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Spine Jan 2017Systematic review. (Review)
Review
STUDY DESIGN
Systematic review.
OBJECTIVE
To elucidate the existence of soft tissue connections between the neck muscles and cervical dura mater.
SUMMARY OF BACKGROUND DATA
Several studies discuss the existence of a cervical myodural bridge; however, conflicting data have been reported.
METHODS
Searches were conducted in the PubMed, Web of Science, Cochrane Library, and PEDro databases. Studies reporting original data regarding the continuity of non-post-surgical soft tissue between the cervical muscles and dura mater were reviewed. Two reviewers independently selected articles, and a third one resolved disagreements. Another two researchers extracted the methodology of the study, the anatomical findings, and evaluated the quality of the studies using Quality Appraisal for Cadaveric Studies Scale. A different third researcher resolved disagreements.
RESULTS
Twenty-six studies were included. A soft tissue connection between the rectus capitis posterior minor, the rectus capitis posterior major, and the obliquus capitis inferior muscles seems to be proved with a strong level of evidence for each one of them. Controversy exists about the possible communication between the dura mater and the upper trapezius, rhomboideus minor, serratus posterior superior, and splenius capitis by means of the ligamentum nuchae. Finally, there is limited evidence about the existence of a soft tissue connection between rectus capitis anterior muscle and the dura mater.
CONCLUSION
There is a continuity of soft tissue between the cervical musculature and the cervical dura mater; this might have physiological, pathophysiological, and therapeutic implications, and going some way to explaining the effect of some therapies in craniocervical disorders.
LEVEL OF EVIDENCE
N/A.
Topics: Connective Tissue; Dura Mater; Fascia; Humans; Neck Muscles
PubMed: 27116115
DOI: 10.1097/BRS.0000000000001655 -
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 -
Clinical Neurology and Neurosurgery Oct 2014Posterior fossa decompression is carried out to improve passage of cerebrospinal fluid (CSF) in patients with symptomatic Chiari 1 malformations (CM1), but the extent... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Posterior fossa decompression is carried out to improve passage of cerebrospinal fluid (CSF) in patients with symptomatic Chiari 1 malformations (CM1), but the extent and means of decompression remains controversial. Dural opening with subsequent duraplasty may contribute to clinical outcome, but may also increase complication risk. The aim of this systematic review and meta-analysis is to assess the effects of durotomy with subsequent duraplasty on clinical outcome in surgical treatment of adults with CM1.
DATA SOURCES AND STUDY ELIGIBILITY CRITERIA
We systematically searched MEDLINE, Embase and CENTRAL, and screened references in relevant articles and in UpToDate. Publications with previously untreated adults (>15 years) with CM1 with or without associated syringomyelia, treated in the period 1990-2013 were eligible.
INTERVENTIONS
Posterior fossa decompression with duraplasty (PFDD group) was compared to posterior fossa decompression with bony decompression alone (PFD group).
RESULTS
The search retrieved 233 articles. After the review we included 12 articles, but only 4 articles included posterior fossa decompression with both techniques. Only 2 out of 12 studies were prospective. The odds ratio (OR) for reoperation was 0.15 (95% CI 0.05-0.49) in the PFDD group compared to PFD (p=0.002). The OR of clinical failure at follow-up was 1.06 (95% CI 0.52-2.14) for PFDD compared to PFD (p=0.88). There was also no difference in syringomyelia improvement between techniques (p=0.60). The OR for CSF-related complications were 6.12 (95% CI 0.37-101.83) for PFDD compared to PFD (p=0.21).
CONCLUSION
This systematic review of observational studies reveals higher reoperation rates after bony decompression alone, but clinical improvement was not higher after primary decompression with duraplasty. There are so far no high-quality studies that offer guidance in the choice of decompressive technique in adult CM1 patients. We think that a randomized controlled trial on this topic is both needed and feasible.
Topics: Adult; Arnold-Chiari Malformation; Decompression, Surgical; Dura Mater; Humans; Observational Studies as Topic; Postoperative Complications; Syringomyelia; Treatment Outcome
PubMed: 25087160
DOI: 10.1016/j.clineuro.2014.07.019 -
Clinical Endocrinology Dec 2013Headache is very common in pituitary disease and is reported to be present in more than a third of all patients with pituitary adenomas. Tumour size, cavernous sinus... (Review)
Review
Headache is very common in pituitary disease and is reported to be present in more than a third of all patients with pituitary adenomas. Tumour size, cavernous sinus invasion, traction or displacement of intracranial pain-sensitive structures such as blood vessels, cranial nerves and dura mater, and hormonal hypersecretion are implicated causes. The present review attempts to systematically review the literature for any combination of headache and pituitary or hormone overproduction or deficiency. Most data available are retrospective and/or not based on the International Headache Society (IHS) classification. Whereas in pituitary apoplexy a mechanical component explains the almost universal association of the condition with headaches, this correlation is less clear in other forms of pituitary disease and a positive impact of surgery on headaches is not guaranteed. Similarly, invasion into the cavernous sinus or local inflammatory changes have been linked to headaches without convincing evidence. Some studies suggest that oversecretion of GH and prolactin may be important for the development of headaches, and treatment, particularly with somatostatin analogues, has been shown to improve symptoms in these patients. Otherwise, treatment rests on general treatment options for headaches based on an accurate clinical history and a precise classification which includes assessment of the patient's psychosocial risk factors.
Topics: Adenoma; Biomechanical Phenomena; Dopamine Agonists; Headache; Human Growth Hormone; Humans; Pituitary Apoplexy; Pituitary Diseases; Pituitary Neoplasms; Prolactin; Somatostatin
PubMed: 23941570
DOI: 10.1111/cen.12314 -
Minerva Anestesiologica Oct 2013Accidental dural puncture (ADP) after epidural analgesia (EDA) for labor pain may cause severe postdural puncture headache (PDPH) and may prolong hospital stay. We aimed... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Accidental dural puncture (ADP) after epidural analgesia (EDA) for labor pain may cause severe postdural puncture headache (PDPH) and may prolong hospital stay. We aimed to identify techniques that reduce the incidence of ADP.
METHODS
A systematic literature search was performed. Data on the occurrence of ADP and PDPH were extracted and subjected to meta-analysis. The random effects model was applied. Risk ratios (RR) and 95% confidence intervals (CI) were calculated.
RESULTS
We identified 54 articles, 13 non-randomized controlled trials and 41 randomized controlled trials (RCTs), reporting on a total of 98,869 patients. In non-RCTs, the use of liquid for the identification of the epidural space was associated with a reduced risk of ADP compared to the use of air (RR 0.55, 95% CI 0.39 to 0.79, P=0.001). In our analysis of RCTs this comparison did not produce a significant difference. No effect was found for combined spinal-epidural analgesia, maternal position, type of the catheter, needle size, bevel direction, operator experience, or use of ultrasound.
CONCLUSION
A reduction of the risk of ADP was found for liquid use for the loss of resistance, but only in lower quality studies. Based on current evidence, we cannot make a recommendation regarding any of the techniques under study. Therefore, clinicians should focus on measures to prevent or treat PDPH once ADP has occurred.
Topics: Adult; Analgesia, Epidural; Analgesia, Obstetrical; Clinical Trials as Topic; Dura Mater; Female; Humans; Intraoperative Complications; Post-Dural Puncture Headache; Pregnancy; Randomized Controlled Trials as Topic; Retrospective Studies
PubMed: 23857441
DOI: No ID Found -
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 -
Leukemia & Lymphoma Oct 2013
Review
Topics: Adult; Aged; Antigens, CD20; Biomarkers; Dura Mater; Female; Humans; Immunohistochemistry; Lymphocytes, Tumor-Infiltrating; Lymphoma, B-Cell, Marginal Zone; Male; Middle Aged
PubMed: 23363270
DOI: 10.3109/10428194.2013.771399 -
Epilepsia May 2013Implantation of subdural grids and invasive electroencephalography (EEG) monitoring is important to define the ictal-onset zone and eloquent cortex in selected patients... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Implantation of subdural grids and invasive electroencephalography (EEG) monitoring is important to define the ictal-onset zone and eloquent cortex in selected patients with medically refractory epilepsy. The objective of this systematic review is to summarize data about adverse events related to this procedure.
METHODS
English-language studies published up to July 2012, reporting such adverse events were reviewed. Outcome measures included demographic variables; surgical protocol including number of subdural electrodes implanted per patient, duration of monitoring, antibiotic, and steroid prophylaxis; and adverse events.
KEY FINDINGS
Twenty-one studies were identified including a total of 2,542 patients. The reported mean number of electrodes per patient and duration of monitoring varied from 52 to 95 and 5 to 17 days, respectively. There is a trend toward more uniform use of antibiotics and steroids in the perioperative period. Neurologic infections (pooled prevalence 2.3%, 95% confidence interval 1.5-3.1), superficial infections (3.0%, 1.9-4.1), intracranial hemorrhage (4.0%, 3.2-4.8), and elevated intracranial pressure (2.4%, 1.5-3.3) were found to be the most common adverse events. Up to 3.5% of patients required additional surgical procedure(s) for management of these adverse events. Increased number of electrodes (≥67) was found to be independently associated with increased incidence of adverse events.
SIGNIFICANCE
Although providing critical information for patients with medically refractory epilepsy, subdural grids implantation and invasive EEG monitoring entails risks of infection, hemorrhage, and elevated intracranial pressure. The prevalence estimates, likely to be conservative due to selective reporting, are expected to be helpful in counseling patients.
Topics: Databases, Factual; Electroencephalography; Epilepsy; Female; Humans; Magnetic Resonance Imaging; Male; Monitoring, Physiologic; Postoperative Complications; Subdural Space; Time Factors
PubMed: 23294329
DOI: 10.1111/epi.12073 -
Plastic and Reconstructive Surgery Nov 2012The use of acellular dermal matrices has been well described in the scientific literature since the early 1990 s and has been utilized for multiple applications in the... (Review)
Review
BACKGROUND
The use of acellular dermal matrices has been well described in the scientific literature since the early 1990 s and has been utilized for multiple applications in the head and neck for both aesthetic and reconstructive efforts.
METHODS
After systematically searching the PubMed database and following further refinement (based on the authors' inclusion and exclusion criteria), the authors identified 30 studies that provided information about patients who had undergone head and neck reconstruction with the use of acellular dermal matrix. Studies had to report quantifiable objective results in patients who were older than 1 year and younger than 90 years. The authors excluded single case reports, studies with fewer than 10 patients, and studies not published in English.
RESULTS
The optimal material used as an implant for reconstruction possesses the following properties: facilitation of vascular ingrowth, decreased propensity to incite inflammation, biologic inertness, resistance to infection, and ease of handling. Acellular dermal matrix possesses many of these properties and is utilized in reconstructing nasal soft tissue and skeletal support, tympanic membrane, periorbital soft tissue, extraoral and intraoral defects, oropharyngeal defects, dura mater, and soft-tissue deficits from parotidectomy. Furthermore, it is used to assist in preventing Frey syndrome following parotidectomy and surgical treatment of facial paralysis.
CONCLUSIONS
Use of acellular dermal matrix for head and neck reconstruction has expanded exponentially and is validated in many studies. Further prospective randomized control trials are warranted to further investigate the efficacy of acellular dermal matrix in head and neck reconstruction.
Topics: Absorbable Implants; Acellular Dermis; Collagen; Ear; Esthetics; Face; Head; Humans; Neck; Ophthalmologic Surgical Procedures; Oral Surgical Procedures; Parotid Gland; Postoperative Complications; Plastic Surgery Procedures; Rhinoplasty; Treatment Outcome
PubMed: 23096983
DOI: 10.1097/PRS.0b013e31825eff7a -
Child's Nervous System : ChNS :... Jan 2013Positioned anatomically between the spinal epidural space and the intramedullary compartment, the spinal subdural space remains the least common area of localized... (Review)
Review
INTRODUCTION
Positioned anatomically between the spinal epidural space and the intramedullary compartment, the spinal subdural space remains the least common area of localized infection in the central nervous system. Infectious processes of the subdural spinal space include subdural spinal empyema, subdural spinal abscess, infected spinal subdural cyst, and infectious spinal subdural cyst. To date, there has been no systematic review of these entities in children, with the cumulative knowledge of the pathophysiologic, microbiologic, and demographic characteristics of these infections relegated solely to few small series and case reports.
METHODS
A series of 11 recent cases culled from the collaboration of international authors are presented. In addition, an exhaustive MEDLINE search and manual review of the international literature was performed, identifying a total of 73 cases of spinal subdural infections in patients under the age of 21. Data of interest include the age, sex, signs, and symptoms at presentation, spinal location of infection, presence of spinal dysraphism, and other comorbidities, offending organism, treatment, outcome, and follow-up.
RESULTS
Patients ages ranged from 4 weeks to 20 years (mean, 6.5 years). Males outnumbered females by a ratio of 2:1. Over half (53 %) of spinal subdural infections in children were associated with spinal dysraphism or other congenital abnormalities of the spine. The commonest organism to infect the spinal subdural space in children is mycobacterium tuberculosis and the thoracic spinal region was most commonly infected.
CONCLUSIONS
The disease is usually treated surgically, although a more expectant approach consisting of antibiotics and observation has also been proposed.
Topics: Adolescent; Adult; Africa; Child; Child, Preschool; Female; Humans; Infant; International Cooperation; MEDLINE; Male; Meningitis; Spinal Cord; Spinal Cord Diseases; Subdural Space; Young Adult
PubMed: 23053357
DOI: 10.1007/s00381-012-1916-4