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- 저자 : Angelos Kolias (검색결과 2 건)
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Cerebral Vasospasm Affects Arterial Critical Closing Pressure
Varsos, Georgios V,Budohoski, Karol P,Czosnyka, Marek,Kolias, Angelos G,Nasr, Nathalie,Donnelly, Joseph,Liu, Xiuyun,Kim, Dong-Joo,Hutchinson, Peter J,Kirkpatrick, Peter J,Varsos, Vassilis G,Smielewski SAGE Publications 2015 Journal of cerebral blood flow and metabolism Vol.35 No.2
<P> The effect of cerebral vasospasm (CVS) after aneurysmal subarachnoid hemorrhage (SAH) on critical closing pressure (CrCP) has not been fully delineated. Using cerebral impedance methodology, we sought to assess the behavior of CrCP during CVS. As CrCP expresses the sum of intracranial pressure (ICP) and vascular wall tension, we also explored its role in reflecting changes in vascular tone occurring in small vessels distal to spasm. This retrospective analysis was performed using recordings from 52 patients, diagnosed with CVS through transcranial Doppler measurements. Critical closing pressure was calculated noninvasively using arterial blood pressure and blood flow velocity. Outcome was assessed at both discharge and 3 months after ictus with the Glasgow Outcome Scale. The onset of CVS caused significant decreases in CrCP ( P=0.025), without any observed significant changes in ICP ( P=0.134). Vasospasm induced asymmetry, with CrCP ipsilateral to CVS becoming significantly lower than contralateral ( P=0.025). Unfavorable outcomes were associated with a significantly lower CrCP after the onset of CVS (discharge: P=0.014; 3 months after SAH: P=0.020). Critical closing pressure is reduced in the presence of CVS in both temporal and spatial assessments. As ICP remained unchanged during CVS, reduced CrCP most probably reflects a lower wall tension in dilated small vessels distal to spasm. </P>
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Predictors of Cerebrospinal Fluid Leak Following Dural Repair in Spinal Intradural Surgery
Lei Jiang,Alexandru Budu,Muhammad Shuaib Khan,Edward Goacher,Angelos Kolias,Rikin Trivedi,Jibin Francis 대한척추신경외과학회 2023 Neurospine Vol.20 No.3
Objective: We aim to compare the effectiveness of dural closure techniques in preventing cerebrospinal fluid (CSF) leaks following surgery for intradural lesions and seek to identify additional factors associated with CSF leaks. Surgical management of spinal intradural lesions involves durotomy which requires a robust repair to prevent postoperative CSF leakage. The ideal method of dural closure and the efficacy of sealants has not been established in literature. Methods: We performed a retrospective analysis of all intradural spinal cases performed at a tertiary spine centre from 1 April 2015 to 29 January 2020 and collected data on patient bio-profile, dural repair technique, and CSF leak rates. Multivariate analysis was performed to identify predictors for postoperative CSF leak. Results: A total of 169 cases were reported during the study period. There were 15 cases in which postoperative CSF leak was reported (8.87%). Multivariate analysis demonstrated that patient age (odds ratio [OR], 0.942; 95% confidence interval [CI], 0.891–0.996), surgical indication listed in the “others” category (OR, 44.608; 95% CI, 1.706–166.290) and dural closure with suture, sealant and patch (OR, 22.235; 95% CI, 2.578–191.798) were factors associated with CSF leak. Postoperative CSF leak was associated with the risk of surgical site infection with a likelihood ratio of 8.704 (χ² (1) = 14.633, p < 0.001). Conclusion: Identifying predictors for CSF leaks can assist in the counselling of patients with regard to surgical risk and expected postoperative recovery.
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