Neurosurgical review
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Neurosurgical review · Jun 2021
Review Meta AnalysisExtent of resection in diffuse low-grade gliomas and the role of tumor molecular signature-a systematic review of the literature.
There is a lack of class I evidence concerning the impact of surgery in the treatment of diffuse low-grade glioma; the early maximal resection with preservation of eloquent brain areas has been accepted as the first therapeutic option. We performed a systematic review of the literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and protocol. Inclusion criteria: only case series with at least 100 patients containing supratentorial hemispheric diffuse low-grade glioma (according to any of the WHO classification used in papers published between 2000 to 2019), with pre- and postoperative MRI study were included in the qualitative and quantitative analyses. ⋯ Six studies showed a statistically significant improvement of MPFS with a greater EOR. We demonstrate that when a more rigorous analysis of EOR is performed, a benefit of a more aggressive resection on OS and MPFS is observed. Our review about EOR in different molecular groups of DLGG also suggests a benefit of maximum safe resection for all different subtypes, even though "radical surgery" may be associated with better OS and MPFS in tumors with a more aggressive signature.
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Neurosurgical review · Jun 2021
Meta Analysis Comparative StudyPosterior decompression and fusion versus laminoplasty for cervical ossification of posterior longitudinal ligament: a systematic review and meta-analysis.
Both posterior decompression and fusion (PDF) and laminoplasty (LAMP) have been used to treat cervical myelopathy due to multilevel ossification of posterior longitudinal ligament (OPLL). However, considerable controversy exists over the choice of the two surgical strategies. Thus, the aim of this study is to compare clinical outcomes of PDF and LAMP for treatment of cervical myelopathy due to multilevel OPLL. ⋯ A total of nine studies were included in the current study, involving 324 patients. The current study suggests that compared with LAMP, PDF achieves a lower OPLL progression rate, better postoperative cervical curvature and similar neurological improvement in the treatment of multilevel cervical OPLL. However, PDF has a higher complication rate, more surgical trauma and higher postoperative VAS than LAMP.
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Neurosurgical review · Jun 2021
Assessing the efficacy of repeat resections in recurrent glioblastoma: a systematic review.
The inevitable recurrence of glioblastoma (GBM) results in patients often undergoing multiple resections with questionable benefit to overall survival (OS). ⋯ Recurrent GBM presents a treatment challenge. There appears to be an OS benefit for RR upon first recurrence as well as sRR. Such findings warrant further investigation of the potential benefits of continued surgical intervention after subsequent progressions of GBM.
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Neurosurgical review · Mar 2021
ReviewIntravenous milrinone for treatment of delayed cerebral ischaemia following subarachnoid haemorrhage: a pooled systematic review.
Small trials have demonstrated promising results utilising intravenous milrinone for the treatment of delayed cerebral ischaemia (DCI) after subarachnoid haemorrhage (SAH). Here we summarise and contextualise the literature and discuss the future directions of intravenous milrinone for DCI. A systematic, pooled analysis of literature was performed in accordance with the PRISMA statement. ⋯ Intravenous milrinone is a safe and feasible therapy for DCI. A signal for efficacy is demonstrated in small, low-quality trials. Future research should endeavour to establish the optimal protocol and dose, prior to a phase-3 study.
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Neurosurgical review · Dec 2020
Review Biography Historical ArticleFedor Krause (1857-1937): the father of neurosurgery.
Fedor Krause's inspiring biography shows the value of translational thinking: one of the fathers of modern neurosurgery, this gifted child was recognized for his musical talent; he was able to study medicine thanks to financial support in recognition for his study performances. He wrote his doctor thesis on pneumology, and contributed to general surgery, neuroanaesthesiology, and neurosurgery application of novel technologies in neurosurgery and ethics. More in detail, in the neurosurgical field, he performed the first lumbar discectomy, set up intraoperative nerve monitoring, and pioneered trigeminal and acusticus nerve surgery, epilepsy surgery, and cortical mapping. His passion and engagement for surgery allowed him to make small centers turn into great centers recognized as renowned academic environments.