World Neurosurg
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Meta Analysis Comparative Study
Magnetic Resonance guided Laser Interstitial Thermal Therapy (MRgLITT) vs Stereotactic Radiosurgery (SRS) for Medically Intractable Temporal Lobe Epilepsy (TLE) : A Systematic Review and Meta-Analysis of Seizure Outcomes and Complications.
Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) and stereotactic radiosurgery (SRS) are 2 emerging minimally invasive procedures being increasingly used for surgical intervention in cases of medically intractable temporal lobe epilepsy (TLE). To date, no comparative analyses of these 2 procedures have been made. In the current study, we synthesized pooled data from existing studies in an attempt to present a systematic review and meta-analysis of seizure and clinical outcomes of the 2 procedures in patients with TLE. ⋯ As minimally invasive procedures continue to gain popularity for use in surgery for epilepsy, it is imperative to evaluate their efficacy and safety outcomes. In this study we pooled the data from existing studies to compare the seizure and clinical outcomes in patients with TLE undergoing MRgLITT and SRS. We found similar outcomes and complications between the 2 procedures.
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Randomized trials of commonly performed surgical interventions are notoriously difficult to conduct. The trial methodology may nevertheless be the best way to offer outcome-based neurovascular care in the presence of uncertainty. One obstacle to promoting such trials is the conventional prohibition of publication and dissemination of interim results as the trial progresses. ⋯ In our opinion, the early publication of inconclusive interim results may increase awareness of the feasibility of surgical care trials.
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Review Case Reports
Endoscopic endonasal repair of a persistent craniopharyngeal canal and sphenoid meningoencephalocele: Case report and review of literature.
A persistent craniopharyngeal canal (PCC) is a rare cause of cerebrospinal fluid rhinorrhea in children. The condition often coexists with other midline facial defects, such as cleft palate. Children with PCC may also have pituitary dysfunction or neoplasms, such as craniopharyngiomas within the canal. ⋯ The extended endonasal approach can be used to treat PCC with nasopharyngeal encephaloceles in young children. The approach is suitable to address both conditions at the same time. The extended endonasal approach avoids potentially morbid transfacial approaches and can help in earlier recovery after surgery.
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Review
Stereotactic Radiosurgery for Neurosurgical Patients: A Historical Review and Current Perspectives.
Today, stereotactic radiosurgery is an effective therapy for a variety of intracranial pathology that were treated solely with open neurosurgery in the past. The technique was developed from the combination of therapeutic radiation and stereotactic devices for the precise localization of intracranial targets. ⋯ Although neurosurgeons, residency directors, and department chairs agree that stereotactic radiosurgery education and exposure during neurosurgery training could be improved, a limited number of resources exist for this kind of education. This review describes the history of stereotactic radiosurgery, assesses the state of its use and education today, and provides recommendations for the improvement of neurosurgical education in stereotactic radiosurgery for the future.
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The objective of our study was to describe the local control (LC) outcomes with 3- or 5-fraction stereotactic body radiotherapy (SBRT) to the spine in patients with oligometastatic (≤5 systemic metastases) versus polymetastatic disease (>5 metastases). ⋯ Our study was hypothesis-generating in that patients with an oligometastatic disease state appear to have improved LC after SBRT, suggesting a biological advantage exists with local therapy for this group of patients not seen for patients with polymetastatic disease.