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Endoscopic endonasal skull base surgery for vascular lesions: a systematic review of the literature.Journal of Neurosurgical Sciences Dec 2016Endoscopic endonasal skull base surgery for vascular lesions is a controversial topic in neurosurgical practice. Concerns regarding the ability to effectively work... (Review)
Review
INTRODUCTION
Endoscopic endonasal skull base surgery for vascular lesions is a controversial topic in neurosurgical practice. Concerns regarding the ability to effectively work through the relatively narrow and deep endonasal corridor and manage serious hemorrhagic complications such as inadvertent internal carotid artery (ICA) injury during endoscopic surgery (EES) are relevant sources of disagreement between neurosurgeons. Nevertheless, following careful preoperative evaluation, EES may be indicated for rare, well-selected cases, including medially-projecting paraclinoid aneurysms and cavernous malformations (CMs) located next to the ventral surface of the brainstem. To date, only small retrospective case series and case reports, attesting the safety, feasibility and technical aspects of the EES for aneurysm clipping, CM resection and arterio-venous malformations (AVMs), have been published in the literature.
EVIDENCE ACQUISITION
In this manuscript, we conducted a systematic review of the literature applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines on EES for treatment of intracranial vascular lesions. We discuss the indications, advantages, limitations and technical aspects of EES for vascular lesions.
EVIDENCE SYNTHESIS AND CONCLUSIONS
Although rarely indicated, EES may be considered as an alternative treatment and part of the armamentarium of cerebrovascular neurosurgeons dealing with these challenging lesions.
Topics: Carotid Artery Injuries; Endoscopy; Humans; Neurosurgical Procedures; Orthopedic Procedures; Skull Base; Treatment Outcome
PubMed: 27327518
DOI: No ID Found -
Journal of Clinical Laboratory Analysis Aug 2022Non-coding RNAs (ncRNAs) are involved in neuropathic pain development. Herein, we systematically searched for neuropathic pain-related ncRNAs expression changes,... (Review)
Review
BACKGROUND
Non-coding RNAs (ncRNAs) are involved in neuropathic pain development. Herein, we systematically searched for neuropathic pain-related ncRNAs expression changes, including microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular non-coding RNAs (circRNAs).
METHODS
We searched two databases, PubMed and GeenMedical, for relevant studies.
RESULTS
Peripheral nerve injury or noxious stimuli can induce extensive changes in the expression of ncRNAs. For example, higher serum miR-132-3p, -146b-5p, and -384 was observed in neuropathic pain patients. Either sciatic nerve ligation, dorsal root ganglion (DRG) transaction, or ventral root transection (VRT) could upregulate miR-21 and miR-31 while downregulating miR-668 and miR-672 in the injured DRG. lncRNAs, such as early growth response 2-antisense-RNA (Egr2-AS-RNA) and Kcna2-AS-RNA, were upregulated in Schwann cells and inflicted DRG after nerve injury, respectively. Dysregulated circRNA homeodomain-interacting protein kinase 3 (circHIPK3) in serum and the DRG, abnormally expressed lncRNAs X-inactive specific transcript (XIST), nuclear enriched abundant transcript 1 (NEAT1), small nucleolar RNA host gene 1 (SNHG1), as well as ciRS-7, zinc finger protein 609 (cirZNF609), circ_0005075, and circAnks1a in the spinal cord were suggested to participate in neuropathic pain development. Dysregulated miRNAs contribute to neuropathic pain via neuroinflammation, autophagy, abnormal ion channel expression, regulating pain-related mediators, protein kinases, structural proteins, neurotransmission excitatory-inhibitory imbalances, or exosome miRNA-mediated neuron-glia communication. In addition, lncRNAs and circRNAs are essential in neuropathic pain by acting as antisense RNA and miRNA sponges, epigenetically regulating pain-related molecules expression, or modulating miRNA processing.
CONCLUSIONS
Numerous dysregulated ncRNAs have been suggested to participate in neuropathic pain development. However, there is much work to be done before ncRNA-based analgesics can be clinically used for various reasons such as conservation among species, proper delivery, stability, and off-target effects.
Topics: Ganglia, Spinal; Humans; MicroRNAs; Neuralgia; RNA, Circular; RNA, Long Noncoding
PubMed: 35808924
DOI: 10.1002/jcla.24592 -
BMC Surgery Nov 2023The recently developed Hybrid Hernia Repair technique (HHR), an adaptation of the laparoscopic method, has been proposed as a potential alternative for the treatment of... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The recently developed Hybrid Hernia Repair technique (HHR), an adaptation of the laparoscopic method, has been proposed as a potential alternative for the treatment of complex Incisional Ventral Hernias (IVH). While single-arm studies have reported promising outcomes, a comprehensive meta-analysis affirming these benefits is lacking. This meta-analysis aims to compare the clinical outcomes of HHR and Laparoscopic Hernia Repair (LHR) in the management of IVH.
METHODS
An exhaustive search of the literature was conducted, targeting publications in both English and Chinese that compare HHR and LHR up to March 31, 2023. The primary outcomes examined were operation time, blood loss, and intestinal injury. Secondary outcomes included rates of seroma, wound infection, post-operative acute/chronic pain, recurrence, and mesh bulging. The RevMan 5.0 software facilitated the statistical meta-analysis.
RESULTS
The final analysis incorporated data from 14 studies, encompassing a total of 1158 patients, with 555 undergoing HHR and 603 treated with LHR. Follow-up data, ranging from 12 to 88 months, were available in 12 out of the 14 identified studies. The HHR method was associated with a significantly lower risk of seroma (OR = 0.29, P = 0.0004), but a higher risk of wound infection (OR = 2.10, P = 0.04). No significant differences were observed between the two techniques regarding operation time, blood loss, intestinal injury, intestinal obstruction, post-operative pain, mesh bulging, and recurrence.
CONCLUSIONS
The HHR technique did not demonstrate a clear advantage over LHR in reducing surgical complications, apart from a lower incidence of postoperative seroma. Surgeons with substantial expertise may choose to avoid incidental conversion or intentional hybrid procedures. Further research is needed to clarify the optimal surgical approach for IVH.
Topics: Humans; Seroma; Neoplasm Recurrence, Local; Hernia, Ventral; Incisional Hernia; Postoperative Complications; Laparoscopy; Pain, Postoperative; Herniorrhaphy; Wound Infection; Surgical Mesh; Recurrence
PubMed: 37974133
DOI: 10.1186/s12893-023-02254-6 -
Neurosurgery Nov 2020Obsessive compulsive disorder (OCD) is a complex neuropsychiatric disease characterized by obsessions and compulsions. Deep brain stimulation (DBS) has demonstrated...
BACKGROUND
Obsessive compulsive disorder (OCD) is a complex neuropsychiatric disease characterized by obsessions and compulsions. Deep brain stimulation (DBS) has demonstrated efficacy in improving symptoms in medically refractory patients. Multiple targets have been investigated.
OBJECTIVE
To systematically review the current level and quality of evidence supporting OCD-DBS by target region with the goal of establishing a common nomenclature.
METHODS
A systematic literature review was performed using the PubMed database and a patient/problem, intervention, comparison, outcome search with the terms "DBS" and "OCD." Of 86 eligible articles that underwent full-text review, 28 were included for review. Articles were excluded if the target was not specified, the focus on nonclinical outcomes, the follow-up period shorter than 3 mo, or the sample size smaller than 3 subjects. Level of evidence was assigned according to the American Association of Neurological Surgeons/Congress of Neurological Surgeons joint guideline committee recommendations. Quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.
RESULTS
Selected publications included 9 randomized controlled trials, 1 cohort study, 1 case-control study, 1 cross-sectional study, and 16 case series. Striatal region targets such as the anterior limb of the internal capsule, ventral capsule/ventral striatum, and nucleus accumbens were identified, but stereotactic coordinates were similar despite differing structural names. Only 15 of 28 articles included coordinates.
CONCLUSION
The striatal area is the most commonly targeted region for OCD-DBS. We recommend a common nomenclature based on this review. To move the field forward to individualized therapy, active contact location relative to stereotactic coordinates and patient specific anatomical and clinical variances need to be reported.
Topics: Case-Control Studies; Cohort Studies; Cross-Sectional Studies; Deep Brain Stimulation; Humans; Obsessive-Compulsive Disorder; Treatment Outcome
PubMed: 32615588
DOI: 10.1093/neuros/nyaa249 -
Magnetic Resonance Insights 2015To assess the use of fMRI of the spinal cord in measuring noxious stimulation. (Review)
Review
OBJECTIVE
To assess the use of fMRI of the spinal cord in measuring noxious stimulation.
METHODS
The Scopus, Medline, EMBASE, and Web of Science databases were searched, along with the reference lists of included articles. Two independent reviewers screened abstracts, full-text articles, and extracted data. Original research was included if fMRI of the human spinal cord was used to measure responses to noxious stimulation.
RESULTS
Of the 192 abstracts screened, 19 met the search criteria and were divided according to their focus: investigating pain responses (n = 6), methodology (n = 6), spinal cord injury (n = 2), or cognition-pain interactions (n = 5). All but one study appear to have observed activity in ipsilateral and dorsal gray matter regions in response to noxious stimuli, although contralateral or ventral activity was also widely observed.
CONCLUSIONS
Although nociception can be investigated using spinal fMRI, establishing reliability, standardizing methodology, and reporting of results will greatly advance this field.
PubMed: 26543372
DOI: 10.4137/MRI.S23556 -
Effectiveness of Deep Brain Stimulation in Reducing Body Mass Index and Weight: A Systematic Review.Stereotactic and Functional Neurosurgery 2022Obesity has become a major public health concern worldwide, with current behavioral, pharmacological, and surgical treatments offering varying rates of success and...
BACKGROUND
Obesity has become a major public health concern worldwide, with current behavioral, pharmacological, and surgical treatments offering varying rates of success and adverse effects. Neurosurgical approaches to treatment of refractory obesity include deep brain stimulation (DBS) on either specific hypothalamic or reward circuitry nuclei, which might contribute to weight reduction through different mechanisms. We aimed to determine the safety and clinical effect of DBS in medical refractory obesity.
SUMMARY
Adhering to PRISMA guidelines, we performed a systematic review to identify all original studies - observational and experimental - in which DBS was performed to treat refractory obesity. From database inception to April 2021, we conducted our search in PubMed, Scopus, and LILACS databases using the following MeSH terms: "Obesity" OR "Prader-Willi Syndrome" AND "Deep Brain Stimulation." The main outcomes were safety and weight loss measured with the body mass index (BMI). The Grading of Recommendations Assessment, Development, and Evaluation methods were applied to evaluate the quality of evidence. This study protocol was registered with PROSPERO ID: CRD42019132929. Seven studies involving 12 patients met the inclusion criteria; the DBS target was the nucleus accumbens in four (57.1%), the lateral hypothalamic area in two (29.6%), and the ventral hypothalamus in one (14.3%). Further, 33% of participants had obesity secondary to Prader-Willi syndrome (PWS) and 66.6% had primary obesity. The global BMI average at baseline was 46.7 (SD: 9.6, range: 32.2-59.1), and after DBS, 42.8 (SD: 8.8, range: 25-53.9), with a mean difference of 3.9; however, the delta in PWS patients was -2.3 and 10 in those with primary obesity. The incidence of moderate side effects was 33% and included manic symptoms (N = 2), electrode fracture (N = 1), and seizure (N = 1); mild complications (41.6%) included skin infection (N = 2), difficulties falling asleep (N = 1), nausea (N = 1), and anxiety (N = 1).
KEY MESSAGES
Despite available small case series and case reports reporting a benefit in the treatment of refractory obesity with DBS, this study emphasizes the need for prospective studies with longer follow-ups in order to further address the efficacy and indications.
Topics: Body Mass Index; Deep Brain Stimulation; Humans; Nucleus Accumbens; Prospective Studies; Weight Loss
PubMed: 34583359
DOI: 10.1159/000519158 -
Brain and Behavior Aug 2021Many researchers took advantage of the well-established rubber hand illusion (RHI) paradigm to explore the link between the sense of body ownership and the different... (Review)
Review
INTRODUCTION
Many researchers took advantage of the well-established rubber hand illusion (RHI) paradigm to explore the link between the sense of body ownership and the different brain structures and networks. Here, we aimed to review the studies that have investigated this phenomenon by means of neurophysiological techniques.
METHODS
The MEDLINE, accessed by Pubmed and EMBASE electronic databases, was searched using the medical subject headings: "Rubber hand illusion" AND "Transcranial magnetic stimulation (TMS)" OR "Evoked potentials (EP)" OR "Event related potentials (ERP)" OR "Electroencephalography (EEG)".
RESULTS
Transcranial magnetic stimulation studies revealed a significant excitability drop in primary motor cortex hand circuits accompanying the disembodiment of the real hand during the RHI experience and that the perceived ownership over the rubber hand is associated with normal parietal-motor communication. Moreover, TMS provided causal evidence that the extrastriate body area is involved in the RHI and subsequently in body representation, while neuromodulation of ventral premotor area and the inferior parietal lobe did not result in an enhancement of embodiment. EP and ERP studies suggest that pre-existing body representations may affect larger stages of tactile processing and support predictive coding models of the functional architecture of multisensory integration in bodily perceptual experience. High-frequency oscillations on EEG play a role in the integrative processing of stimuli across modalities, and EEG activity in γ band activity in the parietal area reflects the visuotactile integration process. EEG studies also revealed that RHI is associated with the neural circuits underlying motor control and that premotor areas play a crucial role in mediating illusory body ownership.
CONCLUSION
Neurophysiological studies shed new light on our understanding of the different aspects that contribute to the formation of a coherent self-awareness in humans.
Topics: Body Image; Hand; Humans; Illusions; Parietal Lobe; Proprioception; Touch Perception; Visual Perception
PubMed: 34288558
DOI: 10.1002/brb3.2124 -
International Journal of Surgery... Aug 2015Development of an incisional hernia after abdominal surgery is a common complication following laparotomy. Following recent advancements in laparoscopic and open repair... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Development of an incisional hernia after abdominal surgery is a common complication following laparotomy. Following recent advancements in laparoscopic and open repair a literature review has demonstrated no difference in the short term outcomes between open and laparoscopic repair, concluding there was no favourable method of repair over the other and that both techniques are appropriate methods of surgical repair. However, long term outcomes in the available literature between these two approaches were not clearly analysed or described. The objective of this study is to assess the effectiveness and safety of laparoscopic versus open abdominal incisional hernia repair, and to evaluate the short and long term outcomes in regards to hernia recurrence using meta-analysis of all randomised controlled trials from 2008 to end of 2013.
POPULATION
Patients who developed an abdominal hernia or abdominal incisional hernia following a laparotomy.
INTERVENTION
Two methods of surgical repair, laparoscopic and open abdominal wall hernia repair. Comparison: To compare between laparoscopic and open repair in abdominal wall incisional hernia.
OUTCOME
length of hospital stay, operation time, wound infection and hernia recurrence rate.
METHODS
This study is a systematic review on all randomized controlled trials of laparoscopic versus open abdominal wall and incisional hernia repair. Medline, Pubmed, Cochrane library, Cinahl and Embase were the databases interrogated. Inclusion & exclusion criteria had been defined. The relevant studies identified from January 2008 to December 2013, are included in the analysis. The primary end point can be described as hernia recurrence, and secondary outcomes can be described as length of hospital stay post operatively, operation time and wound infection.
RESULTS
Five randomized controlled trials (RCTs) were identified and included in the final analysis with a total number of 611 patients randomized. Three hundreds and six patients were in the laparoscopic group and 305 patients in the open repair group. The range of follow up in the studies was two months to 35 months. The recurrence rate was similar (P = 0.30), wound infection was higher in the open repair group (P < 0.001), length of hospital stay was not statistically different (P = 0.92), and finally the operation time was longer in the laparoscopic group but did not reach statistical significance (P = 0.05) CONCLUSION: The short and long-term outcomes of laparoscopic and open abdominal wall hernia repairs are equivalent; both techniques are safe and credible and the outcomes are very comparable.
Topics: Abdominal Wall; Herniorrhaphy; Humans; Incisional Hernia; Laparoscopy; Length of Stay; Randomized Controlled Trials as Topic; Recurrence
PubMed: 26074289
DOI: 10.1016/j.ijsu.2015.05.050 -
Frontiers in Neurology 2018Around 30% Parkinson's disease (PD) patients develop impulse control disorders (ICDs) to D dopamine agonists and, to a lesser extent, levodopa. We aim to investigate...
Around 30% Parkinson's disease (PD) patients develop impulse control disorders (ICDs) to D dopamine agonists and, to a lesser extent, levodopa. We aim to investigate striatal dopaminergic function in PD patients with and without ICD. PubMed, Science Direct, EBSCO, and ISI Web of Science databases were searched (from inception to March 7, 2018) to identify PET or SPECT studies reporting striatal dopaminergic function in PD patients with ICD (ICD+) compared to those without ICD (ICD-). Studies which included drug naïve patients, explored non-pharmacological procedures (e.g., deep brain stimulation), and those using brain blood perfusion or non-dopaminergic markers were excluded. Standardized mean difference (SDM) was used and random-effect models were applied. Separate meta-analyses were performed for dopamine transporter level, dopamine release, and dopamine receptors availability in the putamen, caudate, dorsal, and ventral striatum. A total of 238 studies were title and abstract screened, of which 19 full-texts were assessed. Nine studies (ICD+: = 117; ICD-: = 175 patients) were included in the analysis. ICD+ showed a significant reduction of dopamine transporter binding in the putamen (SDM = -0.46; 95% CI: -0.80, -0.11; = 2.61; = 0.009), caudate (SDM = -0.38; 95% CI: -0.73, -0.04; = 2.18; = 0.03) and dorsal striatum (SDM = -0.45; 95% CI: -0.77, -0.13; = 2.76; = 0.006), and increased dopamine release to reward-related stimuli/gambling tasks in the ventral striatum (SDM = -1.04; 95% CI: -1.73, -0.35; = 2.95; = 0.003). Dopamine receptors availability did not differ between groups. Heterogeneity was low for dopamine transporter in the dorsal striatum ( = 0%), putamen ( = 0%) and caudate ( = 0%), and pre-synaptic dopamine release in the dorsal ( = 0%) and ventral striatum ( = 0%); heterogeneity was high for dopamine transporter levels in the ventral striatum ( = 80%), and for dopamine receptors availability in the ventral ( = 89%) and dorsal ( = 86%) striatum, putamen ( = 93%), and caudate ( = 71%). ICD+ patients show lower dopaminergic transporter levels in the dorsal striatum and increased dopamine release in the ventral striatum when engaged in reward-related stimuli/gambling tasks. This dopaminergic imbalance might represent a biological substrate for ICD in PD. Adequately powered longitudinal studies with drug naïve patients are needed to understand whether these changes may represent biomarkers of premorbid vulnerability to ICD.
PubMed: 30568628
DOI: 10.3389/fneur.2018.01018 -
Danish Medical Journal Nov 2014Evidence for the effect of post-operative abdominal binders on post-operative pain, seroma formation, physical function, pulmonary function and increased intra-abdominal... (Review)
Review
INTRODUCTION
Evidence for the effect of post-operative abdominal binders on post-operative pain, seroma formation, physical function, pulmonary function and increased intra-abdominal pressure among patients after surgery remains largely un-investigated.
METHODS
A systematic review was conducted. The PubMed, EMBASE and Cochrane databases were searched for studies on the use of abdominal binders after abdominal surgery or abdominoplasty. All types of clinical studies were included. Two independent assessors evaluated the scientific quality of the studies. The primary outcomes were pain, seroma formation and physical function.
RESULTS
A total of 50 publications were identified; 42 publications were excluded leaving eight publications counting a total of 578 patients for analysis. Generally, the scientific quality of the studies was poor. Use of abdominal binder revealed a non-significant tendency to reduce seroma formation after laparoscopic ventral herniotomy and a non-significant reduction in pain. Physical function was improved, whereas evidence supports a beneficial effect on psychological distress after open abdominal surgery. Evidence also supports that intra-abdominal pressure increases with the use of abdominal binders. Reduction of pulmonary function during use of abdominal binders has not been revealed.
CONCLUSION
Abdominal binders reduce post-operative psychological distress, but their effect on post-operative pain after laparotomy and seroma formation after ventral hernia repair remains unclear. Due to the sparse evidence and poor quality of the literature, solid conclusions may be difficult to make, and procedure-specific, high-quality randomised clinical trials are warranted.
Topics: Abdomen; Abdominal Wall; Adhesives; Bandages; Female; Hernia, Ventral; Herniorrhaphy; Humans; Intra-Abdominal Hypertension; Laparoscopy; Laparotomy; Male; Motor Activity; Pain, Postoperative; Respiratory Function Tests; Seroma; Surgical Tape
PubMed: 25370959
DOI: No ID Found