Acta neurochirurgica
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Acta neurochirurgica · Apr 2019
ReviewRandomized controlled trials comparing surgery to non-operative management in neurosurgery: a systematic review.
A randomized controlled trial (RCT) remains the pinnacle of clinical research design. However, RCTs in neurosurgery, especially those comparing surgery to non-operative treatment, are rare and their relevance and applicability have been questioned. This study set out to assess trial design and quality and identify their influence on outcomes in recent neurosurgical trials that compare surgery to non-operative treatment. ⋯ Neurosurgical RCTs comparing surgical to non-operative treatment often find a benefit for surgical treatment. Changes to outcome measurements and anticipated accrual are common and funding sources are not always reported.
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Acta neurochirurgica · Apr 2019
Comparative StudyComparative study of single and dual nerve transfers for repairing shoulder abduction.
The purpose of this study was to compare the effects of single and dual nerve transfer for the repair of shoulder abduction in patients with upper or upper and middle trunk root avulsion. ⋯ For patients with nerve root avulsion of C5-C6 or C5-C7, repairing suprascapular nerve and axillary nerve at the same time is more effective than repairing suprascapular nerve alone in terms of shoulder abduction angle and excellent rate of functional recovery of the shoulder joint. Therefore, we recommend the repair of the suprascapular nerve and the axillary nerve simultaneously if conditions permit.
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Acta neurochirurgica · Apr 2019
Factors related to improvement of cerebrovascular reserve after superficial temporal artery to middle cerebral artery anastomosis for patients with atherosclerotic steno-occlusive disease.
This study aimed to investigate factors related to improvement of hemodynamics and evaluated the usefulness of intraoperative Doppler for predicting postoperative hemodynamics in patients with cerebrovascular atherosclerotic steno-occlusive disease (CASD) of the internal carotid artery (ICA) or middle cerebral artery (MCA) who were treated with extracranial-intracranial (EC-IC) bypass surgery. ⋯ A higher eGFR might have prognostic value for improvement in CVR after EC-IC bypass surgery in patients with CASD and misery perfusion.
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Acta neurochirurgica · Apr 2019
Application of indocyanine green fluorescence endoscopic system in transsphenoidal surgery for pituitary tumors.
For the precise removal of pituitary tumors, preserving the surrounding normal structures, we need real-time intraoperative information on tumor location, margins, and surrounding structures. The aim of this study was to evaluate the benefits of a new intraoperative real-time imaging modality using indocyanine green (ICG) fluorescence through an endoscopic system during transsphenoidal surgery (TSS) for pituitary tumors. ⋯ The ICG endoscopic system is simple, user-friendly, quick, cost-effective, and reliable. The method offered real-time information during TSS to delimit pituitary and parasellar region tumor tissue from surrounding normal structures. This method can contribute to the improvement of total removal rates of tumors, reduction of complications after TSS, saving surgical time, and preserving endocrinological functions.