World Neurosurg
-
The authors present a comprehensive review on the history and development of oncolytic herpes simplex viral therapies for malignant glioma with a focus on mechanisms of delivery in prior and ongoing clinical trials. This review highlights the advancements made with regard to delivering these therapies to a highly complex immunologic environment in the setting of the blood-brain and blood-tumor barrier in a safe and effective manner.
-
Brainstem cavernous malformations are relatively rare lesions with a higher tendency of hemorrhage than supratentorial cavernous malformations. Due to the compact arrangement of fiber tracts and nuclei of the region, any hemorrhagic event can cause severe neurological deficits. This eloquent architecture of the area also makes any surgical attempt challenging. ⋯ The paramedian supracerebellar infratentorial translateral mesencephalic sulcus approach is used to resect the lesion with the patient in a dynamic lateral semisitting position. The paramedian variant of the supracerebellar infratentorial approach provides a relatively bridging vein-free corridor compared with midline approaches.6 With the patient in the semisitting position, gravity retraction of the brain provided a natural corridor with a clear surgical field. In the dynamic lateral semisitting position, we aimed to reduce the risk of venous air embolism associated with the sitting position by keeping the patient in the lateral decubitus position during the dural and extradural phases of the surgery.7.
-
Each year, thousands of individuals, particularly young adults, experience traumatic brachial plexus injuries (TBPIs), leading to significant limitations, permanent disabilities, reduced quality of life, and infrequent return to work. Current treatments and assistive devices have shown limited success, resulting in considerable social and economic challenges for patients. Given the devastating nature of this injury and the lack of literature on return to work rates among young adults, this study aims to determine the percentage of individuals reintegrating into work after a TBPI. ⋯ Preliminary findings indicate that approximately 60% of patients with TBPI return to work, although most require a change in their occupational roles. Despite variations in health care systems and governmental support, the reintegration of patients with TBPI into work and society remains a critical and universal challenge. This comparative analysis highlights disparities in TBPI research and outcomes, providing valuable insights for future improvements in patient care and support mechanisms.
-
Perioperative neurocognitive disorders are common perioperative complications associated with various poor outcomes. Regional cerebral oxygen saturation (rSO2) monitoring is a noninvasive technique based on near-infrared spectroscopy detection. Due to the considerable controversy among currently published studies on the application of intraoperative rSO2 monitoring in adult patients undergoing elective noncardiac surgery, this study aims to conduct a systematic review and meta-analysis to provide more comprehensive and robust evidence to support clinical decision-making. ⋯ Despite the presence of heterogeneity and the inclusion of a limited number of studies for some outcomes, it is still recommended that clinical anesthesiologists routinely perform intraoperative rSO2 monitoring and optimize intraoperative anesthesia management based on the monitoring results to maximize rSO2 and improve cerebral perfusion, thereby improving patients' neurocognitive outcomes. Further large-scale, high-quality studies are needed to confirm the conclusions of this study.
-
This study was to evaluate the initial efficacy of lateral lumbar interbody fusion (LLIF) in treating degenerative lumbar spinal stenosis (DLSS), encompassing a spectrum of stenosis severity from minor to extreme cases. ⋯ Under certain indications, patients with varying degrees of DLSS, ranging from mild to extreme, can achieve favorable outcomes through LLIF, and preoperative imaging revealing severe or extreme stenosis does not automatically disqualify patients from undergoing indirect decompression surgery.