World Neurosurg
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Review Meta Analysis
Cost Comparison of Surgical Clipping and Endovascular Coiling of Unruptured Intracranial Aneurysms - A Systematic Review.
Rupture of unruptured intracranial aneurysms (UIA) is the main cause for subarachnoid hemorrhage. UIA are widespread among the population. Advanced technology enables us to diagnose UIAs with increasing reliability and subsequently treat them. There are 2 main treatment options: surgical clipping and endovascular treatment of the aneurysm. This article aims to analyze costs of neurosurgical clipping and the endovascular approach to treat UIA, and to give an overview over the existing literature. ⋯ Due to different definitions of hospital costs and hardly reproducible calculations, comparability of the stated numbers is limited. Besides the economic impact, outcomes must be considered when making a treatment decision. The 2 treatment modalities are not equally suitable in every patient nor for every aneurysm location.
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Review Meta Analysis
Intracranial Administration of Nicardipine after Aneurysmal Subarachnoid Hemorrhage: A Review of the Literature.
Intrathecal (IT), intraventricular (IVt), and intracisternal administration of nicardipine deliver treatment directly into the central nervous system. This route of drug delivery is being investigated as a potential treatment of vasospasm following aneurysmal subarachnoid hemorrhage (aSAH). ⋯ Given the findings presented in these studies, IT, IVt, and intracisternal (pellet) nicardipine administration can be useful treatment adjuncts for vasospasm following aSAH, especially in cases refractory to conventional forms of treatment. However, larger, controlled clinical trials are warranted.
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Review Meta Analysis
Intra-operative neuromonitoring in patients with intramedullary spinal cord tumor: a systematic review, meta-analysis, and case series.
Intramedullary spinal cord tumors (IMSCT) comprise the least common types of spinal neoplasms; surgery is mostly conducted with intraoperative neuromonitoring (IONM). However, although IONM is widely used to prevent neurologic damage and many single-center studies have been reported, the added value, in terms of overall sensitivity and specificity, of different monitoring techniques used in IMSCT surgery remains to be clearly defined. ⋯ IONM showed high but not perfect sensitivity and specificity. IONM prevents neurologic damage but can also limit the extent of tumor resection. Prospective studies will have to define the definitive value of IONM.
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Review Meta Analysis
A systematic review of unilateral bi-portal endoscopic spinal surgery: preliminary clinical results and complications.
Unilateral biportal endoscopic spine surgery (UBE) for the treatment of lumbar spinal diseases has achieved favorable results. In this systematic review, the technical nuances, surgical outcomes, and complications of UBE are summarized. ⋯ Although the existing studies are limited to small cohorts and short-term follow-up, based on the given preliminary results and experiences of current studies, UBE may be a feasible option for lumbar spinal surgery.
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Randomized Controlled Trial Multicenter Study
Recovery trajectories and long-term outcomes in traumatic brain injury: A secondary analysis of the phase 3 COBRIT clinical trial.
Prospects for recovery after traumatic brain injury (TBI) are often underestimated, potentially leading to withdrawal of care in the comatose TBI patient who may ultimately have a favorable outcome with aggressive care. Outcomes and trajectories of recovery in a large series of patients with TBI were evaluated at 30, 90, and 180 days postinjury. ⋯ In this secondary analysis of the COBRIT trial, most patients had favorable outcomes by the GOS-E at 6 months postinjury in all complicated mild and moderate TBI groups, with over half of patients with severe TBI achieving a favorable outcome as well. Of subjects in a vegetative state (GOS-E score 2) at 1 month postinjury, 18% improved to a favorable outcome by 6 months postinjury. There was substantial improvement in all groups from 1 to 6 months, and this improvement may continue beyond 6 months. Clinical trials in TBI should consider recovery curves with repeated measures to assess outcomes because arbitrary single-moment outcome determination likely underestimates treatment effect in TBI care.