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Neurocirugia (Asturias, Spain) 2013The endoscopic endonasal techniques used in skull base surgery have evolved greatly in recent years. Our study objective was to perform a qualitative systematic review... (Review)
Review
INTRODUCTION AND OBJECTIVE
The endoscopic endonasal techniques used in skull base surgery have evolved greatly in recent years. Our study objective was to perform a qualitative systematic review of the likewise systematic reviews in published English language literature, to examine the evidence and conclusions reached in these studies comparing transcranial and endoscopic approaches in skull base surgery.
MATERIAL AND METHODS
We searched the references on the MEDLINE and EMBASE electronic databases selecting the systematic reviews, meta-analyses and evidence based medicine reviews on skull based pathologies published from January 2000 until January 2013. We focused on endoscopic impact and on microsurgical and endoscopic technique comparisons.
RESULTS
Full endoscopic endonasal approaches achieved gross total removal rates of craniopharyngiomas and chordomas higher than those for transcranial approaches. In anterior skull base meningiomas, complete resections were more frequently achieved after transcranial approaches, with a trend in favour of endoscopy with respect to visual prognosis. Endoscopic endonasal approaches minimised the postoperative complications after the treatment of cerebrospinal fluid (CSF) leaks, encephaloceles, meningoceles, craniopharyngiomas and chordomas, with the exception of postoperative CSF leaks.
CONCLUSIONS
Randomized multicenter studies are necessary to resolve the controversy over endoscopic and microsurgical approaches in skull base surgery.
Topics: Brain Neoplasms; Chordoma; Endoscopy; Humans; Meningioma; Nose; Skull Base
PubMed: 23831339
DOI: 10.1016/j.neucir.2013.05.002 -
Journal of the American Academy of... Mar 2017Hair collar sign (HCS) and hair tuft of the scalp (HTS) are cutaneous signs of an underlying neuroectodermal defect, but most available data are based on case reports. (Review)
Review
BACKGROUND
Hair collar sign (HCS) and hair tuft of the scalp (HTS) are cutaneous signs of an underlying neuroectodermal defect, but most available data are based on case reports.
OBJECTIVE
We sought to define the clinical spectrum of HCS and HTS, clarify the risk for underlying neurovascular anomalies, and provide imaging recommendations.
METHODS
A 10-year multicenter retrospective and prospective analysis of clinical, radiologic, and histopathologic features of HCS and HTS in pediatric patients was performed.
RESULTS
Of the 78 patients included in the study, 56 underwent cranial and brain imaging. Twenty-three of the 56 patients (41%) had abnormal findings, including the following: (1) cranial/bone defect (30.4%), with direct communication with the central nervous system in 28.6%; (2) venous malformations (25%); or (3) central nervous system abnormalities (12.5%). Meningeal heterotopia in 34.6% (9/26) was the most common neuroectodermal association. Sinus pericranii, paraganglioma, and combined nevus were also identified.
LIMITATIONS
The partial retrospective design and predominant recruitment from the dermatology department are limitations of this study.
CONCLUSIONS
Infants with HCS or HTS are at high risk for underlying neurovascular anomalies. Magnetic resonance imaging scans should be performed in order to refer the infant to the appropriate specialist for management.
Topics: Abnormalities, Multiple; Brain; Choristoma; False Negative Reactions; False Positive Reactions; Female; Hair; Humans; Infant; Infant, Newborn; Magnetic Resonance Imaging; Male; Meninges; Multimodal Imaging; Neural Plate; Neuroimaging; Prospective Studies; Retrospective Studies; Scalp; Skull; Tomography, X-Ray Computed; Ultrasonography, Doppler, Color; Veins
PubMed: 27742172
DOI: 10.1016/j.jaad.2016.08.046 -
Otolaryngology--head and Neck Surgery :... Jul 2024To review surgical techniques used in the endoscopic transnasal repair of pediatric basal meningoencephaloceles and compare perioperative outcomes in children <2 and... (Review)
Review
OBJECTIVE
To review surgical techniques used in the endoscopic transnasal repair of pediatric basal meningoencephaloceles and compare perioperative outcomes in children <2 and ≥2 years old.
DATA SOURCES
MEDLINE, EMBASE, and CENTRAL.
REVIEW METHODS
Data sources were searched from inception to August 22, 2022, using search terms relevant to endoscopic transnasal meningoencephalocele repair in children. Reviews and Meta-analyses were excluded. Primary outcomes were the incidence of intraoperative and postoperative complications, including cerebrospinal fluid leak, recurrence, and reintervention. Quality assessments were performed using Newcastle-Ottawa Scale, ROBIN-I, and NIH.
RESULTS
Overall, 217 patients across 61 studies were identified. The median age at surgery was 4 years (0-18 years). Fifty percent were female; 31% were <2 years. Most defects were meningoencephaloceles (56%), located transethmoidal (80%), and of congenital origin (83%). Seventy-five percent of repairs were multilayered. Children ≥2 years underwent multilayer repairs more frequently than those <2 years (P = 0.004). Children <2 years more frequently experienced postoperative cerebrospinal fluid leaks (P = 0.02), meningoencephalocele recurrence (P < 0.0001), and surgical reintervention (P = 0.005). Following multilayer repair, children <2 years were more likely to experience recurrence (P = 0.0001) and reintervention (P = 0.006).
CONCLUSION
Younger children with basal meningoencephaloceles appear to be at greater risk of postoperative complications following endoscopic endonasal repair, although the quality of available evidence is weakened by incomplete reporting. In the absence of preoperative cerebrospinal fluid leak or meningitis, it may be preferable to delay surgery as access is more conducive to successful repair in older children.
Topics: Adolescent; Child; Child, Preschool; Female; Humans; Infant; Encephalocele; Endoscopy; Meningocele; Natural Orifice Endoscopic Surgery; Nose; Postoperative Complications; Male; Infant, Newborn
PubMed: 38494838
DOI: 10.1002/ohn.711 -
Journal of Plastic, Reconstructive &... Apr 2022Complex back wounds with cerebrospinal fluid (CSF) leak constitute a challenge for surgeons in clinical practice. While repair of complex back wounds with various flaps... (Review)
Review
Complex back wounds with cerebrospinal fluid (CSF) leak constitute a challenge for surgeons in clinical practice. While repair of complex back wounds with various flaps is well described in the literature, there is a paucity of reviews and articles regarding optimal treatment for refractory CSF leaks. The aim of this systematic review was to present the different flap techniques proposed in the literature for CSF leaks fistulas and pseudo-meningoceles. A systematic review of the literature was conducted using the PubMed, Medline, Embase, and Cochrane databases. Studies tackling different flap techniques used for spinal or skull base CSF leak were included in the studies. The main outcomes were complications and recurrences after previous failed treatments. Fifteen studies were included in the study, constituting a cohort of 42 patients (mean age 45 years; F/M ratio 1.15:1). A previous unsuccessful non-flap procedure was proposed in 88.1% of patients for their CSF leak. Only 16.7% had a recurrence of their CSF leak after the flap procedure. Free radial forearm flap and regional muscle flaps were more frequently used in the skull base region. Pedicled omental flaps and reverse turnover latissimus dorsi were the most commonly used flaps in the thoracolumbar region. No statistically significant differences were found between these flaps regarding rates of complications and recurrence. Flaps should be considered as a safe and effective treatment option for complex back wounds with CSF leaks. All proposed flaps in the literature seem to provide an equivalent cure rate for recurrent and refractory leaks.
Topics: Cerebrospinal Fluid Leak; Humans; Middle Aged; Plastic Surgery Procedures; Retrospective Studies; Skull Base; Skull Base Neoplasms; Surgical Flaps
PubMed: 35168923
DOI: 10.1016/j.bjps.2022.01.022 -
BJOG : An International Journal of... Feb 2019Controversy exists regarding the optimal mode of delivery for fetuses with open neural tube defects. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Controversy exists regarding the optimal mode of delivery for fetuses with open neural tube defects.
OBJECTIVE
To compare neurological outcomes among infants with open neural tube defects who underwent vaginal compared with caesarean delivery.
SEARCH STRATEGY
Electronic databases MEDLINE, EMBASE, Scopus, and Clinicaltrials.gov were searched from inception to November 2017.
SELECTION CRITERIA
Eligible studies included observational or randomised studies comparing vaginal and caesarean delivery in pregnancies with fetal open neural tube defects who did not undergo prenatal repair.
DATA COLLECTION AND ANALYSIS
Two reviewers independently reviewed abstracts and full-text articles. Outcomes were compared between vaginal and caesarean delivery and prelabour caesarean versus exposure to labour. The primary outcome was motor-anatomic level difference. Secondary outcomes included shunt requirement, sac disruption, meningitis, and ambulation at 2 years. Meta-analysis was performed and mean difference or odds ratios with 95% CI were calculated.
MAIN RESULTS
Of 201 abstracts identified in the primary search, nine studies (672 women) met the eligibility criteria. Comparing vaginal and caesarean delivery, there was no significant difference in motor-anatomic level difference (mean difference -0.10, 95% CI -0.58 to 0.38; I = 57%). The vaginal delivery group was less likely to require a shunt or have sac disruption [odds ratio (OR) 0.37, 95% CI 0.14-0.95 and OR 0.46, 95% CI 0.23-0.90, respectively]. Comparisons by prelabour caesarean versus exposure to labour showed no significant difference in motor-anatomic level difference (OR 1.29, 95% CI 0.63-3.21) or ambulation at 2 years (OR 2.13, 95% CI 0.35-13.12).
CONCLUSION
Caesarean delivery was not associated with improved neurological outcomes among fetuses with open neural tube defects.
TWEETABLE ABSTRACT
Available evidence does not support routine caesarean delivery for fetuses with open neural tube defects.
Topics: Cerebrospinal Fluid Shunts; Cesarean Section; Delivery, Obstetric; Disease Management; Female; Humans; Labor, Obstetric; Meningitis; Meningocele; Meningomyelocele; Neural Tube Defects; Obstetric Labor Complications; Odds Ratio; Pregnancy; Walking
PubMed: 29924919
DOI: 10.1111/1471-0528.15342 -
The Laryngoscope Feb 2012Systematically review the outcomes of endoscopic endonasal techniques to reconstruct large skull base defects (ESBR). Such surgical innovation is likely to be reported... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES/HYPOTHESIS
Systematically review the outcomes of endoscopic endonasal techniques to reconstruct large skull base defects (ESBR). Such surgical innovation is likely to be reported in case series, retrospective cohorts, or case-control studies rather than higher level evidence.
STUDY DESIGN
Systematic review and meta-analysis.
METHODS
Embase (1980-December 7, 2010) and MEDLINE (1950-November 14, 2010) were searched using a search strategy designed to include any publication on endoscopic endonasal reconstruction of the skull base. A title search selected those articles relevant to the clinical or basic science of an endoscopic approach. A subsequent abstract search selected articles of any defect other than simple cerebrospinal fluid (CSF) fistula, sella only, meningoceles, or simple case reports. The articles selected were subject to full-text review to extract data on perioperative outcomes for ESBR. Surgical technique was used for subgroup analysis.
RESULTS
There were 4,770 articles selected initially, and full-text analysis produced 38 studies with extractable data regarding ESBR. Of these articles, 12 described a vascularized reconstruction, 17 described free graft, and nine were mixed reconstructions. Three had mixed data in clearly defined patient groups that could be used for meta-analysis. The overall CSF leak rate was 11.5% (70/609). This was represented as a 15.6% leak rate (51/326) for free grafts and a 6.7% leak rate (19/283) for the vascularized reconstructions (χ(2) = 11.88, P = .001).
CONCLUSIONS
Current evidence suggests that ESBR with vascularized tissue is associated with a lower rate of CSF leaks compared to free tissue graft and is similar to reported closure rates in open surgical repair.
Topics: Cerebrospinal Fluid Rhinorrhea; Dura Mater; Endoscopy; Humans; Nasal Cavity; Plastic Surgery Procedures; Skull Base; Surgical Flaps
PubMed: 22253060
DOI: 10.1002/lary.22475 -
European Spine Journal : Official... May 2013In this article, we review the English literature of calcified pseudomeningoceles in the lumbar region. (Review)
Review
PURPOSE
In this article, we review the English literature of calcified pseudomeningoceles in the lumbar region.
METHODS
A systematic review using the Medline Database using the varied nomenclature for pseudomeningoceles, as well as reviewing the reference lists of relevant article found.
RESULTS
We discuss the different pathological theories on formation of a pseudomeningocele, the formation of a calcified wall and the optimal management for this entity. To date, 17 cases have been described, of which 13 are reviewed here. Calcification of pseudomeningocele is a rare entity and in the lumbar spine this occurs postsurgically. The only predisposing factor is prior surgery to the lumbar spine. Computer tomography, magnetic resonance imaging (MRI) and MRI myelography in combination are the preoperative investigations of choice. The radiological work-up can be preoperatively diagnostic and is important in the surgical planning.
CONCLUSIONS
The treatment is surgicel removal and the decision to treat is based on patient symptoms and correlating these with imaging. There is an average reported follow-up of 1.7 years postoperatively for these patients and the reported outcome after surgery is good.
Topics: Calcinosis; Female; Humans; Lumbar Vertebrae; Meningocele; Middle Aged; Orthopedic Procedures
PubMed: 23233216
DOI: 10.1007/s00586-012-2610-7 -
Child's Nervous System : ChNS :... Jul 2024Meckel-Gruber Syndrome (MKS) is an autosomal recessive genetic disorder, notable for its triad of occipital encephalocele, polycystic renal dysplasia, and postaxial... (Review)
Review
INTRODUCTION
Meckel-Gruber Syndrome (MKS) is an autosomal recessive genetic disorder, notable for its triad of occipital encephalocele, polycystic renal dysplasia, and postaxial polydactyly. Identified by Johann Friederich Meckel in 1822, MKS is categorized as a ciliopathy due to gene mutations. Diagnosis is confirmed by the presence of at least two key features. The condition is incompatible with life, leading to death in the womb or shortly after birth. Recent studies have largely focused on the genetic aspects of MKS, with limited information regarding the impact of neurosurgical approaches, particularly in treating encephaloceles.
METHODS
A systematic review was performed according to the PRISMA statement. The PubMed, Embase, and Web of Science databases were consulted for data screening and extraction, which was conducted by two independent reviewers. The search strategy aimed to encompass studies documenting cases of MKS with published reports of encephalocele excisions, and the search strings for all databases were: Meckel-Gruber syndrome OR Meckel Gruber syndrome OR Meckel-gruber OR Meckel Gruber.
RESULTS
The study included 10 newborns with MKS associated with occipital encephalocele or meningocele, all of whom underwent surgical repair of the occipital sac. The mean gestational age at birth was 36 (± 2) weeks. The mean of birth weight was 3.14 (± 0.85) kilograms. The average head circumference at birth was 33.82 cm (± 2.17). The mean diameter of the encephalocele/meningocele was 5.91 (± 1.02) cm. Other common central nervous system abnormalities included hydrocephalus, Dandy-Walker malformation, and agenesis of the corpus callosum. 40% required shunting for hydrocephalus. Surgery to remove the occipital sac occurred at a median age of 2.5 days (1.5-6.5). The most common post-surgical complication was the need for mechanical ventilation. The most common cause of death was pneumonia and the median age at death was 6.66 (0.03-18) months.
CONCLUSION
Our findings suggest that neurosurgical intervention, especially for managing encephaloceles, may offer some improvement in survival, albeit within a context of generally poor prognosis. However, these results should be interpreted with caution.
Topics: Humans; Encephalocele; Retinitis Pigmentosa; Neurosurgical Procedures; Ciliary Motility Disorders; Polycystic Kidney Diseases; Eye Abnormalities; Infant, Newborn
PubMed: 38459147
DOI: 10.1007/s00381-024-06346-3 -
World Neurosurgery 2013Neurocysticercosis (NCC) is the most common worldwide parasitic infection of the central nervous system, and ventricular cysts are particularly problematic, carrying the... (Review)
Review
BACKGROUND
Neurocysticercosis (NCC) is the most common worldwide parasitic infection of the central nervous system, and ventricular cysts are particularly problematic, carrying the risk of acute obstructive hydrocephalus. Herein, we present a typical case in which complete resection was possible and explore the evidence supporting the use of postoperative oral antihelminthic therapy.
METHODS
We performed a systematic review of the medical literature. Articles were included if they provided: 1) documentation of intraventricular disease, 2) discussion of management strategy, and 3) a presentation of outcomes. Available data were analyzed based on the primary therapy for NCC.
RESULTS
Data from 264 patients were abstracted from 32 references. Of all patients undergoing surgical resection of an isolated neurocysticercal cyst, 33.5% received postoperative antihelminthic therapy, most commonly albendazole. Among patients who had undergone surgical resection of a single intraventricular lesion (as was the case with our own patient), those who received postoperative antihelminthic therapy had a significantly lower risk of developing delayed hydrocephalus (18.8%, compared to 59.1% for those who received no medical therapy) (P = 0.02). The total mortality rate in our review was 3%.
CONCLUSIONS
This review produced surprising results: 1) the generous proportion of patients who underwent medical therapy as first-line treatment for intraventricular NCC (20.8%), and 2) the significant overall mortality. The data found in this review also provided for a strong consensus for the use of postresection antihelminthic therapy, and thus we elected to treat our index case with albendazole, assuming the risk to be low and the potential benefit meaningful.
Topics: Adult; Albendazole; Anthelmintics; Anti-Inflammatory Agents; Cerebral Ventricles; Combined Modality Therapy; Cysts; Dexamethasone; Female; Humans; Magnetic Resonance Imaging; Meningocele; Neurocysticercosis; Neurosurgical Procedures; Postoperative Care; Treatment Outcome
PubMed: 22120374
DOI: 10.1016/j.wneu.2011.05.053 -
Disability and Health Journal Apr 2020We combined literature review and consensus-building methodologies to develop health care guidelines for people with Spina Bifida across the life span.
BACKGROUND
We combined literature review and consensus-building methodologies to develop health care guidelines for people with Spina Bifida across the life span.
OBJECTIVE
The present paper describes the methodology used to update and expand this fourth edition of the Guidelines for the Care of People with Spina Bifida ("Guidelines"). This process was a fundamental initiative within the Spina Bifida Collaborative Care Network.
METHODS
Working groups were formed consisting of international, multidisciplinary teams of clinical and research experts. A systematic review of multiple databases was conducted. The consensus building methodology, One-Text Procedure, was followed to draft and revise documents. Each section of the Guidelines was presented by working group chairs at a face-to-face meeting using the Nominal Group Technique (NGT).
RESULTS
The Level 1 review resulted in 2449 abstracts being reviewed, and the Level 2 review resulted in 874 full text articles being archived for working groups. After working groups added and eliminated articles, a total of 803 manuscripts were included in the bibliography of the Guidelines. The final version of the Guidelines was then released in 2018.
CONCLUSIONS
Evidenced based-research and consensus methodologies were used to develop the fourth edition of the Guidelines. It is hoped that this document will guide not only health care providers, but also patients and families, so that people with Spina Bifida can have the best and most scientifically-based care and treatments throughout ever-longer and higher-quality lives.
Topics: Consensus; Delivery of Health Care; Disabled Persons; Evidence-Based Medicine; Female; Health Services for Persons with Disabilities; Humans; Practice Guidelines as Topic; Quality of Life; Spinal Dysraphism; Systematic Reviews as Topic
PubMed: 31248776
DOI: 10.1016/j.dhjo.2019.06.005