World Neurosurg
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Review Meta Analysis
Effects of miRNA-modified exosomes alleviate cerebral ischemic reperfusion injury in Pre-clinical Studies: A Meta-analysis.
Cell-derived exosomes bearing microRNAs (miRNAs) have emerged as a potential therapeutic option for cerebral ischemia-reperfusion injury (CIRI). However, their mechanism of action and clinical translation value remain unclear. The present meta-analysis investigated the therapeutic effects of miRNA-modified exosomes used in preclinical animal models of CIRI. ⋯ miRNA-modified exosomal therapy demonstrated the potential to improve infarct volume and neurobehavioral performance in preclinical animal models of CIRI. Despite the heterogeneity among studies, the results may provide some direction for future clinical research.
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Meta Analysis
Prolonged Opioid Use After Lumbar Fusion Surgery: A Meta-Analysis of Prevalence and Risk Factors.
Persistent opioid utilization after spine surgery is a rising complication among both preoperatively opioid-naïve and opioid-tolerant patients. To our knowledge, this is the first meta-analysis to determine the prevalence and characterize the risk factors that predispose patients to prolonged opioid use (≥3 months) after lumbar fusion. ⋯ The high prevalence of prolonged opioid use after lumbar fusion underscores the importance of screening patients for comorbidities and implementing targeted strategies to minimize opioid misuse.
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Percutaneous cement discoplasty (PCD) is a minimally invasive surgical procedure that can provide a segmental stabilizing and indirect decompression effect in the case of severely degenerated discs characterized by vacuum phenomenon. This systematic review aims to analyze the available literature relating to correct indications and clinical and radiologic efficacy of PCD in patients affected by advanced degenerative spine conditions. ⋯ PCD provides good clinical results in elderly patients, especially for pain relief. However, the current literature is poor and the article included in the systematic review showed a poor methodologic score, which could affect the conclusions.
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Multicenter Study
International Survey of Antiseizure Medication Use in Patients with Complicated Mild Traumatic Brain Injury: A New York Neurotrauma Consortium Study.
Seizures and epilepsy after traumatic brain injury (TBI) negatively affect quality of life and longevity. Antiseizure medication (ASM) prophylaxis after severe TBI is associated with improved outcomes; these medications are rarely used in mild TBI. However, a paucity of research is available to inform ASM use in complicated mild TBI (cmTBI) and no empirically based clinical care guidelines for ASM use in cmTBI exist. We aim to identify seizure prevention and management strategies used by clinicians experienced in treating patients with cmTBI to characterize standard care and inform a systematic approach to clinical decision making regarding ASM prophylaxis. ⋯ This study is the first to characterize factors influencing clinical decision making in ASM prophylaxis after cmTBI based on multidisciplinary multicenter provider practices. Prospective controlled studies are necessary to inform standardized guideline development.
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The National Health Service faces substantial challenges with staffing in the face of administrative turbulence just after a global pandemic resulting in significant economic losses. This staffing crisis extends to neurosurgical training with pervasive problems with the balance between trainees and consultants. ⋯ Creating a sustainable neurosurgery training program to adequately fill gaps in the National Health Service will require long-term solutions and the commitment of multiple stakeholders. The first step to achieving these goals would be to maximize the available opportunities to allow trainees maximize training time to become competent day-one consultants.