World Neurosurg
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Review Meta Analysis Comparative Study
Treatment of Ethmoidal Dural Arteriovenous Fistulas: A Meta-analysis Comparing Endovascular vs Surgical Treatment.
Dural arteriovenous fistulas (DAVFs) in the anterior cranial fossa constitute approximately 1%-1.5% of intracranial vascular malformations. Depending on the drainage patterns, the diagnosis of ethmoidal DAVFs should prompt treatment because of the high risk of bleeding. Available treatments strategies are surgical treatment and the endovascular approach. ⋯ Surgical treatment was superior to endovascular therapy in terms of complete obliteration and overall good outcome. Adverse event rates were similar between the 2 groups. Future studies should be conducted to validate our results.
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Review Meta Analysis
The efficacy and safety of epsilon-aminocaproic acid for blood loss and transfusions in spinal deformity surgery: A meta-analysis.
To assess the efficacy and safety of epsilon-aminocaproic acid (EACA) in reducing the blood loss and transfusion volume during open spinal deformity surgery. ⋯ This meta-analysis demonstrated that EACA could be safe and potentially efficacious for reducing blood loss and transfusions volume in patients with spinal deformity surgeries when compared with placebo. In light of the significant heterogeneity, the findings of this meta-analysis should be confirmed in methodologically rigorous and adequately powered clinical trials.
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Review Case Reports
Intravenous Stem cell Therapy for High Grade Aneurysmal Subarachnoid Haemorrhage: Case Report and Literature Review.
Aneurysmal subarachnoid hemorrhage (SAH) is associated with high mortality (30%-40%) and morbidity with long-term physical, neurologic, and psychological impairments; most patients present with high initial Hunt and Hess grade. In view of the great need for efficacious therapies for high-grade SAH, recent animal studies have demonstrated improved outcomes with administration of mesenchymal stem cells (MSCs) as a potential neuroregenerative strategy. We present the first case of human intravenous administration of MSCs after aneurysmal SAH. ⋯ Several studies using models of ischemic brain injury have found that administration of MSCs may improve functional neurologic recovery and decrease brain lesion volume. Although there have been limited human studies in patients with stroke, the role of stem cell therapy for aneurysmal SAH remains unclear. This is the first case of use of MSCs in a patient for treatment of aneurysmal SAH. In conjunction with the promising results in animal studies, this encouraging preliminary case report supports the need for additional clinical trials.
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Review Historical Article
The history of Arachne through historic descriptions of meningiomas with hyperostosis: from prehistory to the present.
Intracranial meningiomas are brain tumors that have probably been known the longest, largely because of the occasional production of grotesque cranial deformities that have attracted the attention and interest of humankind. Because of the tendency of some intracranial meningiomas to cause skull deformation and thickening, these tumors have given rise to various speculations and theories related to their origin, starting in prehistoric times up to the present. ⋯ The contribution of neurosurgeons or pathologists over the centuries is of undeniable importance and is the basis for understanding future molecular mechanisms.
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Ruptured vertebral artery dissecting aneurysms (VADAs) involving the posterior inferior cerebellar artery (PICA) are the most difficult to treat among variations of VADAs but require prompt treatment. The major challenge is to preserve the PICA while occluding the aneurysm. Despite advances in the management of ruptured VADAs involving the PICA, each treatment, whether it is combined or not, is associated with a significant degree of risk. ⋯ Although it is sometimes very difficult to determine the exact rupture point of VADAs, ruptures tend to occur at distal segments of a dissecting aneurysm presenting as bleb. Also, when planning a trapping of the VA, careful examination of angiography is needed to assess the contralateral VA and rupture point. Our staged and combined strategy may provide another valuable treatment option for treating VADAs involving the PICA with special emphasis on the safety and efficacy in our method.