World Neurosurg
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Meta Analysis
Stereotactic Radiosurgery for Glomus Jugulare Tumors: Systematic Review and Meta-Analysis.
Glomus jugulare tumors (GJTs) are benign paragangliomas of the jugular foramen. Traditional management of these tumors involves surgical resection; however, considering the proximity of these tumors to important neurovasculature, stereotactic radiosurgery (SRS) may be an appropriate noninvasive treatment to consider. The aim of this meta-analysis was to evaluate SRS as a treatment option for GJTs. ⋯ The tumor control rate of 95% and 47% symptomatic improvement suggest that SRS may be a suitable treatment modality for these hypervascular skull base tumors. Future studies are warranted to further evaluate the potential role of SRS in management of GJTs.
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Thoracolumbar burst fracture without neurological deficit is a common spinal injury. The ideal classification for the diagnosis and the optimal management strategies, including conservative management, surgical approach, implant constructs, need for spinal fusion, and implant removal, are controversial and currently being investigated. This article reviews the current literature to provide updated evidence on these topics. ⋯ Spinal fusion is not necessary for this type of injury. Minimally invasive surgery techniques provide equivalent outcomes and can safely replace open approaches. Implant removal after stabilization may provide some benefits, especially in younger patients.
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Patients with fusiform dilatation of the carotid artery (FDCA) following pediatric craniopharyngioma resection typically have a benign clinical course. We reviewed the neurosurgical literature for FDCA outcomes after resection of these tumors. ⋯ FDCA is a rare complication following pediatric craniopharyngioma resection. The exact cause is unclear, and factors related to tumor invasiveness, size, location, and differences in surgical approach may contribute to FDCA development. Most patients who go on to develop FDCA have an innocuous course on follow-up, with no reports of rupture in the present literature. For this reason, patients rarely require surgical or endovascular intervention for these lesions, and conservative management is favored.
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To understand the extent and type of evidence on diagnosis, clinical presentation, management, outcomes, and costs of traumatic spinal cord injury (TSCI) in the early stages in Latin America. ⋯ Information about the management of traumatic spinal cord injury in the early stages in Latin America is not exhaustive and high variability exists among the studies in all the examined sections. Nevertheless, many patients are polytraumatized, and little is known about ICU requirement. Treatment is heterogeneous and the complications are in many cases preventable conditions that can increase LOS, costs, and mortality.
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Isocitrate dehydrogenase (IDH) mutations are present in 70% of World Health Organization grade II and III gliomas. IDH mutation induces accumulation of the oncometabolite 2-hydroxyglutarate. Therefore, therapies targeting reversal of epigenetic dysregulation in gliomas have been suggested. However, the utility of epigenetic treatments in gliomas remains unclear. Here, we present the first clinical systematic review of epigenetic therapies in treatment of IDH-mutant gliomas and highlight their safety and efficacy. ⋯ IDH inhibitors appear promising given their benign toxicity profile and ease of monitoring. Histone deacetylase inhibitors appear to have a narrow therapeutic index, as lower concentrations do not appear effective, while increased doses can produce severe immunosuppressive effects. Preliminary data suggest that epigenetic therapies are generally well tolerated and may control disease in certain patient groups, such as those with nonenhancing lesions.