The impact of surgical simulation on patient outcomes: a systematic review and meta-analysis
The objective of this research is to investigate the effects of surgical simulation training on clinically relevant patient outcomes by evaluating randomized controlled trials (RCT). PubMed was searched using PRISMA guidelines: “surgery” [All Fields] AND “simulation” [All Fields] AND “patient outcome” [All Fields]. Of 119 papers identified, 100 were excluded for various reasons. Meta-analyses were conducted using the inverse-variance random-effects method. Nineteen papers were reviewed using the CASP RCT Checkl ist. Sixteen studies looked at surgical training, two studies assessed patien...
Source: Neurosurgical Review - May 13, 2020 Category: Neurosurgery Source Type: research

Iatrogenic vascular laceration during posterior lumbar disc surgery: a literature review
AbstractIatrogenic vascular laceration is a rare but well-known complication of posterior lumbar disc surgery (PLUDS). We performed a review of the literature to evaluate the management of this life-threatening complication. A total of 54 papers containing 100 cases of vascular laceration following PLUDS between 1969 and 2018 were analyzed with our representative case with a left common iliac artery (CIA) laceration during a posterior approach for a far lateral L4 –L5 disc herniation. There were 54 females and 35 males (12 cases with unreported gender) with ages ranging from 20 to 72 years. The most commonly involved...
Source: Neurosurgical Review - May 12, 2020 Category: Neurosurgery Source Type: research

Pulmonary embolism in neurocritical care-introduction of a novel grading system for risk stratification: the Frankfurt AMBOS score
AbstractPulmonary embolism (PE) due to deep vein thrombosis is a complication with severe morbidity and mortality rates. Neurocritical care patients constitute an inhomogeneous cohort with often strict contraindications to conventional embolism treatment. The aim of the present study is to identify risk factors for pulmonary embolism for intensified risk stratification in this demanding cohort. In this retrospective analysis, 387 neurocritical care patients received computed tomography for clinical suspicion of PE (304 neurosurgical and 83 neurological patients). Analysed parameters included age, gender, disease pattern, t...
Source: Neurosurgical Review - May 12, 2020 Category: Neurosurgery Source Type: research

Natural history of incidentally diagnosed brainstem cavernous malformations in a prospective observational cohort
AbstractThere was a lack of natural history of incidental brainstem cavernous malformations (CMs), hemorrhage of which would lead to severe neuropathies. The study aimed to evaluate the prospective hemorrhage rate and neurological outcome of the disease. This prospective cohort included patients with incidental brainstem CMs referred to our institute from 2009 to 2015. The diagnosis was confirmed based on the patients ’ complain, physical examination, and radiographic evidence. Clinical data were collected, scheduled follow-up was performed, and the independent risk factors were identified by multivariate analysis. T...
Source: Neurosurgical Review - May 12, 2020 Category: Neurosurgery Source Type: research

Same viewing angle, minimal craniotomy enlargement, extreme exposure increase: the extended supraorbital eyebrow approach
AbstractThe supraorbital eyebrow approach (SEa) has been commonly used as a straightforward route to reach lesions located in the anterior cranial fossa. The reduced surgical exposure provided by this approach limits its applicability. A modification of the SEa, the extended supraorbital eyebrow approach (X-SEa), allows use of the transylvian corridor to approach parasellar lesions, while maintaining most of the aesthetic advantages of the SEa. To quantify the surgical exposure and maneuverability provided by the X-SEa using a cadaveric study. Eleven heads were used to obtain all stereotactic measurements. Surgical exposur...
Source: Neurosurgical Review - May 11, 2020 Category: Neurosurgery Source Type: research

Location-based treatment of intracranial aneurysms in moyamoya disease: a systematic review and descriptive analysis
AbstractWe conducted a systematic review of the literature to evaluate the efficacy of various treatment modalities for intracranial aneurysms (IA) in patients with moyamoya disease (MMD) based on anatomical location of IA. A comprehensive review of studies documenting single cases or series of MMD patients with concomitant IA was conducted. Aneurysms were classified into two primary anatomical categories: those of the Circle of Willis (CoW) and those of peripheral “moyamoya” collateral vessels. Conservative, endovascular, and open surgical treatment modalities and their outcomes between each anatomical subgrou...
Source: Neurosurgical Review - May 8, 2020 Category: Neurosurgery Source Type: research

Outcome prediction in brain tumor surgery: a literature review on the influence of nonmedical factors
AbstractThe purpose of the present study was to review the existing data on preoperative nonmedical factors that are predictive of outcome in brain tumor surgery. Our hypothesis was that also the individual characteristics (e.g., emotional state, cognitive status, social relationships) could influence the postoperative course in addition to clinical factors usually investigated in brain tumor surgery. PubMed, Embase, and Scopus were searched from 2008 to 2018 using terms relating to brain tumors, craniotomy, and predictors. All types of outcome were considered: clinical, cognitive, and psychological. Out of 6.288 records i...
Source: Neurosurgical Review - May 7, 2020 Category: Neurosurgery Source Type: research

Safety and efficacy of surgical treatment for brainstem hemangioblastoma: a meta-analysis
AbstractBrainstem hemangioblastomas are benign, highly vascular tumors located in the mesencephalon, pons, and medulla oblongata. Although surgical resection is currently considered the main therapeutic option for symptomatic lesions, evidence supporting the application of microsurgery has not been systematically assessed. This meta-analysis aims to evaluate the safety and efficacy of surgical treatment for brainstem hemangioblastomas. A comprehensive search of the PubMed, Embase, and Web of Science databases was performed to identify all English language publications reporting the outcomes of surgical treatment for brains...
Source: Neurosurgical Review - April 30, 2020 Category: Neurosurgery Source Type: research

Ulnar nerve subluxation and dislocation: a review of the literature
This article reviews the extant literature with the aim of bringing knowledge of the topic into perspective and standardizing terminology. (Source: Neurosurgical Review)
Source: Neurosurgical Review - April 27, 2020 Category: Neurosurgery Source Type: research

A systematic review of surgical treatments of idiopathic intracranial hypertension (IIH)
AbstractIdiopathic intracranial hypertension denotes raised intracranial pressure in the absence of an identifiable cause and presents with symptoms relating to elevated ICP, namely headaches and visual deterioration. Treatment of IIH aims at reducing intracranial pressure, relieving headache and salvaging patients ’ vision. Surgical interventions are recommended for medically refractory IIH and include CSF diversion techniques, optic nerve sheath fenestration, bariatric surgery and venous sinus stenting. Prospective studies on the surgical options for IIH are scant and no evidence-based guidelines for the s urgical ...
Source: Neurosurgical Review - April 25, 2020 Category: Neurosurgery Source Type: research

Diabetes mellitus contributes to carbamazepine resistance in patient with trigeminal neuralgia
ConclusionsThis study shows that blood glucose status is a significant factor contributing to the CBZ resistance in the treatment of TN. The progression-free survival of patients is affected by the status of DM and blood HbAlc levels. (Source: Neurosurgical Review)
Source: Neurosurgical Review - April 24, 2020 Category: Neurosurgery Source Type: research

Predicting the risk of postoperative recurrence and high-grade histology in patients with intracranial meningiomas using routine preoperative MRI
AbstractRisk factors for prediction of prognosis in meningiomas derivable from routine preoperative magnetic resonance imaging (pMRI) remain elusive. Correlations of tumor and edema volume, disruption of the arachnoid layer, heterogeneity of contrast enhancement, enhancement of the capsule, T2-intensity, tumor shape, and calcifications on pMRI with tumor recurrence and high-grade (WHO grade II/III) histology were analyzed in 565 patients who underwent surgery for WHO grade I (N = 516, 91%) or II/III (high-grade histology,N = 49, 9%) meningioma between 1991 and 2018. Edema volume (OR, 1.00;p&thin...
Source: Neurosurgical Review - April 23, 2020 Category: Neurosurgery Source Type: research

The pharyngeal plexus: an anatomical review for better understanding postoperative dysphagia
AbstractThe pharyngeal plexus is an essential anatomical structure, but the contributions from the glossopharyngeal and vagus nerves and the superior cervical ganglion that give rise to the pharyngeal plexus are not fully understood. The pharyngeal plexus is likely to be encountered during various anterior cervical surgical procedures of the neck such as anterior cervical discectomy and fusion. Therefore, a detailed understanding of its anatomy is essential for the surgeon who operates in and around this region. Although the pharyngeal plexus is an anatomical structure that is widely mentioned in literature and anatomy boo...
Source: Neurosurgical Review - April 22, 2020 Category: Neurosurgery Source Type: research

The role of EC-IC bypass in ICA blood blister aneurysms —a systematic review
AbstractTo perform a systematic review of extracranial-to-intracranial (EC-IC) bypass surgery with parent vessel trapping for blood blister –like aneurysms (BBAs) of the internal carotid artery (ICA) according to PRISMA guidelines. Search of PubMed using “bypass” [all fields] and “ICA” [all fields] or “internal carotid artery” [all fields] and (“blood blister–like aneurysm” [MeSH terms]. Thirty-four original articles were identified, of which 21 were excluded (treatment not including bypass or insufficient details on complications or clinical outcomes). Thirteen a...
Source: Neurosurgical Review - April 21, 2020 Category: Neurosurgery Source Type: research

Surgical treatment of hypothalamic hamartomas
AbstractHypothalamic hamartomas are aberrant masses, composed of abnormally distributed neurons and glia. Along endocrine and cognitive symptoms, they may cause epileptic seizures, including the specific gelastic and dacrystic seizures. Surgery is the treatment of drug-resistant hamartoma epilepsy, with associated positive results on endocrine, psychiatric, and cognitive symptoms. Recently, alternatives to open microsurgical treatment have been proposed. We review these techniques and compare their efficacy and safety. Open resection or disconnection of the hamartoma, either through pterional, transcallosal, or transventri...
Source: Neurosurgical Review - April 21, 2020 Category: Neurosurgery Source Type: research

Stereotactic radiosurgery for head and neck paragangliomas: a systematic review and meta-analysis
AbstractHead and neck paragangliomas (HNPs) are rare, usually benign hyper vascularized neuroendocrine tumors that traditionally have been treated by surgery, with or without endovascular embolization, or, more recently stereotactic radiosurgery (SRS). The aim of our study is to determine the clinical and radiographic effectiveness of SRS for treatment of HNPs. A systematic search of electronic databases was performed, and 37 articles reporting 11,174 patients (1144 tumors) with glomus jugulare (GJT: 993, 86.9%), glomus tympanicum (GTT: 94, 8.2%), carotid body tumors (CBTs: 28, 2.4%), and glomus vagale (GVT: 16, 1.4%) trea...
Source: Neurosurgical Review - April 21, 2020 Category: Neurosurgery Source Type: research

The potential predictive value of salivary cortisol on the occurrence of secondary cognitive impairment after ischemic stroke
In this study, we aimed to investigate the relationship between salivary cortisol content and secondary mild cognitive impairment (MCI), thereby supporting the prediction of MCI in clinical practice. In this study, the salivary cortisol levels were examined in 120 patients with MCI after cerebral ischemic stroke (CIS) (CIS-MIC) and 80 CIS patients without MIC (CIS). The clinical data were compared among these patients with different cortisol levels. The salivary level of cortisol was significantly higher in patients with CIS-MIC (0.85 –3.65 nmol/L) than that in those with CIS (0.52–1.21 nmol/L). The c...
Source: Neurosurgical Review - April 20, 2020 Category: Neurosurgery Source Type: research

Traumatic pneumorrhachis: systematic review and an illustrative case
AbstractPneumorrhachis (PR) refers to free air in the spinal canal. We aim to describe a case report and conduct a systematic review focused on the clinical presentation, diagnosis, and management of traumatic PR. We conducted a language-restricted PubMed, SciELO, Scopus, and Ovid database search for traumatic PR cases published till June 2019. Categorical variables were assessed by Fisher ’s exact test. In addition to our reported index case, there were 82 articles (96 individual cases) eligible for meta-analysis according to our inclusion/exclusion criteria. Eighty per cent of patients had blunt trauma, while 17% h...
Source: Neurosurgical Review - April 19, 2020 Category: Neurosurgery Source Type: research

Risk factors for wound-related complications after microvascular decompression
AbstractRetrosigmoid craniotomy for microvascular decompression (MVD) has been traditionally performed via craniectomy. Various closure techniques have been described, yet factors associated with wound-related complications remain undetermined. Accordingly, herein, we sought to identify risk factors associated with wound-related complications after such procedures. An institutional retrospective case-control study was performed; outcomes of interest were cerebrospinal fluid (CSF) leak, wound dehiscence, wound infection, and pseudomeningocele. Univariate analysis was performed using Wilcoxon rank sum test for non-parametric...
Source: Neurosurgical Review - April 18, 2020 Category: Neurosurgery Source Type: research

Comparative efficacy and safety of pharmacological prophylaxis and intermittent pneumatic compression for prevention of venous thromboembolism in adult undergoing neurosurgery: a systematic review and network meta-analysis
AbstractWhether intermittent pneumatic compression (IPC) is a more effective form of thromboprophylaxis than anticoagulants in individuals undergoing neurosurgery remains controversial. Relevant studies are sparse and inconsistent. Therefore, direct comparisons are difficult to perform and impractical. Hence, we summarized and compared the efficacy and safety of IPC and anticoagulants for the prevention of venous thromboembolism (VTE) in adults undergoing cranial or spinal procedures. Several electronic databases were searched for randomized controlled trials on the use of IPC and anticoagulants for thromboembolism prevent...
Source: Neurosurgical Review - April 16, 2020 Category: Neurosurgery Source Type: research

Surgical management of primary and secondary pilocytic astrocytoma of the cerebellopontine angle (in adults and children) and review of the literature
We present four cases of pilocytic astrocytoma of the CPA (PA-CPA) that were treated in our department. Patients who received surgical treatment for PA-CPA from January 2004 to December 2019 were identified by a computer search of their files from the Department of Neurosurgery, T übingen. Patients were evaluated for initial symptoms, pre- and postoperative facial nerve function and cochlear function, complications, and recurrence rate by reviewing surgical reports, patient documents, neuroradiological data, and follow-up data. We identified four patients with PA-CPA out of about 1500 CPA lesions (~ 0.2%), whic...
Source: Neurosurgical Review - April 15, 2020 Category: Neurosurgery Source Type: research

Spinal cord stimulation programming: a crash course
This article provides practitioners with the basic knowledge of SCS parameters and programming systems. Understanding their use is essential to providing optimal pain reli ef to patients. (Source: Neurosurgical Review)
Source: Neurosurgical Review - April 15, 2020 Category: Neurosurgery Source Type: research

Lumbar disc herniation with contralateral radiculopathy: a systematic review on pathophysiology and surgical strategies
The objective of this article is to review the current literature on lumbar disc herniations with contralateral radiculopathy regarding its pathophysiology and surgical strategies. A systematic review of the literature on LDH with contralateral radiculopathy was performed using MEDLINE (via PubMed) using MeSH terms. This review was done following recommendations of PRISMA statement and PICOT strategy of search. Initial electronic search identified 126 papers. Finally, 18 articles were reviewed. None of the included papers was described as comparative. Pathophysiological processes underlying contralateral pain may include p...
Source: Neurosurgical Review - April 13, 2020 Category: Neurosurgery Source Type: research

Evolution of cerebellomedullary fissure opening: its effects on posterior fossa surgeries from the fourth ventricle to the brainstem
AbstractSurgical approaches to the fourth ventricle and its surrounding brainstem regions have changed significantly in the previous 30  years, after the establishment of cerebellomedullary fissure (CMF) opening. With the development of CMF opening techniques, CMF opening surgeries have become widely used for the treatment of various pathologies and have contributed to the improvement of surgical results in posterior fossa surgerie s. We here review the historical progress of CMF opening surgeries to help the future progression of neurosurgical treatments. The authors studied the available literature to clarify how CM...
Source: Neurosurgical Review - April 12, 2020 Category: Neurosurgery Source Type: research

Characteristics and management of hydrocephalus associated with vestibular schwannomas: a systematic review
AbstractHydrocephalus (HC) can be associated with vestibular schwannoma (VS) at presentation. Although spontaneous resolution of HC after VS removal is reported, first-line treatment is varied including preoperative ventriculoperitoneal (VP) shunt, external ventricular drainage (EVD), or lumbar drainage (LD). We performed a systematic review to clarify optimal management of HC associated with VS at presentation, as well as characteristics of patients with initial and persistent HC after VS removal, and prevalence of HC associated with VS. Fourteen studies were included. Patients were grouped according to the timing of HC t...
Source: Neurosurgical Review - April 7, 2020 Category: Neurosurgery Source Type: research

Is surgery justified for 80-year-old or older intracranial meningioma patients? A systematic review
AbstractSince the number of elderly people with intracranial meningiomas (IM) continues to rise, surgical treatment has increasingly become a considerable treatment option, even in very old ( ≥ 80 years old) meningioma patients. Since little is known about whether meningioma surgery in this age group is safe and justified, we conducted a systematic review to summarize the results of surgical outcomes in very old meningioma patients. We performed a systematic literature search in Pub med, Cochrane Library, and Scopus databases. Primarily, we extracted 1-month and 1-year survival rates, and 1-year morbidity ra...
Source: Neurosurgical Review - April 4, 2020 Category: Neurosurgery Source Type: research

Using overlapping low-profile visualized intraluminal support stent-assisted coil embolization for treating blood blister-like aneurysms of the internal carotid artery
In this study, we attempted to discuss the key techniques for overlapping low-profile visualized intraluminal support (LVIS) stent-assisted coil embolization, which is used for treating BBAs in our center. Clinical characteristics, endovascular treatment details, outcomes, and follow-up results of 13 patients with BBA treated at our center were retrospectively evaluated in this study. Overlapping LVIS stent-assisted coil embolization was successfully performed in all 13 patients of ruptured BBAs located in the ICAs. Recurrence of aneurysm was observed in 4 cases (30.8%) during the angiographic follow-up; in 2 of these case...
Source: Neurosurgical Review - April 2, 2020 Category: Neurosurgery Source Type: research

First clinical experience with the new noninvasive transfontanelle ICP monitoring device in management of children with premature IVH
AbstractWe previously introduced a novel noninvasive technique of intracranial pressure (ICP) monitoring in children with open fontanelles. Within this study, we describe the first clinical implementation and results of this new technique in management of children with hydrocephalus caused by intraventricular hemorrhage (IVH). In neonates with posthemorrhagic hydrocephalus (PHH), an Ommaya reservoir was implanted for initial treatment of hydrocephalus. The ICP obtained noninvasively with our new device was measured before and after CSF removal and correlated to cranial ultra-sonographies. Six children with a mean age of 27...
Source: Neurosurgical Review - April 1, 2020 Category: Neurosurgery Source Type: research

Primary intracranial intraventricular leiomyoma: a literature review
We present the case of a 40-year-old woman with a primary intraventricular leiomyoma. She consulted us for headache, dizziness, and black spots in her vision. Magnetic resonance images (MRI) disclosed a mass rooted in the posterior septum pellucidum. The tumor was totally excised by the senior author with no residual seen on intraoperative MRI. Pathological examination showed it to be a benign spindle-cell neoplasm. On the 6th month control MRI, there was no recurrence. We also reviewed articles relevant to primary intracranial leiomyomas. (Source: Neurosurgical Review)
Source: Neurosurgical Review - March 30, 2020 Category: Neurosurgery Source Type: research

Microsurgery of residual or recurrent complex intracranial aneurysms after coil embolization – a quest for the ultimate therapy
AbstractThe long-term stability of coil embolization (CE) of complex intracranial aneurysms (CIAs) is fraught with high rates of recanalization. Surgery of precoiled CIAs, however, deviates from a common straightforward procedure, demanding sophisticated strategies. To shed light on the scope and limitations of microsurgical re-treatment, we present our experiences with precoiled CIAs. We retrospectively analysed a consecutive series of 12 patients with precoiled CIAs treated microsurgically over a 5-year period, and provide a critical juxtaposition with the literature. Five aneurysms were located in the posterior circulat...
Source: Neurosurgical Review - March 24, 2020 Category: Neurosurgery Source Type: research

Elevated body mass index facilitates early postoperative complications after surgery for intracranial meningioma
AbstractSurgical resection represents the primary treatment option for patients suffering from intracranial meningioma. However, early postoperative complications significantly worsen initial favorable postoperative outcomes. Therefore, the ability to preoperatively assess potential risk factors for early postoperative unfavorable events is important to preselect critical patients who might require special attention during clinical management. In the current study, we therefore analyzed our institutional database in order to identify risk factors associated with early postoperative complications after initial meningioma re...
Source: Neurosurgical Review - March 24, 2020 Category: Neurosurgery Source Type: research

Endoscopic-assisted surgery versus microsurgery for pineal region tumors: a single-center retrospective study
AbstractPineal region tumors are extremely deep-seated and surgically challenging. The exposure and visualization obtained by microscopic surgery are relatively limiting. The application of high-definition endoscopes has recently provided neurosurgeons with a much more magnified and clearer view of the anatomy in the pineal region. The present study was performed to compare endoscopic-assisted surgery (ES) with microsurgery (MS) for pineal region tumors. We retrospectively analyzed patients admitted to our hospital for treatment of pineal region tumors from January 2016 to June 2019. All patients consented to undergo tumor...
Source: Neurosurgical Review - March 20, 2020 Category: Neurosurgery Source Type: research

The clinical, radiological, and immunohistochemical characteristics and outcomes of primary intracranial gliosarcoma: a retrospective single-centre study
This study aimed to identify risk factors for progression-free survival (PFS) and overall survival (OS) in these cases. This retrospective single-centre study evaluated 103 patients (median age, 51  years; 67 men [65%]) with primary intracranial gliosarcoma between 2006 and 2017. Treatments included surgery (GTR, 63 patients; STR, 39 patients; biopsy, 1 patient), radiotherapy (adjuvant, 76 patients; exclusive treatment, 1 patient), and chemotherapy (adjuvant temozolomide, 52 patients; adjuvan t nimustine/teniposide, 19 patients; adjuvant bevacizumab, 1 patient; exclusive nimustine/teniposide treatment, 1 patient). The...
Source: Neurosurgical Review - March 18, 2020 Category: Neurosurgery Source Type: research

Tuberculum sellae meningioma surgery: visual outcomes and surgical aspects of contralateral approach
AbstractThe main purpose of surgery for tuberculum sellae meningioma (TSM) is the improvement and/or stabilization of patients ’ visual function. Options for the side of lateral approaches usually were restricted for nondominant right-sided craniotomy or to the side of impaired vision (ipsilateral approaches). Although the safety and effectiveness of ipsilateral transcranial approach was proved, there are some doubts and discussions about the contralateral craniotomy. We retrospectively analyzed the series of contralateral surgeries of TMS and their visual outcomes comparing with ipsilateral approach. Twenty-six pati...
Source: Neurosurgical Review - March 16, 2020 Category: Neurosurgery Source Type: research

Beta-blockers and glioma: a systematic review of preclinical studies and clinical results
AbstractGiven the median survival of 15  months after diagnosis, novel treatment strategies are needed for glioblastoma. Beta-blockers have been demonstrated to inhibit angiogenesis and tumor cell proliferation in various cancer types. The aim of this study was to systematically review the evidence on the effect of beta-blockers on gliom a growth. A systematic literature search was performed in the PubMed, Embase, Google Scholar, Web of Science, and Cochrane Central to identify all relevant studies. Preclinical studies concerning the pharmacodynamic effects of beta-blockers on glioma growth and proliferation were incl...
Source: Neurosurgical Review - March 14, 2020 Category: Neurosurgery Source Type: research

Stereotactic radiosurgery for management of vestibular schwannoma: a short review
This article is a short review of the role of stereotactic radiosurgery in management of newly diagnosed VS. (Source: Neurosurgical Review)
Source: Neurosurgical Review - March 13, 2020 Category: Neurosurgery Source Type: research

Minimally invasive versus open surgery for the correction of adult degenerative scoliosis: a systematic review
AbstractWhile open surgery has been the primary surgical approach for adult degenerative scoliosis, minimally invasive surgery (MIS) represents an alternative option and appears to be associated with reduced morbidity. Given the lack of consensus, we aimed to conduct a systematic review on available literature comparing MIS versus open surgery for adult degenerative scoliosis. PubMed, Embase, and Cochrane databases were searched through December 16, 2019, for studies that compared both MIS and open surgery in patients with degenerative scoliosis. Four cohort studies reporting on 350 patients met the inclusion criteria. In ...
Source: Neurosurgical Review - March 12, 2020 Category: Neurosurgery Source Type: research

Is the unruptured intracranial aneurysm treatment score (UIATS) sensitive enough to detect aneurysms at risk of rupture?
AbstractTo evaluate if the unruptured intracranial aneurysm treatment score (UIATS) is a sensitive tool to detect aneurysms at risk of rupture, we conducted an a posteriori retrospective study on ruptured intracranial aneurysms. We performed a retrospective analysis of adult patients admitted to our center from January 2010 to April 2016 with aneurysmal subarachnoid hemorrhage. The UIATS was applied to all ruptured aneurysms. Patients for whom the UIATS recommended treatment were labeled as “true positives,” whereas patients for whom the UIATS recommended observation were labeled as “false negatives.&rdqu...
Source: Neurosurgical Review - March 12, 2020 Category: Neurosurgery Source Type: research

The right hemisphere is important for driving-related cognitive function after stroke
In this study, directed attention and sustained attention, which are thought to be crucial for driving, were examined. Identification of specific brain structure abnormalities associated with post-stroke cognitive dysfunction related to driving ability would help in determining fitness for car driving after stroke. Magnetic resonance imaging was performed in 57 post-stroke patients (51 men; mean age, 63  ± 11 years) who were assessed for attention deficit using a standardized test (the Clinical Assessment for Attention, CAT), which includes a Continuous Performance Test (CPT)-simple version (CPT-S...
Source: Neurosurgical Review - March 11, 2020 Category: Neurosurgery Source Type: research

Role of the patient comorbidity in the recurrence of chronic subdural hematomas
AbstractChronic subdural hematoma (CSDH) is an old blood collection between the cortical surface and the dura. Recurrence of CSDH after surgical evacuation occurs in up to a quarter of patients. The association between patient premorbid status and the rate of recurrence is not well known, and some previous results are contradictory. We aim to determine the impact of patient comorbidities in the risk of recurrence after surgical evacuation of CSDH. Retrospective data of a single institution ’s surgically evacuated CSDH cases followed up for at least 6 months were analyzed, and univariate and multivariate analyses...
Source: Neurosurgical Review - March 7, 2020 Category: Neurosurgery Source Type: research

What is the risk of venous cerebellar infarction in the supracerebellar infratentorial approach?
The objective of this study is to address the incidence of cerebellar venous infarction in SCITA. A search through the currently available literature was performed in September 2019 from the year 2000 until September 2019 dealing with ‘supracerebellar infratentorial approach’. Out of the 578 patients found in thirteen case series, two venous infarctions were present; the remaining four patients were published as case reports. By analysing the case series, we calculated the risk of such a complication to be 0.345% (95% CI [0.0 61%, 1.248%]). Case reports were not included. The real risk is estimated to be higher...
Source: Neurosurgical Review - March 7, 2020 Category: Neurosurgery Source Type: research

Non-steroidal anti-inflammatory drugs in the pathophysiology of vasospasms and delayed cerebral ischemia following subarachnoid hemorrhage: a critical review
The objective of this review is to critically assess the effects of non-steroidal anti-inflammatory drugs (NSAIDs) following aSAH. A systematic literature review was conducted following PRISMA guidelines. The search was aimed at studies addressing aSAH and NSAIDs during the 2010 to 2019 period, and it yielded 13 articles. Following the application of search criteria, they were divided into two groups, one containing 6 clinical articles and the other containing 7 experimental articles on animal models of aSAH. Inflammatory cerebral changes after aneurysm rupture contribute to the development of EBI, DCI and cerebral vasospa...
Source: Neurosurgical Review - March 2, 2020 Category: Neurosurgery Source Type: research

Supplementing decompression with instrumented fusion for symptomatic lumbar spinal stenosis —a critical appraisal of available randomized controlled trials
AbstractLumbar spinal stenosis (LSS) is one of the most common indications for surgery in the USA. The addition of instrumented fusion to decompression for the treatment of LSS has become common, but recent randomized controlled trials (RCTs) have produced percieved conflicting results with unclear clinical implications. This review seeks clarity through an analysis of available RCTs. We performed a search of the PubMed database for RCTs that directly addressed decompression vs. decompression and fusion for the surgical treatment of LSS. RCTs were screened and reviewed to compare content such as patient selection, patholog...
Source: Neurosurgical Review - March 2, 2020 Category: Neurosurgery Source Type: research

External validation and modification of the Oslo grading system for prediction of postoperative recurrence of chronic subdural hematoma
AbstractRecently, Oslo grading system (OGS) for prediction of recurrence in chronic subdural hematoma (cSDH) was introduced. The aim of the study was to validate and if applicable to modify the grading system. Data of all patients admitted to the Goethe University Hospital between 2016 and 2018 with chronic subdural hematoma were prospectively entered into a database. Dataset of patients with uni- (n = 272) and bilateral cSDH (n = 177) were used for the validation of OGS via logistic regression analysis. Additional predictors were identified and integrated to build a modified OGS (mOGS). Interna...
Source: Neurosurgical Review - February 28, 2020 Category: Neurosurgery Source Type: research

Surgery for posterior fossa meningioma: elevated postoperative cranial nerve morbidity discards aggressive tumor resection policy
AbstractRadical excision of meningioma is suggested to provide for the best tumor control rates. However, aggressive surgery for meningiomas located at the posterior cranial fossa may lead to elevated postoperative morbidity of adjacent cranial nerves which in turn worsens patients ’ postoperative quality of life. Therefore, we analyzed our institutional database with regard to new cranial nerve dysfunction as well as postoperative cerebrospinal fluid (CSF) leakage depending on the extent of tumor resection. Between 2009 and 2017, 89 patients were surgically treated for post erior fossa meningioma at the authors&rsqu...
Source: Neurosurgical Review - February 27, 2020 Category: Neurosurgery Source Type: research

Combination analysis on the impact of the initial vision and surgical time for the prognosis of indirect traumatic optic neuropathy after endoscopic transnasal optic canal decompression
AbstractTo analyze the impact of the initial vision and surgical time for endoscopic transnasal/transethmosphenoid optic canal decompression (ETOCD) in the treatment of indirect traumatic optic neuropathy (TON). This retrospective case series analysis included 72 patients with indirect TON who underwent ETOCD from August 2017 to May 2019. Visual acuity (VA) was compared before and after surgery to estimate the improvement rate. The overall VA improvement rate of ETOCD was 54.2%. There were 83.3% and 33.3% improvement rate of  patients with residual vision and blindness, respectively. VA was improved in 60.9% of patien...
Source: Neurosurgical Review - February 25, 2020 Category: Neurosurgery Source Type: research

Outcome of the surgical decompression for traumatic optic neuropathy: a systematic review and meta-analysis
AbstractThere exists a persisting controversy regarding the indications for optic nerve surgical decompression (ONSD) in traumatic optic neuropathy (TON). A meta-analysis is warranted to help guiding therapeutic decisions and address gaps in knowledge. The authors conducted a search of PubMed and MEDLINE electronic databases. Primary endpoint was the improvement in the visual function with ONSD in comparison with the conservative management. Secondary endpoint was visual function improvement when surgery was performed within the first 7  days. A random effects model meta-analysis was conducted. Data from each study we...
Source: Neurosurgical Review - February 22, 2020 Category: Neurosurgery Source Type: research

Outcome of retreatment for recurrent saccular cerebral aneurysms: a propensity score-matched analysis
This study showed that the treatment of recurrent sCA was a risk factor for recurrence after treatment but not for additional treatment, rupture after treatment, or neurological worsening. Altho ugh decision-making regarding the treatment varies depending on the institutional protocols and personal experience of the physicians, endovascular or surgical retreatment could be performed without hesitation. (Source: Neurosurgical Review)
Source: Neurosurgical Review - February 21, 2020 Category: Neurosurgery Source Type: research

Long-term outcomes and prognostic predictors of 111 pediatric hemorrhagic cerebral arteriovenous malformations after microsurgical resection: a single-center experience
The objective of this study was to elucidate these points. The authors retrospectively reviewed the pediatric hemorrhagic AVMs resected in their neurosurgical department between March 2010 and June 2017. The natural history was represented by rupture risk. Neurological outcome was assessed with the modified Rankin Scale (mRS) for children. Multivariate logistic regression analyses were used to assess the risk factors for disability (mRS> 2). The hemorrhagic early phase was defined as less than 30 days after bleeding. The corresponding prognosis of different surgical timing (early intervention or delayed intervention) wa...
Source: Neurosurgical Review - February 20, 2020 Category: Neurosurgery Source Type: research

A novel surgical technique for spontaneous intracerebral hematoma evacuation
AbstractStereotactic removal of intracerebral hematoma is a routine procedure for treating hypertensive intracerebral hemorrhage, but the complex sequence of operations limits its adoption. We explored the application of a novel surgical technique for the removal of spontaneous intracerebral hematomas. The surgical technique based on computed tomography (CT) images was used in hematoma projection and surgical planning. Markers placed on the scalp based on an Android smartphone app allowed the installation of a stereotactic head frame to facilitate the selection of the best trajectory to the hematoma center for removing the...
Source: Neurosurgical Review - February 20, 2020 Category: Neurosurgery Source Type: research