Neurosurgery
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Meta Analysis
Resuming Anticoagulants in Patients With Intracranial Hemorrhage: A Meta-Analysis and Literature Review.
Intracerebral hemorrhage (ICH) is one of the most disabling cerebrovascular events. Several studies have discussed oral anticoagulant (OAC)-related ICH; however, the optimal timing of resuming OAC in patients with ICH is still a dilemma. In this literature review/meta-analysis, we will summarize, discuss, and provide the results of studies pertaining to OAC resumption in patients with ICH. ⋯ Based on our meta-analysis, the average time of resuming OAC in patients with ICH is around 30 days. Several factors including the type of intracranial hemorrhage, the type of OAC, and the indication for OACs should be taken into consideration for future studies to try and identify the best time to resume OAC in patients with ICH.
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Multicenter Study
Clinical and Imaging Outcomes After Trigeminal Schwannoma Radiosurgery: Results From a Multicenter, International Cohort Study.
An international, multicenter, retrospective study was conducted to evaluate the long-term clinical outcomes and tumor control rates after stereotactic radiosurgery (SRS) for trigeminal schwannoma. ⋯ SRS was associated with long-term freedom (10 year) from additional management in 80% of patients. SRS proved to be a valuable salvage option after resection. When used as a primary management for smaller volume tumors, both clinical improvement and prevention of new deficits were optimized.
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Review
A Review of Preoperative Embolization Effectiveness in Patients With Arteriovenous Malformations.
Preoperative embolization of arteriovenous malformations (AVMs) remains controversial. This study sought to analyze the cost-effectiveness of preoperative embolization of AVMs. ⋯ Preoperative embolization was cost-effective for patients with SM grade III AVMs but not for patients with lower-grade AVMs.
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Although stereotactic radiation has frequently supplanted whole-brain radiation therapy (WBRT) in treating patients with multiple brain metastases, the role of surgery for these patients remains unresolved. No randomized trials have compared surgical resection with postoperative stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) to SRS/SRT alone. Previous studies addressing surgery for patients with multiple brain metastases are often limited by small sample sizes, a lack of appropriate comparison groups, or a focus on patients treated before recent advances in targeted therapy and immunotherapy. We compared outcomes in patients with multiple brain metastases treated with surgical resection and postoperative SRS/SRT to those treated with SRS/SRT alone. ⋯ In patients with multiple brain metastases, surgical resection before SRS/SRT is associated with reduced mortality and radiation necrosis. Prospective studies may further delineate patient populations that benefit from aggressive local, brain-directed treatment even with significant intracranial disease burden.
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Posterior reconstruction of the cervicothoracic junction poses significant biomechanical challenges secondary to transition from the mobile cervical to rigid thoracic spines and change in alignment from lordosis to kyphosis. After destabilization, the objectives of the current investigation were to compare the rod strain and multidirectional flexibility properties of the cervicothoracic junction using a 4-rod vs traditional 2-rod reconstructions. ⋯ Supplemental accessory rods affixed to traditional 2-rod constructs significantly improved stability of Ti alloys and CoCr alloy materials. The 4.0-mm CoCr rods provided greater stability than 3.5-mm Ti rods in flexion-extension, lateral bending, and axial rotation. While rod strain was not significantly reduced by the addition of accessory rods, it was reduced in CoCr rod treatment groups compared with the Ti rods.