World Neurosurg
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Review Meta Analysis
Unruptured brain arteriovenous malformations: a systematic review and meta-analysis of mortality and morbidity in ARUBA-eligible studies.
Treating unruptured brain arteriovenous malformations (bAVMs) represent significant challenges, with numerous uncertainties still in debate. The ARUBA trial induced further investigation into optimal management strategies for these lesions. Here, we present a systematic-review and meta-analysis focusing on ARUBA-eligible studies, aiming to correlate patient data with outcomes and discuss key aspects of these studies. ⋯ The analysis revealed that studies with a higher proportion of bAVMs presenting SM 1-2 lesions were associated with lower mortality rates. Mortality did not show a significant association with treatment modalities.
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Meta Analysis
Treatment Effects of Acetazolamide on Ischemic Stroke: Meta-Analysis and Systematic Review.
Ischemic stroke significantly contributes to high mortality and disability rates. Cerebral edema is a common consequence of ischemic stroke and can lead to aggravation or even death. Current treatment strategies are limited to decompressive craniectomy and the intravascular administration of hypertonic drugs, which have significant side effects. Acetazolamide (ACZ) plays a therapeutic role in cerebral edema by inhibiting aquaporin-4 (AQP-4) and improving collateral circulation. This study aimed to perform a meta-analysis and systematic review of ACZ therapy for ischemic stroke and evaluate its efficacy in animal models. ⋯ ACZ inhibited AQP-4 and alleviated brain edema after ischemic stroke in the early stages but seemingly could not improve the neurological function.
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Case Reports
Virtual Planning & Augmented Reality Guided Microsurgical Resection of a Frontal Arteriovenous Malformation.
Arteriovenous malformations (AVMs) are complex vascular lesions that can pose significant risk for spontaneous hemorrhage, seizures, and symptoms related to ischemia and venous hypertension.1 Microsurgical management of AVMs requires a deep understanding of the surrounding anatomy and precise identification of the lesion characteristics. We demonstrate the use of augmented reality in the localization of arterial feeders and draining veins in relation to bordering normal structures (Video 1). A 66-year-old man presented with several episodes of severe right frontal headaches. ⋯ Postoperative angiography showed complete resection of the AVM. The patient was discharged home on postoperative day 3 with no complications. He remains neurologically well at 4 months of follow-up.
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For patients with medically refractory epilepsy, newer minimally invasive techniques such as laser interstitial thermal therapy (LITT) have been developed in recent years. This study aims to characterize trends in the utilization of surgical resection versus LITT to treat medically refractory epilepsy, characterize complications, and understand the cost of this innovative technique to the public. ⋯ The present study highlights LITT's advantages through its association with lower costs and shorter length of stay. The present study also highlights the associated predictors of LITT versus resection, such as that most LITT cases happen at academic centers for patients with private insurance. As the adoption of LITT continues, more data will become available to further understand these issues.
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Review Biography Historical Article
Carl Wernicke of "Wernicke's Area": A Historical Review.
The Wernicke area, also known as Brodmann area 22, is located in the posterior segment of the superior temporal gyrus in the dominant hemisphere. Carl Wernicke, a German neurologist, described this area in 1874. ⋯ We explore his remarkable ability to turn his many setbacks into steps forward, his controversial foray into psychiatry, and his wide-ranging set of contributions, including his work on external ventricular drainage for hydrocephalus and encephalopathy; his description of the eponymous Wernicke area; and his field-defining work on aphasia. This historical review attempts to bring to life a seminal figure in the neurosciences, providing an insight into his visionary thought process.