World Neurosurg
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As an established antifibrinolytic agent, tranexamic acid (TXA) has garnered widespread use during surgery to limit intraoperative blood loss. In the field of neurosurgery, TXA is often introduced in cases of traumatic brain injury or elective spine surgeries; however, its role during elective cranial surgeries is not well established. We report a systematic review of the use of TXA in elective surgical resection of intracranial neoplasms. ⋯ These results support the use of intraoperative TXA in tumor resection. However, its role in tumor resection has been less well investigated compared with its use in other areas of neurosurgery.
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A meta-analysis of patients with sporadic vestibular schwannoma (VS) primarily treated with stereotactic radiosurgery (SRS) or microsurgery (MS) was performed, and hearing preservation outcome (HPO), tumor control (TC), and facial nerve dysfunction (FND) were analyzed. ⋯ MS and SRS are comparable primary treatments for small (<3 cm) sporadic VS with respect to HPO at 5-year follow-up in patients with serviceable hearing at presentation; approximately 50% of patients for both modalities likely lose serviceable hearing by that time point. High TC rates (>90%) were seen with both modalities; MS 98% versus SRS 92%. The posttreatment FND was significantly less with the SRS group (2%) versus the MS group (10%).
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Review Meta Analysis
Evaluate the outcomes of the biportal endoscopic lumbar interbody fusion compare to the conventional fusion operations: A systematic review and meta-analysis.
In recent years, biportal endoscopic lumbar interbody fusion (BE-LIF) has been increasingly used in the treatment of lumbar degenerative diseases. BE-LIF combines the benefits of minimally invasive fusion with endoscopic spine surgery. However, there is little evidence on whether BE-LIF is superior to posterolateral lumbar interbody fusion (PLIF). The purpose of this meta-analysis is to compare the clinical outcomes, complications, and fusion rates of BE-LIF and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF)/PLIF in treating lumbar degenerative diseases. ⋯ The benefits of BE-LIF and MI-TLIF/PLIF were approximately equivalent in terms of clinical outcomes and achievement of fusion, and complication rates were similar in both groups. However, BE-LIF reduced postoperative back pain and blood loss, despite longer operative times.
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Randomized Controlled Trial Multicenter Study
Middle Cerebral Artery Aneurysm Trial (MCAAT): A randomized care trial comparing surgical and endovascular management of MCA aneurysm patients.
Whether the best management of middle cerebral artery (MCA) aneurysm patients is surgical or endovascular remains uncertain, with little evidence to guide decision-making. A randomized care trial offering MCA aneurysm patients a 50% chance of surgical and a 50% chance of endovascular management may optimize outcomes in the presence of uncertainty. ⋯ Patients with MCA aneurysms can be optimally managed within a care trial protocol.
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Randomized Controlled Trial Multicenter Study
Endovascular aneurysm treatment with the Numen coil embolization system: A prospective, randomized, controlled, open-label, multi-center, non-inferiority trial in China.
We investigated the safety and efficacy of the Numen coil compared with the Axium coil in the treatment of intracranial aneurysms. ⋯ This trial showed that the Numen coil was noninferior to the Axium coil in terms of intracranial aneurysm embolization and can be considered as a safe and effective coil for treating patients with intracranial aneurysm in clinical practice.