World Neurosurg
-
Review Meta Analysis
Cavernous Sinus Invasion in Pituitary Adenomas: Systematic Review and Pooled Data Meta-analysis of Radiological Criteria and Comparison of Endoscopic and Microscopic Surgery.
Despite the substantial impact of cavernous sinus invasion (CSI) in pituitary adenoma surgery, its radiologic determination has been inconsistent and variable, and the role of endonasal endoscopic surgery has been unclear. This is a systematic review and pooled data meta-analysis of the literature to ascertain the best radiologic criteria for CSI and verify the efficacy and safety of an endonasal endoscopic approach. ⋯ Knosp 3-4 remains the best objective indicator of CSI. Microscopy tends to overestimate intraoperative CSI compared with endoscopy. Among pituitary adenomas with CSI, GTR in endoscopic series is higher than microscopy and improves with experience without significant additional morbidity.
-
Review Case Reports Meta Analysis
Invasive Giant Cell Tumor of The Lateral Skull Base: A Systematic Review, Meta-analysis and Case Illustration.
The current literature regarding cranial giant cell tumor (GCT) management includes scattered case reports and small case series. We present a comprehensive literature review and meta-analysis on this subject, along with a case report describing our management of a patient with temporal GCT. ⋯ GCTs of the skull commonly affect young adults, with an equal sex distribution, and are most often centered in temporal bone. GTR is associated with the lowest recurrence rate and should be the goal of treatment. If GTR cannot be achieved, the combination of STR and radiation results in a similar recurrence rate. With the advent of denosumab, there is now a role for chemotherapy in the treatment of GCTs.
-
Review Case Reports
Flow Diversion for Treatment of Growing A2 Aneurysm in a Child: Case Report and Review of Flow Diversion for Intracranial Aneurysms in Pediatric Patients.
Intracranial flow diversion has gained increasing popularity since the approval of the Pipeline Embolization Device (PED). Although it is only approved for use in adult patients, the PED has been used to treat aneurysms in pediatric patients. We present the first reported case of the use of a PED in a pediatric patient to treat an unusual fusiform distal anterior cerebral artery aneurysm. ⋯ Follow-up digital subtraction angiography and magnetic resonance angiography at 6 and 12 months, respectively, showed complete occlusion of the aneurysm. We also reviewed the literature on flow diversion for treatment of pediatric intracranial aneurysms.
-
Review Historical Article
Neurosurgical Postgraduate Training in China: Moving Toward A National Training Standard.
China currently has the most populous and rapidly aging nation in the world. In the next few decades, China will have to increase the throughput, quality, and scope of its neurosurgical training programs to meet forecasted demand. Until recently, China lacked national education standards in neurosurgery that fostered imbalances in medical and pedagogical resources, quality of care, and education between different regions and introduced significant heterogeneity in neurosurgical competency. ⋯ Establishment of a national standardized training system represents a significant milestone in the development and evolution of neurosurgery in China and establishes a comprehensive standards-based system that will help reduce nationwide diversity in neurosurgical training. Although this program is still in its infancy and will not see its first graduating class until 2017 in Shanghai, it represents an essential step toward meeting China's growing demand for quality and consistent neurosurgical care. We review the history of neurosurgical training in Mainland China and describe the new Neurosurgical Specialist Standardized Training Program.
-
Carotid cavernous fistulas (CCFs) are abnormal connections between the carotid arteries and the cavernous sinus. CCFs often present with double vision, reduced visual acuity, and conjunctivitis. Deteriorating ocular symptoms caused by abnormal fistula drainage can cause permanent blindness, and so urgent interventional treatment is necessary. Transvenous embolization of the fistula is the primary treatment option for most patients with symptomatic CCFs. Orbital approaches are considered to be risky compared with the traditional approach via the inferior petrosal sinus and are thus used as a secondary option. These approaches include embolization via the superior ophthalmic vein, inferior ophthalmic vein, and medial ophthalmic vein and direct transorbital puncture. This study aims to assess the merits and risks of orbital approaches in transvenous embolization of CCFs. ⋯ All orbital approaches for transvenous embolization of CCFs are effective and safe.