-
The Cochrane Database of Systematic... Jul 2005Traditional suburethral slings are surgical operations used to treat women with symptoms of stress urinary incontinence. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Traditional suburethral slings are surgical operations used to treat women with symptoms of stress urinary incontinence.
OBJECTIVES
To determine the effects of traditional suburethral slings on stress incontinence alone or stress with other types of urinary (mixed) incontinence in comparison with other management options.
SEARCH STRATEGY
We searched the Cochrane Incontinence Group Specialised Trials Register (searched 22 December 2004), The UK National Research Register (Issue 1, 2001) and the reference lists of relevant articles. We hand searched the proceedings of the Brazilian Congress of Urology from 1991 to 2003, inclusive.
SELECTION CRITERIA
Randomised or quasi-randomised trials that included traditional suburethral slings for the treatment of stress or mixed urinary incontinence.
DATA COLLECTION AND ANALYSIS
All three reviewers independently extracted data from included trials onto a standard form and assessed trial methodological quality. The data abstracted were relevant to predetermined outcome measures. Where appropriate, a summary statistic was calculated: a relative risk for dichotomous data and a weighted mean difference for continuous data.
MAIN RESULTS
Thirteen trials were identified including 760 women of whom 627 were treated with suburethral slings. Five compared suburethral slings with open abdominal retropubic colposuspension (Burch/Marshall-Marchetti-Krantz) and one compared suburethral slings with needle suspension (Stamey). In six trials, different types of suburethral sling were compared with each other. Nine types of slings were included (Teflon, polytetrafluoroethylene, prolene used for transvaginal tape (TVT), porcine dermis, lyophilised dura mater, fascia lata, vaginal wall, autologous dermis and rectus fascia). There were no comparisons of suburethral sling with anterior repair, laparoscopic retropubic suspension, peri-urethral injections or artificial sphincters. One trial compared surgery (including slings) with anticholinergic medication.There were no statistically significant differences between traditional slings and other types of continence surgery, or between one type of traditional sling and another sling. Confidence intervals around the estimates were wide, reflecting the few data available, and so clinically important differences could not be ruled out.
AUTHORS' CONCLUSIONS
The data on sub urethral sling operations remain too few to address the effects of this type of surgical treatment. Few trials are reported by authors in a complete fashion and most information came from abstracts presented in annual meetings. The broader effects of suburethral slings could not be established since trials did not include appropriate outcome measures such as general health status, health economics, pad testing, third party analysis and time to return to normal activity level. Data obtained from thirteen trials did not provide reliable estimates because of their sizes, and heterogeneity of designs, populations studied, and types of comparisons made. Reliable evidence on which to judge whether or not suburethral slings are better or worse than other surgical or conservative management is currently not available.
Topics: Female; Humans; Polytetrafluoroethylene; Randomized Controlled Trials as Topic; Urethra; Urinary Incontinence, Stress; Urologic Surgical Procedures
PubMed: 16034866
DOI: 10.1002/14651858.CD001754.pub2 -
Beijing Da Xue Xue Bao. Yi Xue Ban =... Apr 2022To compare the clinical effect of microsurgery and endovascular embolization in the treatment of spinal dural arteriovenous fistula (SDAVF) by meta-analysis. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To compare the clinical effect of microsurgery and endovascular embolization in the treatment of spinal dural arteriovenous fistula (SDAVF) by meta-analysis.
METHODS
A systematic review was performed to retrieve all relevant literature about surgical treatment or endovascular embolization of SDAVF up to December 2019 through PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials Results, CNKI, Wanfang Data, and SinoMed. The Chinese and English key words included: "SDAVF", "spinal dural arteriovenous fistula", "spinal AVM", "spinal vascular malformation and treatment". The included studies were evaluated using the Newcastle-Ottawa scale. The early failure rate, long-term recurrence, neurological recovery, and complications were evaluated and the clinical effects of the two methods in the treatment of SDAVF were compared by using RevMan 5.3 software. And a further subgroup analysis of the therapeutic effect of endovascular embolization with different embolic agents was conducted.
RESULTS
A total of 46 studies involving 1 958 cases of SDAVF were included, in which 935 cases were treated by microsurgery and 1 023 cases were treated by endovascular embolization. The funnel plot demonstrated that there was no publication bias. The results of meta-analysis showed that the incidence of early surgical failure was lower than that of endovascular embolization (=0.20, 95%: 0.13-0.30, < 0.05), and the long-term recurrence was also lower than that of endovascular embolization (=0.36, 95%: 0.22-0.58, < 0.05). The improvement of neurological function in the surgical patients is significantly higher than that in the patients treated with endovascular embolization (=2.86, 95%: 1.36-5.99, < 0.05). There was no significant difference in the occurrence of complications in these two groups (=1.52, 95%: 0.88-2.64, =0.14). In the cases of endovascular embolization, the risk of treatment failure or recurrence was higher with Onyx glue than with n-butyl 2-cyanoacrylate (NBCA), and the difference was statistically significant (=4.70, 95%: 1.55-14.28, < 0.05).
CONCLUSION
Although the treatment of dural arteriovenous fistulas by intravascular embolization has been widely used, the clinical effect of microsurgery is still better than that of endovascular embolization. Large scale and high-quality randomized controlled trials are required to validate the efficacy and safety of endovascular treatment in SDAVF patients.
Topics: Central Nervous System Vascular Malformations; Embolization, Therapeutic; Enbucrilate; Endovascular Procedures; Humans; Microsurgery; Retrospective Studies; Treatment Outcome
PubMed: 35435197
DOI: 10.19723/j.issn.1671-167X.2022.02.018 -
Journal of Clinical Neuroscience :... Apr 2021The subdural evacuating port system (SEPS) is a minimally invasive option for treating chronic subdural hematoma (cSDH). Individual case series have shown it to be safe... (Meta-Analysis)
Meta-Analysis
The subdural evacuating port system (SEPS) is a minimally invasive option for treating chronic subdural hematoma (cSDH). Individual case series have shown it to be safe and effective, but outcomes have not been systematically reviewed. We sought to review the literature in order to determine the safety and efficacy of SEPS as a first line treatment for cSDH. A comprehensive literature search for outcomes following SEPS placement as a primary treatment for cSDH was performed. The primary outcome was treatment success, which was defined as a composite of improvement in presenting symptoms and no need for further treatment in the operating room. Additional outcomes included discharge disposition, length of stay (LOS), hematoma recurrence, and complications. A total of 12 studies comprising 953 patients who underwent SEPS placement met the inclusion criteria. The pooled rate of a successful outcome was 0.79 (95% CI 0.75-0.83). Frequency of delayed hematoma recurrence was 0.15 (95% CI 0.10-0.21). The pooled inpatient mortality rate was 0.02 (95% CI 0.01-0.03). Complications rates included 0.02 (95% CI 0.00-0.03) for any acute hemorrhage, 0.01 (95% CI 0.00-0.01) for acute hemorrhage requiring surgery, and 0.02 (95% CI 0.01-0.03) for seizure. SEPS placement is associated with a success rate of 79% and very low rates of acute hemorrhage and seizure. This data supports its use as a first-line management strategy, although prospective randomized studies are needed.
Topics: Craniotomy; Disease Management; Drainage; Female; Hematoma, Subdural, Chronic; Humans; Length of Stay; Male; Mortality; Operating Rooms; Prospective Studies; Recurrence; Retrospective Studies; Subdural Space; Treatment Outcome
PubMed: 33775320
DOI: 10.1016/j.jocn.2021.01.039 -
The Journal of Laryngology and Otology Feb 2021This study aimed to provide a systematic review on survival outcome based on Pittsburgh T-staging for patients with primary external auditory canal squamous cell...
OBJECTIVE
This study aimed to provide a systematic review on survival outcome based on Pittsburgh T-staging for patients with primary external auditory canal squamous cell carcinoma.
METHOD
This study was a systematic review in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines performed until January 2018; pertinent studies were screened. Quality of evidence was assessed using the grading of recommendation, assessment, development and evaluation working group system.
RESULTS
Eight articles were chosen that reported on 437 patients with external auditory carcinoma. The 5-year overall survival rate was 53.0 per cent. The pooled proportion of survivors at 5 years for T1 tumours was 88.4 per cent and for T2 tumours was 88.6 per cent. For the combined population of T1 and T2 cancer patients, it was 84.5 per cent. For T3 and T4 tumours, it was 53.3 per cent and 26.8 per cent, respectively, whereas for T3 and T4 tumours combined, it was 40.4 per cent. Individual analysis of 61 patients with presence of cervical nodes showed a poor survival rate.
CONCLUSION
From this review, there was not any significant difference found in the survival outcome between T1 and T2 tumours. A practical classification incorporating nodal status that accurately stratifies patients was proposed.
Topics: Aged; Carcinoma, Squamous Cell; Dura Mater; Ear Canal; Ear Neoplasms; Facial Paralysis; Female; Head and Neck Neoplasms; Humans; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Staging; Parotid Gland; Retrospective Studies; Survival Rate
PubMed: 33568243
DOI: 10.1017/S0022215121000323 -
Journal of Neurointerventional Surgery Sep 2011Cervical hemangiopericytoma (HPC) is a rare tumor involving dura and bone. Because HPC shares some imaging features with meningioma, hemangioblastoma, schwannoma and... (Review)
Review
Cervical hemangiopericytoma (HPC) is a rare tumor involving dura and bone. Because HPC shares some imaging features with meningioma, hemangioblastoma, schwannoma and solitary fibrous tumors; histology with appropriate immunohistochemistry is essential for its diagnosis and treatment. HPC is highly vascular and has a high rate of local recurrence following resection. Thus it can pose significant therapeutic challenges. To the best of our knowledge this is the 13th reported case of HPC of the cervical spine and the first case of cervical HPC treated using embolization with Onyx-18. In addition, a systematic review of the literature is presented describing previous experience with HPC of the cervical region. The case of a 61-year-old woman is reported who presented with a 7 month history of dizziness, mild ataxia and left-sided tinnitus when supine. MRI of the cervical spine demonstrated a gadolinium enhancing mass arising from the dorsal cervical dura, extending from the occiput to C2, with internal flow voids and extension into the C2 lamina and spinous process. Digital subtraction angiography demonstrated multiple corkscrew-shaped supplying vessels, marked hypervascularity, rapid arteriovenous shunting and delayed contrast washout. Super selective injection of Onyx-18 yielded approximately 90% embolization of the lesion, followed by subtotal resection and radiotherapy. Histology confirmed the presumptive diagnosis of HPC. Preoperative embolization with Onyx-18 should be considered for large HPC as it may decrease the risk of intraoperative hemorrhage. In this case, embolization with Onyx-18 did not preclude histopathologic diagnosis of HPC.
Topics: Angiography, Digital Subtraction; Cervical Vertebrae; Drug Combinations; Dura Mater; Embolization, Therapeutic; Female; Hemangiopericytoma; Humans; Middle Aged; Polyvinyls; Spinal Neoplasms; Tantalum; Vertebral Artery
PubMed: 21990849
DOI: 10.1136/jnis.2010.003756 -
No Shinkei Geka. Neurological Surgery Apr 2013
Review
Topics: Aging; Dura Mater; Humans; Informed Consent; Meningeal Neoplasms; Meningioma; Postoperative Complications
PubMed: 23542799
DOI: No ID Found -
World Neurosurgery Feb 2019Intracranial chondromas are rare, benign neoplasms representing only 0.2%-0.3% of neoplastic intracranial lesions. They commonly originate from the skull base but can...
Intracranial chondromas are rare, benign neoplasms representing only 0.2%-0.3% of neoplastic intracranial lesions. They commonly originate from the skull base but can infrequently arise from the falx, convexity dura, or ventricular ependyma. Diagnosis requires histopathologic confirmation, as patients present with nonspecific symptoms related to mass effect, and imaging characteristics often resemble meningiomas, oligodendrogliomas, and vascular malformations. We describe the case of a patient harboring a parafalcine dural chondroma that was discovered incidentally and was managed surgically at our institution. We also provide a systematic review of the literature to elucidate incidence, origin, imaging findings, surgical management approaches, and prognosis of this rare tumor.
Topics: Adult; Brain Neoplasms; Chondroma; Dura Mater; Humans; Male; Meningeal Neoplasms
PubMed: 30273721
DOI: 10.1016/j.wneu.2018.09.169 -
AJNR. American Journal of Neuroradiology Oct 2015Tentorial dural arteriovenous fistulas are characterized by a high hemorrhagic risk. We evaluated trends in outcomes and management of tentorial dural arteriovenous... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND AND PURPOSE
Tentorial dural arteriovenous fistulas are characterized by a high hemorrhagic risk. We evaluated trends in outcomes and management of tentorial dural arteriovenous fistulas and performed a meta-analysis evaluating clinical and angiographic outcomes by treatment technique.
MATERIALS AND METHODS
We performed a comprehensive literature search for studies on surgical and endovascular treatment of tentorial dural arteriovenous fistulas. We compared the proportion of patients undergoing endovascular, surgical, and combined endovascular/surgical management; the proportion of patients presenting with ruptured tentorial dural arteriovenous fistulas; and proportion of patients with good neurologic outcome across 3 time periods: 1980-1995, 1996-2005, and 2006-2014. We performed a random-effects meta-analysis, evaluating the rates of occlusion, long-term good neurologic outcome, perioperative morbidity, and resolution of symptoms for the 3 treatment modalities.
RESULTS
Twenty-nine studies with 274 patients were included. The proportion of patients treated with surgical treatment alone decreased from 38.7% to 20.4% between 1980-1995 and 2006-2014. The proportion of patients treated with endovascular therapy alone increased from 16.1% to 48.0%. The proportion of patients presenting with ruptured tentorial dural arteriovenous fistulas decreased from 64.4% to 43.6%. The rate of good neurologic outcome increased from 80.7% to 92.9%. Complete occlusion rates were highest for patients receiving multimodality treatment (84.0%; 95% CI, 72.0%-91.0%) and lowest for endovascular treatment (71.0%; 95% CI, 56.0%-83.0%; P < .01). Long-term good neurologic outcome was highest in the endovascular group (89.0%; 95% CI, 80.0%-95.0%) and lowest for the surgical group (73.0%; 95% CI, 51.0%-87.0%; P = .03).
CONCLUSIONS
Patients with tentorial dural arteriovenous fistulas are increasingly presenting with unruptured lesions, being treated endovascularly, and experiencing higher rates of good neurologic outcomes. Endovascular treatment was associated with superior neurologic outcomes but lower occlusion rates.
Topics: Angiography; Central Nervous System Vascular Malformations; Dura Mater; Embolization, Therapeutic; Humans; Outcome and Process Assessment, Health Care; Retrospective Studies; Spinal Cord
PubMed: 26316563
DOI: 10.3174/ajnr.A4394 -
Acta Neurochirurgica Mar 2020The evidence for subperiosteal drainage (SPD) versus subdural drainage (SDD) in chronic subdural hematoma (CSDH) remains controversial, and most surgeons prefer to use... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
The evidence for subperiosteal drainage (SPD) versus subdural drainage (SDD) in chronic subdural hematoma (CSDH) remains controversial, and most surgeons prefer to use SDD over SPD. We aim to assess the latest evidence on the use of SPD compared to SDD in patients with CSDH undergoing burr hole evacuation.
METHODS
We performed a systematic literature search on topics that assesses the use of SPD compared to SDD in patients with CSDH up until November 2019 from PubMed, EuropePMC, Cochrane Central Database, ScienceDirect, ProQuest, and ClinicalTrials.gov. The primary outcome was recurrent CSDH, and the secondary outcomes were mortality, surgical morbidities, and modified Rankin Score (mRS).
RESULTS
There were a total of 3241 subjects from 10 studies. SPD was shown to reduce recurrent CSDH (OR 0.66 [0.52, 0.84], p < 0.001; I: 17%, p = 0.30) compared to SDD. Recurrent CSDH was lower in SPD group in subgroup analysis at 3-months (OR 0.63 [0.49, 0.81]; I: 68%, p = 0.04) and 6-months (OR 0.66 [0.51, 0.85], p = 0.001; I: 77%, p = 0.01) follow-up. However, there was no difference in CSDH recurrence upon subgroup analysis of RCTs. Similar mortality was demonstrated between SPD and SDD group (p = 0.13). The occurrence of parenchymal injury/new neurological deficit was significantly lower in SPD group (OR 0.26 [0.14, 0.51], p < 0.001; I: 49%, p = 0.08). The rate of seizure, (p = 0.57), postoperative bleeding (p = 0.29), and infection (p = 0.25) were shown to be similar in both SPD and SDD group. Overall, the rate of surgical morbidity was significantly lower in SPD group (OR 0.61 [0.44, 0.85], p = 0.003; I: 16%, p = 0.25). mRS at the end of follow-up was similar in SPD and SDD group (p = 0.12).
CONCLUSION
SPD was associated with less CSDH recurrence, but similar rate of mortality, seizures, postoperative bleeding, and infections compared to SDD. The rate of parenchymal injury/new neurological deficit was lower in the SPD group.
Topics: Drainage; Hematoma, Subdural, Chronic; Humans; Postoperative Hemorrhage; Subdural Space; Trephining
PubMed: 31940094
DOI: 10.1007/s00701-019-04208-5 -
European Journal of Radiology Nov 2011Intracranial metastases are a rare manifestation of prostate carcinoma and the dura mater is the most affected site. We report a series of six patients with dural... (Review)
Review
Intracranial metastases are a rare manifestation of prostate carcinoma and the dura mater is the most affected site. We report a series of six patients with dural prostate metastases (DPM) and perform a systematic review of the current literature in order to depict imaging trademarks of this condition. This review points to a magnetic resonance imaging (MRI) pattern of meningeal involvement characterized by a diffuse smooth thickening, nodular appearance or dural-based masses. We also demonstrate an osteoblastic pattern of lesions, particularly in sphenoid wing, by computed tomography (CT) scans. We suggest that these imaging findings may support an elevated index of suspicion of DPM in elderly men, including those patients without urologic symptoms.
Topics: Aged; Dura Mater; Humans; Magnetic Resonance Imaging; Male; Meningeal Neoplasms; Middle Aged; Prostatic Neoplasms; Tomography, X-Ray Computed
PubMed: 20619564
DOI: 10.1016/j.ejrad.2010.06.007