World Neurosurg
-
Radiographic worsening in patients with glioblastoma undergoing treatment may be due to tumor recurrence or treatment effect. The overall prognosis of these patients based on histologic findings at the time of repeat resection is not well established. ⋯ In patients with worsening imaging, the absence of tumor on histologic diagnosis is associated with improved survival from the time of second surgery.
-
Most pineal cysts are not surgical lesions and should be conservatively managed. Select lesions, notably those that present with hydrocephalus and Parinaud syndrome and lesions presenting with symptoms consistent with intermittent blockage of cerebrospinal fluid pathways and/or neurovascular compression, however, can be considered for surgical intervention. Two workhorse surgical approaches to the pineal region include the occipital interhemispheric transtentorial and supracerebellar infratentorial approaches. ⋯ Opening of the arachnoid membranes ventrolateral to the confluence of the deep cerebral veins allows for direct access to the cyst with minimal manipulation of the venous complex and risk for injury. The cyst is then fenestrated, and the cyst capsule is removed. It should be noted that surgical fenestration does not guarantee relief of headache symptoms, and patients should be consoled about this preoperatively.
-
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.
-
Review Meta Analysis
The Utility of Closed Incision Negative Pressure Wound Therapy following Spinal Fusion: A Systematic Review and Meta-Analysis.
To determine if closed incision negative pressure wound therapy (ciNPWT) decreases surgical site infection (SSI) or wound dehiscence after spinal fusion. ⋯ ciNPWT may reduce the rates of SSI after spinal fusion. The use of ciNWPT may also significantly reduce the burden associated with postoperative wound complications, but the meta-analysis was insufficiently powered to make this association. Additional studies may identify a subset of patients who benefit from ciNPWT for other wound-related complications.
-
Review Meta Analysis
Supraorbital keyhole craniotomy for clipping cerebral aneurysms: a systematic review and meta-analysis.
Open cerebrovascular surgery remains an irreplaceable tool in the neurosurgeon's armamentarium for cerebral aneurysms. Among open approaches, the supraorbital keyhole approach provides a novel approach with less soft tissue dissection and cortical exposure compared with the traditional pterional approach. ⋯ Aneurysm treatment is highly heterogeneous within the literature. The supraorbital keyhole approach is an effective strategy for aneurysm treatment.