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1.
Endoscopic Surgery Versus Stereotactic Aspiration in Spontaneous Intracerebral Hemorrhage Treatment: A Systematic Review and Meta-analysis
Yang, L., Yang, M., He, M., Zhou, X., Zhou, Z.
World neurosurgery. 2024
Abstract
OBJECTIVE To comprehensively compare the safety and efficacy of endoscopic surgery (ES) and stereotactic aspiration (SA) in patients with spontaneous intracerebral hemorrhage (sICH). METHODS We searched Web of Science, PubMed, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) from inception to July 31, 2023. Studies comparing ES and SA for sICH treatment were also included. Outcome measures included primary outcomes (mortality and good functional outcome (GFO)) and secondary outcomes (evacuation rate, residual hematoma, perihematomal edema (PHE), operation time, volume of intraoperative blood loss, hospital stay duration, intensive care unit (ICU) stay duration, hospital cost, complications, and reoperation). Subgroup analyses assessed the influence of age, hematoma volume, Glasgow Coma Scale (GCS) score, and time to surgery on the outcomes. RESULTS Nine studies (one randomized controlled trial and eight observational studies) with 2105 patients (705 and 1400 in the ES and SA groups, respectively) were included in this meta-analysis. The final analysis indicated that compared with SA, ES was associated with enhanced GFO and a higher evacuation rate 1 d post-surgery along with reduced mortality and residual hematoma. Conversely, ES did not confer benefits in terms of perihematomal edema, operation time, intraoperative blood loss volume, or hospital stay duration compared with SA. Subgroup analysis highlighted the significant influences of age and hematoma volume on mortality, whereas hematoma volume and GCS score affected GFO. CONCLUSIONS ES is a safe and effective approach for sICH treatment, leading to improved patient prognosis and quality of life compared to SA.
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2.
Comparison of intraoperative blood loss and perioperative complications between preoperative embolization and nonembolization combined with spinal tumor surgeries: a systematic review and meta-analysis
Qiao, R., Ma, R., Zhang, X., Lun, D., Li, R., Hu, Y.
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2023
Abstract
PURPOSE The present study aimed to comparatively evaluate intraoperative blood loss (IBL) and perioperative complications between preoperative embolization (PE) and nonembolization (NE) combined with spinal tumor surgeries as well as to determine the subgroup of spinal tumor surgeries suitable for PE. METHODS A systematic search in PubMed and EMBASE and an additional search by reference lists of the retrieved studies were undertaken by two reviewers. The mean IBL and perioperative complication rate were employed as the effect size in the general quantitative synthesis through direct calculation. Meta-analysis was performed using standardized mean difference (SMD) and weighted mean difference (WMD) of IBL and the odds ratio (OR) of complications. Heterogeneity was assessed using the I2 statistic. RESULTS The reviewers selected 17 published studies for the general quantitative synthesis and meta-analyses. The mean IBL of spinal tumor surgeries was 1786.3 mL in the NE group and 1716.4 mL in the PE group. The mean IBL between the two groups was similar. The pooled WMD and SMD of IBL in spinal tumor surgeries was 324.15 mL (95% CI 89.50-1640.9, p = 0.007) and 0.398 (95% CI 0.114-0.682, p = 0.006), respectively. The reduction of the PE group compared with the NE group for the rates of major complications and major hemorrhagic complications were 7.80% and 5.71%, respectively. The risk of PE-related complications in the PE group was only 1.53% more than in the PE group. The pooled OR of major complications in spinal tumor surgeries was 1.426 (95% CI 0.760-2.674; p = 0.269). CONCLUSIONS PE may be suitable for spinal tumor surgeries and some subgroups. From the perspective of complications, PE may also be a feasible option for spinal tumor surgeries.
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3.
Collagen-bound fibrin sealant (TachoSil®) for dural closure in cranial surgery: single-centre comparative cohort study and systematic review of the literature
Carretta A, Epskamp M, Ledermann L, Staartjes VE, Neidert MC, Regli L, Stienen MN
Neurosurgical review. 2022
Abstract
Cerebrospinal fluid (CSF) leakage is a well-known complication of craniotomies and there are several dural closure techniques. One commonly used commercial product as adjunct for dural closure is the collagen-bound fibrin sealant TachoSil®. We analysed whether the addition of TachoSil has beneficial effects on postoperative complications and outcomes. Our prospective, institutional database was retrospectively queried, and 662 patients undergoing craniotomy were included. Three hundred fifty-two were treated with dural suture alone, and in 310, TachoSil was added after primary suture. Our primary endpoint was the rate of postoperative complications associated with CSF leakage. Secondary endpoints included functional, disability and neurological outcome. Systematic review according to PRISMA guidelines was performed to identify studies comparing primary dural closure with and without additional sealants. Postoperative complications associated with CSF leakage occurred in 24 (7.74%) and 28 (7.95%) procedures with or without TachoSil, respectively (p = 0.960). Multivariate analysis confirmed no significant differences in complication rate between the two groups (aOR 0.97, 95% CI 0.53-1.80, p = 0.930). There were no significant disparities in postoperative functional, disability or neurological scores. The systematic review identified 661 and included 8 studies in the qualitative synthesis. None showed a significant superiority of additional sealants over standard technique regarding complications, rates of revision surgery or outcome. According to our findings, we summarize that routinary use of TachoSil and similar products as adjuncts to primary dural sutures after intracranial surgical procedures is safe but without clear advantage in complication avoidance or outcome. Future studies should investigate whether their use is beneficial in high-risk settings.
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4.
Intracranial Hemorrhage following Spinal Surgery: A Systematic Review of a Rare Complication
Al-Saadi T, Al-Kindi Y, Allawati M, Al-Saadi H
Surgery journal (New York, N.Y.). 2022;8(1):e98-e107
Abstract
Introduction Intracranial hemorrhage (ICH) is a potentially severe complication of spinal surgeries. The occurrence of such complications causes deterioration of the patient's clinical status and delayed discharge from the hospital. Although no specific etiological factors were identified for this complication, but multiple risk factors might play role in its development, they include the use of anticoagulants, presence of uncontrolled hypertension, and perioperative patient positioning. Aim A systematic review of the literature to investigate the prevalence of different types of intracranial hemorrhages in patients who underwent spinal surgeries. Methods A literature review was conducted using multiple research databases. Data were extracted using multiple variables that were formulated incongruent with the study aim and then further analyzed. Results A total of 79 studies were included in our analysis after applying the exclusion criteria and removing of repeated studies, 109 patients were identified where they were diagnosed with intracranial hemorrhage after spine surgery with a mean age of 54 years. The most common type of hemorrhage was cerebellar hemorrhage (56.0%) followed by SDH and intraparenchymal hemorrhage; 23.9 and 17.4%, respectively. The most common spine surgery was laminectomy (70.6%), followed by fixation and fusion (50.5%), excision of spinal lesions was done in 20.2% of the patient, and discectomy (14.7%). Conclusion The data in this study showed that out of 112 patients with ICH, cerebellar hemorrhage was the most common type. ICH post-spine surgery is a rare complication and the real etiologies behind this complication are still unknown, cerebrospinal fluid drain and durotomy were suggested.
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5.
Posterior minimally invasive scoliosis surgery versus the standard posterior approach for the management of adolescent idiopathic scoliosis: an updated meta-analysis
Yang, H., Jia, X., Hai, Y.
Journal of Orthopaedic Surgery and Research. 2022;17(1):58
Abstract
BACKGROUND Surgical management of adolescent idiopathic scoliosis (AIS) can be performed using standard posterior spinal fusion (PSF) or with a posterior minimally invasive approach. Minimally invasive scoliosis surgery (MISS) has several theoretical advantages, such as less tissue dissection, less blood loss, and earlier recovery. However, the difference in safety and effectiveness between MISS and PSF still needs to be clarified. This updated meta-analysis aimed to compare the outcomes of MISS and standard PSF for the management of AIS. METHODS A comprehensive literature search of PubMed, EMBASE, MEDLINE, and Cochrane Library without time restriction was performed to identify relevant studies. MISS and PSF were compared in terms of radiographic parameters, estimated blood loss (EBL), blood transfusion rate, operative time (ORT), length of hospital stay (LOS), overall Scoliosis Research Society-22 (SRS-22) score, postoperative pain, and complication rate. RESULTS A total of seven studies comprising 767 patients (329 MISS and 438 PSF) with AIS were included. MISS and PSF yielded comparable deformity correction at the last follow-up. There were no significant differences in the overall SRS-22 scores or complication rates between the groups. Nevertheless, greater restoration of thoracic kyphosis (WMD, 2.98; 95% CI 0.58 to 5.37, P = 0.015), less EBL (WMD, -218.76; 95% CI -256.41 to -181.11, P < 0.001), a lower blood transfusion rate (RR, 0.31; 95% CI 0.20 to 0.48, P < 0.001), a shorter LOS (WMD, -1.48; 95% CI -2.48 to -0.48, P = 0.004), less postoperative pain (WMD, 0.57; 95% CI 0.16 to 0.98, P = 0.006), and a longer ORT (WMD, 84.85; 95% CI 33.30 to 136.40, P = 0.001) were observed in the MISS group. CONCLUSION Despite its inherent technical challenges, MISS is a feasible and effective alternative to standard PSF for AIS patients with moderate and flexible curves. MISS was associated with adequate deformity correction, better restoration of sagittal alignment, less EBL, fewer transfusions, shorter LOS, and better pain management compared to PSF. Further research is required to determine the detailed indications for the MISS procedure.
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6.
The outcome in patients with spinal cavernomas presenting with symptoms due to mass effect and/or hemorrhage: conservative vs surgical management. A meta-analysis: Direct Comparison of Approach-Related Complications
Fotakopoulos G, Kivelev J, Andrade-Barazarte H, Tjahjadi M, Goehre F, Hernesniemi J
World neurosurgery. 2021
Abstract
AIMS: To examine the conservative treatment of symptomatic spinal cavernomas as well as to evaluate the efficacy and safety of surgical management of SCCMs. METHODS This meta-analysis included articles comparing outcomes of conservative treatment and surgical management of spinal cavernomas, published in the full-text form (from 2000 to June 31, 2020). Collected variables included: first author name, country, covered study period, publication year, the total number of patients and at follow-up, bleeding, motor weakness, pain, bladder and/ or bowel dysfunction neurological improvement or deterioration after discharge and the need for re-intervention after subtotal surgical resection or hemorrhage. RESULTS After the initial searching, and applying all exclusion and inclusion criteria, there were 9 articles left in the final article pool. The total number of patients was 396 with 264 (66.6 %) undergoing surgical resection and 132 (33.4%) electing conservative management. Regarding motor weakness, Bladder/Bowel dysfunction, Deterioration, and Re-intervention the final results demonstrated no potential significant difference between the two groups. As regards the subgroup of patients with Bleeding, Improvement, and Pain the results of the analysis showed a statistically significant difference between the two groups. CONCLUSIONS Patients who have experienced a hemorrhagic episode should consider surgical intervention which decreases the risk of recurrent hemorrhage and further neurological deterioration. In addition, surgical decompression obtained by resection of the hemorrhage and cavernoma seems to lead to slight neurological improvement in some patients. In non-hemorrhagic cavernomas, conservative treatment might be optimal due to surgery-related morbidity risks.
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7.
Timing of temporizing neurosurgical treatment in relation to shunting and neurodevelopmental outcomes in post-hemorrhagic ventricular dilatation of prematurity: a meta-analysis
Lai GY, Chu-Kwan W, Westcott AB, Kulkarni AV, Drake JM, Lam S
The Journal of pediatrics. 2021
Abstract
OBJECTIVE To determine the relationship between timing of initiation of temporizing neurosurgical treatment and rates of ventriculoperitoneal shunting (VPS) and neurodevelopmental impairment in premature infants with post-hemorrhagic ventricular dilatation (PHVD). STUDY DESIGN We searched MEDLINE, EMBASE, CINAHL, Web of Science, Cochrane Database of Systematic Reviews, and Cochrane Center Register of Controlled Trials for studies that reported on premature infants with PHVD who received TNP. Timing of TNP, gestational age, birth weight, and outcomes of conversion to VPS, moderate-to-severe NDI, infection, TNP revision, and death at discharge were extracted. RESULTS Sixty-two full-length articles and six conference abstracts (n=2533 patients) published through November 2020 were included. Pooled rate for conversion to VPS was 60.5% (95% CI=54.9-65.8), moderate-severe NDI 34.8% (95% CI=27.4-42.9), infection 8.2% (95% CI=6.7-10.1), revision 14.6% (95% CI=10.4-20.1), and death 12.9% (95% CI=10.2-16.4). Average age at TNP was 24.2+/-11.3 days. On meta-regression, older age at TNP was a predictor of conversion to VPS (p<0.001) and NDI (p<0.01). Later year of publication predicted increased survival (p<0.01) and external ventricular drains were associated with more revisions (p=0.001). Tests for heterogeneity reached significance for all outcomes and qualitative review showed heterogeneity in study inclusion and diagnosis criteria for PHVD and initiation of TNP. CONCLUSIONS Later timing of TNP predicted higher rates of conversion to VPS and moderate-severe NDI. Outcomes were often reported relative to number of patients who received TNP and criteria for study inclusion and initiation of TNP varied across institutions. There is need for more comprehensive outcome reporting that includes all infants with PHVD regardless of treatment.
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8.
External ventricular drain management in subarachnoid haemorrhage: a systematic review and meta-analysis
Palasz J, D'Antona L, Farrell S, Elborady MA, Watkins LD, Toma AK
Neurosurgical review. 2021
Abstract
External ventricular drainage (EVD) is one of the most commonly performed neurosurgical procedures. Despite this, the optimal drainage and weaning strategies are still unknown. This PRISMA-compliant systematic review and meta-analysis analysed the outcomes of patients undergoing EVD procedures, comparing continuous versus intermittent drainage and rapid versus gradual weaning. Four databases were searched from inception to 01/10/2020. Articles reporting at least 10 patients treated for hydrocephalus secondary to subarachnoid haemorrhage were included. Other inclusion criteria were the description of the EVD drainage and weaning strategies used and a comparison of continuous versus intermittent drainage or rapid versus gradual weaning within the study. Random effect meta-analyses were used to compare functional outcomes, incidence of complications and hospital length of stay. Intermittent external CSF drainage was associated with lower incidence of EVD-related infections (RR = 0.20, 95% CI 0.05-0.72, I-squared = 0%) and EVD blockages compared to continuous CSF drainage (RR = 0.45, 95% CI 0.27-0.74, I-squared = 0%). There was no clear advantage in using gradual EVD weaning strategies compared to rapid EVD weaning; however, patients who underwent rapid EVD weaning had a shorter hospital length of stay (SMD = 0.34, 95% CI 0.22-0.47, I-squared = 0%). Intermittent external CSF drainage after SAH is associated with lower incidence of EVD-related infections and EVD blockages compared to continuous CSF drainage. Patients who underwent rapid EVD weaning had a shorter hospital length of stay and there was no clear clinical advantage in using gradual weaning.
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9.
EXPRESS: Therapeutic Hypothermia for Intracerebral Hemorrhage: Systematic Review and Meta-Analysis of the Experimental and Clinical Literature
Baker T, Durbin J, Troiani Z, Ascanio-Cortez L, Baron R, Costa A, Rincon F, Colbourne F, Lyden P, Mayer S, et al
International journal of stroke : official journal of the International Stroke Society. 2021;:17474930211044870
Abstract
BackgroundIntracerebral hemorrhage (ICH) remains the deadliest form of stroke worldwide, inducing neuronal death through a wide variety of pathways. Therapeutic hypothermia (TH) is a robust and well studied neuroprotectant widely used across a variety of specialties. AimsThis review summarizes results from preclinical and clinical studies to highlight the overall effectiveness of TH to improve long-term ICH outcomes while also elucidating optimal protocol regimens to maximize therapeutic effect.Summary of Review A systematic review was conducted across three databases to identify trials investigating the use of TH to treat ICH. A random-effects meta-analysis was conducted on preclinical studies, looking at neurobehavioral outcomes, blood brain barrier breakdown (BBB), cerebral edema, hematoma volume, and tissue loss. Several mixed-methods meta-regression models were also performed to adjust for variance and variations in hypothermia induction procedures. 21 preclinical studies and 5 human studies were identified. The meta-analysis of preclinical studies demonstrated a significant benefit in behavioral scores (ES=-0.43, p=0.02), cerebral edema (ES=1.32, p=0.0001), and BBB (ES=2.73, p=<0.00001). TH was not found to significantly affect hematoma expansion (ES=-0.24, p=0.12) or tissue loss (ES=0.06, p=0.68). Clinical study outcome reporting was heterogeneous, however there was recurring evidence of TH-induced edema reduction. ConclusionsThe combined preclinical evidence demonstrates that TH reduced multiple cell death mechanisms initiated by ICH, yet there is no definitive evidence in clinical studies. The cooling strategies employed in both preclinical and clinical studies were highly diverse, and focused refinement of cooling protocols should be developed in future preclinical studies. The current data for TH in ICH remains questionable despite the highly promising indications in preclinical studies. Definitive randomized controlled studies are still required to answer this therapeutic question.
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10.
Management of Intracranial Hemorrhage in Patients with a Left Ventricular Assist Device: A Systematic Review and Meta-Analysis
Carroll AH, Ramirez MP, Dowlati E, Mueller KB, Borazjani A, Chang JJ, Felbaum DR
Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association. 2020;30(2):105501
Abstract
BACKGROUND Intracranial hemorrhage (ICH) has been reported to occur in up to 23% of patients with left ventricular assist devices (LVADs). Currently, limited data exists to guide neurosurgical management strategies to optimize outcomes in patients with an LVAD who develop ICH. METHODS A systematic review and meta-analysis of the literature was performed to evaluate the mortality rate in these patients following medical and/or surgical management and to evaluate antithrombotic reversal and resumption strategies after hemorrhage. RESULTS 17 studies reporting on 3869 LVAD patients and 545 intracranial hemorrhages spanning investigative periods from 1996 to 2019 were included. The rate of ICH in LVAD patients was 10.6% (411/3869) with 58.6% (231/394) being intraparenchymal hemorrhage (IPH), 23.6% (93/394) subarachnoid hemorrhage (SAH), and 15.5% (61/394) subdural hemorrhage (SDH). Total mortality rates for surgical management 65.6% (40/61) differed from medical management at 45.2% (109/241). There was an increased relative risk of mortality (RR=1.45, 95% CI: 1.10-1.91, p = 0.01) for ICH patients undergoing surgical intervention. The hemorrhage subtype most frequently managed with anticoagulation reversal was IPH 81.8% (63/77), followed by SDH 52.2% (12/23), and SAH 39.1% (18/46). Mean number of days until antithrombotic resumption ranged from 6 to 10.5 days. CONCLUSION Outcomes remain poor, specifically for those undergoing surgery. As experience with this population increases, prospective studies are warranted to contribute to management and prognostication .