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The International Journal of... Dec 2019Studies have shown that linezolid (LZD) can be used to treat extensively drug-resistant tuberculosis (XDR-TB). To conduct a systematic review and meta-analysis to... (Meta-Analysis)
Meta-Analysis
Studies have shown that linezolid (LZD) can be used to treat extensively drug-resistant tuberculosis (XDR-TB). To conduct a systematic review and meta-analysis to assess existing evidence concerning efficacy and safety of LZD for XDR-TB treatment. The MEDLINE@OVID, PubMed, EMBASE, the Cochrane Library, Clinical Trials, Sinomed, CMCI, CNKI, VIP and Wanfang databases were systematically searched for randomised controlled trials, cohort studies, case series or case reports on XDR-TB patients treated with LZD from January 2000 to December 2016. Summary estimates of the rate of sputum culture conversion, treatment success and adverse effects were calculated; data that could not be combined were summarised and described qualitatively. The combined results were examined for heterogeneity, sensitivity and publishing bias. Twenty-two original studies covering a total of 302 patients with XDR-TB fulfilled the inclusion criteria. Pooled estimates for sputum culture conversion and treatment success rates were respectively 93.2% and 67.4% in XDR-TB patients on LZD treatment. The pooled estimates for the rate of myelosuppression, peripheral neuropathy, optic neuritis and adverse reactions of the gastrointestinal tract were respectively 42.5%, 26.0%, 19.0% and 35.0%. Heterogeneity was mostly due to the initial dose of LZD (≤600 mg/d or >600 mg/d), as patients with a high initial dose of LZD were more likely to have myelosuppression (48.4% vs. 24.8%, = 0.010) and adverse events of the gastrointestinal tract (41.3% vs.15.4%, = 0.100). LZD appears to be effective for XDR-TB, but adverse events are common. An LZD dose of ≤600 mg/d as the initial dose for treating XDR-TB patients is recommended.
Topics: Antitubercular Agents; Extensively Drug-Resistant Tuberculosis; Humans; Linezolid; Tuberculosis, Pulmonary
PubMed: 31931914
DOI: 10.5588/ijtld.18.0822 -
Neurosurgical Review Jan 2024Cavernomas are histologically benign vascular malformations found at different sites in the brain. A rare site for such cavernomas, however, is the anterior optic... (Review)
Review
Cavernomas are histologically benign vascular malformations found at different sites in the brain. A rare site for such cavernomas, however, is the anterior optic pathway, comprising the optic nerve, chiasma, and optic tract-called optochiasmatic cavernomas (OCC). These lesions usually present with sudden onset or progressive vision loss, headache, and features mimicking pituitary apoplexy. In this paper, we describe a case of OCC operated at our center. We carry out an updated review of literature depicting cases of OCC, their clinical presentation, management, and postoperative complications. We also propose a novel classification system based on lesion location and further analyze these cavernoma types with respect to the surgical approach used and visual outcome. A 30-year-old lady had presented with a 3-week history of progressive bilateral vision loss and headache. Based on imaging, she was suspected to have a cavernous angioma of the chiasma and left optic tract. Due to progressive vision deterioration, the lesion was surgically excised using pterional craniotomy. Postoperatively, her visual symptoms improved, but she developed diabetes insipidus. Clinical and radiological follow-up has been done for 18 months after surgery. A total of 81 cases have been described in the literature, including the present case. Chiasmal apoplexy is the most common presentation. Surgical excision is the standard of care. Our analysis based on lesion location shows the most appropriate surgical approach to be used for each cavernoma type. Visual outcome correlates with the preoperative visual status. Visual outcome is good in patients presenting with acute chiasmal apoplexy, and when complete surgical excision is performed. The endonasal endoscopic approach was found to provide the best visual outcome. In addition to preoperative visual status, complete surgical excision predicts favorable visual outcomes in OCC. Our proposed classification system guides the appropriate surgical approach required for a particular location of the cavernoma.
Topics: Adult; Female; Humans; Headache; Hemangioma, Cavernous; Optic Chiasm; Optic Nerve; Stroke; Vision Disorders
PubMed: 38238497
DOI: 10.1007/s10143-024-02288-1 -
Journal of Neuro-oncology Dec 2022Spheno-orbital meningiomas are rare tumors, accounting for up to 9% of all intracranial meningiomas. Patients commonly present with proptosis, and visual deficits. These... (Review)
Review
Endoscopic endonasal approach for resection of a recurrent spheno-orbital meningioma resulting in complete resolution of visual symptoms: A case report and review of literature.
PURPOSE
Spheno-orbital meningiomas are rare tumors, accounting for up to 9% of all intracranial meningiomas. Patients commonly present with proptosis, and visual deficits. These slow growing tumors are hard to resect due to extension into several anatomical compartments, resulting in recurrence rates as high as 35-50%. Although open surgical approaches have been historically used for resection, a handful of endoscopic approaches have been reported in recent years. We aimed to review the literature and describe a case of spheno-orbital meningioma with severe vision loss which was resected with an endoscopic endonasal approach achieving complete resolution of visual symptoms.
METHODS
A systematic review of literature was conducted in accordance with the PRISMA guidelines. PubMed, Cochrane, and Web of Science databases were queried for spheno-orbital meningiomas resected via an endoscopic endonasal approach. Furthermore, the presentation, surgical management, and post-operative outcomes of a 53-year-old female with a recurrent spheno-orbital meningioma are described.
RESULTS
The search yielded 26 articles, of which 8 were included, yielding 19 cases. Average age at presentation was 60.5 years (range: 44-82), and 68.4% of patients were female. More than half of the cases achieved subtotal resection. Common complications associated with endoscopic endonasal surgery included CN V2 or CN V2/V3 hypoesthesia. Following surgical intervention, visual acuity and visual field remained stable or improved in the majority of the patients.
CONCLUSION
Endoscopic approaches are slowly gaining momentum for treatment of spheno-orbital meningiomas. Further studies on the clinical benefits of this approach on patient outcomes and post-operative complications is warranted.
Topics: Humans; Female; Adult; Middle Aged; Aged; Aged, 80 and over; Male; Meningioma; Sphenoid Bone; Orbital Neoplasms; Neurosurgical Procedures; Treatment Outcome; Neoplasm Recurrence, Local; Meningeal Neoplasms; Retrospective Studies
PubMed: 36445608
DOI: 10.1007/s11060-022-04141-1