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Neurosurgical Review Oct 2021Foramen magnum meningiomas (FMMs) account for 1.8-3.2% of all meningiomas. With this systematic review and meta-analysis, our goal is to detail epidemiology, clinical... (Meta-Analysis)
Meta-Analysis Review
Foramen magnum meningiomas (FMMs) account for 1.8-3.2% of all meningiomas. With this systematic review and meta-analysis, our goal is to detail epidemiology, clinical features, surgical aspects, and outcomes of this rare pathology. Using PRISMA 2015 guidelines, we reviewed case series, mixed series, or retrospective observational cohorts with description of surgical technique, patient and lesion characteristics, and pre- and postoperative clinical status. A meta-analysis was performed to search for correlations between meningioma characteristics and rate of gross total resection (GTR). We considered 33 retrospective studies or case series, including 1053 patients, mostly females (53.8%), with a mean age of 52 years. The mean follow-up was of 51 months (range 0-258 months). 65.6% of meningiomas were anterior, and the mean diameter was of 29 mm, treated with different surgical approaches. Postoperatively, 17.2% suffered complications (both surgery- and non-surgery-related) and 2.5% had a recurrence. The Karnofsky performance score improved in average after surgical treatment (75 vs. 81, p < 0.001). Our meta-analysis shows significant rates of GTR in cohorts with a majority of posterior and laterally located FMM (p = 0.025) and with a mean tumor less than 25 mm (p < 0.05). FMM is a rare and challenging pathology whose treatment should be multidisciplinary, focusing on quality of life. Surgery still remains the gold standard and aim at maximal resection with neurological function preservation. Adjuvant therapies are needed in case of subtotal removal, non-grade I lesions, or recurrence. Specific risk factors for recurrence, other than Simpson grading, need further research.
Topics: Female; Foramen Magnum; Humans; Male; Meningeal Neoplasms; Meningioma; Middle Aged; Neoplasm Recurrence, Local; Neurosurgical Procedures; Quality of Life; Retrospective Studies; Treatment Outcome
PubMed: 33507444
DOI: 10.1007/s10143-021-01478-5 -
Neurosurgical Review Jun 2021Chiari malformation type I is a developmental abnormality with an array of surgical techniques introduced for the management of it. The most common technique is foramen... (Comparative Study)
Comparative Study Meta-Analysis
Chiari malformation type I is a developmental abnormality with an array of surgical techniques introduced for the management of it. The most common technique is foramen magnum decompression with duraplasty. Dura-splitting technique as one of the non-dura-opening techniques is a less known procedure that spares the internal layer of the dura and can theoretically result in fewer complications compared to duraplasty. So, we performed a review of literature and meta-analysis on different clinical and radiological aspects of this technique and compared its outcomes to duraplasty. MOOSE guidelines were followed. A systematic search of three databases based on predefined search strategy and inclusion/exclusion criteria was performed. After quality assessment and data extraction by two authors, summarized data were presented in form of tables, and meta-analysis results were illustrated in forest plots. A review of 10 included studies consisting of 370 patients revealed significantly shorter operation duration and less intraoperative blood loss in the dura-splitting technique compared to duraplasty. Interestingly, there was no significant difference between these two techniques in terms of clinical and radiological outcomes. Overall complication rate and incidence of CSF-related complications or infections were significantly in favor of the dura-splitting technique. Dura-splitting technique can be considered as a safe and effective surgical procedure for Chiari I malformation with comparable outcomes and fewer complications compared to duraplasty, although this interpretation is derived from retrospective observational studies and lack of a prospective clinical trial is evident.
Topics: Arnold-Chiari Malformation; Blood Loss, Surgical; Databases, Factual; Decompression, Surgical; Dura Mater; Foramen Magnum; Humans; Observational Studies as Topic; Plastic Surgery Procedures; Retrospective Studies; Treatment Outcome
PubMed: 32567026
DOI: 10.1007/s10143-020-01334-y -
Clinical Neurology and Neurosurgery Sep 2020To date, the literature directly comparing the translabyrinthine approach and retrosigmoid approach in the operation of patients with vestibular schwannoma was limited.... (Comparative Study)
Comparative Study Meta-Analysis
BACKGROUND
To date, the literature directly comparing the translabyrinthine approach and retrosigmoid approach in the operation of patients with vestibular schwannoma was limited. We aimed to evaluate postoperative complications between translabyrinthine approach and retrosigmoid approach for treating vestibular schwannoma patients.
MATERIAL AND METHOD
Potential publications were selected from PubMed, Web of Science and Cochrane Library. Gray relevant studies were manually searched. We set the searching time spanning from the creation date of electronic engines to February 2020. STATA version 12.0 was exerted to process the pooled data.
RESULTS
A total of 9 literature included in the study, involving 2429 patients, hails from the Germany, USA, Canada, Italy, and France. Of these 2429 patients with vestibular schwannoma, there were 1628 cases from the translabyrinthine approach group versus 801 cases from the retrosigmoid approach group. The results demonstrated that the translabyrinthine approach group was associated with a lower rate of tinnitus (OR = 2.687; 95 %CI, 1.167-6.191; P = 0.02) and cranial nerve deficit (OR = 2.946; 95 %CI, 1.562-5.557; P = 0.001). And the translabyrinthine approach group was associated with a higher total resection rate (OR = 0.246; 95 %CI (0.071-0.848); P = 0.026). However, no statistic differences were found in the incidence of the near total (OR = 0.751; P = 0.351), subtotal resection (OR = 3.664; P = 0.109), postoperative facial nerve dysfunctions (OR, 0.763; P = 0.626), postoperative meningitis (OR = 2.7; P = 0.279), cerebrospinal fluid leak (OR = 1.225; P = 0.777), postoperative headache (OR = 1.412; P = 0.339), ophthalmic complications (OR = 0.87; P = 0.59), and vascular complications (OR = 2.501; P = 0.139).
CONCLUSION
Based on current evidence, the translabyrinthine approach was associated with a higher rate of total resection and a lower rate of the tinnitus and cranial nerve deficit. But the risk of cranial nerve deficit was clearly affected by the preoperative status. And a translabyrintine approach could imply a complete sensorineural hearing loss, which contribute to the lower rate of postoperative tinnitus. Consequently, more evidence-based researches are needed to supplement this opinion.
Topics: Cerebrospinal Fluid Leak; Cranial Nerve Injuries; Craniotomy; Headache Disorders, Secondary; Humans; Incidence; Meningitis; Neuroma, Acoustic; Observational Studies as Topic; Occipital Bone; Postoperative Complications; Randomized Controlled Trials as Topic; Tinnitus; Treatment Outcome; Vascular Diseases; Vestibule, Labyrinth; Vision Disorders
PubMed: 32540713
DOI: 10.1016/j.clineuro.2020.105994 -
International Orthopaedics Jul 2020The diagnosis of instability of the injured upper cervical spine remains controversial, due to its complicated anatomical configuration and biomechanical property. Since... (Review)
Review
OBJECTIVE
The diagnosis of instability of the injured upper cervical spine remains controversial, due to its complicated anatomical configuration and biomechanical property. Since identifying unstable injuries of the upper cervical spine is essential for immediate stabilizing therapy, this article reviews the current classification systems of upper cervical spine injuries and their statements towards instability.
METHODS
A systematic review of literature concerning upper cervical spine injuries was performed on the PubMed database from inception to December 2019. An English literature search was conducted using various combinations of keyword terms.
RESULTS
Numerous separate classification systems for each specific injury of the upper cervical spine were obtained. The early classifications are based primarily on injury morphology and mechanism. The recent classifications pay more attention to the investigation of ligamentous status. Various instability criteria were established as well. The determinants involve translation, vertical distraction, angulation, rotation, obliquity of fracture line, comminution, and ligamentous disruption. The status of crucial ligaments plays a key role in determining instability of upper cervical spine injuries. CT scan is more sensitive and reliable than X-ray in detecting misalignment of the upper cervical spine.
CONCLUSION
Only a few classification systems support decision-making concerning instability leading to early operative treatment. The ligamentous integrity is the key element of impacting the stability of the upper cervical spine injuries. The transverse ligament serves as the most crucial element in determining the stability of occipital condyle fractures and atlas fractures as well as atlanto-axial injury. The integrity of anterior longitudinal ligament, disc, and facet joint attributes to the stability of axis fractures. The integrity of tectorial membrane and alar ligaments determines the stability of atlanto-occipital dislocation. The development of a newly classification system concerning ligamentous instability with a high clinical and scientific impact is recommended.
Topics: Cervical Vertebrae; Fractures, Bone; Humans; Joint Dislocations; Ligaments, Articular; Spinal Injuries
PubMed: 32451654
DOI: 10.1007/s00264-020-04593-y -
World Neurosurgery Jun 2020Chiari malformation (CM) is defined as a herniation of cerebellar tonsils below the foramen magnum and is considered to be due to underdevelopment of posterior fossa... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Chiari malformation (CM) is defined as a herniation of cerebellar tonsils below the foramen magnum and is considered to be due to underdevelopment of posterior fossa (PF) bone components. There is overcrowding of neural structures, and normal cerebrospinal fluid circulation is frequently blocked. Although several publications exist of measurements of dimensions and volumes from bone components of PF in CM, there is no systematic review evaluating quantitatively these dimensions. The aim of this study was to evaluate PF dimensions and volumes in a meta-analysis.
METHODS
An electronic search using PubMed and Google Scholar was done. Study eligibility criteria were defined by the PICO strategy, which selected patients and interventions. Studies comparing PF dimensions between patients with CM and normal subjects were selected. A meta-analysis of pooled data was done using statistical software.
RESULTS
Data for pooled analysis were obtained from 12 studies. Data synthesis was based on small published sample sizes in the majority of studies. Key findings included smaller measurements of clivus, supraoccipital bone, and PF area dimensions in patients with CM compared with normal subjects. Brainstem and cerebellar length was not different between groups.
CONCLUSIONS
This review provides evidence of smaller measurements of clivus, supraoccipital bone, and PF area dimensions in patients with CM compared with normal subjects. An implication of the key findings is that surgical treatment of CMs should consider the smaller dimensions of PF in planning.
Topics: Arnold-Chiari Malformation; Case-Control Studies; Cephalometry; Cranial Fossa, Posterior; Humans; Magnetic Resonance Imaging; Occipital Bone; Organ Size; Platybasia; Reference Values; Tomography, X-Ray Computed
PubMed: 32156591
DOI: 10.1016/j.wneu.2020.02.182 -
Ciencia & Saude Coletiva Feb 2020The scope of this article is to analyze the concept of the Zika Virus Congenital Syndrome. It is a conceptual analysis, based on Walker and Avant. In order to...
The scope of this article is to analyze the concept of the Zika Virus Congenital Syndrome. It is a conceptual analysis, based on Walker and Avant. In order to operationalize the search, a systematic review was conducted. The essence of the concept of the Zika Virus Congenital Syndrome is determined by the following attributes: intracranial calcification, ventriculomegaly, and diminished brain volume. For this syndrome to occur, it is necessary to have the following antecedents: transplacental transmission of a mother infected by the bite of the Aedes SSP mosquito or by sexual contact. Accordingly, this entails a set of signs and symptoms that go beyond fetal or postnatal microcephaly, such as, for example, delayed neuropsychomotor development, auditory and visual abnormalities, craniofacial disproportion, overlapping cranial sutures, prominent occipital bone, excess nuchal skin, epilepsy, irritability, dyskinesia, hypertonia, hypotonia, hemiplegia, hemiparesis, spasticity and hyperreflexia. The concept of the Zika Virus Congenital Syndrome is newly acknowledged. The presence of the set of signs and symptoms by the Zika Virus Congenital Syndrome is determined by intracranial calcification and decreased brain volume, and the baby may present microcephaly at birth or subsequently.
Topics: Calcinosis; Female; Humans; Infant, Newborn; Infectious Disease Transmission, Vertical; Microcephaly; Pregnancy; Pregnancy Complications, Infectious; Zika Virus Infection
PubMed: 32022196
DOI: 10.1590/1413-81232020252.30002017 -
Neurosurgical Review Feb 2021Foramen magnum decompression (FMD) is widely accepted as the standard treatment for syringomyelia associated with Chiari type I malformation (CMI). Despite extensive... (Meta-Analysis)
Meta-Analysis
Foramen magnum decompression (FMD) is widely accepted as the standard treatment for syringomyelia associated with Chiari type I malformation (CMI). Despite extensive clinical investigations, relevant surgical details are still matter of debate. The authors performed a systematic review and meta-analysis of the literature examining the radiological outcome of syringomyelia in adult patients with CMI after different surgical strategies. PRISMA guidelines were followed. A systematic search of three databases was performed for studies published between 1990 and 2018. Our systematic review included 13 studies with a total of 276 patients with CMI associated with syringomyelia. Overall, the rate of post-operative radiological improvement at last follow-up was 81.1% (95% CI 73.3-88.9%; p < 0.001; I = 71.4%). The rate of post-operative syrinx shrinkage did not differ significantly among both groups of decompression with the extra-arachnoidal technique and arachnoid dissection (90%, 95% CI 85.1-94.8%, I = 0% vs 79.8%, 95% CI 61.7-98%, I = 85.5%). A lower rate of post-operative radiological syrinx shrinkage was observed after decompression with splitting of the outer layer of the dura (55.6% 95% CI 40.5-70.8%, I = 0%). CSF-related complications and infections were similar among the different groups. Our meta-analysis found that FMD with the extra-arachnoidal technique and arachnoid dissection provides similar results in terms of post-operative shrinkage of syringomyelia. Patients undergoing decompression with splitting of the dura presented the lower rate of syrinx reduction. These data should be considered when choosing the surgical approach in adult patients with CMI associated with syringomyelia.
Topics: Arnold-Chiari Malformation; Decompression, Surgical; Foramen Magnum; Humans; Neurosurgical Procedures; Syringomyelia; Treatment Outcome
PubMed: 31953784
DOI: 10.1007/s10143-020-01239-w -
Archives of Gynecology and Obstetrics Feb 2020Despite the well-known second trimester ultrasound signs, current possibilities of in utero surgical repair of open spina bifida require a timely detection of the spine... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Despite the well-known second trimester ultrasound signs, current possibilities of in utero surgical repair of open spina bifida require a timely detection of the spine defect.
OBJECTIVE
To evaluate the diagnostic accuracy of the ratio between brain stem (BS) diameter and its distance to the occipital bone (BSOB) (BS/BSOB ratio) in the detection of fetuses with open spina bifida at first trimester ultrasound.
METHODS
A systematic review and meta-analysis of diagnostic accuracy was performed by searching seven electronic databases from their inception to February 2019 for all studies assessing the association between BS/BSOB ratio and diagnosis of spine bifida. Diagnostic accuracy of BS/BSOB ratio in prenatal diagnosis of spine bifida was assessed as sensitivity, specificity, positive and negative likelihood ratios (LR + and LR-), and area under the curve (AUC) on SROC curves.
RESULTS
Four studies, including 17,598 fetuses with 23 cases of open spina bifida, were included in the meta-analysis. BS/BSOB ratio showed pooled sensitivity of 0.70 (95% CI 0.47-0.87; I = 78.3%), specificity of 1.00 (95% CI 0.99-1.0; I = 99.2%), LR + and LR- of 51.44 (95% CI 9.53-277.64; I = 85.5%) and 0.23 (95% CI 0.04-1.17; I = 64.8%), respectively, and an AUC of 0.9649.
CONCLUSION
First trimester BS/BSOB ratio has a high diagnostic accuracy in detecting fetuses with open spina bifida.
Topics: Brain Stem; Female; Fetus; Gestational Age; Humans; Meningomyelocele; Occipital Bone; Pregnancy; Pregnancy Trimester, First; Prenatal Care; Prenatal Diagnosis; Sensitivity and Specificity; Spina Bifida Cystica; Spinal Dysraphism; Ultrasonography, Prenatal
PubMed: 31875250
DOI: 10.1007/s00404-019-05422-3 -
Pediatric Neurosurgery 2019Occipitocervical distraction injuries (OCDI) in children occur on a wide spectrum of severity, and decisions about treatment suffer from a lack of rigorous guidelines...
BACKGROUND
Occipitocervical distraction injuries (OCDI) in children occur on a wide spectrum of severity, and decisions about treatment suffer from a lack of rigorous guidelines and significant inter-institutional variability. While clear cases of frank atlanto-occipital dislocation (AOD) are treated with surgical stabilization, the approach for less severe cases of OCDI is not standardized. These patients require a careful assessment of both radiographic and clinical criteria, as part of a complex risk-benefit analysis, to establish whether occipitocervical fusion (OCF) is indicated. Here, we performed a systematic review of the literature that describes traumatic OCDI in children < 18 years of age.
SUMMARY
We performed a systematic review, according to PRISMA guidelines, of children < 18 years of age presenting with traumatic etiologies of OCDI. We searched PubMed to identify papers congruent with these criteria. Exclusion criteria included (1) reports on atraumatic causes of OCDI and (2) studies with insufficient clinical and radiographic details on individual patients. We identified 16 reports describing a total of 144 patients treated for pediatric traumatic OCDI. Based on the synthesis of these findings and the collective experience of the authors, we present the demographic, clinical, and radiographic factors that underlie OC instability, which we hope will serve as components of a grading system in the future. We considered various clinical and radiographic findings including: (1) the mechanism of injury, (2) the patient's age, (3) CT/CT angiography of head and neck findings and parameters, (4) MRI findings, and (5) neurological exam, for the purpose of determining the severity of the OCDI and offering treatment guidelines based on the summative risk of underlying OC instability. Key Messages: OCDI is a potentially devastating injury, especially in children. Although missing the diagnosis can have potentially catastrophic consequences, reverting to surgical fixation in less severe cases can subject children to unnecessary operative risk and permanently reduce their range of motion. After reviewing all the available reports of pediatric traumatic OCDI in the neurosurgical literature, we propose an outline of clinical and radiographic factors influencing underlying OC instability that could be incorporated into a grading scale to guide treatment. We hope this study stimulates discussion on the standardization of treatment for pediatric OCDI.
Topics: Cervical Vertebrae; Child; Humans; Joint Dislocations; Occipital Bone
PubMed: 30844793
DOI: 10.1159/000496832 -
Acta Neurochirurgica. Supplement 2019Since 1972, when Hammon first described the far lateral approach (FLA) for treatment of vertebral artery aneurysms, it has undergone numerous modifications, including...
INTRODUCTION
Since 1972, when Hammon first described the far lateral approach (FLA) for treatment of vertebral artery aneurysms, it has undergone numerous modifications, including drilling of the occipital condyle, removal of the laminas of upper cervical vertebrae and so on. Also, the range of indications has increased exponentially.
OBJECTIVE
In this paper we discuss state-of-the-art advances in the FLA, such as promising minimally invasive variants where an endoscope is used, and many others.
METHODS
We reviewed all articles touching upon the FLA in the modern era (from the year 2000 onward) and selected those that presented a significant contribution to the development of the relevant approach. The database used was PubMed.
RESULTS AND CONCLUSION
We found several new caveats not mentioned in other reviews or book chapters. The FLA is an ever-changing field of battle where the common and ultimate goals are to minimize the risk of injuring the major vessel in the region-the vertebral artery-and to provide such an angle of attack upon the tumours in the anterior and anterolateral foramen magnum that it is feasible to ensure gross total resection. This paper is an update on the knowledge about this approach, which we feel is necessary.
Topics: Brain Neoplasms; Cadaver; Cervical Vertebrae; Foramen Magnum; Humans; Neurosurgical Procedures; Skull
PubMed: 30610317
DOI: 10.1007/978-3-319-62515-7_23