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Scientific Articles

The possibility of Central Nervous System regeneration after acute trauma is arguably one of the most interesting fields of neurosurgical research. In this article, authors evaluate the therapeutic role of nAG protein in the healing of an acute spinal injury in a rat model. Motor recovery scores, MRI signals and histopathology evaluations demonstrate a significant improvement in experimental subjects. Since nAG protein reduces gliosis, reduces vacuole and granulation tissue formation and enhances neuro-restoration, it is a promising candidate for assisting the recovery of acute spinal trauma.

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Traumatic brain injury (TBI) remains a major cause of death and disability in those <40 years old worldwide. There is evidence from large cohort studies that intracranial hypertension is associated with higher mortality. Decompressive craniectomy (DC) leads to a reduction of the ICP, increasing the volume which the intracranial contents can occupy. However, uncertainties still remain regarding the optimal timing, long- and short-term clinical effects of DC and indications of the procedure. Current evidence (thanks to different trials) suggests that for patients with diffuse TBI, early bifrontal DC is not superior to medical therapy. Primary DC for patients with ASDH is evaluated in the RESCUE-ASDH trial, and secondary DC (applied to refractory ICP) is the subject of the RESCUEicp study. The evidence base suggest that, considering also the potential complications with DC, patients with TBI must be carefully selected to undergo DC to optimise outcomes.

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In this study, Kolias et al. Observe the work done by Soleman and colleagues about the pharmacotherapy in cSDH management, highlighting the limited evidence base for its application. At last, the authors hope that the randomised trials that are currently underway will change this situation by providing robust evidence.

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Friday, 15 June 2018 05:52

The Top-100 Most-Cited Articles on Meningioma

Written by

AUTHORS: Almutairi O, Albakr A, Al-Habib A, Ajlan A.

SUMMARY: Meningioma is a tumor that forms from the meninges, the membranous layers surrounding the brain and spinal cord. There are unquestionably articles with important historical data that are not valued by their citation counts alone. Nevertheless, count system remains an accepted method to assess article’s impact. In this study, they performed an analysis of the 100 most impactful articles on meningiomas and analyzed their characteristics. Authors performed a title-specific search of the Scopus database to identify highly cited articles on meningioma in November 2016.

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Trauma is the leading cause of death and disability in those <45 years old. In more recent years, advances in different subspecialities led to the provision of better care and improved outcomes. Different techniques are described in this article: monitoring of intracranial pressure (ICP), evacuation of intracranial haematomas and external ventricular drainage to name a few. Finallly, trauma neurosurgery is emerging as a distinct subspecialty due to all the recent research advances explained in the article and an interdisciplinary working group between trauma neurosurgeons and clinicians from other disciplines is crucial to ensure high-quality care.

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An external ventricular drain (EVD) is a neurosurgical device used to treat hydrocephalus and relieve elevated intracranial pressure, most commonly when the normal flow of cerebrospinal fluid (CSF) inside the brain is obstructed. It is among the most common procedures performed by neurosurgeons, however it does carry a number of risks. A prospective multicentre cohort study of EVD insertions was conducted  by British Neurosurgical Trainee Research Collaborative to assess the incidence of infections infections. A total of 495 EVD catheters were inserted into 452 patients. In the assessed population, the incidence of EVD-associated infections was 9.3%.

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After the inspiration coming from the success of the West Midlands Research Collaborative (WMRC), a regional general surgical research collaborative established in 2008, the British Neurosurgical Trainee Research Collaborative (BNTRC) was founded in 2012. This initiative has also proven to be a scientific success, and has identified practices associated with improved outcome. The BNTRC has also provided an important platform for allowing high-quality research to be coordinated on a national level, and has given trainees the opportunity to be involved in the development and execution of research protocols - vital skills for the future generation of academic neurosurgeons.

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In this study, a retrospective single center one, Dr Al-Habib et al. analyzed the anatomic relationship between cervical pedicle screws, vertebral artery (VA), and related anatomic structures in the Saudi population. This work demonstrates important differences between various ethnic groups, which should be always considered. Moreover, assessment of VA entry at each level should be performed on an individual basis, as the characteristics of VA entry was found to vary in the same patient at different cervical levels.

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The superior approach for managing ruptured intracranial aneurysms (endovascular or clipping) has long been the subject of debate in the neurosurgical literature.

In 2012, the first results from The Barrow Ruptured Aneurysm Trial (BRAT) were published. This study was a single-centre randomized trial with 471 patients in which treatment with clipping was compared to treatment with coil embolization.

In January 2018, Dr Spetzler and his team published in Journal of Neurosurgery a scientific study, where only the outcomes from those patients with saccular aneurysms were considered. This cohort made up the majority of the original sample (362 out of 471). Authors concluded that there was no statistical difference between the two different types of treatment, showed by the modified Rankin Scale outcomes at 10 years follow-up. There was a significantly increased rate of retreatment required in the coiling group, as well as higher obliterations in the clipping arm.

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Aneurysms are thought to arise from weak spots on a blood vessel wall, that leads to an outward bulging, likened to a bubble or balloon. They may be a result of a hereditary condition or an acquired disease. The securing of the aneurysm (which can be endovascular or open) may be undertaken prior to or after its rupture. Nowadays, it is still not entirely clear which is the best option of treatment for unruptured aneurysms. In this review, doctors Kelly D. Flemming and Giuseppe Lanzino elegantly discuss the best therapeutic approach to this kind of aneurysms.

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