Endovascular treatment of blister aneurysms is a promising approach, even though they are vascular lesions challenging to treat due to their angioarchitectural characteristics.
Our aim was to ...investigate clinical and radiologic outcomes after endovascular treatment of ruptured blister aneurysms.
PubMed, Ovid MEDLINE, Ovid EMBASE, Scopus, and the Web of Science were screened.
We performed a comprehensive review of the literature from 2010 to 2019 reporting series of patients with blister aneurysms treated with an endovascular approach.
Event rates were pooled across studies using a random effects meta-analysis.
A total of 32 studies reporting on 684 patients (707 aneurysms) were included. Stent placement, stent-assisted coiling, and flow diversion were the most commonly described treatments (282, 256, and 155 patients, respectively). The long-term complete occlusion rate was 76.9% (95% CI, 69.2%-83.9%). The perioperative complication rate was 8.9%, and clinical outcome at final follow-up was mRS <2 in 76.6% (95% CI, 68.2%-84.2%) of patients. The mortality rate was 4.7% (95% CI, 2.30%-7.80%). Among the different techniques, stent-assisted coiling is the one that had the higher rate of immediate occlusion (63.4%); however, the occlusion rate at the final follow-up was comparable among the different techniques.
Different techniques were described and data were reported in a nonhomogeneous way, possibly representing a bias in the present study.
This study suggests that endovascular treatment of blister aneurysms is associated with good long-term occlusion rates and reasonable complication and mortality rates. There is no consensus on the best endovascular techniques in blister aneurysm management.
Background
Due to the lack of high-quality evidence which has hindered the development of evidence-based guidelines, there is a need to provide general guidance on cranioplasty (CP) following ...traumatic brain injury (TBI), as well as identify areas of ongoing uncertainty via a consensus-based approach.
Methods
The international consensus meeting on post-traumatic CP was held during the International Conference on Recent Advances in Neurotraumatology (ICRAN), in Naples, Italy, in June 2018. This meeting was endorsed by the Neurotrauma Committee of the World Federation of Neurosurgical Societies (WFNS), the NIHR Global Health Research Group on Neurotrauma, and several other neurotrauma organizations. Discussions and voting were organized around 5 pre-specified themes: (1) indications and technique, (2) materials, (3) timing, (4) hydrocephalus, and (5) paediatric CP.
Results
The participants discussed published evidence on each topic and proposed consensus statements, which were subject to ratification using anonymous real-time voting. Statements required an agreement threshold of more than 70% for inclusion in the final recommendations.
Conclusions
This document is the first set of practical consensus-based clinical recommendations on post-traumatic CP, focusing on timing, materials, complications, and surgical procedures. Future research directions are also presented.
•VoA – DBS is effective on both dystonia and tremor.•VoA – DBS benefits are not impaired by tolerance or side effects.•The variable VoA-DBS outcome previously reported were not proven by VTA ...simulation.•Application of new consensus on tremor classification may improve patient selection.
Background
The current use of external cervical orthoses (ECO) after cervical discectomy is still based on a common practice than a solid scientific literature. The aim of this study is to evaluate ...the impact of ECO on radiological and functional outcomes in patients undergoing anterior cervical discectomy and fusion (ACDF).
Methods
We compared two cohorts of consecutive patients who underwent ACDF with and without ECO after surgery. Thirty-six patients operated from January 2015 to June 2016 received an ECO whereas 36 patients, operated from July 2016 to December 2017, did not. Each patient underwent radiological and functional evaluation using plain x-ray at 1, 6, and 12 months after surgery and Neck Disability Index (NDI) at 2 weeks and 3, 6, and 12 months after surgery, respectively.
Results
In the ECO group, 5 patients (13.9%) presented an incomplete fusion and 31 patients (86.1%) presented a complete fusion (CI 0.705–0.953). In the non-ECO group, 8 patients (22.2%) presented an incomplete fusion and 28 patients (77.8% CI 0.608–0.899) had a complete fusion, with no statistically significant differences between two groups. No statistically significant differences were also observed regarding the NDI neither at 2 weeks nor at 3-, 6-, and 12-month follow-up. At multivariate analysis, patients who underwent two-level ACDF showed a five-fold increased risk of worse NDI at 3-, 6-, 12-month (
p
= 0.003, CI 1.770–14.584) follow-up.
Conclusions
We advise against the routine use of ECO after single- or two-level ACDF as we did not find out any significant statistical differences between the two groups.
Background and purpose
Reports on the safety and efficacy of intraventricularly administered (IVT) colistin for the treatment of Acinetobacter baumannii ventriculomeningitis in adults are limited and ...no comparative studies of IVT colistin versus intravenous (IV) therapy alone have been published. This study compared outcomes of patients with postneurosurgical ventriculomeningitis caused by extensively drug‐resistant A. baumannii treated with IV colistin or IV plus IVT colistin.
Methods
In an 11‐year period, information on 18 consecutive patients with extensively drug‐resistant A. baumannii ventriculomeningitis was collected. Infection was defined on the basis of (i) isolation of A. baumannii from the cerebrospinal fluid (CSF); (ii) laboratory evidence of CSF infection; (iii) signs/symptoms of central nervous system (CNS) infection. Patients were divided into group 1 (nine patients, IV colistin alone) and group 2 (nine patients, IV plus IVT colistin).
Results
Cerebrospinal fluid sterilization was documented for 12 of 18 patients (66.6%). The CSF sterilization rate was 33.3% in group 1 and 100% in group 2 (P = 0.009). The mean time to CSF sterilization was 21 days (range 8–48). Five patients died due to A. baumannii CNS infection (all in group 1), and five deaths were unrelated to A. baumannii ventriculomeningitis. Intensive care unit mean length of stay was shorter in group 2 (20.7 vs. 41.6 days, P = 0.046). Crude relative risk ratio of cumulative incidence of persistent CNS infection in group 1 versus group 2 was 13. No cases of chemical meningitis due to intrathecal colistin administration were encountered.
Conclusions
Intraventricular colistin administration is much more effective than IV therapy alone and does not seem to add further toxicity.
The clinical relevance of promoter mutations and single nucleotide polymorphism rs2853669 of telomerase reverse transcriptase (TERT) and telomere length in patients with isocitrate dehydrogenase ...(IDH) wild-type glioblastoma (GBM) patients remains unclear. Moreover, some studies speculated that TERT promoter status might influence the prognostic role of O6-methylguanine DNA methyltransferase (MGMT) promoter methylation in newly diagnosed GBM. We carried out a large study to investigate their clinical impact and their interaction in newly diagnosed GBM patients.
We included 273 newly diagnosed IDH wild-type GBM patients who started treatment at Veneto Institute of Oncology IOV – IRCCS (Padua, Italy) from December 2016 to January 2020. TERT promoter mutations (−124 C>T and −146 C>T) and SNP rs2853669 (−245 T>C), relative telomere length (RTL) and MGMT methylation status were retrospectively assessed in this prospective cohort of patients.
Median overall survival (OS) of 273 newly diagnosed IDH wild-type GBM patients was 15 months. TERT promoter was mutated in 80.2% of patients, and most had the rs2853669 single nucleotide polymorphism as T/T genotype (46.2%). Median RTL was 1.57 (interquartile range 1.13-2.32). MGMT promoter was methylated in 53.4% of cases. At multivariable analysis, RTL and TERT promoter mutations were not associated with OS or progression-free survival (PFS). Notably, patients C carrier of rs2853669 (C/C+C/T genotypes) showed a better PFS compared with those with the T/T genotype (hazard ratio 0.69, P = 0.007). In terms of OS and PFS, all interactions between MGMT, TERT and RTL and between TERT and rs2853669 genotype were not statistically significant.
Our findings suggest the presence of the C variant allele at the rs2853669 of the TERT promoter as an attractive independent prognostic biomarker of disease progression in IDH wild-type GBM patients. RTL and TERT promoter mutational status were not correlated to survival regardless of MGMT methylation status.
•TERT promoter status and telomere length were not associated to OS and PFS in newly diagnosed IDH wild-type glioblastoma.•No interaction between TERT promoter status, relative telomere length and MGMT methylation status in terms of OS and PFS.•The C variant allele at the rs2853669 of the TERT promoter resulted in an independent biomarker of disease progression.
Orbital surgery has always been disputed among specialists, mainly neurosurgeons, otorhinolaryngologists, maxillofacial surgeons and ophthalmologists. The orbit is a borderland between intra- and ...extracranial compartments; Krönlein's lateral orbitotomy and the orbitozygomatic infratemporal approach are the historical milestones of modern orbital-cranial surgery.
Since its first implementation, endoscopy has significantly impacted neurosurgery, changing perspectives and approaches to the skull base. Since its first application in 2009, transorbital endoscopic surgery opened the way for new surgical scenario, previously feasible only with extensive tissue dissection.
A PRISMA based literature search was performed to select the most relevant papers on the topic.
Here, we provide a narrative review on the current state and future trends in endoscopic orbital surgery.
This manuscript is a joint effort of the EANS frontiers committee in orbital tumors and the EANS skull base section.
•Orbital surgery is a frontier between different specialties: neurosurgeons, otorhinolaryngologists, maxillofacial surgeons, and ophthalmologists. Endoscopy opened a whole new scenario of surgical possibilities.•Trans-Orbital surgery seems to provide useful access to different intracranial compartments, previously reachable only via an extensive tissue dissection, with good functional and oncological outcomes.•Homogeneous nomenclature of approaches and anatomical landmarks, data consistency across studies, broad shared classifications and well-designed randomized clinical trials are strongly advocated.•Next years will be crucial to precise indications, techniques, outcomes and complications of trans-orbital endoscopy through data obtained from high-level scientific studies.•Specific and dedicated applications are needed for transorbital endoscopic surgery to incorporate this topic into the common neurosurgical knowledge of the new generations.
Barbosa M, Lopes A, Mota C, Martins E, Oliveira J, Alves S, De Bonis P, do Céu Mota M, Dias C, Rodrigues‐Santos P, Fortuna AM, Quelhas D, Lacerda L, Bisceglia L, Cardoso ML. Clinical, biochemical and ...molecular characterization of Cystinuria in a cohort of 12 patients.
Cystinuria is a rare autosomal inherited disorder characterized by impaired transport of cystine and dibasic aminoacids in the proximal renal tubule. Classically, Cystinuria is classified as type I (silent heterozygotes) and non‐type I (heterozygotes with urinary hyperexcretion of cystine). Molecularly, Cystinuria is classified as type A (mutations on SLC3A1 gene) and type B (mutations on SLC7A9 gene). The goal of this study is to provide a comprehensive clinical, biochemical and molecular characterization of a cohort of 12 Portuguese patients affected with Cystinuria in order to provide insight into genotype–phenotype correlations. We describe seven type I and five non‐type I patients. Regarding the molecular classification, seven patients were type A and five were type B. In SLC3A1 gene, two large genomic rearrangements and 13 sequence variants, including four new variants c.611‐2A>C; c.1136+44G>A; c.1597T (p.Y533N); c.*70A>G, were found. One large genomic rearrangement was found in SLC7A9 gene as well as 24 sequence variants including 3 novel variants: c.216C>T (p.C72C), c.1119G>A (p.S373S) and c.*82C>T. In our cohort the most frequent pathogenic mutations were: large rearrangements (33.3% of mutant alleles) and a missense mutation c.1400T>C ( p.M467T) (11.1%). This report expands the spectrum of SLC3A1 and SLC7A9 mutations and provides guidance in the clinical implementation of molecular assays in routine genetic counseling of Portuguese patients affected with Cystinuria.
Elderly patients with glioblastoma multiforme (GBM) are frequently excluded from cancer therapy trials, treated suboptimally or not treated at all. The average survival in elderly patients is 4-8 ...months. The goal of the present study was to evaluate the efficacy of different treatment options in terms of survival in an elderly population affected with GBM.
About 34 Patients with primary supratentorial GBM aged 65 or higher were included in this study. All patients underwent craniotomy and tumor mass resection. After surgery they received radiation therapy, chemotherapy and radioimmunotherapy in different combinations.
Overall median survival was 10.5 months with one patient still alive at 35 months. Survival was longer for patients who underwent total resection instead of partial (13 months vs 4 months, P=0.006). If total en-bloc resection was used a further survival advantage was obtained (16 months for en-bloc resection, 9 months for inside-out resection, P=0.008). Where a second surgical intervention was performed median survival was 21 months (P=0.05). Survival according to adjuvant therapy has been 21 months (radiotherapy, chemotherapy, radioimmunotheraphy), 18 months (radiotherapy, chemotherapy) and 7 months (radiotherapy) (P=0.0001).
We think that single prognostic factor such as age should be not a reason for undertreatment.
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