World Neurosurg
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Review Meta Analysis
Predictive factors determining the overall outcome of Primary Spinal Glioblastoma Multiforme: An integrative survival analysis.
Primary glioblastoma multiforme of the spinal cord is a rare entity. The aim of this study was to perform an integrative analysis of patients whose cases were selected from the published studies, and to examine the influence of various factors on overall outcomes. ⋯ In this systemic analysis of primary spinal glioblastoma multiforme, we found that surgery followed by adjuvant therapy (radiotherapy, chemotherapy, or both) was significantly associated with improved survival. The additional finding was that overall median survival was better in the age group of 18-65 years (68 cases) compared with the extremes (<18 years, 53 cases; >65 years, 4 cases).
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Chronic subdural hematomas (CSDHs) are common neurosurgical conditions among elderly patients. ⋯ This comprehensive, best evidence-based, quantitative, systematic review indicates that the use of a closed system drainage after burr-hole evacuation reduces the rate of recurrences but has no other significant differences. The findings also suggest that: (1) treatment with twist drills is equivalent to that with burr holes; (2) the postoperative bed header in the elevated position might reduce the length of hospital stay; (3) irrigation of the subdural space with thrombin solution in patients with high risk of recurrence might reduce this risk; and (4) treatment with twist drill followed by a closed system drainage during 48 hours, instead of 96 hours, might reduce general complication rates. Most of the trials suffered from unclear or high risks of bias and many involved small samples, precluding strong and definitive conclusions.
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To investigate adequate radiation doses for repeat Gamma Knife radiosurgery (GKS) for trigeminal neuralgia in our series and meta-analysis. ⋯ Our study suggests that the second GKS dose is a potentially important factor.
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The three-dimensional (3D) endoscope is a novel tool that provides stereoscopic vision and may allow for improved dexterity and safety during surgical resection of ventral skull base lesions. We describe here the cumulative experience available in the neurosurgical literature. ⋯ Our findings suggest that 3D endoscopy provides improved surgical dexterity by affording the surgeon with depth perception when manipulating tissue and maneuvering the endoscope in the endonasal corridor.
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Traumatic spinal cord injury (SCI) is a devastating neurologic entity characterized by a primary insult followed by a secondary pathologic cascade that propagates further injury. Hypothermia has an established clinical role in preventing SCI after cardiac arrest and thoracoabdominal aortic aneurysm repair, yet its emergence as a potential neuroprotectant after spinal cord trauma remains experimental. There are currently no pharmacologic interventions available to prevent secondary mechanisms of injury after spinal cord trauma. ⋯ Although variability exists in the literature, therapeutic hypothermia most likely confers neuroprotection after spinal cord trauma by diminishing the destructive secondary cascade. The available clinical data suggest that regional and systemic hypothermia is a relatively safe and feasible initial treatment modality for patients with acute SCI when combined with surgical decompression/stabilization with or without steroids. However, establishing a clinical role for therapeutic hypothermia after spinal cord trauma will invariably depend on future well-designed, multicentered, randomized, controlled clinical trial data.