World Neurosurg
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Review Meta Analysis
Application of Ultrahigh Field MRI in the Treatment of Brain Tumors: a Meta-analysis.
Magnetic resonance imaging (MRI) is the imaging modality of choice for the clinical management of brain tumors, and the majority of scanners operate with static magnetic field strengths of 1.5 or 3.0 Tesla (T). During the past decade, ultrahigh field (UHF) MRI has been investigated for its clinical applicability. This meta-analysis evaluates studies pertaining to the application of UHF MRI to patients with brain tumors. ⋯ UHF MRI shows promise to improve detection and characterization of brain tumors, preoperative planning for neurosurgical resection, and longitudinal monitoring of the effects of radiation and antibody-based therapies. Technical innovations are needed to overcome field inhomogeneity and susceptibility artifacts in certain regions of the skull. Finally, larger studies comparing 1.5 T, 3.0 T, and 7.0 T or greater will determine whether UHF MRI gains acceptance as a clinical standard.
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Review Meta Analysis
Antibiotic Impregnated External Ventricular Drains: Meta and Cost Analysis.
To determine whether antibiotic impregnated external ventricular drains (AI-EVDs) are effective in preventing ventriculostomy associated infection (VAI), and to examine their cost effectiveness. ⋯ Meta-analysis demonstrated a significant protective benefit of AI-EVDs against VAI, and this benefit is likely associated with cost savings. However, current data on AI-EVDs are limited, and overall hospital costs will vary among institutions. Although both the efficacy and cost effectiveness of AI-EVDs are supported by this analysis, further study of AI-EVDs is clearly warranted.
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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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Randomized Controlled Trial
Predictors of Shunt-Dependent Hydrocephalus Following Aneurysmal Subarachnoid Hemorrhage.
Shunt-dependent hydrocephalus is a common complication of aneurysmal subarachnoid hemorrhage (aSAH). There is a need to identify patients who require ventriculoperitoneal shunt (VPS) insertion so that any modifiable risk factors can be addressed early after aSAH. ⋯ The presence of an external ventricular drain and increased daily CSF output (above 78 mL/day) seems to be predictive of subsequent VPS insertion after aSAH. Although we could not identify modifiable risk factors for needing a VPS, nevertheless, these findings identify patients at greatest risk of VPS placement and inform treatment decisions as well as patient expectations.