Randomized controlled trials in neurosurgery.

Randomized controlled trials (RCTs) have become the standard method of evaluating new interventions (whether medical or surgical), and the best evidence used to inform the development of new practice guidelines. When we review the history of medical versus surgical trials, surgical RCTs usually face more challenges and difficulties when conducted. These challenges can be in blinding, recruiting, funding, and even in certain ethical issues.

Reoperation in adult patients with recurrent glioblastoma: A matched cohort analysis.

Background: Despite maximal safe cytoreductive surgery and postoperative adjuvant therapies, glioblastoma (GBM) inevitably recurs and leads to deterioration of neurological status and eventual death. There is no consensus regarding the benefit of repeat resection for enhancing survival or quality of life in patients with recurrent GBM. We aimed to examine if reoperation for GBM recurrence incurs a survival benefit as well as examine its complication profile.

Comprehensive comparison of carotid endarterectomy primary closure and patch angioplasty: A single-institution experience.

Background: Carotid endarterectomy (CEA) is an effective intervention for the treatment of high-grade carotid stenosis. Technical preferences exist in the operative steps including the use patch for arteriotomy closure. The goals of this study are to compare the rate of postoperative complications and the rate of recurrent stenosis between patients undergoing primary versus patch closure during CEA.

Image-Guided versus Freehand Ventricular Drain Insertion: Systematic Review and Meta-analysis.

Background: Ventricular drain insertion is a common neurosurgical procedure, typically performed using a freehand approach. Use of image guidance during drain insertion could improve accuracy and reduce the incidence of drain failure. This review aims to assess the impact of image guidance on drain placement accuracy, failure rate, and number of ventricular cannulation attempts.

Comparison of Two Drainage Systems on Chronic Subdural Hematoma Recurrence.

Background:  Chronic subdural hematoma (CSDH) is a common type of intracranial hemorrhage, especially among the elderly, with a recurrence rate as high as 33%. Little is known about the best type of drainage system and its relationship with recurrence. In this study, we compare the use of two drainage systems on the recurrence rate of CSDH.

Safety of Early Mobilization in Patients With Intraoperative Cerebrospinal Fluid Leak in Minimally Invasive Spine Surgery: A Case Series.

Background: Cerebrospinal fluid (CSF) leak is a common complication in spine surgery. Repairing durotomy is more difficult in the setting of minimally invasive spine surgery (MISS). Efficacy of postoperative bed rest in case of dural tear in MISS is not clear.

Assessment of Frailty in Predicting Surgical Outcomes in Patients with Chronic Subdural Hematomas: Retrospective Chart Review.

Background: The aim of this study is to determine if frailty, defined as modified frailty index (MFI) >2.7, correlated with worse postoperative outcomes in patients with chronic subdural hematomas (CSDHs). We also compare the predictive ability of the MFI with another widely used frailty measure, the Clinical Frailty Scale (CFS).

Mini-Tubular Access Surgery: A Single Surgeon's 12 Years in the Corridors of the Neuroaxis.

Background:  Tubular approach surgery now includes complex spinal and cranial procedures. Aided by modified instrumentation and frameless stereotaxy, minimal access surgery is being offered for a growing array of neurosurgical conditions.

Methods:  This article explores the flexibility and adaptability of the tubular retractor system for multiple indications by highlighting the 12-year experience of the primary surgeon using a tubular retractor system reported for the entire neuroaxis including intracranial, foramen magnum, and the craniocaudal extent of the spine for intra- and extradural pathologies.

Endoscopic versus open microvascular decompression for trigeminal neuralgia: a systematic review and comparative meta-analysis.

Objective: Microvascular decompression (MVD) is commonly used in the treatment of trigeminal neuralgia (TN) with positive clinical outcomes. Fully endoscopic MVD (E-MVD) has been proposed as an effective minimally invasive alternative, but a comparative review of the two approaches has not been conducted. The authors performed a meta-analysis of studies, comparing patient outcome rates and complications for the open versus the endoscopic technique.

Optic chiasmal cavernous angioma: A rare suprasellar vascular malformation.

Background: Suprasellar cavernous malformation in the optic pathway is not commonly encountered. To date, there are only few reports present in the literature.

Case Description: The authors report a rare case of suprasellar optic pathway cavernous malformation in a 33-year-old female who presented with progressive visual loss.