Abstract:
BACKGROUND:Posterior fossa decompression is carried out to improve passage of cerebrospinal fluid (CSF) in patients with symptomatic Chiari 1 malformations (CM1), but the extent and means of decompression remains controversial. Dural opening with subsequent duraplasty may contribute to clinical outcome, but may also increase complication risk. The aim of this systematic review and meta-analysis is to assess the effects of durotomy with subsequent duraplasty on clinical outcome in surgical treatment of adults with CM1. DATA SOURCES AND STUDY ELIGIBILITY CRITERIA:We systematically searched MEDLINE, Embase and CENTRAL, and screened references in relevant articles and in UpToDate. Publications with previously untreated adults (>15 years) with CM1 with or without associated syringomyelia, treated in the period 1990-2013 were eligible. INTERVENTIONS:Posterior fossa decompression with duraplasty (PFDD group) was compared to posterior fossa decompression with bony decompression alone (PFD group). RESULTS:The search retrieved 233 articles. After the review we included 12 articles, but only 4 articles included posterior fossa decompression with both techniques. Only 2 out of 12 studies were prospective. The odds ratio (OR) for reoperation was 0.15 (95% CI 0.05-0.49) in the PFDD group compared to PFD (p=0.002). The OR of clinical failure at follow-up was 1.06 (95% CI 0.52-2.14) for PFDD compared to PFD (p=0.88). There was also no difference in syringomyelia improvement between techniques (p=0.60). The OR for CSF-related complications were 6.12 (95% CI 0.37-101.83) for PFDD compared to PFD (p=0.21). CONCLUSION:This systematic review of observational studies reveals higher reoperation rates after bony decompression alone, but clinical improvement was not higher after primary decompression with duraplasty. There are so far no high-quality studies that offer guidance in the choice of decompressive technique in adult CM1 patients. We think that a randomized controlled trial on this topic is both needed and feasible.
journal_name
Clin Neurol Neurosurgjournal_title
Clinical neurology and neurosurgeryauthors
Förander P,Sjåvik K,Solheim O,Riphagen I,Gulati S,Salvesen Ø,Jakola ASdoi
10.1016/j.clineuro.2014.07.019subject
Has Abstractpub_date
2014-10-01 00:00:00pages
58-64eissn
0303-8467issn
1872-6968pii
S0303-8467(14)00279-0journal_volume
125pub_type
杂志文章,meta分析,评审abstract:OBJECTIVE:Gliomas are a group of center nervous system tumors of glial origin. Most are characterized by diffuse infiltrative growth in the surrounding brain. Patients almost always ultimately die from their disease. The drastically increased knowledge about the molecular abnormalities, these are linked with tumor grad...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2011.11.005
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abstract:OBJECTIVE:Early brain injury after aneurysmal subarachnoid hemorrhage (aSAH) comprises a pronounced neuroinflammatory reaction. Nevertheless, its relevance for functional outcome and its role as outcome predictor remains uncertain. We evaluated the relationship of various early inflammatory parameters regarding functio...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
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abstract:BACKGROUND:Discrimination between tuberculous and acute bacterial meningitis is difficult by clinical features alone and laboratory methods may only supplement the clinical suspicion. We aimed to validate the diagnostic criteria by Thwaites et al. [1] and construct our own diagnostic predictors based on the clinical an...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2011.12.033
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abstract::Non-pituitary lesions account for a minority of sellar region abnormalities. We report the unusual occurrence of non-pituitary sellar/suprasellar lesions in a mother and her two daughters. Each of these cases was diagnosed and managed differently, illustrating the relative importance of radiographic imaging, tumor mar...
journal_title:Clinical neurology and neurosurgery
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doi:10.1016/j.clineuro.2007.09.021
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journal_title:Clinical neurology and neurosurgery
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doi:10.1016/j.clineuro.2007.06.001
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abstract::For the first time, Kluver Bucy syndrome (KBS) is described in young children who had no environmental learning of sex. The syndrome has so far been noted only in adults after bilateral temporal lobe affection. A few of its components, especially the hypersexuality and hypermetamorphosis, are likely to manifest differ...
journal_title:Clinical neurology and neurosurgery
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doi:10.1016/s0303-8467(98)00055-9
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doi:10.1016/j.clineuro.2005.10.002
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journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章,评审
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journal_title:Clinical neurology and neurosurgery
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journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2012.03.017
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journal_title:Clinical neurology and neurosurgery
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doi:10.1016/j.clineuro.2018.04.019
更新日期:2018-08-01 00:00:00
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journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2015.08.006
更新日期:2015-11-01 00:00:00
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journal_title:Clinical neurology and neurosurgery
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更新日期:2020-02-01 00:00:00
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journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2016.05.005
更新日期:2016-07-01 00:00:00
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journal_title:Clinical neurology and neurosurgery
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doi:10.1016/j.clineuro.2019.105623
更新日期:2020-02-01 00:00:00
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journal_title:Clinical neurology and neurosurgery
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doi:10.1016/j.clineuro.2017.01.004
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journal_title:Clinical neurology and neurosurgery
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journal_title:Clinical neurology and neurosurgery
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doi:10.1016/j.clineuro.2018.03.007
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journal_title:Clinical neurology and neurosurgery
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journal_title:Clinical neurology and neurosurgery
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journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2008.04.013
更新日期:2008-09-01 00:00:00
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更新日期:2019-08-01 00:00:00
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更新日期:1993-12-01 00:00:00
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journal_title:Clinical neurology and neurosurgery
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doi:10.1016/j.clineuro.2013.01.023
更新日期:2013-08-01 00:00:00
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journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/j.clineuro.2013.04.008
更新日期:2013-09-01 00:00:00
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journal_title:Clinical neurology and neurosurgery
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doi:10.1016/s0303-8467(78)80067-5
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journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/0303-8467(80)90059-1
更新日期:1980-01-01 00:00:00
abstract::After acute cerebral stroke, the (peri-) infarct tissue is characterized by calcium (Ca)-mediated neuronal damage and inflammatory processes. Monitoring Ca-mediated damage using the isotope cobalt-55 (Co) as a Ca-tracer may enable PET-imaging of this tissue. Since the fate of (peri-) infarct tissue determines clinical...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章
doi:10.1016/s0303-8467(96)00558-6
更新日期:1997-02-01 00:00:00
abstract::A 45-year-old man presented with headaches of 6 months' duration and generalized seizures in a cluster 2 days prior to admission. Examination revealed bilateral papilloedema and no focal deficits. CT scan showed an isodense enhancing mass lesion in the right frontobasal region with perilesional edema. Bifrontal cranio...
journal_title:Clinical neurology and neurosurgery
pub_type: 杂志文章,评审
doi:10.1016/s0303-8467(98)00058-4
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