World Neurosurg
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Progressive myoclonic epilepsy (PME) is a syndrome characterized by development of progressive myoclonus, cognitive impairment, and other neurologic deficits. Despite major advances in medical treatment of epilepsy, some PME patients remain refractory to antiepileptic drugs. This may further accentuate cognitive impairment and deteriorate functional capacity. Corpus callosotomy (CC) is used in patients with drug-resistant epilepsy who are not candidates for either excisional epilepsy surgery or neurostimulation. We report the application of the standard complete callosotomy to control medically refractory status epilepticus in a patient with PME. ⋯ Inasmuch as surgery was the last resort to control severe disabling status epilepticus, because most of the epileptogenic discharges were originating from the parieto-occipital regions and profound cognitive impairment was present, we decided to perform a complete rather than just an anterior callosotomy. CC may be considered to prevent secondary generalized seizures as the most disabling attacks in patients with certain epilepsy syndromes. Nevertheless, the impact of palliative surgical intervention on the overall disease course of patients with an underlying diffuse pathologic state remains to be determined.
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Review Meta Analysis Comparative Study
Assessing the Difference in Clinical and Radiological Outcomes between Expandable Cage and Non-Expandable Cage among Patients undergoing MIS-TLIF: A Systematic Review and Meta-Analysis.
Minimally invasive transforaminal interbody fusion (MIS-TLIF) has been shown to have excellent outcomes for surgical management of degenerative disc disease. However, the challenge is in addressing coronal imbalance and restoring lumbar lordosis and sagittal alignment. Use of expandable cages in MIS-TLIF has been hypothesized to circumvent this disadvantage. An indirect meta-analysis of the evidence is presented comparing outcomes from expandable cages with those from nonexpandable cages, in patients undergoing MIS-TLIF. ⋯ Our results indicate that there may not be a significant difference in clinical and radiologic parameters between expandable cages and nonexpandable cages among patients undergoing MIS-TLIF, and it is unclear if the higher cost of the expandable cages is justified.
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Triventricular hydrocephalus is caused by an obstruction of cerebrospinal fluid flow causing increased intracranial pressure (ICP). Common treatment options include ventricular shunting or endoscopic third ventriculocisternostomy. Spontaneous third ventriculocisternostomy is a rare phenomenon in patients with obstructive triventricular hydrocephalus. We present the case of a patient with triventricular hydrocephalus and evidence of spontaneous third ventriculocisternostomy. ⋯ Spontaneous third ventriculocisternostomy is seen in patients with chronic hydrocephalus. MRI sensitive to flow artefacts can be useful in the diagnosis of patients with apparent compensated hydrocephalus, and phase-contrast imaging can prove cerebrospinal fluid flow across the stoma. Resolution of symptoms owing to elevated ICP is regularly observed in patients with a spontaneous ventriculocisternostomy.
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Review Meta Analysis Comparative Study
Comparison of Frame-based vs Frameless Intracranial Stereotactic Biopsy: Systematic Review and Meta-Analysis.
Frame-based stereotaxy has generally been considered the reference standard for brain biopsies. However, frameless stereotaxy might expedite the efficiency of the clinical work flow. Conflicting findings have been reported regarding the relative efficacy and safety of frame-based and frameless needle biopsy of brain lesions. We performed a meta-analysis of the reported data to compare the relative efficacy, safety, and time efficiency of frame-based and frameless stereotactic needle biopsy. ⋯ The results from our meta-analysis suggest no significant differences exist between frame-based and frameless biopsy in diagnostic yield, morbidity, and mortality. Frameless biopsy is associated with shorter procedural times relative to frame-based biopsy. We have also discussed the relative merits of frame-based and frameless biopsies.
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Review Meta Analysis
Meta-analysis of the prognosis of Different treatments of symptomatic moyamoya disease.
The purpose of this study was to evaluate the efficacy of surgical revascularization versus conservative treatment and different surgical modalities, in order to provide evidence for the patient with moyamoya disease (MMD) to choose the appropriate treatment. ⋯ In patients with symptomatic moyamoya disease, bypass surgery is more effective than conservative treatment to prevent future strokes. In surgical patients, direct bypass seems to reduce the risk of stroke more than an indirect bypass.