World Neurosurg
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Review Meta Analysis Comparative Study
Comparision of results between posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation Type I：a systematic review and meta-analysis.
Posterior fossa decompression without (PFD) or with duraplasty (PFDD) for the treatment of type 1 Chiari malformation (CM-1) is controversial. We thus performed a systematic review and meta-analysis of studies to assess the effect on clinical and imaging improvement, operative time, complications, and recurrence rate between PFD and PFDD in patients with CM-1. ⋯ PFDD can be an optimal surgical strategy because of its higher clinical improvement and lower recurrence rate in the patients with syringomyelia. In patients without syringomyelia, PFD can be a preferred choice because of its similar clinical improvement and lower costs. Future randomized studies with large numbers and the power to provide illumination for surgical decision making in CM-1 are warranted.
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Review Meta Analysis
Epidural steroids at closure post-microdiscectomy/laminectomy for reduction of post-operative analgesia: systematic review and meta-analysis.
This review assessed the efficacy of epidural steroid administration on the reduction of pain, hospital stay time, and use of opioid analgesics postoperatively. ⋯ Intraoperative or perioperative epidural administration of steroids offers significant benefits in terms of pain control, reduction in LOS, and use of postoperative opioid analgesia. Before steroids are routinely used by spinal surgeons, however, significantly more research is required. A particular emphasis should be placed on quality study protocols and data recording, to allow for more thorough analyses in the future.
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Review Multicenter Study
Intraoperative monitoring of the integrity of the anterior visual pathways: a methodological review and meta-analysis.
Diverse methods have been developed for intraoperative monitoring of the integrity of the visual pathways. We performed a review of the literature to determine the methodology of each technique as well as their recent development. The predictive power of each eligible technique was determined based on a meta-analysis. ⋯ Each technique had limitations. Visual evoked potentials had a high predictive power for detection of deterioration but with low sensitivity. Fractional anisotropy of the optic chiasma had high predictive power for improvement of vision with low predictive power for deterioration.
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Tentorial meningiomas are notorious for their critical location. Selection of a suitable approach that exposes the multicompartmental growth of tumor is important for a complete and safe resection. This paper discusses about various operative approaches and their overall surgical outcome. ⋯ Similar to intracranial meningiomas at other locations, extent of resection and tumor grade significantly affect the PFS for tentorial meningiomas. Careful preoperative planning based on the location and extension of the tumor guides the optimal surgical approach that translates into maximal safe resection.
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Review Meta Analysis
Decompressive craniectomy for spontaneous intracerebral hemorrhage: a systematic review and meta-analysis.
Spontaneous intracerebral hemorrhage (sICH) is a devastating disease with high mortality and morbidity, and the application of decompressive craniectomy (DC) in sICH is controversial. We conducted a systematic review to verify the effects of DC on improving outcome in sICH. ⋯ The application of DC effectively reduced mortality in patients with sICH. DC might improve functional outcomes in certain populations and needs further verification. DC is not associated with increased incidences of postoperative rebleeding and hydrocephalus.