World Neurosurg
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Review Meta Analysis
A systematic review and meta-analysis of antiepileptic prophylaxis in spontaneous intracerebral hemorrhage.
Frequency of clinical seizures may be as high as 16% in patients with spontaneous intracerebral hemorrhage (ICH). Current guidelines recommend against antiepileptic drug (AED) prophylaxis, but this recommendation is based on older trials, and the effect of newer AEDs is uncertain. The aim of this review was to study effects of AEDs on seizure occurrence and outcome in patients with spontaneous ICH. ⋯ This systematic review and meta-analysis including recent studies focusing on newer AEDs supports the 2015 guidelines regarding AED use in spontaneous ICH. There are some important caveats, including a possible confounding association between AED use and higher ICH score and the overall poor quality of the available data. A randomized clinical trial may be helpful.
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Review Meta Analysis
Near-Infrared Spectroscopy in Neurocritical Care: a Review of Recent Updates.
Neurocritical diseases and conditions are common causes of long-term disability and mortality. Early recognition and management of neurocritically ill patients is a significant challenge for neurosurgeons, neurologists, and neurointensivists. Although cerebral angiography, magnetic resonance imaging, computed tomography, and radionuclide imaging are useful in neuromonitoring and neuroimaging, they have several important limitations: they are not readily available, cannot be used for a continuous assessment of cerebral function, and frequently require patient transport to the radiological department. ⋯ NIRS can detect and monitor multiple critical parameters, including cerebral oximetry, intracranial pressure, temperature, and cerebral blood flow. NIRS can be valuable for a wide variety of neurocritical diseases and conditions, such as ischemic and hemorrhagic strokes, severe traumatic brain injury, brain tumors, and perioperative neurosurgery. Although NIRS has been studied extensively in multiple neurocritical conditions, more evidence on its application is needed.
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Meta Analysis
Expandable versus Static Cages in Minimally Invasive Lumbar Interbody Fusion: A Systematic Review and Meta-analysis.
Expandable cages for interbody fusion allow for in situ expansion optimizing fit while mitigating endplate damage. Studies comparing outcomes after using expandable or static cages have been conflicting. ⋯ Expandable interbody cages in MIS-LIF were associated with a decrease in subsidence rate, operative time and greater in increase in disc height.
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Case Reports Meta Analysis
Optimal management of calvarial lymphoma: a meta-analysis.
Calvarial lymphoma is an exceedingly rare phenomenon; the clinical presentation and imaging pattern mimic many diseases of the central nervous system. Several treatment approaches have been undertaken with variable use of surgery plus adjuvant chemotherapy and radiation; an optimal treatment algorithm has yet to be defined. The aim of this study was to better characterize management strategies and patient outcomes. ⋯ In an analysis from 1976 to 2019, 62 patients with a median age of 60 were included. The most common presentations were subcutaneous scalp mass (89%), headaches (26%), and focal neurological deficits (21%). Osteolytic changes on computed tomography were seen in 69% of patients with extension into either the intracranial or extracranial space in 97% of cases. Surgical excision was performed in 41 patients with a remission rate of 85% and a recurrence rate of 5%, which did not vary significantly from patients treated nonsurgically (remission in 75%, P = 0.479; recurrence in 0%, P = 1.000) CONCLUSIONS: In patients presenting with a progressively enlarging scalp mass, calvarial lymphoma should be in the differential diagnosis, as it can be effectively managed with a biopsy followed by chemotherapy and radiation. The role for open surgery may be limited.
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Pain is a common occurrence in patients with cancer, which, in some cases, is not adequately controlled with medical analgesia. Thalamotomy is a treatment option in such circumstances, but synthesis of historical evidence and thalamic stratified data are lacking. We therefore sought to systematically review evidence supporting radiofrequency thalamotomy for intractable cancer pain. ⋯ Adverse events were typically transient. We conclude that radiofrequency thalamotomy for cancer pain is well tolerated and can produce significant relief from intractable cancer pain. No superiority of thalamic target could be determined.