British journal of neurosurgery
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Review Meta Analysis Comparative Study
Ruptured carotid-ophthalmic aneurysm treatment: a non-inferiority meta-analysis comparing endovascular coiling and surgical clipping.
Aneurysms of the carotid-ophthalmic segment are relatively rare, comprising only five percent of all intracranial aneurysms. There is no consensus regarding the optimal management for ruptured carotid-ophthalmic aneurysms, whether endovascular coiling or surgical clipping provide the most favourable patient outcome. The aim of this meta-analysis is to analyse these two treatment modalities for ruptured carotid-ophthalmic aneurysms with respect to independent clinical outcome. ⋯ Clinical outcome after endovascular coiling and surgical clipping for ruptured carotid-ophthalmic aneurysms was comparable between surgical clipping and endovascular coiling. There was no proven difference in clinical outcome after endovascular coiling and surgical clipping for ruptured carotid-ophthalmic aneurysms but the evidence was based on few studies of moderate to low quality and we cannot rule out the possibility of a difference in clinical outcome between the two treatment modalities.
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Suspected cauda equina syndrome (CES) requires urgent evaluation, investigation and treatment. Timing of cauda equina decompression is crucial, and delays in its management, leading to significant irreversible disability can be devastating for patient and surgeon alike. ⋯ Todd and Dickson have written an excellent paper summarising the condition, and have outlined what they feel is the standard of care. We would ask the authors to clarify an important point.
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Several studies have demonstrated the role of decompression surgery in preventing secondary injury and improving the neurological outcome after spinal cord injury (SCI). We retrospectively analyzed the prognostic factors affecting the outcomes of decompression surgery in patients with SCI. ⋯ Prognostic factors for AIS improvement include the initial neurological status before surgery and hemodynamic MAP at admission. The interval between decompression surgery and trauma does not affect the neurological outcome.
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Observational Study
Transforaminal epidural steroid injection in lumbar spinal stenosis: an observational study with two-year follow-up.
Transforaminal epidural steroid injection (TFESI) is recognised as a treatment for symptomatic lumbar disc herniation, whilst surgical decompression is generally thought to be the most effective treatment option for lumbar spinal stenosis. There is little available literature examining the effect of TFESI on symptomatic lumbar spinal stenosis. ⋯ Our study reports a considerably lower percentage patients opting for surgery than previously demonstrated by the available literature. TFESI is a reasonable treatment for lumbar spinal stenosis and can result in long-term relief from symptoms in a high proportion of patients.