World Neurosurg
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Review Meta Analysis
Predictors of Shunt-dependent Hydrocephalus after Aneurysmal Subarachnoid Hemorrhage? A systematic review and meta-analysis.
Hydrocephalus is a well-recognized complication after aneurysmal subarachnoid hemorrhage (aSAH). This study aimed to identify predictors for shunt-dependent hydrocephalus (SDHC) after aSAH via a systematic review and meta-analysis. ⋯ Several new predictors of SDHC after aSAH were identified that may assist with the early recognition and prevention of SDHC. The controversial evidence found in this study was insufficient to support the potential of neurosurgical clipping for reducing the risk of shunt dependency. Further well-designed studies are warranted to explore the effect of treatment modality on SDHC risk.
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Review Comparative Study
A Comparison of Pharmacologic Therapeutic Agents used for the Reduction of Intracranial Pressure Following Traumatic Brain Injury.
In neurotrauma care, a better understanding of treatments after traumatic brain injury (TBI) has led to a significant decrease in morbidity and mortality in this population. TBI represents a significant medical problem, and complications after TBI are associated with the initial injury and postevent intracranial processes such as increased intracranial pressure and brain edema. Consequently, appropriate therapeutic interventions are required to reduce brain tissue damage and improve cerebral perfusion. We present a contemporary review of literature on the use of pharmacologic therapies to reduce intracranial pressure after TBI and a comparison of their efficacy. ⋯ Current research suggests that the use of hypertonic saline after TBI is the best option for immediate decrease in intracranial pressure. A better understanding of the efficacy of each treatment option can help to direct treatment algorithms during the critical early hours of trauma care and continue to improve morbidity and mortality after TBI.
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Although extreme lateral interbody fusion (XLIF) largely provides successful indirect decompression, some patients have recurrent same-level pain and functional disability. Identifying risk factors for this failure would facilitate better patient selection and improve outcomes. The aim of this study is to identify preoperative radiographic risk factors for failure of XLIF. ⋯ Bony lateral recess stenosis is an independent predictor for failure to achieve adequate spinal decompression via XLIF and thus may benefit from undergoing direct decompression.