Emerging Treatments

Cervical Spinal Cord

Historically, it was common for patients with spinal injuries to be placed in
unmonitored beds on hospital wards for prolonged periods while elements of the
bony injury healed. This approach has been supplanted by aggressive medical and
surgical methods focused on maintaining cord perfusion, avoiding complications,
decompressing the spinal cord and restoring spinal stability.
One of the most used therapies is the hypothermia therapeutic, preclinical studies
have suggested that cooling mitigates secondary injury mechanisms. Initial clinical
studies involving direct cooling of the cord during surgery failed to show any
benefit. However, a recent phase I trial investigated the acute use of modest (33C)
systemic intravascular hypothermia. Complications did not differ between the
patients receiving the treatment and the patients to whom they were matched in
the control group. At 1-year follow-up, 6 of 14 patients in the treatment group
(42.9%) converted from complete (no motor or sensory function below the level of
injury) to incomplete (motor or sensory function present below the level of injury)
status (3/14 [21.4%] of patients in the control group showed the same degree of
recovery), which compares favourably with a neurologic recovery rate of 20%
reported in the literature. Although there is currently insufficient evidence to support
the use of systemic hypothermia, a multicenter efficacy trial exploring this therapy
is being planned.
Leaving aside the treatments that have been used along the last years, there are
several new ones that lead us to a new era in medical treatments, such as the
following ones:

A Randomized, Controlled Trial of Methylprednisolone or Naloxone in the

Treatment of Acute Spinal-Cord Injury Results of the Second National
Acute Spinal Cord Injury Study: Studies in animals indicate that
methylprednisolone and naloxone are both potentially beneficial in acute spinalcord injury, but whether any treatment is clinically effective remains uncertain. We
evaluated the efficacy and safety of methylprednisolone and naloxone in a
multicenter randomized, double-blind, placebo-controlled trial in patients with acute
spinal-cord injury, 95 percent of whom were treated within 14 hours of injury.
Methylprednisolone was given to 162 patients as a bolus of 30 mg per kilogram of
body weight, followed by infusion at 5.4 mg per kilogram per hour for 23 hours.
Naloxone was given to 154 patients as a bolus of 5.4 mg per kilogram, followed by
infusion at 4.0 mg per kilogram per hour for 23 hours. Placebos were given to 171
patients by bolus and infusion. Motor and sensory functions were assessed by

systematic neurologic examination on admission and six weeks and six months
after injury.

Skull Fractures
Once a skull fracture has been diagnosed, one or more of the following treatments
may be necessary:

Medication. The medications used to treat a skull fracture include

antibiotics to treat and prevent an infection caused by bacteria; steroids to
help decrease any swelling that may occur; and pain relievers to help
alleviate any pain that may be associated with the injury.

Lumbar drain. A lumbar drain may be used in order to decrease the

pressure in the victims head and brain.

Spinal tap. A spinal tap is sometimes used to drain cerebrospinal fluid and
decrease pressure in the head and brain of the victim.

Surgery. The victim of a skull fracture may need to undergo surgery in order
to repair damage to the skull bones or to remove pieces of the bone.

A victims recovery depends on a number of factors including the extent of the

injury and how quickly medical help was sought.
Treatment of traumatic aneurysms and arteriovenous fistulas of the skull
base by using endovascular stents
The authors describe their preliminary clinical experience with the use of
endovascular stents in the treatment of traumatic vascular lesions of the skull base
region. Because adequate distal exposure and direct surgical repair of these
lesions are not often possible, conventional treatment has been deliberate arterial
occlusion. The purpose of this report is to demonstrate the safety and efficacy as
well as limitations of endovascular stent placement in the management of
craniocervical arterial injuries.
Emerging pharmacotherapy for treatment of traumatic brain injury: targeting
hypopituitarism and inflammation
Introduction: Traumatic brain injury (TBI) is a common cause of morbidity and
mortality in the developed world. In particular, TBI is an important cause of death
and disability in young adults with consequences ranging from physical disabilities
to long-term cognitive, behavioural, psychological and social defects.

Areas covered: There is a large body of evidence that suggest that TBI conditions
may adversely affect pituitary function in both the acute and chronic phases of
recovery. Prevalence of hypopituitarism, from total to isolated pituitary deficiency,
ranges from 5 to 90%. The time interval between TBI and pituitary function
evaluation is one of the major factors responsible for variations in the prevalence of
hypopituitarism reported. Diagnosis of hypopituitarism and accurate treatment of
pituitary disorders offers the opportunity to improve mortality and outcome in TBI
conditions.