World Neurosurg
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Meta Analysis Comparative Study
Comparison of Craniotomy versus Decompressive Craniectomy for Acute Subdural Hematoma: a Systematic Review and Meta-Analysis.
Acute subdural hematoma (ASDH) is a common critical neurosurgical condition, often requiring immediate surgical intervention. Craniotomy and decompressive craniectomy are the 2 mainstay surgical approaches. This comprehensive review and meta-analysis aims to summarize the existing evidence and compare the outcomes of these 2 procedures. ⋯ Our findings suggest that craniotomy is associated with better clinical outcomes and lower mortality compared to decompressive craniectomy for ASDH, but a higher rate of residual subdural hematoma. Further high-quality randomized controlled trials are needed to validate our findings.
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Review Case Reports
Treatment outcomes of lower urinary tract symptoms due to fragility sacral fractures: A review of eight patients and literature.
Sacral fractures can cause lower urinary tract symptoms (LUTS) due to damage to the cauda equina. While several studies have reported on sacral fractures due to high-energy trauma, those due to fragility fractures have only been reported in case reports and their clinical differences are not well known. This study aimed to investigate the clinical characteristics of LUTS caused by fragility sacral fractures and propose a novel treatment strategy. ⋯ LUTS can improve even with conservative treatment and should be utilized as the primary choice. LUTS caused by severe sacral canal deformity and stenosis can be reversible, and the decision to perform surgical treatment is still timely if LUTS do not improve with conservative treatment for several weeks.
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Traumatic brain injury (TBI) has become a major source of disability worldwide, increasing the interest in algorithms that use artificial intelligence (AI) to optimize the interpretation of imaging studies, prognosis estimation, and critical care issues. In this study we present a bibliometric analysis and mini-review on the main uses that have been developed for TBI in AI. ⋯ AI has become a relevant research field in TBI during the last 20 years, demonstrating great potential in imaging, but a more modest performance for prognostic estimation and neuromonitoring.
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In accordance with technique advancement and minimal invasiveness surgical approaches, the minipterional has progressively replaced the standard pterional approach for treatment of unruptured middle cerebral artery (MCA) aneurysms. Nowadays, multimodal intraoperative resources including microDoppler and microflow probes, indocyanine green videoangiography, and neurophysiologic monitoring constitute a fundamental prerequisite for increasing the safety of the clipping procedure. Our study investigated and compared in a single-center experience the effect of the evolution of a minimally invasive and multimodal approach in unruptured MCA aneurysm surgery by measuring postoperative complication rate, recovery time, and long-term neuropsychological and functional outcomes. ⋯ Decreased complication rates, faster recovery time, and a trend toward better cognitive and functional performances were documented for the MPT group of patients. In our experience, the minipterional approach with multimodality-assisted microsurgery reduced neurologic complications and recovery time and improved long-term cognitive outcome and quality of life.
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Neuroendovascular procedures can be challenging due to severe angulation of the cervical and cranial vessels. Typical approaches for overcoming this tortuosity involve using multiple telescoping catheter systems to provide proximal support for therapeutic device delivery. Although this approach can be effective, it does have limitations. ⋯ Although helpful in overcoming challenging anatomy, the Guidezilla guide extension catheter should be used with caution when used as a bailout device.