World Neurosurg
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Intramedullary spinal cord ependymomas (IMSCEs) are rare tumors that mostly occur in adults. Management strategies and related outcomes are heterogeneously reported across the literature, demanding a comprehensive analysis to standardize guidelines. We performed a systematic review of the literature on IMSCEs. ⋯ IMSCEs are uncommon tumors that frequently manifest with debilitating symptoms that require surgical treatment. When feasible, gross total resection may be pursued to improve the patient's functional status and prevent tumor progression, with adjuvant radiotherapy required only in some more aggressive grade III lesions. Future studies should investigate different growth patterns and prognoses based on different IMSCE subtypes.
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Review Meta Analysis
Comparison of one-level osteotomy and two-level osteotomy in thoracolumbar kyphotic deformity in ankylosing spondylitis: a systematic review and meta-analysis.
One- and two-level osteotomies have been used to treat thoracolumbar kyphosis in patients with ankylosing spondylitis (AS). However, the effectiveness and safety of the 2 methods have not been systematically compared, and few studies have reported on which method might be more suitable for treating AS. ⋯ Our findings have shown that one-level osteotomy is safer than two-level osteotomy. For AS patients with nonsevere kyphosis, one-level osteotomy will be sufficient for spinal sequence correction and maintenance of balance, and two-level osteotomy will not be needed. For AS patients with severe kyphosis, two-level osteotomy can be recommended for better orthopedic effects; however, a careful surgical technique is required.
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Review Meta Analysis
Spinal Fusion Versus Repeat Discectomy For Recurrent Lumbar Disc Herniation: A Systematic Review and Meta-Analysis.
Recurrent lumbar disc herniation (RLDH) is one of the major causes of failure for primary surgery. Repeat discectomy (RD) and spinal fusion (SF) are 2 surgical options for RLDH. The objective of our study is to compare the effectiveness of SF compared with RD in the treatment of RLDH. ⋯ The pooled evidence suggests that fusion achieves better results than RD for RLDH. The results of this review should be further confirmed by future high-quality randomized controlled trials.
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Meta Analysis
Opioid versus non-opioid analgesia for craniotomy: A systematic review and meta-analysis of randomized controlled trials.
Despite the use of intraoperative opioid analgesia, postoperative pain is often reported by patients undergoing craniotomies. Opioids also cause undesirable side effects in neurosurgical patients. Hence, the role of nonopioid analgesia has been explored for craniotomies in recent years. ⋯ There were no important differences in clinical outcomes between the groups in our review. The GRADE certainty of evidence was rated low for most outcomes. Available evidence does not suggest superiority of intraoperative nonopioid over opioid analgesia for postoperative pain in patients undergoing craniotomy. More studies are needed to firmly establish the role of nonopioid intraoperative analgesics as an alternative to opioids in this population.