scholarly journals Endovascular and Surgical Treatment of Unruptured MCA Aneurysms: Meta-Analysis and Review of the Literature

2014 ◽  
Vol 2014 ◽  
pp. 1-11 ◽  
Author(s):  
Spiros L. Blackburn ◽  
Abdelrahman M. Abdelazim ◽  
Andrew B. Cutler ◽  
Kevin T. Brookins ◽  
Kyle M. Fargen ◽  
...  
Keyword(s):  
Software Package ◽  
Meta Analysis ◽  
Endovascular Coiling ◽  
Random Effects Model ◽  
Review Of The Literature ◽  
Surgical Clipping ◽  
Statistical Software ◽  
Pubmed Search ◽  
Occlusion Rate

Introduction. The best treatment for unruptured middle cerebral artery (MCA) aneurysms is unclear. We perform a meta-analysis of recent publications to evaluate the results of unruptured MCA aneurysms treated with surgical clipping and endovascular coiling.Methods. A PubMed search for articles published between January 2004 and November 2013 was performed. The R statistical software package was used to create a random effects model for each desired incidence rate. Cochran’sQtest was used to evaluate possible heterogeneity among the rates observed in each study.Results. A total of 1891 unruptured MCA aneurysms, 1052 clipped and 839 coiled, were included for analysis. The complete occlusion rate at 6–9 months mean follow-up was 95.5% in the clipped group and 67.8% in the coiled group (P<0.05). The periprocedural thromboembolism rate in the clipping group was 1.8% compared with 10.7% in the aneurysms treated by coiling (P<0.05). The recanalization rate was 0% for clipping and 14.3% for coiling (P=0.05). Modified Rankin scores of 0–2 were obtained in 98.9% of clipped patients compared to 95.5% of coiled (NS).Conclusions. This review weakly supports clipping as the preferred treatment of unruptured MCA aneurysms. Clinical outcomes did not differ significantly between the two groups.

scholarly journals Incidence and Characteristics of Kidney Stones in Patients on Ketogenic Diet: A Systematic Review and Meta-Analysis

Diseases ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 39
Author(s):  
Prakrati Acharya ◽  
Chirag Acharya ◽  
Charat Thongprayoon ◽  
Panupong Hansrivijit ◽  
Swetha R. Kanduri ◽  
...  
Keyword(s):  
Uric Acid ◽  
Kidney Stones ◽  
Observational Studies ◽  
Meta Analysis ◽  
Random Effects Model ◽  
Ketogenic Diets ◽  
Cochrane Database ◽  
Uric Acid Stones ◽  
Low Carbohydrate

Very-low-carbohydrate diets or ketogenic diets are frequently used for weight loss in adults and as a therapy for epilepsy in children. The incidence and characteristics of kidney stones in patients on ketogenic diets are not well studied. Methods: A systematic literature search was performed, using MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews from the databases’ inception through April 2020. Observational studies or clinical trials that provide data on the incidence and/or types of kidney stones in patients on ketogenic diets were included. We applied a random-effects model to estimate the incidence of kidney stones. Results: A total of 36 studies with 2795 patients on ketogenic diets were enrolled. The estimated pooled incidence of kidney stones was 5.9% (95% CI, 4.6–7.6%, I2 = 47%) in patients on ketogenic diets at a mean follow-up time of 3.7 +/− 2.9 years. Subgroup analyses demonstrated the estimated pooled incidence of kidney stones of 5.8% (95% CI, 4.4–7.5%, I2 = 49%) in children and 7.9% (95% CI, 2.8–20.1%, I2 = 29%) in adults, respectively. Within reported studies, 48.7% (95% CI, 33.2–64.6%) of kidney stones were uric stones, 36.5% (95% CI, 10.6–73.6%) were calcium-based (CaOx/CaP) stones, and 27.8% (95% CI, 12.1–51.9%) were mixed uric acid and calcium-based stones, respectively. Conclusions: The estimated incidence of kidney stones in patients on ketogenic diets is 5.9%. Its incidence is approximately 5.8% in children and 7.9% in adults. Uric acid stones are the most prevalent kidney stones in patients on ketogenic diets followed by calcium-based stones. These findings may impact the prevention and clinical management of kidney stones in patients on ketogenic diets.

Hypertonic saline for treating raised intracranial pressure: literature review with meta-analysis

2012 ◽  
Vol 116 (1) ◽  
pp. 210-221 ◽  
Author(s):  
Martin M. Mortazavi ◽  
Andrew K. Romeo ◽  
Aman Deep ◽  
Christoph J. Griessenauer ◽  
Mohammadali M. Shoja ◽  
...  
Keyword(s):  
Intracranial Pressure ◽  
Hypertonic Saline ◽  
Observational Studies ◽  
Meta Analysis ◽  
Review Of The Literature ◽  
Effective Agent ◽  
Randomized Controlled ◽  
Retrospective Comparison ◽  
First Choice ◽  
Pubmed Search

Object Currently, mannitol is the recommended first choice for a hyperosmolar agent for use in patients with elevated intracranial pressure (ICP). Some authors have argued that hypertonic saline (HTS) might be a more effective agent; however, there is no consensus as to appropriate indications for use, the best concentration, and the best method of delivery. To answer these questions better, the authors performed a review of the literature regarding the use of HTS for ICP reduction. Methods A PubMed search was performed to locate all papers pertaining to HTS use. This search was then narrowed to locate only those clinical studies relating to the use of HTS for ICP reduction. Results A total of 36 articles were selected for review. Ten were prospective randomized controlled trials (RCTs), 1 was prospective and nonrandomized, 15 were prospective observational trials, and 10 were retrospective trials. The authors did not distinguish between retrospective observational studies and retrospective comparison trials. Prospective studies were considered observational if the effects of a treatment were evaluated over time but not compared with another treatment. Conclusions The available data are limited by low patient numbers, limited RCTs, and inconsistent methods between studies. However, a greater part of the data suggest that HTS given as either a bolus or continuous infusion can be more effective than mannitol in reducing episodes of elevated ICP. A meta-analysis of 8 prospective RCTs showed a higher rate of treatment failure or insufficiency with mannitol or normal saline versus HTS.

scholarly journals Endovascular Coiling of Aneurysm Remnants after Clipping in Patients with Follow-up

2005 ◽  
Vol 11 (1) ◽  
pp. 41-48 ◽  
Author(s):  
S. Mangiafico ◽  
M. Cellerini ◽  
G. Villa ◽  
F. Ammannati ◽  
L. Paoli ◽  
...  
Keyword(s):  
Treatment Strategy ◽  
Intracranial Aneurysms ◽  
Endovascular Embolization ◽  
Endovascular Coiling ◽  
Surgical Clipping ◽  
Anterior Circulation ◽  
Therapeutic Alternative ◽  
Relative Safety

The vast majority of intracranial aneurysms can be obliterated completely with surgical clipping. However, postoperative remnants occur in about 4 to 8% of patients who undergo postoperative angiography. Endovascular embolization has been successfully performed in patients with postoperative aneurysm remnant and it may represent a therapeutic alternative to surgical reintervention. Twelve aneurysm remnants after surgical clipping were treated with endovascular embolization using GDC. All aneurysms were located in the anterior circulation. Our experience confirms the feasibility and relative safety of this treatment strategy that may be considered a valid alternative to reintervention.

scholarly journals Non-Adhesive Liquid Embolic Agents in Extra-Cranial District: State of the Art and Review of the Literature

2021 ◽  
Vol 10 (21) ◽  
pp. 4841
Author(s):  
Filippo Piacentino ◽  
Federico Fontana ◽  
Marco Curti ◽  
Edoardo Macchi ◽  
Andrea Coppola ◽  
...  
Keyword(s):  
State Of The Art ◽  
Case Reports ◽  
Meta Analysis ◽  
Review Of The Literature ◽  
Time Period ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Data Heterogeneity ◽  
New Generation

This review focuses on the use of “new” generation of non-adhesive liquid embolic agents (NALEA). In literature, non-adhesive liquid embolic agents have mainly been used in the cerebral district; however, multiple papers describing the use of NALEA in the extracranial district have been published recently and the aim of this review is to explore and analyze this field of application. There are a few NALEA liquids such as Onyx, Squid, and Phil currently available in the market, and they are used in the following applications: mainly arteriovenous malformations, endoleaks, visceral aneurysm or pseudoaneurysm, presurgical and hypervascular lesions embolization, and a niche of percutaneous approaches. These types of embolizing fluids can be used alone or in combination with other embolizing agents (such as coils or particles) so as to enhance its embolizing effect or improve its possible defects. The primary purpose of this paper is to evaluate the use of NALEAs, predominantly used alone, in elective embolization procedures. We did not attempt a meta-analysis due to the data heterogeneity, high number of case reports, and the lack of a consistent follow-up time period.

Surgical Clipping vs Endovascular Coiling for Newly Diagnosed and Recurrent Cerebral Aneurysms: an Update on the Current Literature. Single-Center Case Series

2018 ◽  
Vol 2 (1) ◽  
pp. 16-21
Author(s):  
F. Salle ◽  
A. Jaume ◽  
G. Castelluccio ◽  
E. Spagnuolo
Keyword(s):  
Intracranial Aneurysms ◽  
Young Patients ◽  
Case Series ◽  
Cerebral Aneurysms ◽  
Endovascular Coiling ◽  
Newly Diagnosed ◽  
Review Of The Literature ◽  
Surgical Experience ◽  
Surgical Clipping ◽  
The Ideal

Abstract The ideal treatment for intracranial aneurysms has been highly controversial in the last few decades. It is particularly difficult to decide between clipping vs. coiling when it comes to an aneurysm that has already been treated. The authors performed a review of the literature published in the last ten years amongst the main neurosurgical publications and make recommendations based on this evidence and the surgical experience of the eldest author of this paper (ES). A series of cases of recurrent, incompletely coiled aneurysms treated with surgery is presented. Conclusions: aneurysms with a convenient configuration and location for either clipping or coiling might be better managed by surgical clipping in young patients considering that this treatment achieves higher rates of occlusion with a lower incidence of rebleeding. In elderly patients, each case must be discussed.

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