World Neurosurg
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Neurosurgery-specific research plays a critical role in improving outcomes in patients with neurosurgical diseases. Despite the high burden of neurosurgical diseases in Ethiopia, little is known about types of neurosurgical research from Ethiopia. The goal of this scoping review is to assess the quantity and types of neurosurgical research published in peer-reviewed journals by authors from Ethiopia. ⋯ Neurosurgery research from Ethiopia is lacking, despite its high disease burden. Case reports/series and cohort studies remain the mainstay, with few systematic reviews and no randomized controlled trial. International collaboration accounts for approximately half of Ethiopian neurosurgery research output. Further research support and infrastructure should be developed to encourage neurosurgery articles from Ethiopia.
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The adoption of the transradial approach (TRA) has been increasing in popularity as a primary method to conduct both diagnostic and therapeutic interventions. As this technique gains broader acceptance and use within the neuroendovascular community, comparing its complication profile with a better-established alternative technique, the transfemoral approach (TFA), becomes more important. This study aimed to evaluate the safety of TRA compared with TFA in patients undergoing diagnostic, therapeutic, and combined neuroendovascular procedures. ⋯ Patients undergoing TFA are significantly more likely to experience access site complications and neurological complications compared with patients undergoing TRA. Patients undergoing TRA are more likely to experience complications such as wound infections and vascular spasm.
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Nonoperative management of odontoid fractures can result in solid fusion, unstable nonunion, and fibrous nonunion. Odontoid fractures with fibrous nonunion will not demonstrate dynamic instability on imaging studies. However, the safety of accepting this outcome has been debated. We have provided, to the best of our knowledge, the first systematic review of the existing literature to explore the safety of allowing fibrous nonunion as an acceptable outcome for odontoid fractures. ⋯ The evidence we found supports that it is safe to forgo surgery for carefully selected patients with nonunited odontoid fractures when near-anatomic alignment is present, dynamic instability is lacking on imaging studies, the neurologic examination findings are normal, and the risk of neck injury is low. Further study is needed to define the full natural history of fibrous nonunion of odontoid fractures.
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Cranioplasty is a common neurologic procedure, with complication rates ranging from 20% to 50%. It is hypothesized that the risks of various complications are affected by which material is used for cranioplasty. ⋯ The quality of existing literature on this topic is relatively poor, almost exclusively comprising single-center retrospective studies. There is not strong enough evidence available to make comprehensive conclusions regarding the risk profiles of various cranioplasty materials across multiple outcomes. Prospective randomized trials are necessary to confirm the significant results found in this analysis and to further elucidate the differential risks of various cranioplasty materials.
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Randomized controlled trials (RCTs) have come under scrutiny due to a frequent lack of reproducibility, due in part to shortcomings of the common P < 0.05 threshold for significance. Here, we utilize fragility indices to assess the statistical robustness of RCTs evaluating low-dose ketamine during scoliosis surgery to reduce opioid tolerance and postoperative pain. ⋯ While evidence for ketamine use is promising, our fragility analysis suggests that RCT findings may be underpowered in some cases. Given the importance of RCTs in clinical decision-making, fragility indices should be reported alongside P values to indicate the strength of statistical findings.