pre-chiasmatic-single-injection-autologous-blood-to-induce

Pre-Chiasmatic, Single Injection of Autologous Blood to Induce Experimental Subarachnoid Hemorrhage in a Rat Model

Despite advances in treatment over the last decades, subarachnoid hemorrhage (SAH) continues to carry a high burden of morbidity and mortality, largely ...

Rigshospitalet

University of Copenhagen

Karolinska Institutet

Neurosurgery and pregnancy.

Acta Neurochirugica 2019.

In Neuro Intensive Care Units (NICU) and neurosurgical units, patients with an external ventricular drain (EVD) due to hydrocephalus following aneurysmal subarachnoid haemorrhage (SAH) are commonly seen. Cessation of the EVD involves the dilemma of either closing the EVD directly, or gradually weaning it before removal. Development of increased intracranial pressure (ICP) and acute hydrocephalus with subsequent need of a permanent shunt has been associated with prompt closure of theEVD, whereas increased risk of infection with possible spreading to the brain and subsequent patient fatality is suspected in connection to a longer treatment as seen in gradual weaning. Sparse data exist on the recommendation of cessation strategy and patients are currently being treated on the basis of personal experience and expert opinion. The objective of this systematic review is to assess the available evidence from clinical trials on the effects of prompt closure versus gradual weaning of EVD treatment for hydrocephalus in adult patients with SAH.

Prompt closure versus gradual weaning of extraventricular drainage for hydrocephalus in adult patients with aneurysmal subarachnoid haemorrhage: a systematic review protocol with meta-analysis and trial sequential analysis.

Clinical Chiari syndrome or anatomical Chiari malformation? A conundrum revisited.

Arachnoid cysts are congenital, benign lesions in the brain and are often incidental radiological findings. Frequently, the arachnoid cysts are left untreated; however, recent studies have shown that arachnoid cysts can cause cognitive dysfunction that affect quality of life. Moreover, the function can improve after surgical decompression. Hence, there is controversy regarding symptomatology and treatment effects of arachnoid cysts. The aim of the study was to analyse if arachnoid cysts can cause cognitive impairment and subjective symptoms and if these impairments are reversible after surgical treatment.

Cognitive dysfunction and subjective symptoms in patients with arachnoid cyst before and after surgery.

Correction to: Cognitive dysfunction and subjective symptoms in patients with arachnoid cyst before and after surgery.

An incorrect set of affiliations for two authors (Tiit Illimar Mathiesen and Andreas K. Demetriades).

Correction to: Clinical Chiari syndrome or anatomical Chiari malformation? A conundrum revisited.

Parasagittal meningiomas are defined as meningiomas that grow into at least one wall of the superior sagittal sinus. Long- and short-term morbidity is, in addition to cortical function, related to management of venous structures and flow. Clinical management needs to address the extent of removal in the sinus wall and to address relations to the adjacent cortex, which is highly eloquent in the Rolandic and calcarine areas.

Parasagittal meningiomas.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or Covid-19), which began as an epidemic in China and spread globally as a pandemic, has necessitated resource management to meet emergency needs of Covid-19 patients and other emergent cases. We have conducted a survey to analyze caseload and measures to adapt indications for a perception of crisis.

A snapshot of European neurosurgery December 2019 vs. March 2020: just before and during the Covid-19 pandemic.

To summarise the evidence on benefits and harms of prompt closure versus gradual weaning of external ventricular drainage (EVD) in patients with hydrocephalus following aneurysmal subarachnoid haemorrhage (aSAH) based on randomised clinical trials (RCTs) in humans.

Prompt closure versus gradual weaning of external ventricular drainage for hydrocephalus in adult patients with aneurysmal subarachnoid haemorrhage: a systematic review.

A pandemic may cause a sudden imbalance between available medical resources and medical needs where fundamental care to a patient cannot be delivered. Inability to fulfil a professional commitment to deliver care as needed can lead to distress among caregivers and patients. This distress is sometimes alleviated through mechanisms that hide the facts that care is rationed and not all medical needs are met. We have identified three mechanisms that jeopardise accountable and optimal allocation of resources: (1) hidden value judgements that allow rationing under the disguise of triage or prioritisation, (2) disguised conflict of interest between societal and individual patient's needs and (3) concealed biases in the application of medical tools. Under these three pitfalls decisions of resource allocation and who gets treated are handled as medical decisions: normative decisions are concealed and perceived as falling with the realm of medical judgement. Value judgements and moral agency are hidden to offer a 'false sense of medical judgement', while in fact there are several ethical judgements and biases at stake. The three pitfalls entail hidden normative deliberation and are inappropriate for sustainable healthcare delivery and resource allocation. We believe it is necessary to maintain transparency in decision making under conditions of insufficient resources to maintain trust in professional care givers and secure fair treatment allocation. Recognition of the pitfalls, by applying our recommendations, may help to ensure transparent and accountable distribution of care and contribute to public acceptance of the ethics behind rationing.

Three pitfalls of accountable healthcare rationing.

The COVID-19 pandemic has resulted in a widespread shortage of personal protective equipment (PPE). Many healthcare workers, including neurosurgeons, have expressed concern about how to safely and adequately perform their medical responsibilities in these challenging circumstances. One of these concerns revolves around the pressing question: should providers continue to work in the absence of adequate PPE? Although the first peak of the COVID-19 crisis seems to have subsided and supply of PPE has increased, concerns about insufficient PPE availability remain. Inconsistent supply, limited efficacy, and continued high demand for PPE, combined with the continued threat of a second COVID-19 wave, mean that the issues surrounding PPE availability remain unresolved, including a duty to work. This paper offers an ethical investigation of whether neurosurgeons should perform their professional responsibilities with limited availability of PPE. We evaluate ethical considerations and conflicting duties and thereby hope to facilitate providers in making a well-considered personal and moral decision about this challenging issue.

Article	Year
Neurosurgery and pregnancy. Acta neurochirurgica\| PubMed ID: 29872914	2018
Acta Neurochirugica 2019. Acta neurochirurgica\| PubMed ID: 30637521	2019
Prompt closure versus gradual weaning of extraventricular drainage for hydrocephalus in adult patients with aneurysmal subarachnoid haemorrhage: a systematic review protocol with meta-analys... BMJ open\| PubMed ID: 31575534	2019
Clinical Chiari syndrome or anatomical Chiari malformation? A conundrum revisited. Acta neurochirurgica\| PubMed ID: 31863299	2020
Cognitive dysfunction and subjective symptoms in patients with arachnoid cyst before and after surgery. Acta neurochirurgica\| PubMed ID: 31960141	2020
Correction to: Cognitive dysfunction and subjective symptoms in patients with arachnoid cyst before and after surgery. Acta neurochirurgica\| PubMed ID: 31993751	2020
Correction to: Clinical Chiari syndrome or anatomical Chiari malformation? A conundrum revisited. Acta neurochirurgica\| PubMed ID: 32430636	2020
Parasagittal meningiomas. Handbook of clinical neurology\| PubMed ID: 32586512	2020
A snapshot of European neurosurgery December 2019 vs. March 2020: just before and during the Covid-19 pandemic. Acta neurochirurgica\| PubMed ID: 32642834	2020
Prompt closure versus gradual weaning of external ventricular drainage for hydrocephalus in adult patients with aneurysmal subarachnoid haemorrhage: a systematic review. BMJ open\| PubMed ID: 33243807	2020
Three pitfalls of accountable healthcare rationing. Journal of medical ethics\| PubMed ID: 33441304	2021
Should neurosurgeons continue to work in the absence of personal protective equipment during the COVID-19 era? Acta neurochirurgica\| PubMed ID: 33469692	2021

Tiit Illimar Mathiesen

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