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Journal of Neurosurgery Dec 2014The purpose of this study was to establish the safety and efficacy of repeat Gamma Knife surgery (GKS) for recurrent trigeminal neuralgia (TN). (Review)
Review
OBJECT
The purpose of this study was to establish the safety and efficacy of repeat Gamma Knife surgery (GKS) for recurrent trigeminal neuralgia (TN).
METHODS
Using the prospective database of TN patients treated with GKS in Timone University Hospital (Marseille, France), data were analyzed for 737 patients undergoing GKS for TN Type 1 from July 1992 to November 2010. Among the 497 patients with initial pain cessation, 34.4% (157/456 with ≥ 1-year follow-up) experienced at least 1 recurrence. Thirteen patients (1.8%) were considered for a second GKS, proposed only if the patients had good and prolonged initial pain cessation after the first GKS, with no other treatment alternative at the moment of recurrence. As for the first GKS, a single 4-mm isocenter was positioned in the cisternal portion of the trigeminal nerve at a median distance of 7.6 mm (range 4-14 mm) anterior to the emergence of the nerve (retrogasserian target). A median maximum dose of 90 Gy (range 70-90 Gy) was delivered. Data for 9 patients with at least 1-year followup were analyzed. A systematic review of literature was also performed, and results are compared with those of the Marseille study.
RESULTS
The median time to retreatment in the Marseille study was 72 months (range 12-125 months) and in the literature it was 17 months (range 3-146 months). In the Marseille study, the median follow-up period was 33.9 months (range 12-96 months), and 8 of 9 patients (88.9%) had initial pain cessation with a median of 6.5 days (range 1-180 days). The actuarial rate for new hypesthesia was 33.3% at 6 months and 50% at 1 year, which remained stable for 7 years. The actuarial probabilities of maintaining pain relief without medication at 6 months and 1 year were 100% and 75%, respectively, and remained stable for 7 years. The systematic review analyzed 20 peer-reviewed studies reporting outcomes for repeat GKS for recurrent TN, with a total of 626 patients. Both the selection of the cases for retreatment and the way of reporting outcomes vary widely among studies, with a median rate for initial pain cessation of 88% (range 60%-100%) and for new hypesthesia of 33% (range 11%-80%).
CONCLUSIONS
Results from the Marseille study raise the question of surgical alternatives after failed GKS for TN. The rates of initial pain cessation and recurrence seem comparable to, or even better than, those of the first GKS, according to different studies, but toxicity is much higher, both in the Marseille study and in the published data. Neither the Marseille study data nor literature data answer the 3 cardinal questions regarding repeat radiosurgery in recurrent TN: which patients to retreat, which target is optimal, and which dose to use.
Topics: Aged; Aged, 80 and over; Databases, Factual; Disease-Free Survival; Female; Follow-Up Studies; Humans; Male; Middle Aged; Radiation Dosage; Radiosurgery; Recurrence; Reoperation; Retrospective Studies; Treatment Outcome; Trigeminal Neuralgia
PubMed: 25434955
DOI: 10.3171/2014.8.GKS141487 -
Research in Developmental Disabilities Jan 2020Cerebral Visual Impairment (CVI) is very common yet often unrecognised visual dysfunction in children with Cerebral Palsy (CP). Magnetic Resonance Imaging (MRI) is the... (Review)
Review
BACKGROUND
Cerebral Visual Impairment (CVI) is very common yet often unrecognised visual dysfunction in children with Cerebral Palsy (CP). Magnetic Resonance Imaging (MRI) is the diagnostic tool in the investigation of brain lesions in children with CP and CVI.
AIM
The aim of this systematic review is to evaluate the relationship between brain structure and CVI, as determined by MRI in children with CP.
METHODS AND PROCEDURES
A comprehensive search of 5 database (PubMed, EMBASE, SCOPUS, CINAHL and Cochrane Database) was undertaken up until June 2019. The PRISMA checklist was then utilised to report on the process of selecting eligible papers. A total of 30 observational studies met the full inclusion criteria. Further, STROBE checklist was employed to report on the observational studies.
OUTCOMES AND RESULTS
Periventricular leucomalacia on MRI was found to have a strong association with CVI in all 30 studies. Only 13 (43 %) studies described dorsal and/ ventral stream dysfunction. There was ambiguity in the definition of CVI.
CONCLUSIONS AND IMPLICATIONS
The overall level of evidence correlating different patterns of CVI and CP (based on GMFCS, motor type and distribution) and MRI was low. Further studies utilising advances in MRI are needed to understand brain reorganisation and patterns of CVI and suggest rehabilitation therapy inclusive of vision.
PubMed: 32004872
DOI: 10.1016/j.ridd.2020.103580 -
Clinical Anatomy (New York, N.Y.) Oct 2017We offer a complete systemic review of the anatomy of arteries of the thumb, including their sources in the first web space. Eleven studies were selected from the... (Review)
Review
We offer a complete systemic review of the anatomy of arteries of the thumb, including their sources in the first web space. Eleven studies were selected from the PubMed, Medline, Embase, Scopus and Ovid databases. Data about each artery of the thumb were obtained; in particular, the incidence and dominance of each of these arteries were calculated. The ulnopalmar digital artery of the thumb (UPDAT) was found in 99.63%, the radiopalmar digital artery of the thumb (RPDAT) in 99.26%, the ulnodorsal digital artery of the thumb (UDDAT) in 83.39%, and the radiodorsal digital artery of the thumb (RDDAT) in 70.38%. The sources for the thumb arteries are the first palmar metacarpal artery (for UPDAT in 63.15%, for RPDAT in 78.88%, for UDDAT in 56.95% and for RDDAT in 41.48%), the first dorsal metacarpal artery (for UPDAT in 20.54%, for RPDAT 2.53%, for UDDAT in 20.62%, and for RDDAT in 4.81%) and the superficial palmar arch, either complete or incomplete (for UPDAT in 25.57%, for RPDAT in 23.04%, for UDDAT in 0%, and for RDDAT in 5.19%). The dominant source could be identified in 88.2% of cases: the first palmar metacarpal artery (66.2%), the first dorsal metacarpal artery (15.5%) and the superficial palmar arch, complete or incomplete (8.2%). Four arteries usually supply the thumb. Any artery in the first web space can be a source for the thumb arteries. We propose a new classification of the arteries of the hand, dividing them into three systems (superficial palmar, deep palmar and dorsal system), and suggest that the term "princeps pollicis artery" be reconsidered and systemic anatomical terms of the thumb arteries preferred. Clin. Anat. 30:963-973, 2017. ©2017 Wiley-Liss, Inc.
Topics: Arteries; Hand; Humans; Thumb
PubMed: 28791730
DOI: 10.1002/ca.22973 -
The Journal of Hand Surgery Dec 2011The interpretation of scaphoid anatomy and kinematics is confusing and controversial. This results from a lack of consensus on the anatomy of the ligaments attaching to... (Review)
Review
PURPOSE
The interpretation of scaphoid anatomy and kinematics is confusing and controversial. This results from a lack of consensus on the anatomy of the ligaments attaching to the scaphoid and an overwhelming variety of substantially different anatomic descriptions and classification systems of the wrist joint in the literature. The present study systemically reviews the consistencies or inconsistencies of the various scaphoid ligament descriptions and aims to clarify and unify different concepts and classification systems.
METHODS
We performed a systematic search of the medical literature from 1950 to 2010. We included all descriptive reports of the anatomy or morphology of the scaphoid, ligaments, or both. With the aim to describe the best available evidence, we considered all anatomical descriptions but emphasized a selection of the most frequently cited articles.
RESULTS
The literature search resulted in 555 potentially eligible descriptive reports, 58 of which met the inclusion criteria and were included in the review. Variations in the anatomic descriptions appear to be mostly due to the difficulty of identifying individual interdigitating ligaments or bundles by macroscopic dissections, as well as the interindividual variability in ligament anatomy. The most important areas of controversy in the scaphoid ligament attachments include the radial collateral ligament, dorsal radiocarpal ligament, dorsal intercarpal ligament, volar scaphotriquetral ligament, and scaphotrapezium-trapezoid ligament.
CONCLUSIONS
None of the scaphoid ligaments other than the scaphocapitate ligament have been described consistently. Future research is required to verify the ligament attachments that currently have the most controversial descriptions, while addressing the interindividual variability of ligament insertions and morphology.
CLINICAL RELEVANCE
Thorough knowledge of the anatomy will enhance our understanding of the kinematics of the scaphoid.
Topics: Biomechanical Phenomena; Humans; Ligaments, Articular; Scaphoid Bone
PubMed: 22051230
DOI: 10.1016/j.jhsa.2011.09.012 -
European Journal of Trauma and... Oct 2023The objective of this systematic review was to perform epidemiological as well as clinical, radiological and patient-reported outcome analysis of surgically treated... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The objective of this systematic review was to perform epidemiological as well as clinical, radiological and patient-reported outcome analysis of surgically treated perilunate dislocations and fracture dislocations (PLDs and PLFDs) based on the so far largest pooled patient population to date.
MATERIAL AND METHODS
This systematic review was written according to the updated guideline for reporting systematic reviews by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. A comprehensive literature search of Pubmed, Embase, CENTRAL, and CINAHL databases was performed. All studies reporting on complications, radiological, functional and/or patient-reported outcomes of surgically treated acute PLDs and PLFDs with a minimum follow-up of 12 months were included.
RESULTS
Twenty-six studies encompassing 550 patients with 553 operatively treated acute perilunate injuries (106 PLDs and 447 PLFDs) were included. The overall postoperative complication rate was 15.0% with secondary reduction loss representing the main contributing factor (10.1%). The overall reoperation rate was 10.4% and the incidence of salvage procedures was 2.8%. The risk for secondary reduction loss was higher for PLD than for PLFD injuries (24.2% vs. 7.0%, relative risk [RR] 3.5, 95% confidence interval [CI] 1.6-7.5). There was a higher overall complication rate for the combined dorsopalmar approach when compared to the isolated dorsal approach (17.4% vs. 8.4%, RR 0.5, 95% CI 0.2-1.0, number needed to treat [NNT] 11.2) and for open surgery versus arthroscopic surgery (17.4% vs. 4.8%, RR 0.3, 95% CI 0.1-0.9, NNT 8.0). A significant correlation was found between radiological osteoarthritis (rOA) and follow-up duration of the individual studies, while functional and patient-rated outcomes were comparable.
CONCLUSIONS
Regardless of surgical technique, PLFDs appear to be less susceptible to secondary reduction loss than PLDs. Whenever possible, less invasive (e.g. arthroscopic) surgery should be performed to minimize postoperative complications. The rate of rOA is high and increases significantly with follow-up duration. Interestingly, rOA does not seem to correlate with reduced wrist function nor patient dissatisfaction and the need for salvage surgery is surprisingly rare.
LEVEL OF EVIDENCE
Systematic review of level IV studies.
Topics: Humans; Lunate Bone; Fractures, Bone; Fracture Dislocation; Joint Dislocations; Wrist Injuries; Postoperative Complications
PubMed: 36750472
DOI: 10.1007/s00068-023-02222-y -
Cells Mar 2022Galanin is a neuropeptide expressed in a small percentage of sensory neurons of the dorsal root ganglia and the superficial lamina of the dorsal horn of the spinal cord.... (Review)
Review
Galanin is a neuropeptide expressed in a small percentage of sensory neurons of the dorsal root ganglia and the superficial lamina of the dorsal horn of the spinal cord. In this work, we systematically reviewed the literature regarding the role of galanin and its receptors in nociception at the spinal and supraspinal levels, as well as in chronic pain conditions. The literature search was performed in PubMed, Web of Science, Scopus, ScienceDirect, OVID, TRIP, and EMBASE using "Galanin" AND "pain" as keywords. Of the 1379 papers that were retrieved in the initial search, we included a total of 141 papers in this review. Using the ARRIVE guidelines, we verified that 89.1% of the works were of good or moderate quality. Galanin shows a differential role in pain, depending on the pain state, site of action, and concentration. Under normal settings, galanin can modulate nociceptive processing through both a pro- and anti-nociceptive action, in a dose-dependent manner. This peptide also plays a key role in chronic pain conditions and its antinociceptive action at both a spinal and supraspinal level is enhanced, reducing animals' hypersensitivity to both mechanical and thermal stimulation. Our results highlight galanin and its receptors as potential therapeutic targets in pain conditions.
Topics: Animals; Chronic Pain; Galanin; Ganglia, Spinal; Sensory Receptor Cells; Spinal Cord
PubMed: 35269462
DOI: 10.3390/cells11050839 -
Medicine May 2020Intramedullary cervical spinal cord teratomas (ICTs) are extremely rare, and diagnosis and treatment are challenging. We conducted a systematic review of the literature...
BACKGROUND
Intramedullary cervical spinal cord teratomas (ICTs) are extremely rare, and diagnosis and treatment are challenging. We conducted a systematic review of the literature on the diagnosis and treatment of ICT.
METHOD
The presentation, imaging manifestations, diagnosis, management, surgery findings, prognosis and histology were reviewed following Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. English-language studies and case reports published from inception to 2018 were retrieved. Data on presentation, imaging characteristics, diagnosis, management, surgery findings, outcomes, and histopathology were extracted.
RESULTS
Ten articles involving 10 patients were selected. The lesions were located in the upper cervical vertebrae in 4 cases, whereas in the lower cervical vertebrae in the remaining 6 cases. In 5 cases, the lesions were located on the dorsal side of the spinal cord, and in the center of the spinal cord in the remaining 5 cases. Quadriparesis (60%), paraplegia (30%), monoplegia (10%), and neck pain (50%) were the main presentations. The lesion appeared as a intramedullary heterogeneous signal during an MRI scan, and the lesion signal would be partially enhanced after the contrast medium was applied. All patients underwent surgical intervention through a posterior approach. Neurological function improved postoperatively in all patients. Two patients with pathology confirmed to be immature teratomas experienced recurrence.
CONCLUSION
ICTs are extremely rare entities that are mainly located in the center or dorsal part of the spinal cord which mainly manifest as quadriplegia and neck pain. MRI is a useful modality that provides diagnostic clues. Surgery from a posterior approach is the primary treatment, and the effect of adjuvant therapy remains uncertain. The prognosis is mainly related to the pathological nature of the tumor and not the method of resection.
Topics: Cervical Vertebrae; Humans; Spinal Cord Neoplasms; Teratoma
PubMed: 32358400
DOI: 10.1097/MD.0000000000020107 -
Plastic Surgery (Oakville, Ont.) Nov 2018The aim of this study was to compare the diagnostic performance (accuracy, sensitivity, specificity, positive predictive value, and negative predictive value) of plain... (Review)
Review
PURPOSE
The aim of this study was to compare the diagnostic performance (accuracy, sensitivity, specificity, positive predictive value, and negative predictive value) of plain film (PF), ultrasonography (USG), and computed tomography (CT) in diagnosing nasal bone fractures (NBFs).
METHODS
In a search of PubMed and Scopus, "nasal bone fracture" AND "X-ray OR CT OR USG OR MRI" were searched. Among the 369 titles from PubMed and 379 titles from Scopus, 257 duplicate titles were excluded and 491 titles were reviewed. Among them, 36 full articles were reviewed. From these, 21 were excluded and 1 mined article was added; thus, 16 articles were reviewed.
RESULTS
The accuracy of CT (94.4% ± 2.3%) was significantly higher ( < .001) than that of USG (85.0% ± 3.6%). The accuracy of USG was significantly higher ( < .001) than that of PF (67.7% ± 4.7%). Computed tomography (89.3% ± 3.1%) and USG (87.2% ± 3.3%) were significantly more sensitive than PF ( < .001 and < .001, respectively). The specificity of CT (94.2% ± 2.3%) was significantly higher ( = .001) than that of USG (87.4% ± 3.3%). The specificity of USG was significantly higher ( < .001) than that of PF (67.8% ± 4.7%). Among the PF techniques, combining a lateral view and the Water's view (71.8% ± 4.5%) had significantly higher accuracy than a lateral view alone (62.4% ± 4.8%) or the Water's view alone (61.0% ± 4.9%). In USG, there was no significant difference ( = .300) in accuracy among lateral and dorsal views (95.8% ± 2.0%), a lateral view alone (84.2% ± 3.7%), and a dorsal view alone (84.2% ± 3.6%).
CONCLUSION
The results of this review might be helpful in choosing the most appropriate diagnostic tool in patients suspected having NBF.
PubMed: 30450348
DOI: 10.1177/2292550317749535 -
Molecular Psychiatry Mar 2022There is growing evidence that placebo effects can meaningfully modulate the brain. However, there has been little consideration of whether these changes may overlap... (Meta-Analysis)
Meta-Analysis
There is growing evidence that placebo effects can meaningfully modulate the brain. However, there has been little consideration of whether these changes may overlap with regions/circuits targeted by depression treatments and what the implications of this overlap would be on measuring efficacy in placebo-controlled clinical trials. In this systematic review and meta-analysis, we searched PubMed/Medline and Google Scholar for functional MRI and PET neuroimaging studies of placebo effects. Studies recruiting both healthy subjects and patient populations were included. Neuroimaging coordinates were extracted and included for Activation Likelihood Estimation (ALE) meta-analysis. We then searched for interventional studies of transcranial magnetic stimulation (TMS) and deep brain stimulation (DBS) for depression and extracted target coordinates for comparative spatial analysis with the placebo effects maps. Of 1169 articles identified, 34 neuroimaging studies of placebo effects were included. There were three significant clusters of activation: left dorsolateral prefrontal cortex (DLPFC) (x = -41, y = 16, z = 34), left sub-genual anterior cingulate cortex (sgACC)/ventral striatum (x = -8, y = 18, z = -15) and the right rostral anterior cingulate cortex (rACC) (x = 4, y = 42, z = 10). There were two significant deactivation clusters: right basal ganglia (x = 20, y = 2, z = 7) and right dorsal anterior cingulate cortex (dACC) (x = 1, y = -5, z = 45). TMS and DBS targets for depression treatment overlapped with the left DLPFC cluster and sgACC cluster, respectively. Our findings identify a common set of brain regions implicated in placebo effects across healthy individuals and patient populations, and provide evidence that these regions overlap with depression treatment targets. We model the statistical impacts of this overlap and demonstrate critical implications on measurements of clinical trial efficacy for this field.
Topics: Depression; Gyrus Cinguli; Humans; Magnetic Resonance Imaging; Neuroimaging; Placebo Effect; Prefrontal Cortex; Transcranial Magnetic Stimulation
PubMed: 34903861
DOI: 10.1038/s41380-021-01397-3 -
Journal of Hand Therapy : Official... 2017Systematic review PURPOSE OF THE STUDY: The purpose was to review the available literature for evidence on the reliability and measurement error of protractor-based... (Review)
Review
STUDY DESIGN
Systematic review PURPOSE OF THE STUDY: The purpose was to review the available literature for evidence on the reliability and measurement error of protractor-based goniometry assessment of the finger joints.
METHODS
Databases were searched for articles with key words "hand," "goniometry," "reliability," and derivatives of these terms. Assessment of the methodological quality was carried out using the Consensus-Based Standards for the Selection of Health Measurement Instruments checklist. Two independent reviewers performed a best evidence synthesis based on criteria proposed by Terwee et al (2007).
RESULTS
Fifteen articles were included. One article was of fair methodological quality, and 14 articles were of poor methodological quality. An acceptable level for reliability (intraclass correlation coefficient > 0.70 or Pearson's correlation > 0.80) was reported in 1 study of fair methodological quality and in 8 articles of low methodological quality. Because the minimal important change was not calculated in the articles, there was an unknown level of evidence for the measurement error.
DISCUSSION
Further research with adequate sample sizes should focus on reference outcomes for different patient groups. For valid therapy evaluation, it is important to know if the change in range of motion reflects a real change of the patient or if this is due to the measurement error of the goniometer. Until now, there is insufficient evidence to establish this cut-off point (the smallest detectable change).
CONCLUSION
Following the Consensus-Based Standards for the Selection of Health Measurement Instruments criteria, there was limited level of evidence for an acceptable reliability in the dorsal measurement method and unknown level of evidence for the measurement error.
LEVEL OF EVIDENCE
2a.
Topics: Arthrometry, Articular; Female; Finger Joint; Humans; Joint Diseases; Male; Range of Motion, Articular; Reproducibility of Results; Severity of Illness Index
PubMed: 28389132
DOI: 10.1016/j.jht.2017.02.012