World Neurosurg
-
Review Meta Analysis
Predictive factors determining the overall outcome of Primary Spinal Glioblastoma Multiforme: An integrative survival analysis.
Primary glioblastoma multiforme of the spinal cord is a rare entity. The aim of this study was to perform an integrative analysis of patients whose cases were selected from the published studies, and to examine the influence of various factors on overall outcomes. ⋯ In this systemic analysis of primary spinal glioblastoma multiforme, we found that surgery followed by adjuvant therapy (radiotherapy, chemotherapy, or both) was significantly associated with improved survival. The additional finding was that overall median survival was better in the age group of 18-65 years (68 cases) compared with the extremes (<18 years, 53 cases; >65 years, 4 cases).
-
Chronic subdural hematomas (CSDHs) are common neurosurgical conditions among elderly patients. ⋯ This comprehensive, best evidence-based, quantitative, systematic review indicates that the use of a closed system drainage after burr-hole evacuation reduces the rate of recurrences but has no other significant differences. The findings also suggest that: (1) treatment with twist drills is equivalent to that with burr holes; (2) the postoperative bed header in the elevated position might reduce the length of hospital stay; (3) irrigation of the subdural space with thrombin solution in patients with high risk of recurrence might reduce this risk; and (4) treatment with twist drill followed by a closed system drainage during 48 hours, instead of 96 hours, might reduce general complication rates. Most of the trials suffered from unclear or high risks of bias and many involved small samples, precluding strong and definitive conclusions.
-
No consensus exists regarding the safety and efficacy of treatment of carotid stenosis before transcatheter aortic valve replacement (TAVR). Our objective was to review our series of patients treated for carotid stenosis with stenting in the setting of severe aortic valve disease and TAVR to evaluate its safety and efficacy. ⋯ We successfully performed carotid stenting in 5 patients before TAVR for severe aortic pathology. These patients require intensive care and careful monitoring. Larger prospective studies are needed to determine whether carotid stenting in the setting of TAVR can provide long-term neurological benefits.
-
Observational Study
Outcome of surgery for idiopathic normal pressure hydrocephalus: Role of pre-operative static and pulsatile intracranial pressure.
To examine the outcome of surgery for idiopathic normal-pressure hydrocephalus (iNPH) and how outcome relates to the preoperative static and pulsatile intracranial pressure (ICP). ⋯ The pulsatile ICP was greater in shunt Responders than Nonresponders. Although the clinical improvement declined over time and the majority did not experience complete relief of symptoms, shunt Responders lived significantly longer than Nonresponders. The present observations suggest that the current surgical treatment regimens for iNPH (primarily shunt surgery) address only some aspects of the disease process, in particular the aspect of brain water disturbance.