Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Mar 2016
ReviewSecond surgery for recurrent glioblastoma: A concise overview of the current literature.
Optimal treatment for recurrent glioblastoma continues to evolve. Currently, however, there is no consensus in the literature on the role of reoperation in the management of these patients, as several studies provide evidence for a longer overall survival in selected patients with recurrent glioblastoma who underwent second surgery and other studies report a limited impact of second surgery in the clinical course. In this paper, a review of the current literature was performed to analyze the role of reoperation in patients with recurrent glioblastoma and to report the overall survival from diagnosis, progression-free survival and quality of life. ⋯ The median overall survival from diagnosis and the median survival from second surgery were 18.5 months and 9.7 months, respectively. Extent of resection at reoperation improves overall survival, even in patients with subtotal resection at initial operation. Preoperative performance status and age are important predictors of a longer survival, reason why younger patients with a good preoperative performance status could benefit from reoperation.
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Clin Neurol Neurosurg · Jan 2016
Review Meta Analysis Comparative StudyLaparotomy vs minimally invasive laparoscopic ventriculoperitoneal shunt placement for hydrocephalus: A systematic review and meta-analysis.
Ventriculoperitoneal shunt (VPS) surgery is the most commonly used method for the treatment of hydrocephalus. Traditionally, distal catheters in the VPS surgery have been placed either through a standard small open laparotomy or via a laparoscopic technique. Although there are many studies demonstrating the benefits of a minimally invasive approach, limited research has directly compared the two techniques used in VPS surgery. ⋯ There was no difference between the laparotomic and laparoscopic approaches in the length of hospital stay, complication rate, proximal shunt failure or infection rate. The present systematic review and meta-analysis demonstrated that the laparoscopic technique in VPS surgery is associated with reduced shunt failure and abdominal malposition compared to the open laparotomy technique, with no significant difference in rates of infection or other complications. The lack of studies with high levels of evidence may contribute to bias in our conclusions and the long-term relative merits require validation by further prospective, randomized studies.
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Clin Neurol Neurosurg · Jan 2016
Review Meta Analysis Comparative StudyLaparotomy vs minimally invasive laparoscopic ventriculoperitoneal shunt placement for hydrocephalus: A systematic review and meta-analysis.
Ventriculoperitoneal shunt (VPS) surgery is the most commonly used method for the treatment of hydrocephalus. Traditionally, distal catheters in the VPS surgery have been placed either through a standard small open laparotomy or via a laparoscopic technique. Although there are many studies demonstrating the benefits of a minimally invasive approach, limited research has directly compared the two techniques used in VPS surgery. ⋯ There was no difference between the laparotomic and laparoscopic approaches in the length of hospital stay, complication rate, proximal shunt failure or infection rate. The present systematic review and meta-analysis demonstrated that the laparoscopic technique in VPS surgery is associated with reduced shunt failure and abdominal malposition compared to the open laparotomy technique, with no significant difference in rates of infection or other complications. The lack of studies with high levels of evidence may contribute to bias in our conclusions and the long-term relative merits require validation by further prospective, randomized studies.
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Clin Neurol Neurosurg · Dec 2015
ReviewIatrogenic neurologic deficit after lumbar spine surgery: A review.
Iatrogenic neurologic deficits after lumbar spine surgery are rare complications, but important to recognize and manage. Complications such as radiculopathy, spinal cord compression, motor deficits (i.e. foot drop with L5 radiculopathy), and new onset radiculitis, while uncommon do occur. Attempts at mitigating these complications with the use of neuromonitoring have been successful. ⋯ Despite the introduction of neuromonitoring, these complications still occur. Interpretation of neurologic injury rates for lumbar surgery is limited by the few prospective and cohort-matched controlled studies. Likewise, most injuries were associated with the placement of instrumentation despite the type of approach.
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Clin Neurol Neurosurg · Nov 2015
ReviewRole of intraoperative indocyanine green video-angiography to identify small, posterior fossa arteriovenous malformations mimicking cavernous angiomas. Technical report and review of the literature on common features of these cerebral vascular malformations.
To illustrate the usefulness of intraoperative indocyanine green videoangiography (ICG-VA) to identify the nidus and feeders of a small cerebellar AVM resembling a cavernous hemangioma. To review the unique features regarding the overlay between these two vascular malformations and to highlight the importance to identify with ICG-VA, and treat accordingly, the arterial and venous vessels of the AVM. ⋯ Despite technical limitations associated with ICG-VA in post-hemorrhage AVMs, this case together with the intraoperative video, demonstrates the useful role of ICG-VA in identifying small AVMs with peculiar features.