World Neurosurg
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Review Meta Analysis Comparative Study
Arachnolysis or cerebrospinal fluid diversion for adult-onset syringomyelia? A Systematic review of the literature.
To identify surgical practice patterns in the literature for nonpediatric syringomyelia by systematic review and to determine the following: 1) What is the best clinical practice of cerebrospinal fluid (CSF) diversion to maximize clinical improvement or to achieve the lowest recurrence rate? 2) Does arachnolysis, rather than CSF diversion, lead to prolonged times to clinical recurrence? ⋯ With postinfectious and posttraumatic etiologies, arachnolysis was the only surgical treatment to have a statistically significant effect on decreasing recurrence rates. More prospective, randomized, controlled studies are required to reach a clear consensus.
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Review Meta Analysis
The use of vancomycin powder in modern spine surgery: systematic review and meta-analysis of the clinical evidence.
Surgical-site infections (SSIs) can lead to greater postoperative morbidity, mortality, and health care costs. Despite current prophylactic measures, rates of SSIs have been reported in up to 15% of patients undergoing spine surgery. The adjunctive local application of vancomycin powder in spine surgery is a low-cost strategy to help reduce SSIs. Vancomycin is active against skin pathogens that can potentially contaminate the wound during spinal surgery. The local application of vancomycin in its powder form ensures adequate surgical-site concentrations while minimizing adverse effects caused by undetectable systemic distribution. However, clinical studies have produced conflicting results, and the clinical evidence behind the use of vancomycin powder in modern spinal surgery practices is not clear. ⋯ Numerous clinical studies have confirmed the safety of using vancomycin powder in the surgical site. The pooled clinical data supports the use of vancomycin to prevent SSIs in adult spine surgeries. The majority of the supporting literature is class III evidence. Existing studies use different definitions for surgical site infections and different pre-, peri-, and postoperative antibiotic regimens. Further high-quality investigations should use standardized protocols to confirm these findings.
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Review Meta Analysis
Outcome predictors in the management of spinal myxopapillary ependymoma: an integrative survival analysis.
The results in earlier studies have described a variable association with age, extent of resection, and radiotherapy (RT) correlating with the survival of myxopapillary ependymomas. The aim of our study is to perform a survival analysis on patient data gathered from a comprehensive review of the literature and determine the influence of these factors on progression-free (PFS) and overall survival (OS). ⋯ Gross-total resection plays the most important role in improving PFS and OS. Older patients had better PFS; however, the influence of adjuvant RT was significant in younger age groups. A dose of >50 Gy improves the results, but a randomized controlled study is warranted to arrive at a definite conclusion.
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Review Meta Analysis
The role of adjuvant radiotherapy after gross total resection of atypical meningiomas.
Atypical meningiomas (AMs) frequently recur after gross total resection (GTR). ⋯ Postoperative RT for AMs may decrease risk for relapse of disease and improve local control, although most tumors are salvageable with surgery or radiation. Although the data suggest little or no impact of postoperative RT on survival, further investigation regarding the long-term efficacy and toxicity of radiation is warranted.