-
Biomechanics and Modeling in... Jun 2022Accurate biomechanical properties of the human dura mater are required for computational models and to fabricate artificial substitutes for transplantation and surgical... (Meta-Analysis)
Meta-Analysis Review
Accurate biomechanical properties of the human dura mater are required for computational models and to fabricate artificial substitutes for transplantation and surgical training purposes. Here, a systematic literature review was performed to summarize the biomechanical properties of the human dura mater that are reported in the literature. Furthermore, anthropometric data, information regarding the mechanically tested samples, and specifications with respect to the used mechanical testing setup were extracted. A meta-analysis was performed to obtain the pooled mean estimate for the elastic modulus, ultimate tensile strength, and strain at maximum force. A total of 17 studies were deemed eligible, which focused on human cranial and spinal dura mater in 13 and 4 cases, respectively. Pooled mean estimates for the elastic modulus (n = 448), the ultimate tensile strength (n = 448), and the strain at maximum force (n = 431) of 68.1 MPa, 7.3 MPa and 14.4% were observed for native cranial dura mater. Gaps in the literature related to the extracted data were identified and future directions for mechanical characterizations of human dura mater were formulated. The main conclusion is that the most commonly used elastic modulus value of 31.5 MPa for the simulation of the human cranial dura mater in computational head models is likely an underestimation and an oversimplification given the morphological diversity of the tissue in different brain regions. Based on the here provided meta-analysis, a stiffer linear elastic modulus of 68 MPa was observed instead. However, further experimental data are essential to confirm its validity.
Topics: Biomechanical Phenomena; Dura Mater; Elastic Modulus; Humans; Mechanical Phenomena; Tensile Strength
PubMed: 35266061
DOI: 10.1007/s10237-022-01566-5 -
Acta Otorrinolaringologica Espanola 2021Hypertrophic pachymeningitis is an infrequent inflammatory disease resulting in thickening and fibrosis of the dura mater. In most cases, the cause in unknown and is... (Review)
Review
BACKGROUND AND OBJECTIVE
Hypertrophic pachymeningitis is an infrequent inflammatory disease resulting in thickening and fibrosis of the dura mater. In most cases, the cause in unknown and is called idiopathic hypertrophic pachymeningitis (IHP). Audiovestibular symptoms are infrequent and the pathogenesis is still unclear.
MATERIALS AND METHODS
A systematic literature review of cases with IHP and vestibular symptoms from 2000 to February 2020 was performed. PRISMA Checklist was followed and PubMED database, Web of Science and Cochrane library were searched. We report a case of an adolescent with a diagnosis of vestibular neuritis in the context of IHP attended in our clinic.
RESULTS
We reviewed 5 articles related to IHP and vestibular disorders. A total of 7 cases (5 women and 2 men), with ages between 27 and 68 years with IHP were found. They all had audiovestibular symptoms. In contrast to our patient, uni or bilateral neurosensorial hearing loss was reported in all cases. Furthermore, there is no other case report published describing the association between IHP and vestibular neuritis. High dose steroids improved symptoms in 85.7% of the patients.
CONCLUSION
Vestibular symptoms in IHP are uncommon and the pathogenesis is still debatable. Entrapment of nerves in the internal auditory canal and secondary neuronal damage could be suspected as the main cause of hearing and vestibular loss.
Topics: Adolescent; Adult; Aged; Dura Mater; Female; Humans; Hypertrophy; Male; Meningitis; Middle Aged
PubMed: 34844678
DOI: 10.1016/j.otoeng.2020.08.006 -
World Neurosurgery Feb 2022Chronic subdural hematoma (CSDH) is a neurologic condition characterized as a hematoma in the subdural space with a period >3 weeks that primarily affects the elderly.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Chronic subdural hematoma (CSDH) is a neurologic condition characterized as a hematoma in the subdural space with a period >3 weeks that primarily affects the elderly. Glucocorticoid, especially dexamethasone, either alone or combined with surgery, has been used to manage CSDH. We aimed to perform an updated systematic review and meta-analysis of the literature regarding the role of steroids in CSDH.
METHODS
We searched the electronic databases PubMed, PubMed Central, Scopus, and Embase for relevant articles until December 2020. Study characteristics, quality, and end points were extracted, and analysis was performed by RevMan 5.4.
RESULTS
The odds for subdural hematoma recurrence were decreased by 61% in the steroid group (odds ratio [OR], 0.39; confidence interval [CI], 0.19-0.79) compared with the control group. There was no significant difference in mortality during the study period (OR, 0.66; CI, 0.20-2.18), modified Rankin Scale score 0-3 (OR, 0.87; CI, 0.31-2.40), and modified Rankin Scale score 4-6 (OR, 1.15; CI, 0.42-3.18) between the 2 groups. However, pooling data from 3 studies showed 2.7 times higher odds of occurring adverse effects in steroid groups using the fixed-effect model (OR, 2.70; CI, 1.71-4.28). The treatment success was similar between the steroid and control groups (OR, 2.39; CI, 0.94-6.04).
CONCLUSIONS
Treatment with steroids was associated with a lesser recurrence of CSDH. However, there was no benefit of steroid treatment in CSDH compared with nonsteroid treatment in terms of mortality and treatment success and some but significantly increased risk of adverse events.
Topics: Aged; Glucocorticoids; Hematoma, Subdural, Chronic; Humans; Recurrence; Steroids; Subdural Space
PubMed: 34728401
DOI: 10.1016/j.wneu.2021.10.167 -
Surgical and Radiologic Anatomy : SRA Nov 2021The maxillary artery (MA) is one of the terminal branches of the external carotid artery (ECA) and through its branches, it is responsible for vascularizing several... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The maxillary artery (MA) is one of the terminal branches of the external carotid artery (ECA) and through its branches, it is responsible for vascularizing several organs and muscles of the head and neck, including their surrounding soft tissues, the oral and sinonasal cavities, dura mater, and various cranial nerves. The aim of this study was to conduct a systematic review and meta-analysis of maxillary artery anatomy according to the Anatomical Quality Assurance (AQUA) checklist.
METHODS
We conducted a systematic search through PubMed, EMBASE, Scopus, ScienceDirect, Web of Science, SciELO, Springerlink, WILEY and BIREME databases. We applied the Anatomical Quality Assurance (AQUA) checklist for analysis the methodological quality of the articles.
RESULTS
From a total of 11,759 articles found in the first search, and after applying the inclusion/exclusion criteria, in addition to eliminating duplicate articles, a final number of 24 articles were identified. The information on the maxillary artery was analyzed from each study regarding its course in relation to the lateral pterygoid muscle, the intra- and extraluminal diameters of the maxillary artery and its branches, and the types of branching of the maxillary artery in the pterygopalatine fossa.
CONCLUSION
From this study, it was possible to conclude the importance of anatomical knowledge of the maxillary artery, for its application in the clinical study of the head and neck, as well as the need to apply the AQUA checklist in the development of systematic anatomical reviews to ensure accurate reliability and a better assessment of the effect of anatomical publications.
Topics: Checklist; Humans; Maxillary Artery; Pterygoid Muscles; Pterygopalatine Fossa; Reproducibility of Results
PubMed: 34480213
DOI: 10.1007/s00276-021-02825-3 -
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 -
Acta Otorrinolaringologica Espanola Feb 2021Hypertrophic pachymeningitis is an infrequent inflammatory disease resulting in thickening and fibrosis of the dura mater. In most cases, the cause in unknown and is... (Review)
Review
BACKGROUND AND OBJECTIVE
Hypertrophic pachymeningitis is an infrequent inflammatory disease resulting in thickening and fibrosis of the dura mater. In most cases, the cause in unknown and is called idiopathic hypertrophic pachymeningitis (IHP). Audiovestibular symptoms are infrequent and the pathogenesis is still unclear.
MATERIALS AND METHODS
A systematic literature review of cases with IHP and vestibular symptoms from 2000 to February 2020 was performed. PRISMA Checklist was followed and PubMED database, Web of Science and Cochrane library were searched. We report a case of an adolescent with a diagnosis of vestibular neuritis in the context of IHP attended in our clinic.
RESULTS
We reviewed 5 articles related to IHP and vestibular disorders. A total of 7 cases (5 women and 2 men), with ages between 27 and 68 years with IHP were found. They all had audiovestibular symptoms. In contrast to our patient, uni or bilateral neurosensorial hearing loss was reported in all cases. Furthermore, there is no other case report published describing the association between IHP and vestibular neuritis. High dose steroids improved symptoms in 85.7% of the patients.
CONCLUSION
Vestibular symptoms in IHP are uncommon and the pathogenesis is still debatable. Entrapment of nerves in the internal auditory canal and secondary neuronal damage could be suspected as the main cause of hearing and vestibular loss.
PubMed: 33648724
DOI: 10.1016/j.otorri.2020.08.008 -
World Neurosurgery May 2021Incidental or intentional durotomy in spine surgery is associated with a risk of cerebrospinal fluid (CSF) leakage and reoperation. Several strategies have been...
BACKGROUND
Incidental or intentional durotomy in spine surgery is associated with a risk of cerebrospinal fluid (CSF) leakage and reoperation. Several strategies have been introduced, but the incomplete closure is still relatively frequent and troublesome. In this study, we review current evidence on spinal dural repair strategies and evaluate their efficacy.
METHODS
PubMed, Web of Science, and Scopus were used to search primary studies about the repair of the spinal dura with different techniques. Of 265 articles found, 11 studies, which specified repair techniques and postoperative outcomes, were included for qualitative and quantitative analysis. The primary outcomes were CSF leakage and postoperative infection.
RESULTS
The outcomes of different dural repair techniques were available in 776 cases. Pooled analysis of 11 studies demonstrated that the most commonly used technique was a combination of primary closure, patch or graft, and sealant (22.7%, 176/776). A combination of primary closure and patch or graft resulted in the lowest rate of CSF leakage (5.5%, 7/128). In this study, sealants as an adjunct to primary closure (13.7%, 18/131) did not significantly reduce the rate of CSF leakage compared with primary closure alone (17.6%, 18/102). The rates of infection and postoperative neurologic deficit were similar regardless of the repair techniques.
CONCLUSIONS
Although the use of sealants has become prevalent, available sealants as an adjunct to primary closure did not reduce the rate of CSF leakage compared with primary closure. The combination of primary closure and patches or grafts could be effective in decreasing postoperative CSF leakage.
Topics: Cerebrospinal Fluid Leak; Dura Mater; Humans; Neurosurgical Procedures; Postoperative Complications; Reoperation; Spinal Diseases; Spine; Tissue Adhesives; Tissue Transplantation; Treatment Outcome
PubMed: 33640528
DOI: 10.1016/j.wneu.2021.02.079 -
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 -
World Neurosurgery Apr 2021The anatomy and spatial relationships of the dural sac comprising the Meckel cave (MC) and its ensheathed trigeminal ganglion (TG) are exceedingly intricate and complex....
BACKGROUND
The anatomy and spatial relationships of the dural sac comprising the Meckel cave (MC) and its ensheathed trigeminal ganglion (TG) are exceedingly intricate and complex. There are conflicting accounts in the literature regarding the dural configuration of the MC around the ganglion and the dual embryology of the MC and TG is still unclear.
METHODS
A combined systematic and narrative literature review was conducted to collate articles addressing MC and TG anatomy, in addition to their embryology, role in tumor spread, somatotopy, and association with trigeminal neuralgia.
RESULTS
Three key anatomic models by Paturet (1964), Lazorthes (1973), and Lang and Ferner (1983) have been put forward to show the arrangement of the MC around the TG. The TG is formed from both neural crest and placodal cells and drags the enveloping dura caudally to form the MC prolongation during development. Both a mediolateral and dorsoventral somatotopic arrangement of neurons exists in the TG, which corresponds to the 3 nerve divisions, of which V2 and V3 are prone to perineural tumor spread along their course.
CONCLUSIONS
Sound knowledge concerning the dural arrangement of the MC and the trigeminal divisions will be invaluable in optimally treating cancers in this region, and understanding TG somatotopy will immensely improve treatment of trigeminal neuralgia in terms of specificity, efficacy, and positive patient outcomes.
Topics: Cranial Fossa, Posterior; Dura Mater; Humans; Neurosurgical Procedures; Trigeminal Ganglion; Trigeminal Neuralgia
PubMed: 33516868
DOI: 10.1016/j.wneu.2021.01.081 -
World Neurosurgery Mar 2021Surgery is the definitive treatment option for symptomatic Chiari malformation I (CMI), but there is no clear consensus as to the preferred surgical method. This study... (Comparative Study)
Comparative Study Meta-Analysis
Outcomes of Dura Splitting Decompression Versus Posterior Fossa Decompression With Duraplasty in the Treatment of Chiari I Malformation: A Systematic Review and Meta-analysis.
BACKGROUND
Surgery is the definitive treatment option for symptomatic Chiari malformation I (CMI), but there is no clear consensus as to the preferred surgical method. This study aimed to quantitatively assess and compare the effect and safety of dura splitting decompression (DSD) and posterior fossa decompression with duraplasty (PFDD) in treating patients with CMI.
METHODS
A literature search of EMBASE, MEDLINE, PubMed, Cochrane Library, and Web of Science databases was conducted. References from January 1990 to September 2020 were retrieved. We only included papers containing original data, comparing the use of DSD and PFDD in CMI patients.
RESULTS
Overall, 11 relevant studies were identified, wherein 443 patients treated for CMI by DSD were compared with 261 patients treated by PFDD. No difference was observed between PFDD and PFD in terms of clinical improvement (P = 0.69), syringomyelia improvement (P = 0.90), or reoperation (P = 0.22). DSD was associated with shorter operation durations (P = 0.0007), shorter length of stay (P = 0.0007), and shorter overall postoperative complications (P < 0.0001) (especially cerebrospinal fluid [CSF] leak [P = 0.005], meningitis [P = 0.002], and pseudomeningocele [P = 0.002]), as compared with PFDD.
CONCLUSIONS
This study confirmed that dura splitting decompression has clinical and syringomyelia improvement outcomes comparable to posterior fossa decompression with duraplasty. Compared with PFDD, DSD not only significantly shortened the operation time and length of stay, but also significantly reduced the overall complication rate, especially those related to incidence of CSF-related complications. More evidence from advanced multicenter studies are needed to require to validate the findings.
Topics: Arnold-Chiari Malformation; Cerebrospinal Fluid Leak; Cranial Fossa, Posterior; Decompression, Surgical; Dura Mater; Epidural Space; Humans; Length of Stay; Meningitis; Neurosurgical Procedures; Operative Time; Postoperative Complications; Reoperation; Surgical Wound Infection; Syringomyelia; Treatment Outcome
PubMed: 33290896
DOI: 10.1016/j.wneu.2020.11.163