injury 3. Specifically, the risk of death was reduced in patients with mild-to-moderate head injury but not in those with severe head injury 3. Another study within the CRASH-2 trial framework found that TXA might reduce the growth of intracranial hemorrhage, although the results were not statistically significant 4. These findings suggest that early administration of TXA is crucial for improving outcomes in TBI patients 34.
Enhancing Surgical Visibility During Brain Bleed Surgery
One of the significant challenges during brain surgery is maintaining visibility in the presence of massive bleeding. A novel approach using near-infrared (NIR) camera data and shearlet-transform with color-coding algorithms has been proposed to enhance the visibility of brain tissues during surgery 6. This method aims to improve the brightness characteristics of images and segment biological tissues of interest, potentially aiding surgeons in managing bleeding more effectively 6.
Conclusion
Recent research provides valuable insights into managing intracranial bleeding in both surgical and traumatic contexts. The incidence of bleeding in DBS surgery is relatively low but higher in older patients. The BBR offers a promising tool for predicting the need for surgery in head trauma cases. Tranexamic acid shows potential in reducing mortality and hemorrhage growth in TBI, particularly when administered early. Additionally, advancements in imaging technology may enhance surgical visibility, improving outcomes in brain bleed surgeries. These findings collectively contribute to better management strategies for patients at risk of intracranial bleeding.
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Most relevant research papers on this topic
Intracranial Bleeding in Deep Brain Stimulation Surgery: A Systematic Review and Meta-Analysis
Intracranial bleeding in deep brain stimulation surgery is rare, but older patients have a higher risk, with no significant difference between genders or implantation targets.
Meta-AnalysisDerivation of a Bleed to Brain Ratio to Predict the Need for Surgery in Head Injury
The bleed-to-brain ratio (BBR) is a more accurate predictor of the need for surgery in head trauma patients than bleed volume alone, with a cutoff value of 0.0535 being clinically significant.
Observational StudyEffects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial
Tranexamic acid reduces the risk of head injury-related death in patients with acute traumatic brain injury when administered within 3 hours of injury.
RCT
Large Human Trial
Rigorous Journal
Highly CitedEffect of tranexamic acid in traumatic brain injury: a nested randomised, placebo controlled trial (CRASH-2 Intracranial Bleeding Study)
Tranexamic acid shows no clear benefits or harm in reducing intracranial haemorrhage in patients with traumatic brain injury, but further clinical trials are needed.
RCTRigorous JournalHighly CitedCRASH-3 - tranexamic acid for the treatment of significant traumatic brain injury: study protocol for an international randomized, double-blind, placebo-controlled trial
Early administration of tranexamic acid (TXA) may reduce death and disability in patients with traumatic brain injury by reducing intracranial bleeding and blood transfusion needs.
RCTLarge Human Trial
Very Rigorous JournalHighly CitedEnhancement of brain tissues visibility in conditions of massive bleeding based on NIR-camera data and shearlet-transform
NIR-camera data and shearlet-transform can enhance brain tissue visibility during brain surgery, improving hemostasis in blood-filled surgical wounds.
Tranexamic acid for patients with traumatic brain injury: a randomized, double-blinded, placebo-controlled trial
Tranexamic acid may reduce progressive intracranial haemorrhage in patients with traumatic brain injury, but its effect was not statistically significant in this trial.
RCTRigorous JournalHighly CitedOriginal memoirs: the control of bleeding in operations for brain tumors: with the description of silver "clips" for the occlusion of vessels inaccessible to the ligature. 1911.
Silver "clips" can effectively control bleeding in intracranial surgery, reducing blood loss and brain damage.
Wound bleeding after head and neck surgery
Wound bleeding after head and neck surgery is common, but treatment options do not significantly impact wound healing or hospital stay duration.
Observational Study