World Neurosurg
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Review Meta Analysis Comparative Study
Comparison of the Efficacy and Safety of Endovascular Coiling Versus Microsurgical Clipping for Unruptured Middle Cerebral Artery Aneurysms: A Systematic Review and Meta-Analysis.
Middle cerebral artery aneurysms (MCAAs) are regularly treated by both microsurgical clipping and endovascular coiling. We performed a systematic meta-analysis to compare the safety and efficacy of these 2 methods. ⋯ Based on this systematic review and meta-analysis of unruptured MCAAs, after careful consideration of patient, aneurysmal, and treatment center factors, we recommend surgical clipping for unruptured MCAA.
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Review Case Reports Meta Analysis
Blister-like Aneurysms in Atypical Locations: A Single-Center Experience and Comprehensive Literature Review.
Blister-like aneurysms (BLAs) were originally described to arise typically along the nonbranching segment of the dorsal wall of the internal carotid artery (ICA); however, BLAs located in areas other than the dorsal ICA have been described more recently. We present a case series of "atypical" BLAs and a systematic review of the literature on this subject. ⋯ Endovascular treatment of BLAs seems to be associated with reduced morbidity and mortality and to provide a better outcome compared with surgical approaches. Further prospective studies are needed to confirm these results. It is important for clinicians to remember that BLAs may also occur in sites other than the typical ICA location.
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Review Meta Analysis
Role of Genetic Polymorphisms in Predicting Delayed Cerebral Ischemia and Radiographic Vasospasm After Aneurysmal Subarachnoid Hemorrhage: A Meta-Analysis.
The pathophysiology on cerebral vasospasm and delayed cerebral ischemia (DCI) remains poorly understood. Much research has been dedicated to finding genetic loci associated with vasospasm and ischemia. We present a systematic review and meta-analysis to identify genetic polymorphisms associated with delayed ischemic neurologic deficit (DIND), radiographic infarction attributed to ischemia, and radiographic vasospasm. ⋯ This is the first systemic review and meta-analysis to study and evaluate the associations between genetic polymorphism with DCI and radiographic vasospasm independently. In our study, eNOS VNTR and Hp polymorphisms appear to have the strongest associations with DIND and radiographic vasospasm, respectively.
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Review Meta Analysis
Anterior and Posterior Ethmoidal Artery Ligation in Anterior Skull Base Meningiomas: A Review on Microsurgical Approaches.
Anterior skull base neoplastic and vascular lesions can receive significant blood supply from the anterior and posterior ethmoidal artery. Although useful in preoperative embolization of middle meningeal artery branches, endovascular techniques for the occlusion of anterior ethmoidal artery expose the parent vessel, the ophthalmic artery, to possible embolic complications, which can cause loss of vision. When dealing with anterior fossa giant meningiomas, moreover, it is not always possible to gain direct intracranial access to anterior ethmoidal arteries because of dimensions and invasiveness of these neoplasms. The aim of this review is to illustrate the anterior and posterior ethmoidal artery anatomy and the microsurgical approaches for extracranial ligation. ⋯ A combination of different surgical and endovascular techniques before resection of hypervascular giant olfactory groove and planum sphenoidale meningiomas should always be considered. Microsurgical extracranial ligation of anterior and sometimes posterior ethmoidal arteries provides a safe and feasible option to limit blood loss during anterior skull base surgery.
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Multicenter Study Observational Study
The Risk of Getting Worse: Predictors of Deterioration After Decompressive Surgery for Lumbar Spinal Stenosis: A Multicenter Observational Study.
To investigate the frequency and predictors of deterioration after decompressive surgery for single and 2-level lumbar spinal stenosis. ⋯ Overall risk of clinically significant deterioration in patient-reported pain and disability after decompressive surgery for lumbar spinal stenosis is approximately 9%. Predictors for deterioration are decreasing age, current tobacco smoking, American Society of Anesthesiologists grade ≥3, decreasing preoperative ODI, and previous surgery at same or different lumbar level. We suggest that these predictors should be emphasized and discussed with the patients before surgery.