Comparison of Clinical Outcome between Craniectomy and Craniotomy as Surgical Management of Traumatic Acute Subdural Hematoma: A Systematic Review and Meta-analysis

BACKGROUND: Acute subdural hematoma (ASDH) is a major problem in traumatic brain injury. Surgical techniques for treating ASDH are varied, including cranioplastic craniotomy and large decompressive craniectomy. The superiority of craniectomy and craniotomy for treating ASDH is still controversial. AIM: The aim of this study was to compare the clinical outcome between craniectomy and craniotomy for treating traumatic ASDH through systematic review and meta-analysis. METHODS: This study used electronic articles published in PubMed, EBSCO, Google Scholar, and Directory of Open Access Journal. Articles included were full-text observational studies in Indonesian or English. Clinical outcome using the Glasgow Outcome Scale was compared between craniectomy and craniotomy. Statistical analysis was done using Review Manager 5.3. RESULTS: Six articles met our inclusion and exclusion criteria. We performed random effect model analysis because of high heterogeneity between studies (I2 = 77%; X2 = 21.98). The pooled risk ratio between craniectomy and craniotomy on poor outcomes was 1.41 (p = 0.02; 95% CI: 1.06–1.88). CONCLUSION: Craniectomy increases the risk of poor clinical outcomes in treating a traumatic ASDH

Scalenus Syndrome: A Literature Review

Scalenus syndrome is often diagnosed as thoracic outlet syndrome (TOS). We performed literature searching reporting scalenus syndrome and we narratively describe the finding in this review. Scalenus syndrome is a unique clinical entity and commonly occurred. This syndrome can be classified into neurogenic TOS (nTOS) on the interscalene triangle, which also related to myofascial pain syndrome. There are three factors that contribute to scalenus syndrome, which are congenital anomaly, trauma, traumatic myositis, and hypertrophy of scalenus anterior muscle. The symptoms of scalenus syndrome can be divided into two types, which are neurologic and vascular symptoms. The neurologic manifestation can originate from the somatic and sympathetic nervous system. There is microscopic evidence of inflammation, hypertrophy, degeneration, and fibrosis of scalenus anterior muscle in scalenus syndrome cases. Scalenus syndrome can be treated surgically or conservatively. Non-surgical or conservative treatment can be applied to mild scalenus syndrome, especially nTOS, in the initial phase. Surgical management should be performed in persistent symptoms of nTOS or involving subclavian artery manifesting as arterial TOS (aTOS). Scalenus syndrome has quite similar clinical manifestation as nTOS and aTOS. However, this clinical syndrome should be considered as different entity because of different pathophysiology compared to TOS. Scalenus syndrome is caused by dynamic pathology of anterior scalenus muscle

The Stromal Cell-derived Factor-1/CXCL12 3’A-gene Polymorphism is Related to the Increased Risk of Coronary Artery Disease: A Systematic Review and Meta-analysis

BACKGROUND: Single-nucleotide polymorphism in the stromal cell-derived factor-1 (SDF-1)/CXCL12 gene had been associated with an increased risk of coronary artery disease (CAD). However, several published studies have shown inconsistent results. AIM: A meta-analysis was assessed to evaluate the association between SDF-1 3’A-gene polymorphism and CAD in the literature. METHODS: A systematic review was conducted in accordance with PRISMA guidelines and adhering to the Cochrane Handbook for Systematic Reviews. The literature search strategy was carried out on April 3, 2019, from PubMed, EBSCO, Google Scholar, and DOAJ during 2013–2018 period using various keywords related to SDF-1, CXCL12, polymorphism, and CAD. Original data from the group, case-control study, English full-text, and DNA polymorphism assessment using polymerase chain reaction were enrolled. Gene polymorphism in A-base nucleotide among patients with CAD and healthy subjects were evaluated. All data were analyzed using Review Manager 5.3 (Cochrane, Denmark) for meta-analysis. RESULTS: Five eligible studies extracted for data analysis (2013–2018) based on the assessment of 2-independent reviewers. Several studies have been excluded due to irrelevant criteria evaluated. A significant result was found between SDF-1 3’A gene polymorphism with the increased risk of CAD in the overall effect evaluation using a fixed-effects model (odds ratio [OR]: 2.02; 95% confidence interval 1.54-2.65; I2: 34%; p<0.001) on the forest plot. CONCLUSION: Our meta-analysis suggests that gene polymorphism in A-base nucleotide of SDF-1/CXCL-12 was associated with the susceptibility of CAD. However, a bigger-scale and well-design of case-control study should be conducted to clarify these conclusions

Action observation training for improving walking ability and balance of stroke patients: A systematic review and meta-analysis

Objective To determine the effect of action observation training on the walking ability and balance of stroke patients. Methods PubMed, Cochrane Central Register of Controlled Trials, PEDro, and ScienceDirect databases were searched from database inception to March 2024. Randomized controlled trials (RCTs) published in English were included. Two independent reviewers assessed the methodological quality of the trials using the Joanna Briggs Institute (JBI) critical appraisal tool for RCTs and performed data extraction using the JBI data extraction form for observational/experimental studies. Review Manager 5.4 was used for quantitative analyses. Results Fourteen RCTs with a total of 367 participants were included in this review. The average quality score of the studies was 8.4 out of 13. The pooled results showed a significant improvement in walking ability measured by the 10-Meter Walk Test (mean difference (MD) = 0.15; p = 0.0001), Timed Up and Go Test (MD = −2.58; p < 0.00001), and Dynamic Gait Index (MD = 2.93; p = 0.007), and spatiotemporal gait parameters, including stride length (MD = 9.67; p < 0.0001), step length (MD = 4.41; p = 0.004), cadence (MD = 7.06; p = 0.0003), and gait velocity (MD = 9.31; p < 0.00001). A significant improvement was found in balance measured by the Limit of Stability (MD = 40.50; p < 0.00001), yet the Activities-specific Balance Confidence Scale showed no significant improvement (MD = 10.26; p = 0.10). Conclusions Action observation training led to improvements in the walking ability of stroke patients. There is some evidence to suggest the effectiveness of action observation training for improving the balance ability of stroke patients, however, the number of studies is still very limited

Malignant Peripheral Nerve Sheath Tumor of the Scalp: A Case Report

Background: Malignant peripheral nerve sheath tumors (MPNSTs) are uncommon tumors typically originating from somatic soft tissues or peripheral nerves. Instances of primary MPNSTs on the scalp are exceedingly rare. Our objective is to present a unique case of MPNST on the scalp and conduct a literature review to outline the clinical presentation and management approaches for individuals diagnosed with MPNSTs. Case Presentation: A 40-year-old male was referred to the neurosurgery clinic, complaining of rapid mass growth on the left side of his head. The mass was told to overgrow within 5 months before visiting the neurosurgeon. The mass was solid and mobile on physical examination, with a distinct margin suggesting a benign tumor based on the examination. On the head CT scan, the tumor was found isodense in the right occipital area with no skull involvement. We completely removed the tumor, which was solid and had a distinct margin; therefore, tumor dissection was performed without any problems: No bone involvement was observed intraoperatively. The histopathology results revealed an MPNST. Conclusion: Although rare, it is important to consider an MPNST as a potential pathological diagnosis for rapidly growing tumors located on the scalp

Transcranial approach as surgical treatment for giant pituitary adenoma during COVID 19 pandemic – What can we learn?: A case report

Introduction: In the COVID 19 pandemic, pituitary surgery is one of challenging surgical treatment, especially the involving transsphenoid approach. It was reported that the aerosolisation and mucosal involvement increase the risk of viral transmission during operation. Therefore, transcranial is a safer surgical approach during COVID-19 pandemic. This study aimed to reported transcranial approach to treat giant pituitary adenoma with aggressive visual disturbance which require urgent surgical management. Case presentation: We reported a 21-year old male, who required urgent surgery because of progressive visual disturbance due to giant pituitary adenoma. On brain MRI with contrast, it was revealed an extraaxial tumor extending anteriorly over plannum sphenoidal with the greatest diameter was 5.34 cm. Transcranial approach was chosen to resect the tumor. Near total removal of the tumor was achieved without damaging vital neurovascular structure. The visual acuity was improved and no significant postoperative complication. Pathology examination revealed pituitary adenoma. Conclusion: Transcranial surgery for pituitary adenoma is still an armamentarium in neurosurgical practice, especially in the COVID 19 pandemic to provide safer surgical approach