Brain & spine最新文献

{"title":"Fat beyond muscle: Assessing epimuscular fat of the lumbar spine and its association with vertebral level, demographics, BMI, and low back pain.","authors":"Jacopo A Vitale, Anne F Mannion, Daniel Haschtmann, Mario Ropelato, Tamás F Fekete, Frank S Kleinstück, Markus Loibl, Tina Haltiner, Fabio Galbusera","doi":"10.1016/j.bas.2024.103916","DOIUrl":"10.1016/j.bas.2024.103916","url":null,"abstract":"<p><strong>Introduction: </strong>Epimuscular fat (EF) has rarely been studied in the context of low back pain (LBP).</p><p><strong>Research question: </strong>This study aims to assess the presence and extent of EF in the lumbar muscles and its association with vertebral level in patients with low back disorders and to explore correlations between EF, demographics, BMI, and LBP.</p><p><strong>Material and methods: </strong>T2 axial MRIs from L1 to L5 were manually segmented to analyze the cross-sectional area (CSA) of EF (mm²), and fat infiltration (FI,%) of 40 patients (23 females, 17 males; mean age:65.9 years) with lumbar degenerative pathologies awaiting a surgical procedure. COMI, LBP, demographic, and clinical data were extracted from the institutional registry. Statistical analyses included Wilcoxon and Mann-Whitney tests for differences in EF between sides and sexes, the Friedman test for EF size differences among lumbar levels, and Spearman's correlation for associations, adjusted for BMI, age, and sex.</p><p><strong>Results: </strong>EF was found in 77.5% of subjects at L1, 92.5% at L2, 100% at L3 and L4, and 95.0% at L5. EF was significantly larger at L4 (253.1 ± 183.6 mm²) and L5 (220.2 ± 194.9 mm²) than at L1 (36.1 ± 37.8 mm²) and L2 (72.2 ± 84.4 mm²). No significant EF differences were found between sides and sexes. EF correlated strongly with BMI (r_s = 0.65,p < 0.001) and moderately with FI (r_s = 0.31,p = 0.04), though its correlation with FI was not significant after adjustment. EF did not correlate with COMI scores but correlated with LBP in the adjusted analysis (r_s:0.31,p = 0.04).</p><p><strong>Discussion and conclusion: </strong>EF is present across all lumbar levels, with higher concentrations at L4 and L5, and a significant correlation between EF and LBP intensity was observed. The present findings are limited to a specific subset of patients with lumbar degenerative disorders who are awaiting surgical procedures.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11533011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142577377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The application of medical ethics in the developing countries - A neurosurgical perspective.","authors":"Iftakher Hossain, Peter Hutchinson, Khandkar Kawsar, Angelos Kolias, Adriana Libório Dos Santos, Ignatius N Esene, Nqobile Thango, Ronnie Baticulon, Beata Laki, Ahmed Ammar","doi":"10.1016/j.bas.2024.103921","DOIUrl":"10.1016/j.bas.2024.103921","url":null,"abstract":"<p><strong>Introduction: </strong>Neurosurgery is one of the rapidly evolving specialities of medical science, where the neurosurgeons have to provide evidence-based interventions in life threatening conditions maintaining the ethical standards.</p><p><strong>Research question: </strong>This narrative review sheds light on the current hindrances of the ethical aspects of neurosurgical practice in low and middle-income countries (LMICs) and provide some feasible solutions for future.</p><p><strong>Material and methods: </strong>A literature search was conducted using PubMed, Scopus and ISI web of knowledge focused on articles in English with the words \"medical ethics\" together with the words \"neurosurgery\", \"ethical practice\", \"low and middle-income countries\", \"surgical innovation\", \"randomized clinical trials\" and \"outcome\" alone or in combination.</p><p><strong>Results: </strong>Due to the lack of neurosurgeons and essential infrastructures in LMICs, the practical application of medical ethics is more complicated in the field of neurosurgery. Main obstacles to conduct preclinical and clinical research in the LMICs are the lack of proper ethics committees, quality data, trained manpower and sufficient research funding. Implementation of randomized clinical trials (RCTs) is also difficult for the neurosurgeons working in LMICs.</p><p><strong>Discussion and conclusion: </strong>To improve the situation, socio-economic development, including educating the citizens of these countries about their rights, functional regulatory bodies like medical and dental councils, teaching the neurosurgeons about the internationally recognized medical ethics, quality control regulations by the ministry of health and welfare, and more funding for the health care sectors are urgently needed. Global collaboration is needed to help the LMICs to provide their patients international but \"customized\" standard care.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11530861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine learning predictive model for lumbar disc reherniation following microsurgical discectomy.","authors":"Angel G Mehandzhiyski, Nikola A Yurukov, Petar L Ilkov, Dilyana P Mikova, Nikolay S Gabrovsky","doi":"10.1016/j.bas.2024.103918","DOIUrl":"10.1016/j.bas.2024.103918","url":null,"abstract":"<p><strong>Introduction: </strong>The integration of machine learning (ML) algorithms into the field of neurosurgery has the potential to facilitate the decision-making process for the surgeons, improve the surgical outcomes and the overall patient satisfaction rates. Reoperations for same level lumbar disc reherniation are associated with poorer outcomes and greater rate of complications.</p><p><strong>Research question: </strong>Proper preoperative patient evaluation could reveal the individuals at higher risk of reherniation. A novel machine learning algorithm was used for the creation of a predictive scoring system for lumbar disc reherniation for patients requiring microdiscectomy without fusion.</p><p><strong>Material and methods: </strong>Retrospective chart review was completed of all adult patients that underwent microdiscectomy without fusion for symptomatic single level LDH, in a single center, over the last 3 years. 230 patients met the inclusion criteria. 19 of them required a second surgical intervention due to same level reherniation.</p><p><strong>Results: </strong>Utilizing the Risk-SLIM model, the Lumbar Reherniation Score (LRS) was created. The score's accuracy was tested against other model architectures, and a standard five-fold cross-validation was performed. The LRS has AUC of 0.87, confusion matrix accuracy of 0.74, Matthews correlation coefficient of 0.36 and informedness of 0.62. The LRS individual reherniation risk probability ranges from 0% to 88.1%.</p><p><strong>Discussion and conclusion: </strong>The LRS is a novel, easy-to-use, patient-specific tool for preoperative prediction of the individual patient-specific risk of same level symptomatic reherniation following microdiscectomy. Further validation and testing of the model is needed before it can be used in real-life patient treatment.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11530842/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review evaluating the association of atherosclerosis and lumbar degenerative disc disease.","authors":"Wensen Li, Niek Djuric, Carmen L A Vleggeert-Lankamp","doi":"10.1016/j.bas.2024.103901","DOIUrl":"10.1016/j.bas.2024.103901","url":null,"abstract":"<p><strong>Introduction: </strong>Lumbar disc herniation (LDH) and disc degeneration (DD) are associated with low back pain (LBP) and sciatica, which are common health problems. Emerging evidence suggests a link between vascular health, specifically abdominal aortic calcification (AAC) and systemic lipid profiles, and these spinal conditions.</p><p><strong>Research question: </strong>This study investigates the associations between AAC, systemic lipid profiles, lumbar Modic Changes (MC), DD/LDH, and the occurrence of LBP or sciatica.</p><p><strong>Material and methods: </strong>A literature search was performed (up to August 2023) in PubMed, Embase, Web of Science, Emcare, Cochrane Library, and Academic Search Premier utilizing a sensitive search strategy. Studies were chosen based on predefined criteria and assessed for bias using an adapted Cochrane checklist. Specifically, studies exploring the relationship between AAC or lipid status and DD/LDH and/or LBP/Sciatica were included.</p><p><strong>Results: </strong>Twenty-seven studies were included. Eight studies assessed the association between atherosclerosis or lipid status and clinical LBP/sciatica, with four showing a positive association between AAC/lumbar artery stenosis and these conditions. Twenty-one studies assessed atherosclerosis and DD/LDH, with seven showing a positive association between AAC and DD/LDH. Eight trials found a positive association between lipid status and DD/LDH, and two trails identified ApoL1 as a biomarker for LDH recovery.</p><p><strong>Discussion and conclusion: </strong>Evidence supports the hypothesis that inadequate blood supply contributes to disc degeneration, inflammation and clinical symptoms. Both local vascular issues and systemic lipid profiles appear to influence lumbar degeneration, highlighting the need for further research to better understand these relationships and develop preventive and therapeutic strategies.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11465040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consensus statement by the Belgian Society of Neurosurgery and literature review on the diagnosis and management of postoperative spinal epidural hematoma.","authors":"Steven Smeijers, Frederic Collignon, Emmanuel Costa, Kris Desmedt, Henri-Benjamin Pouleau, Nikolaas Vantomme, Bertrand Cailliau, Bart Depreitere, Dieter Peuskens","doi":"10.1016/j.bas.2024.103904","DOIUrl":"https://doi.org/10.1016/j.bas.2024.103904","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative spinal epidural hematoma (SEH) is a potentially devastating complication for patients and caregivers, and a leading cause for litigation in spine surgery. This article provides a literature review and the consensus statement of the Belgian Society of Neurosurgery (BSN) on the management of postoperative SEH.</p><p><strong>Research question: </strong>Can we implement current evidence to establish a framework on the management of postoperative SEH?</p><p><strong>Material and methods: </strong>Based on a Pubmed search, abstracts were screened for topics covering incidence, pathophysiology, risk factors, surveillance, diagnosis, treatment, and outcome. Relevant topics are presented in a narrative review format, followed by a consensus statement of the BSN with emphasis on rapid diagnosis and treatment.</p><p><strong>Results: </strong>Symptomatic SEH is rare (0.3-1%) and can have an insidious onset with rapid progression to neurological deficits. Recurring risk factors are coagulation deficiencies and multilevel surgery. The protective effect of a postoperative drainage system is uncertain, and early thrombo-embolic prophylaxis does not increase the risk of SEH. Prognosis is dependent on residual neurological function and critically, on the time to reintervention. There is a need for structured neurological observation formats after spine surgery.</p><p><strong>Discussion and conclusion: </strong>Symptomatic SEH after surgery is an unpredictable and severe complication requiring rapid action to maximize outcomes. The BSN proposes three nuclear terms central to SEH management, converging on a triple 'S': 1) high level of suspicion 2) speed of diagnosis and 3) immediate surgery. All spine centers can benefit from an institutional protocol in which SEH should be treated as an emergency.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11456791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the Letter to the editor concerning \"A propensity-matched study of patients with symptomatic lumbar spinal stenosis opting for surgery versus not\" by Rikke K. Jensen et al.","authors":"Casper Friis Pedersen, Søren Peter Eiskjær, Mikkel Østerheden Andersen, Leah Yacat Carreon, Peter Döring","doi":"10.1016/j.bas.2024.103903","DOIUrl":"https://doi.org/10.1016/j.bas.2024.103903","url":null,"abstract":"","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11470469/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental state as a predictor of outcome in spinal stenosis surgery: Four quadrants model integrating patient satisfaction and functional outcome.","authors":"Judith van Grafhorst, Wouter van Furth, Carmen Vleggeert-Lankamp","doi":"10.1016/j.bas.2024.103902","DOIUrl":"10.1016/j.bas.2024.103902","url":null,"abstract":"<p><strong>Introduction: </strong>Mental status, characterised by anxiety and depression, significantly influences physical well-being, particularly in patients with spinal stenosis symptoms.</p><p><strong>Research question: </strong>The prevalence of depression and anxiety in our cohort. The correlation between psychological distress and physical outcome after surgery, including postoperative recovery and satisfaction.</p><p><strong>Materials and methods: </strong>Questionnaires evaluating anxiety and depression (HADS), functionality (ODI), quality of life (EQ-5D), and perceived recovery (Likert-scale) were sent to a randomly selected cohort of 450 lumbar spinal stenosis patients, with or without spondylolisthesis, who underwent surgery between 2007 and 2013. Results are presented, dichotomised by HADS score (score ≥8 indicating psychologically impaired) and in a Four Quadrants Model integrating functional outcomes and perceived recovery separately for psychologically impaired and non-impaired cases.</p><p><strong>Results: </strong>Among the 147 included patients, 32 (22%) exhibited anxiety and/or depression (impaired cases). Satisfactory outcome (perceived recovery) was reported in 29.0% of the impaired cases and 78.3% of the non-impaired cases (p < 0.001). The mean postoperative functionality score of the impaired cases was 42.46 ± 16.24, in contrast to 18.48 ± 18.25 for the non-impaired cases (p < 0.001). In the impaired group, only 12.5% achieved both a good functional outcome (ODI ≤24) and satisfactory perceived recovery, compared with 58.4% in the non-impaired group.</p><p><strong>Discussion and conclusion: </strong>Patients reporting anxiety and/or depression demonstrate an inferior long-term outcome after spinal stenosis surgery compared to non-impaired patients. This clinically relevant difference underscores the importance of addressing depression and anxiety in preoperative counselling to optimize patient satisfaction and functional outcomes.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11416550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhanced recovery after adolescent idiopathic scoliosis surgery care pathway: Perioperative strategy to improve outcome.","authors":"Ph Creyf, N Parisi, S Munting, M Caudron, R Rossillon, Ch Detrembleur, Munting E","doi":"10.1016/j.bas.2024.103326","DOIUrl":"https://doi.org/10.1016/j.bas.2024.103326","url":null,"abstract":"<p><strong>Intro: </strong>AIS surgery generates a high inflammatory stress response which might influence the outcome in the perioperative period. Enhanced Recovery After Surgery (ERAS) is a global multidisciplinary care pathway aimed to improve patient's recovery.</p><p><strong>Research question: </strong>The purpose of this article is to expose our actual ERAS protocol for AIS surgery and compare it with the earlier non ERAS management in our institution.Our primary outcome focus on the re-hospitalisation and complications rates at 30 and 90 days postoperatively. Our secondary outcomes focus on the overall morphine consumption, pain scores and side effects during the hospitalisation.</p><p><strong>Material: </strong>We compare the results of the ERAS group (2019-2022) with the previous existing classical care pathway (2017-2019). The data were collected in our standard medical files.</p><p><strong>Results: </strong>Our ERAS care pathway for AIS surgery lead to consequently improve the outcome regarding the VAS scores, the morphine consumption, the LOS and the complication and re hospitalisation rates.</p><p><strong>Discussion: </strong>Regarding our results, ERAS care pathway for AIS surgery appears to be efficient in terms of benefits on complications rates, LOS and opioid consumption.Intrathecal morphine and \"anti-inflammatory\" anaesthesia provides a good quality of pain management and allows the patient to get up early.A superiority trial might be interesting to highlight the role of the ERAS pathway in AIS surgery.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11458952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is the ICP pulse waveform P2/P1 ratio during -6° head-down tilt associated with relative VO₂ peak? A non-invasive intracranial compliance monitoring approach.","authors":"Rafaella Mendes Zambetta, Étore De Favari Signini, Aparecida Maria Catai, Thainá Cristina Ramos Dos Santos, Eloisa Soares Michaliski, Ana Karoline Nazario, Gabriela Nagai Ocamoto, Gustavo Frigieri, Thiago Luiz Russo","doi":"10.1016/j.bas.2024.103327","DOIUrl":"https://doi.org/10.1016/j.bas.2024.103327","url":null,"abstract":"<p><strong>Background: </strong>Spaceflights influence intracranial compliance (ICC). P2/P1 ratio, from the intracranial pressure (ICP) waveform, provides information about ICC. Additionally, non-invasive methods for ICC monitoring are needed for spaceflights. Furthermore, astronauts try to maintain good levels of cardiorespiratory fitness before and during spaceflights, not only to sustain exploratory missions, but also to prevent diseases in extreme environments.</p><p><strong>Objective: </strong>to correlate cardiorespiratory fitness levels with the P2/P1 ratio during a microgravity analog [-6° head-down tilt (HDT)].</p><p><strong>Method: </strong>34 individuals (11 women), mean age of 31.7 (±6.3) years and BMI 24.2 (±3.2) performed a cardiopulmonary exercise testing (CPET) with an incremental protocol on a cycle ergometer to determine the cardiopulmonary fitness through peak relative oxygen uptake (VO₂ peak) of each individual. On the second test, which was conducted in an interval of 15 days of the CPET, participants remained for 30 min at HDT with P2/P1 ratio acquired using a non-invasive strain gauge sensor. The average of the last 5 min was used for analysis. The mean P2/P1 ratio and relative VO₂ peak were correlated using the Spearman test.</p><p><strong>Results: </strong>Volunteers presented 1.05 ± 0.2 of P2/P1 ratio and VO₂ peak of 47.5 ± 7.6 mL/kg/min. The Spearman test indicated a negative and low correlation between the P2/P1 ratio and VO₂ peak (ρ = -0.388; p = 0.023).</p><p><strong>Conclusion: </strong>The study suggests that the better the cardiorespiratory fitness, the better ICC in a weightlessness simulation.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11402318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cerebral contusions - Pathomechanism, predictive factors for progression and historical and current management.","authors":"Unni Jirlow, Iftakher Hossain, Otto Korhonen, Bart Depreitere, Elham Rostami","doi":"10.1016/j.bas.2024.103329","DOIUrl":"https://doi.org/10.1016/j.bas.2024.103329","url":null,"abstract":"<p><strong>Introduction: </strong>Cerebral contusions (CCs) are common traumatic brain injuries known for their propensity to progress. Understanding their mechanical pathogenesis and predictive factors for progression is crucial for optimal management.</p><p><strong>Research question: </strong>To provide an overview of current knowledge on CCs, including pathomechanisms, predictive factors of contusion progression, and management strategies.</p><p><strong>Material and methods: </strong>A literature search was conducted using PubMed, Scopus and ISI web of knowledge focused on articles in English with the words \"cerebral contusion\" together with the words \"traumatic brain injury\", \"pathomechanism\", \"progression of contusion\", \"predictive factors\" and \"management\" alone or in combination.</p><p><strong>Results: </strong>The management of CCs has evolved alongside the advances in neurointensive care, yet there is no consensus. Evidence on the effectiveness of early surgery, importantly, for the group which has the potential to expand, is limited. Some predictive factors for contusion progression have been identified, including age, injury mechanism, coagulopathy and initial contusion volume which could help to guide decision-making.</p><p><strong>Discussion and conclusion: </strong>While various theories exist on pathomechanisms and several predictive factors for progression have been proposed, consensus on optimal management remains elusive. Individualized care guided by the predictive factors is essential. Challenges posed by antithrombotic medications highlight the need for early intervention strategies.Decompressive craniectomy could serve as a potential tool in severe traumatic brain injury management including contusions. Conducting large cohort studies to refine predictive models and harmonizing management approaches would help to improve outcomes of patients with CCs.</p>","PeriodicalId":72443,"journal":{"name":"Brain & spine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11402187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142302346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}