World Neurosurg
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Review Meta Analysis
Baseline Risk Factors for Prolonged Opioid Use Following Spine Surgery: Systematic Review and Meta-Analysis.
To conduct a comprehensive systematic review and meta-analysis of current retrospective cohort studies to identify significant preoperative risk factors for prolonged postoperative opioid use following spine surgery. ⋯ Several patient-level factors may play a role in the tendency to persistently use opioids after spine surgery. By preoperatively identifying these characteristics, clinicians may be better able to identify patients who are at risk and employ methods to mitigate potential long-term opioid use.
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Randomized Controlled Trial Multicenter Study
Angulation towards coronal convexity measure and catheter length indication improves the quality of ventricular catheter placement - a smartphone-assisted guidance technique.
Accurate placement of a ventricular catheter (VC) is crucial to reduce the risk of shunt failure. In the randomized, prospective, multicenter GAVCA (guided application of ventricular catheters) trial, which evaluated the quality of VC placement, the subgroup of patients with detailed length-marked VCs (dVCs) reflected a difference in the primary endpoint of optimal VC placement compared with the subgroup of patients with simplified length-marked VCs (sVCs). The objective of the present analysis was to compare the dVC and sVC groups and the smartphone-assisted guidance technique (GA) with the standard freehand technique (FH) for VC placement. ⋯ The results from the present analysis suggest that the combination of a GA technique and the use of a dVC will improve the rate of accurate VC placement. Compared with the FH technique, patient safety was increased by the reduction of unsuccessful VC placement attempts using the GA technique and dVCs.
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Pineal region metastases are rare but often cause severe neurologic deficits. Surgical resection and chemoradiotherapy can provide therapeutic benefit. We investigated the literature to analyze clinical characteristics, management strategies, and survival of adult patients with pineal region metastases. ⋯ Pineal region metastases carry significant morbidity. Biopsy or surgical resection, combined with adjuvant chemotherapy/radiotherapy and/or shunting, may significantly improve performance status.
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Corpus callosotomy is among the oldest surgeries performed for drug-resistant epilepsy. Since it was first performed in 1940, numerous studies have assessed its outcomes in various patient populations in addition to describing different extents of sectioning and emerging technologies (i.e., endoscopic, laser interstitial thermal therapy, and radiosurgery). ⋯ We consider corpus callosotomy to be a safe and efficacious procedure, which should be considered by clinicians when appropriate. Furthermore, it can play an important role in treating patients with drug-resistant epilepsy when appropriate in low-to-middle-income countries where resources are limited.
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Malformations of cortical development (MCDs) are structural anomalies that disrupt the normal process of cortical development. These include microcephaly with simplified gyral pattern/microlissencephaly, hemimegalencephaly, focal cortical dysplasia, lissencephaly, heterotopia, polymicrogyria, and schizencephaly. ⋯ This article shall briefly review the embryology, followed by specific magnetic resonance imaging features of MCD in an attempt to simplify the process of diagnosing these disorders with clinical and genetic correlation. A table has been included to highlight the embryologic, clinical, and genetic findings associated with various MCDs.