World Neurosurg
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Review Meta Analysis
Cavernous Sinus Invasion in Pituitary Adenomas: Systematic Review and Pooled Data Meta-analysis of Radiological Criteria and Comparison of Endoscopic and Microscopic Surgery.
Despite the substantial impact of cavernous sinus invasion (CSI) in pituitary adenoma surgery, its radiologic determination has been inconsistent and variable, and the role of endonasal endoscopic surgery has been unclear. This is a systematic review and pooled data meta-analysis of the literature to ascertain the best radiologic criteria for CSI and verify the efficacy and safety of an endonasal endoscopic approach. ⋯ Knosp 3-4 remains the best objective indicator of CSI. Microscopy tends to overestimate intraoperative CSI compared with endoscopy. Among pituitary adenomas with CSI, GTR in endoscopic series is higher than microscopy and improves with experience without significant additional morbidity.
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Review Case Reports Meta Analysis
Invasive Giant Cell Tumor of The Lateral Skull Base: A Systematic Review, Meta-analysis and Case Illustration.
The current literature regarding cranial giant cell tumor (GCT) management includes scattered case reports and small case series. We present a comprehensive literature review and meta-analysis on this subject, along with a case report describing our management of a patient with temporal GCT. ⋯ GCTs of the skull commonly affect young adults, with an equal sex distribution, and are most often centered in temporal bone. GTR is associated with the lowest recurrence rate and should be the goal of treatment. If GTR cannot be achieved, the combination of STR and radiation results in a similar recurrence rate. With the advent of denosumab, there is now a role for chemotherapy in the treatment of GCTs.
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Surgical treatment of trigeminal neuralgia (TN) associated with vertebrobasilar dolichoectasia is challenging. We analyze the treatments for this disease, discussing the advantages and drawbacks, and present our own technique and series. ⋯ TN associated with vertebrobasilar dolichoectasia can be treated surgically with minimal morbidity. BA repositioning has the highest success rate. Our technique of inducing a dural scar to fix the BA in its new position away from the trigeminal nerve is simple, not technically demanding, and highly effective.