Iñigo Pomposo

BioCruces Health research Institute

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Zoltán Vámos

University of Pecs

Tony Trapani

Monash University

Emmanuel A. Stamatakis

University of Cambridge

Ronny Beer

Innsbruck Medical University

Ana M. Castaño‐León

Hospital Universitario 12 De Octubre

Martin Fabricius

Rigshospitalet

Tomas Menovsky

Antwerp University Hospital

Horia Pleș

Victor Babeș University of Medicine and Pharmacy Timișoara

Marta Correia

MRC Cognition and Brain Sciences Unit

Giuseppe Citerio

University of Milano-Bicocca

Cooperative Institutions

University of Groningen

189

University of Cambridge

163

Addenbrooke's Hospital

148

Heidelberg University

119

University Hospital Heidelberg

113

Karolinska Institutet

105

Hospital de Cruces

104

Erasmus MC

University of Oslo

Oslo University Hospital

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[Chronic subdural haematoma. Presentation and therapeutic attitudes].

PubMed (2002)

C. Hostalot-Panisello A Carrasco-González Gaizka Bilbao-Barandica Iñigo Pomposo J M Garibi-Undabarrena

The chronic subdural haematoma (CSH) is a present pathology in the day by day of any Neurosurgical Department, and even in the beginning of the xxi century, the different therapeutic options are of current debate.To compare retrospectively the results obtained by different types of surgical techniques, different modalities of drainage systems, and the application or not of perioperative intrathecal solutions.The data have been obtained by the review of 109 clinical cases treated of CSH between 1996 and 2000 in the Department of Neurosurgery of the Hospital de Cruces (Bilbao). We have analysed the age, sex, background, presenting symptomatology, type of treatment, evolution and mean hospital stay.The report is centred in the analysis of the recurrence rate of the CSH, its principal feature, and so, according to the type of evacuation technique, a burr hole presents 17,2% recurrences, two burr holes 31%, a small craniotomy 50%, and an ordinary craniotomy 66%. According to the drainage system, the subgaleal shunt presents 33,3% recurrences, the subdural 24,5%, and the subdural subgaleal 15,4%. The intrathecal solutions present 37% recurrences.After studying all the data, we can conclude that for the treatment of the CSH, the choice of a burr hole and subdural subgaleal shunt and intrathecal solution, can result beneficial in relation to other techniques, although with a minimum difference over the subdural shunt.

Subdural haematoma

Presentation (obstetrics)

Intrathecal

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Citations (7)

Derivaciones de líquido cefalorraquídeo. Resultados y complicaciones

Neurocirugía (1995)

Iñigo Pomposo J. Aurrecoechea I. Menchacatorre M. Urigüen J. Zorrilla

10.1016/s1130-1473(95)70781-3

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Citations (2)

Extended Coagulation Profiling in Isolated Traumatic Brain Injury: A CENTER-TBI Analysis

Neurocritical Care (2021)

Julia K. Böhm Victoria Schaeben Nadine Schäfer Helge Güting Rolf Lefering

Abstract Background Trauma-induced coagulopathy in traumatic brain injury (TBI) remains associated with high rates of complications, unfavorable outcomes, and mortality. The underlying mechanisms are largely unknown. Embedded in the prospective multinational Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, coagulation profiles beyond standard conventional coagulation assays were assessed in patients with isolated TBI within the very early hours of injury. Methods Results from blood samples (citrate/EDTA) obtained on hospital admission were matched with clinical and routine laboratory data of patients with TBI captured in the CENTER-TBI central database. To minimize confounding factors, patients with strictly isolated TBI (iTBI) ( n = 88) were selected and stratified for coagulopathy by routine international normalized ratio (INR): (1) INR < 1.2 and (2) INR ≥ 1.2. An INR > 1.2 has been well adopted over time as a threshold to define trauma-related coagulopathy in general trauma populations. The following parameters were evaluated: quick’s value, activated partial thromboplastin time, fibrinogen, thrombin time, antithrombin, coagulation factor activity of factors V, VIII, IX, and XIII, protein C and S, plasminogen, D-dimer, fibrinolysis-regulating parameters (thrombin activatable fibrinolysis inhibitor, plasminogen activator inhibitor 1, antiplasmin), thrombin generation, and fibrin monomers. Results Patients with iTBI with INR ≥ 1.2 ( n = 16) had a high incidence of progressive intracranial hemorrhage associated with increased mortality and unfavorable outcome compared with patients with INR < 1.2 ( n = 72). Activity of coagulation factors V, VIII, IX, and XIII dropped on average by 15–20% between the groups whereas protein C and S levels dropped by 20%. With an elevated INR, thrombin generation decreased, as reflected by lower peak height and endogenous thrombin potential (ETP), whereas the amount of fibrin monomers increased. Plasminogen activity significantly decreased from 89% in patients with INR < 1.2 to 76% in patients with INR ≥ 1.2. Moreover, D-dimer levels significantly increased from a mean of 943 mg/L in patients with INR < 1.2 to 1,301 mg/L in patients with INR ≥ 1.2. Conclusions This more in-depth analysis beyond routine conventional coagulation assays suggests a counterbalanced regulation of coagulation and fibrinolysis in patients with iTBI with hemostatic abnormalities. We observed distinct patterns involving key pathways of the highly complex and dynamic coagulation system that offer windows of opportunity for further research. Whether the changes observed on factor levels may be relevant and explain the worse outcome or the more severe brain injuries by themselves remains speculative.

Coagulation testing

Trauma Center

10.1007/s12028-021-01400-3

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Citations (7)

Neurocognitive correlates of probable posttraumatic stress disorder following traumatic brain injury

Brain and Spine (2021)

Dominique Van Praag Kristien Wouters Filip Van Den Eede Lindsay Wilson Andrew I.R. Maas

Neurocognitive problems associated with posttraumatic stress disorder (PTSD) can interact with impairment resulting from traumatic brain injury (TBI).We aimed to identify neurocognitive problems associated with probable PTSD following TBI in a civilian sample.The study is part of the CENTER-TBI project (Collaborative European Neurotrauma Effectiveness Research) that aims to better characterize TBI. For this cross-sectional study, we included patients of all severities aged over 15, and a Glasgow Outcome Score Extended (GOSE) above 3. Participants were assessed at six months post-injury on the PTSD Checklist-5 (PCL-5), the Trail Making Test (TMT), the Rey Auditory Verbal Learning Test (RAVLT) and the Cambridge Neuropsychological Test Automated Battery (CANTAB). Primary analysis was a complete case analysis. Regression analyses were performed to investigate the association between the PCL-5 and cognition.Of the 1134 participants included in the complete case analysis, 13.5% screened positive for PTSD. Probable PTSD was significantly associated with higher TMT-(B-A) (OR = 1.35, 95% CI: 1.14-1.60, p < .001) and lower RAVLT-delayed recall scores (OR = 0.74, 95% CI: 0.61-0.91, p = .004) after controlling for age, sex, psychiatric history, baseline Glasgow Coma Scale and education.Poorer performance on cognitive tests assessing task switching and, to a lesser extent, delayed verbal recall is associated with probable PTSD in civilians who have suffered TBI.

Neurocognitive

10.1016/j.bas.2021.100854

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Citations (7)

Occurrence and timing of withdrawal of life-sustaining measures in traumatic brain injury patients: a CENTER-TBI study

Intensive Care Medicine (2021)

Ernest van Veen Mathieu van der Jagt Giuseppe Citerio Nino Stocchetti Diederik Gommers

In patients with severe brain injury, withdrawal of life-sustaining measures (WLSM) is common in intensive care units (ICU). WLSM constitutes a dilemma: instituting WLSM too early could result in death despite the possibility of an acceptable functional outcome, whereas delaying WLSM could unnecessarily burden patients, families, clinicians, and hospital resources. We aimed to describe the occurrence and timing of WLSM, and factors associated with timing of WLSM in European ICUs in patients with traumatic brain injury (TBI). The CENTER-TBI Study is a prospective multi-center cohort study. For the current study, patients with traumatic brain injury (TBI) admitted to the ICU and aged 16 or older were included. Occurrence and timing of WLSM were documented. For the analyses, we dichotomized timing of WLSM in early (< 72 h after injury) versus later (≥ 72 h after injury) based on recent guideline recommendations. We assessed factors associated with initiating WLSM early versus later, including geographic region, center, patient, injury, and treatment characteristics with univariable and multivariable (mixed effects) logistic regression. A total of 2022 patients aged 16 or older were admitted to the ICU. ICU mortality was 13% (n = 267). Of these, 229 (86%) patients died after WLSM, and were included in the analyses. The occurrence of WLSM varied between regions ranging from 0% in Eastern Europe to 96% in Northern Europe. In 51% of the patients, WLSM was early. Patients in the early WLSM group had a lower maximum therapy intensity level (TIL) score than patients in the later WLSM group (median of 5 versus 10) The strongest independent variables associated with early WLSM were one unreactive pupil (odds ratio (OR) 4.0, 95% confidence interval (CI) 1.3–12.4) or two unreactive pupils (OR 5.8, CI 2.6–13.1) compared to two reactive pupils, and an Injury Severity Score (ISS) if over 41 (OR per point above 41 = 1.1, CI 1.0–1.1). Timing of WLSM was not significantly associated with region or center. WLSM occurs early in half of the patients, mostly in patients with severe TBI affecting brainstem reflexes who were severely injured. We found no regional or center influences in timing of WLSM. Whether WLSM is always appropriate or may contribute to a self-fulfilling prophecy requires further research and argues for reluctance to institute WLSM early in case of any doubt on prognosis.

Pain medicine

Trauma Center

10.1007/s00134-021-06484-1

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Citations (48)

Vagus nerve stimulation therapy for treatment-resistant epilepsy: A 15-year experience at a single institution

Clinical Neurology and Neurosurgery (2015)

Lara Galbarriatu Iñigo Pomposo J. Aurrecoechea Ainhoa Marinas Marta Agundez

Vagus Nerve Stimulation

10.1016/j.clineuro.2015.06.023

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Citations (34)

Otolicuorrea espontánea en el adulto. Presentación de dos casos y revisión de la literatura

Neurocirugía (2011)

Lara Galbarriatu J. Aurrecoechea E. Ruiz de Gopegui Iñigo Pomposo G. Bilbao

Middle fossa

10.1016/s1130-1473(11)70013-6

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Citations (3)

Complicaciones intra-abdominales de la cirugía de la hernia discal lumbar

Neurocirugía (2004)

G. Bilbao I. Menchacatorre M. Urigüen Iñigo Pomposo F. Bardón

10.1016/s1130-1473(04)70484-4

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Citations (7)

Early vs Late Fixation of Extremity Fractures Among Adults With Traumatic Brain Injury

JAMA Network Open (2024)

Zheng Jiang Yufang Ouyang Ke Zhang Zhixing Wang Alexander Younsi

Importance The optimal timing for fixation of extremity fractures after traumatic brain injury (TBI) remains controversial. Objective To investigate whether patients who underwent extremity fixation within 24 hours of TBI experienced worse outcomes than those who had the procedure 24 hours or more after TBI. Design, Setting, and Participants This cohort study used data from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Patients 16 years or older with TBI who underwent internal extremity fixation met inclusion criteria. To compare outcomes, patients who underwent the procedure within 24 hours were propensity score matched with those who underwent it 24 hours or later. Patients were treated from December 9, 2014, to December 17, 2017. Data analysis was conducted between August 1, 2022, and December 25, 2023. Main Outcomes and Measures The primary outcome was an unfavorable functional status at 6 months (Glasgow Outcome Scale–Extended [GOSE] score ≤4). Results A total of 253 patients were included in this study. The median age was 41 (IQR, 27-57) years, and 184 patients (72.7%) were male. The median Injury Severity Score (ISS) was 41 (IQR, 27-49). Approximately half of the patients (122 [48.2%]) had a mild TBI while 120 (47.4%) had moderate to severe TBI. Seventy-four patients (29.2%) underwent an internal extremity fixation within 24 hours, while 179 (70.8%) had the procedure 24 hours or later. At 6 months, 86 patients (34.0%) had an unfavorable functional outcome. After propensity score matching, there were no statistically significant differences in unfavorable functional outcomes at 6 months (odds ratio [OR], 1.12 [95% CI, 0.51-1.99]; P = .77) in patients with TBI of any severity. Similar results were observed in patients with mild TBI (OR, 0.71 [95% CI, 0.22-2.29]; P = .56) and moderate to severe TBI (OR, 1.08 [95% CI, 0.32-3.70]; P = .90). Conclusions and Relevance The outcomes of extremity fracture fixation performed within 24 hours after TBI appear not to be worse than those of procedures performed 24 hours or later. This finding suggests that early fixation after TBI could be considered in patients with mild head injuries.

Glasgow Outcome Scale

Trauma Center

Abbreviated Injury Scale

10.1001/jamanetworkopen.2024.1556

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Citations (3)

1. Cirugía en la enfermedad de Parkinson: experiencia inicial en el hospital de Cruces

Neurocirugía (2001)

G. Bilbao J. Zorrilla C. Hostalot Evelio Díaz Lezcano I. Lambari

10.1016/s1130-1473(01)70765-8

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Citations (0)