Primary blast-induced traumatic brain injury: Current understandings and translational research

Atsuhiro Nakagawa, Teiji Tominaga

Research output: Contribution to journalArticlepeer-review

Abstract

A blast wave (BW) is generated by an explosion and is comprised of a lead shock wave followed by a subsequent supersonic flow. Pressure induced damage accounts for the occurrence of blast-induced TBI (bTBI) (primary bTBI) in addition to mechanisms observed in civilian traumatic brain injury. Fracture, hemorrhage, massive and rapid edema progression, and cerebral vasospasm characterize the clinical findings of bTBI in the acute phase, whereas cognitive dysfunction and posttraumatic disorder do in the chronic period. Since BW is invisible, and impacts the brain in an extremely short period of time in contrast to penetrating (secondary bTBI) and direct impact mechanism (tertiary bTBI) injury, it is often difficult to screen out the patients who are at high risk. In addition, there have been few animal models experiments that can be conducted in the laboratory and validated in terms of SW physics, which precluded us from understanding the mechanism and pathophysiology of bTBI. On the other hand, we have successfully formed organized infrastructures and accumulated knowledge of SW and BW at the Institute of Fluid Science since 1980s both for engineering issues and medical application. Our translational research platform now covers a broad range of issues related to SW (BW) and brain injury, including the development of a clinically relevant bTBI model as a bedside to bench approach, and the development of a surgical instrument applying shock bubble interaction (one of the mechanisms of SW-induced tissue injury) as a bench to bedside approach. The medical instrument is now clinically applied in neurosurgery as a laser-induced liquid jet, and has shown advantages over conventional surgical instruments. Efforts to utilize the system in minimally invasive surgery and to expand the application in endoscopic surgery became our current goal. In the present article, we describe the mechanism of bTBI and current research problems from the perspectives of SW physics. We also describe our translational research platform aiming to facilitate understanding of TBI and improve clinical treatment for TBI.

Original languageEnglish
Pages (from-to)896-902
Number of pages7
JournalJapanese Journal of Neurosurgery
Volume20
Issue number12
Publication statusPublished - 2012

Keywords

  • Medical engineering
  • Multidisciplinary
  • Neurocritical care
  • Shock wave
  • Traumatic brain injury

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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