World Neurosurg
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Review Meta Analysis Comparative Study
Arachnolysis or cerebrospinal fluid diversion for adult-onset syringomyelia? A Systematic review of the literature.
To identify surgical practice patterns in the literature for nonpediatric syringomyelia by systematic review and to determine the following: 1) What is the best clinical practice of cerebrospinal fluid (CSF) diversion to maximize clinical improvement or to achieve the lowest recurrence rate? 2) Does arachnolysis, rather than CSF diversion, lead to prolonged times to clinical recurrence? ⋯ With postinfectious and posttraumatic etiologies, arachnolysis was the only surgical treatment to have a statistically significant effect on decreasing recurrence rates. More prospective, randomized, controlled studies are required to reach a clear consensus.
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The optimal surgical procedure (direct, indirect, or combined anastomosis) for management of moyamoya disease is still debated. We evaluated the outcome of our broad area revascularization protocol, the Tokyo Daigaku (The University of Tokyo) (TODAI) protocol, analyzing the relative importance of direct, indirect, and combination revascularization strategies to identify the optimal surgical protocol. ⋯ The TODAI protocol provided efficient revascularization and yielded excellent results in preventing strokes in patients with moyamoya disease with very few complications. EMS had a main role in revascularization in each of the combined techniques.
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Multicenter Study
Predictors of severe complications in intracranial meningioma surgery: a population-based multicenter study.
To investigate predictors of complications after intracranial meningioma resection using a standardized reporting system for adverse events. ⋯ Severe complications after meningioma resection are more encountered often in elderly patients (>70 years old), dependent patients (Karnofsky performance scale score <70), and patients who underwent longer lasting surgery (>4 hours). Patient selection, including careful consideration of the individual risk-benefit ratio, is important in improving the safety of intracranial meningioma resection.
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Using current surgical methods, cranioplasty is associated with a high complication rate. We analyzed if there are preexisting medical conditions associated with complications and compared the effect of different implant materials on the degree of complications. ⋯ Based on these results, synthetic materials for cranial bone defect reconstruction exhibit more promising outcomes compared with autograft. There were differences in survival rates among synthetic materials.
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Case Reports Comparative Study
Treatment and outcomes among 102 posterior inferior cerebellar artery aneurysms: a comparison of endovascular and microsurgical clip ligation.
The vicinity of brainstem and cranial nerves as well as the limited operative working space make clip ligation of posterior inferior cerebellar artery (PICA) aneurysms challenging. The small caliber of the PICA and the broad neck often associated with these aneurysms also create challenges in preserving this artery during treatment. Few data exist to compare the 2 treatment approaches for aneurysms in this location. ⋯ PICA aneurysms are challenging and require a multimodality treatment paradigm. Although microsurgery is associated with more short-term postoperative complications, presenting grade and patient's age remain the primary predictors of long-term outcome.