World Neurosurg
-
Review Meta Analysis
The Effect of Intrawound Vancomycin on Surgical Site Infections in Non-spinal Neurosurgical Procedures: A Systematic Review and Meta-Analysis.
Applying vancomycin into the surgical site has been well-described in spinal neurosurgery, with extensive institutional experience and systematic reviews describing its effectiveness in reducing surgical site infections (SSIs). Its use in nonspinal neurosurgical procedures is a logical extension of those findings; however, recent studies have described varying degrees of success. We have summarized the effect of local vancomycin application on SSIs in nonspinal neurosurgical procedures and describe the quality of the supporting evidence. ⋯ Vancomycin use in nonspinal neurosurgery is not supported by high-quality evidence, limiting the strength of the conclusions that can be drawn on the topic. Nonetheless, we found an overall favorable effect on SSIs (except in the context of cranioplasty), which should be reproduced in a randomized controlled fashion.
-
Review Meta Analysis
Anterior Thoracic Spinal Cord Herniation: Surgical Treatment and Postoperative Course. An Individual Participant Data Meta-Analysis of 246 Cases.
Anterior thoracic spinal cord herniation (ATSCH) is a rare cause of progressive myelopathy. Early surgery is essential, but there is no agreement about the best surgical approach. ⋯ In general, postoperative results after surgery for ATSCH are favorable, with a high percentage of patients experiencing postoperative improvement. Postoperative motor function improvement is more likely to occur in patients with a Brown-Séquard-like neurologic deficit. The WDD should be favored above the application of a patch as the technique of choice in surgical treatment of ATSCH.
-
Review Case Reports Meta Analysis
Diagnosis and Treatment of Isolated Cerebral Mucormycosis: Patient-Level Data Meta-Analysis and Mayo Clinic Experience.
Isolated cerebral mucormycosis is a rare and serious infection associated with intravenous drug abuse. ⋯ Isolated cerebral mucormycosis has a pooled mortality rate of 65%. The presence of lesions in the basal ganglia, rapidly progressive symptoms, and a history of intravenous drug abuse should raise suspicion for the early initiation of amphotericin B and stereotactic aspiration.
-
Review Meta Analysis
Decompressive hemicraniectomy in the treatment of malignant middle cerebral artery infarction: a meta-analysis.
Malignant middle cerebral artery infarctions are large space-occupying infarctions involving massive edema, herniation, and frequently death. Survivors are disabled. Management involves medical treatment, with or without decompressive hemicraniectomy and later duraplasty. This meta-analysis aimed to determine whether surgery is worthwhile with particular regard to views on quality of life of professionals and patients. ⋯ Surgical decompression results in lowered mortality but high morbidity, especially in the elderly. There is an increase in Quality Adjusted Life Years but at high costs. Professionals think that surgery is not worth the high disability rate. However, patients and caregivers are satisfied with their postoperative quality of life. Survey data from healthy study participants who are not professionals in stroke care were not available. The decision to treat surgically needs to be decided on an individual basis.
-
Review Meta Analysis
A Review on the Effectiveness of Surgical Intervention for Symptomatic Intracranial Arachnoid Cysts in Adults.
Intracranial arachnoid cysts are generally benign and can be asymptomatic or symptomatic. When symptoms are indicated, the effects of arachnoid cysts can be disabling to the patient. Quantitative assessment on the effectiveness of surgical intervention to relieve symptoms is inconsistently reported throughout the literature and is often contradictory. Due to this lack of direct evidence and disagreement among practitioners, nonsurgical treatment, such as pain management, is often prescribed. The objectives of this research were to evaluate the effectiveness of the 3 most common surgical treatments (craniotomy, endoscopic fenestration, and shunting) in relieving patient symptoms and to provide a resource of case study information for doctors and patients considering surgical intervention. ⋯ The results indicate that surgical intervention is an effective approach to reduce or eliminate symptoms caused by intracranial arachnoid cysts.