World Neurosurg
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The efficacy of tranexamic acid to control blood loss from lumbar spinal fusion surgery remains controversial. We conducted a systematic review and meta-analysis to explore the influence of tranexamic acid on blood loss from lumbar spinal fusion surgery. ⋯ Tranexamic acid has an important ability to decrease intraoperative blood loss and hospitalization for lumbar spinal fusion surgery.
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The orbital cavity is an anatomically complex region and an area of interest of many specialists, each of whom is familiar with specific surgical approaches. ⋯ We recommend, 1) the endoscopic endonasal approach for primary orbital tumors located in the medial or inferior orbital walls without extra-orbital extension; 2) the trans-eyelid approach for tumors of the upper and upper-lateral quadrants extraconally located, and 3) the fronto-orbital approach for intraconally located tumors involving more than one quadrant.
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Among spinal surgeons, the safety of endoscopic spinal techniques has been criticized as the result of a prolonged learning curve and divergent surgical technique from traditional microsurgery. In this manuscript, the authors assessed the learning curve of 4 experienced microsurgical neurosurgeons in endoscopic spinal surgery. ⋯ The learning process in endoscopic tubular-assisted spinal surgery is variable, and the asymptote might be reached after 10-20 procedures. The amount of working space and instrument angulation affects the surgical time. The decrease of surgical time had no significant influence on the rate of intraoperative complication and repeated procedures.
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Review Case Reports
Spontaneous Spinal Subarachnoid Hemorrhage with Development of an Arachnoid Cyst-A Case Report and Review of the Literature.
Spontaneous spinal subarachnoid hemorrhage (SAH) is extremely rare and occurs in <1% of all cases of SAH. To the best of our knowledge, only 1 case of spontaneous spinal SAH with later development of a symptomatic spinal arachnoid cyst (SAC) has been described in the literature to date. The objective of the present study was to report the challenging clinical management of SAC based on a literature review. ⋯ Treatment of secondary SAC is challenging, and surgery of the SAC with or without placement of a shunt is a possible treatment option.
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Although stereotactic radiosurgery (SRS) is an effective modality in the treatment of brainstem metastases (BSM), radiation-induced toxicity remains a critical concern. To better understand how severe or life-threatening toxicity is affected by the location of lesions treated in the brainstem, a review of all available studies reporting SRS treatment for BSM was performed. ⋯ Current data suggest that brainstem substructure location does not predict for toxicity and lesion volume within this cohort with median tumor volumes 0.04-2.8 cc does not predict for toxicity.