World Neurosurg
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Sylvian arteriovenous malformations (sAVMs) are rare and account for approximately 8%-11% of all intracranial arteriovenous malformations (AVMs).1 Because of their proximity to eloquent structures such as the motor speech center, insular cortex, and internal capsule, microsurgical resection of sAVMs remains a challenge. Several classifications have already been suggested for sAVMs, such as Sugita and Yasargil.1,2 It is well established that for low-grade AVMs, results of the microsurgical resection are excellent and tend to favor surgery,1-3 but in high-grade AVM, a multimodal assessment is necessary for formulating treatment strategies.1 In Video 1, we demonstrate the surgical resection of a ruptured sylvian temporal AVM. This AVM was localized in the superior surface of the temporal lobe, and its nidus was just beneath the cortical surface of this lobe. Because it was 5.1 cm at its largest diameter, had a deep drainage vein, and was localized adjacent to the Wernicke area, we classified it as a Spetzler-Martin grade IV AVM.4 Despite the high-grade AVM, microsurgical treatment was the choice in this ruptured AVM and there was no increase in morbidity.
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Review Meta Analysis
Robot versus fluoroscopyassisted vertebroplasty and kyphoplasty for osteoporotic vertebral compression fractures: a systematic review and meta-analysis.
This study aimed to conduct a systematic review and meta-analysis to compare the clinical results and complications of robot-assisted (RA) versus fluoroscopy-assisted (FA) percutaneous vertebral augmentation (PVA) in the treatment of osteoporotic vertebral compression fractures (OVCFs). ⋯ This meta-analysis showed that RA-PVA can reduce bone cement leakage rate, fluoroscopy frequency, and doctors' radiation exposure time. With the advancement of RA technology, we anticipate more high-quality randomized controlled trials of RA versus FA-PVA in the future to validate and update the results of this analysis.
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Review
Frailty in Patients Undergoing Surgery for Brain Tumors: A Systematic Review of the Literature.
Emerging literature suggests that frailty may be an important driver of postoperative outcomes in patients undergoing surgery for brain tumors. We systematically reviewed the literature on frailty in patients with brain tumor with respect to 3 questions: What methods of frailty assessment have been applied to patients with brain tumor? What thresholds have been defined to distinguish between different levels of frailty? What clinical outcomes does frailty predict in patients with brain tumor? ⋯ Frailty is an increasingly popular concept in patients with brain tumor that is associated with important clinical outcomes. However, the extant literature is largely comprised of retrospective studies with heterogeneous definitions of frailty, thresholds for defining levels of frailty, and patient populations. Further work is needed to understand best practices in assessing frailty in patients with brain tumor and applying these concepts to clinical practice.
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Low-grade gliomas are a broad category of tumors that can manifest at different stages of life. As a group, their prognosis has historically been considered to be favorable, and surgery is a mainstay of treatment. Advances in the molecular characterization of individual lesions has led to newer classification systems, a better understanding of the biological behavior of different neoplasms, and the identification of previously unrecognized entities. ⋯ Similarly, more precise methods of intraoperative tumor tissue analysis will aid surgical planning. Improved surgical outcomes propelled by novel surgical techniques and intraoperative adjuncts and emerging forms of medical treatment in the field of immunotherapy have enriched the management of these lesions. We review the contemporary management and innovations in the treatment of low-grade gliomas.