World Neurosurg
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Surgical site infections (SSIs) are surgical complications leading to increased antibiotic usage, higher rates of readmission, prolonged hospitalization, and repeat operations. Use of intraoperative antibiotic irrigation as a form of SSI prophylaxis in neurosurgery may have potential. We aim to review the literature surrounding antibiotic irrigation usage in neurosurgical operations to guide current practice and inform future recommendations. ⋯ Current evidence supports the utility of antibiotic irrigation in preventing neurosurgical SSIs. However, study variability and limitations reduce the generalizability of these results. Given the high morbidity and cost associated with SSIs, randomized control trials are needed to further clarify the best evidence-based practices regarding antibiotic irrigation use in neurosurgical procedures.
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Multicenter Study
Risk factors for cerebral infarction early after revascularization in children younger than 5 years of age with moyamoya disease.
Cerebral revascularization is necessary for pediatric patients younger than 5 years with moyamoya disease (MMD). However, they have a high risk of developing cerebral infarction early after surgery. This study aimed to analyze the risk factors for developing cerebral infarction among these patients. ⋯ No differences were found in the risk of developing cerebral infarction early after surgery as a result of surgical procedures. However, younger patients had higher postoperative risk. Further multicenter research should examine this issue for young pediatric patients with moyamoya at high risk of developing cerebral infarction.
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Despite the fact that bevacizumab (Bev) has been approved to treat recurrent glioblastoma, patients have failed to demonstrate a significant overall survival (OS) advantage. In recent years, the advent of more Bev combination regimens seems to bring new hope for patients; nevertheless, there is still a lack of intuitive comparison among these therapies. ⋯ Both Bev + CCNU and Bev + rindopepimut could be considered as effective therapies for treating the recurrent glioblastoma according to the network meta-analysis results. Among them, Bev + rindopepimut therapy seems to be safer and more effective. Moreover, we found that Bev + Iri also appeared to be an effective therapy in a retrospective study.
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Seizures are the second most common presenting symptom of cerebral arteriovenous malformations (AVMs). Evidence supporting different treatment modalities is continuously evolving and it remains unclear which modality offers better seizure outcomes. ⋯ Interventional management of AVM-related epilepsy was associated with seizure freedom and seizure improvement in 56% and 73% of cases. Microsurgery seemed to be associated with a higher incidence of seizure freedom and seizure improvement than did other modalities. Future well-designed comparative studies are needed to draw definitive conclusions regarding each modality.
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We investigated the anatomical characteristics that complicate utilizing the radial artery approach (RAA) for craniocervical intravascular intervention. ⋯ RAA was difficult to perform in cases involving left-sided lesions and a small angle between the brachiocephalic artery and aortic arch. This study could help delineate the factors associated with difficulty of catheter introduction and instability of RAA.