World Neurosurg
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Review Meta Analysis
A systematic review and meta-analysis of perioperative parameters in robot-guided, navigated, and freehand thoracolumbar pedicle screw instrumentation.
Robotic guidance (RG) and navigation (NV) have been shown to reduce radiologic and clinically relevant pedicle screw malpositions. It remains unknown if there are any additional benefits to these techniques in intraoperative and perioperative end points. ⋯ It seems that navigation may offer potential benefits in perioperative outcomes such as length of hospital stay and overall complications, without significant increase in intraoperative radiation, which cannot yet be said for robotic guidance. The findings must be interpreted with caution, because the evidence is severely limited in both quantity and quality. Further evaluation will establish any demonstrable intraoperative or perioperative benefits to computer assistance, which may warrant the high costs often associated with these devices.
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Review Case Reports Multicenter Study
Pipeline Embolization Device for the Treatment of Intracranial Pseudoaneurysms.
Intracranial pseudoaneurysms (PSAs) are associated with high rupture and mortality rates and have traditionally been treated by parent vessel sacrifice. There has been recent interest in using flow-diverting devices for treatment of these complex lesions while preserving flow through the parent artery. The objective of this study is to examine the safety and efficacy of these devices in the treatment of intracranial PSA. ⋯ In well-selected patients, the use of flow-diverting stents may be a feasible alternative to parent vessel sacrifice. Given the high morbidity and mortality associated with PSA, we recommend short- and long-term radiographic follow-up for patients treated with flow-diverting stents.
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Review Meta Analysis
Effectiveness of Sealants in Prevention of CSF Leakage after Spine Surgery: a Systematic Review.
Sealants are often used in spine surgery to prevent postoperative cerebrospinal fluid (CSF) leakage. ⋯ Currently available sealants seem not to reduce the rate of CSF leakage in spine surgery. In endoscopic and minimally invasive surgery, the CSF leakage rate is less frequent compared with open, conventional surgery regardless of sealant use.
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Review Meta Analysis
Does tranexamic acid improve bleeding, transfusion, and hemoglobin level in patients undergoing multi-level spine surgery? A systematic review and meta-analysis.
To investigate the influence of tranexamic acid (TXA) on blood loss and blood transfusion in multiple-level spine surgery and evaluate whether hemoglobin and platelet levels are altered as a result. ⋯ The application of TXA can effectively reduce intraoperative blood loss and perioperative blood transfusion in patients undergoing multiple-level spine surgery, and it can restore hemoglobin levels after surgery.
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There are some controversies about the surgical treatment strategy of mirror aneurysms. Whether to choose 1-stage or 2-stage surgery, bilateral or unilateral craniotomy, or surgical or interventional treatment are the main points in dispute. In this review, the different surgery strategies faced by patients are discussed. ⋯ The 3D Slicer can help surgeons undertake adequate preoperative preparation. In addition, we also introduce some ruptured factors (e.g., age, gender, hypertension, morphologic, and hemodynamic) concerning mirror aneurysm. Systematic discussion of the controversies and methods in surgical treatment of mirror aneurysms may provide new perspectives in future research for the prevention and treatment of mirror aneurysms.