scholarly journals Brainstem Cavernous Malformations Management: Microsurgery vs. Radiosurgery, a Meta-Analysis

2022 ◽  
Vol 8 ◽  
Author(s):  
George Fotakopoulos ◽  
Hugo Andrade-Barazarte ◽  
Juri Kivelev ◽  
Mardjono Tjahjadi ◽  
Felix Goehre ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Similar Rate ◽  
Neurological Deficits ◽  
Manuscript Preparation ◽  
Complete Excision ◽  
Cavernous Malformations ◽  
Microsurgical Treatment ◽  
Rebleeding Rate ◽  
Meta Analyses ◽  
Leave One Out

Given the rareness of available data, we performed a systematic review and meta-analysis on therapeutic strategy microsurgical resection and stereotactic radiosurgery (SRS) for brainstem cavernous malformations (BSCMs) and assessed mortality, permanent neurological deficits (PNDs), rebleeding rate, and patients who require reintervention to elucidate the benefits of each treatment modality. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) were used for protocol development and manuscript preparation. After applying all inclusion and exclusion criteria, six remaining articles were included in the final manuscript pool. In total, this meta-analysis included 396 patients, among them 168 patients underwent microsurgical treatment and 228 underwent SRS. Findings of the present meta-analysis suggest that regarding the total group of patients, in terms of mortality, late rebleeding rate, and PNDs, there was no superiority of the one method over the other. Applying the leave-one-out method to our study suggests that with low robust of the results for the bleeding rate and patients who require reintervention outcome factor, there was no statistical difference among the surgical and SRS treatment. Microsurgical treatment of BSCMs immediately eliminates the risk of rehemorrhage; however, it requires complete excision of the lesion and it is associated with a similar rate of PNDs compared with SRS management. Apparently, SRS of BSCMs causes a marked reduction in the risk of rebleeding 2 years after treatment, but when compared with the surgical treatment, there was not any remarkable difference.

Stereotactic radiosurgery of brainstem cavernous malformations: a systematic review and meta-analysis

2014 ◽  
Vol 120 (4) ◽  
pp. 982-987 ◽  
Author(s):  
Xin-Yu Lu ◽  
Hui Sun ◽  
Jian-Guo Xu ◽  
Qiao-Yu Li
Keyword(s):  
Systematic Review ◽  
Stereotactic Radiosurgery ◽  
Meta Analysis ◽  
Analysis Data ◽  
Scientific Publication ◽  
Neurological Deficits ◽  
Published Data ◽  
Cavernous Malformations ◽  
Before And After ◽  
High Operative Risk

Object Over the last two decades, stereotactic radiosurgery (SRS) has arisen as a promising approach in the management of brainstem cavernous malformations (CMs). In the present study, the authors report a systematic review and meta-analysis of the available published data regarding the radiosurgical management of brainstem CMs. Methods To identify eligible studies, systematic searches for brainstem CMs treated with SRS were conducted in major scientific publication databases. The search yielded 5 studies, which were included in the meta-analysis. Data from 178 patients with brainstem CMs were extracted. Hemorrhage rates before and after SRS were calculated, a meta-analysis was performed, and the risk ratio (RR) was determined. Results Four studies showed a statically significant reduction in the annual hemorrhage rate after SRS. The overall RR was 0.161 (95% CI 0.052–0.493; p = 0.001), and 21 patients (11.8%) had transient or permanent neurological deficits. Conclusions The present meta-analysis for the radiosurgical management of brainstem CMs shows that SRS can decrease the rate of repeat hemorrhage and has a low rate of adverse effects compared with surgery. The authors suggest that SRS may be considered as an alternative treatment for brainstem CMs that are inoperable or have a high operative risk.

scholarly journals Probing cerebellar involvement in cognition through a meta-analysis of TMS evidence

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Daniele Gatti ◽  
Luca Rinaldi ◽  
Ioana Cristea ◽  
Tomaso Vecchi
Keyword(s):  
Motor Coordination ◽  
Response Times ◽  
Meta Analysis ◽  
Medium Effect ◽  
Motor Tasks ◽  
Wide Range ◽  
Cerebellar Involvement ◽  
Meta Analyses ◽  
Leave One Out ◽  
Stimulation Paradigm

AbstractTraditionally, the cerebellum has been linked to motor coordination, but growing evidence points to its involvement in a wide range of non-motor functions. Though the number of studies using transcranial magnetic stimulation (TMS) to investigate cerebellar involvement in cognitive processes is growing exponentially, these findings have not yet been synthesized in a meta-analysis. Here, we used meta-analysis to estimate the effects of cerebellar TMS on performance in cognitive tasks for healthy participants. Outcomes included participants’ accuracy and response times (RTs) of several non-motor tasks performed either during or after the administration of TMS. We included overall 41 studies, of which 44 single experiments reported effects on accuracy and 41 on response times (RTs). The meta-analyses showed medium effect sizes (for accuracy: d = 0.61 [95% CI = 0.48, .073]; for RTs: d = 0.40 [95% CI = 0.30, 0.49]), with leave-one-out analyses indicating that cumulative effects were robust, and with moderate heterogeneity. For both accuracy and RTs, the effect of TMS was moderated by the stimulation paradigm adopted but not by the cognitive function investigated, while the timing of the stimulation moderated only the effects on RTs. Further analyses on lateralization revealed no moderation effects of the TMS site. Taken together, these findings indicate that TMS administered over the cerebellum is able to modulate cognitive performance, affecting accuracy or RTs, and suggest that the various stimulation paradigms play a key role in determining the efficacy of cerebellar TMS.

scholarly journals Clinical Outcomes After Endovascular and Microsurgical Treatment of Very Small Intracranial Aneurysms: Report of a Consecutive Series and Meta-analysis

2020 ◽  
Author(s):  
Jianfeng Zheng ◽  
Xiaochuan Sun ◽  
Xiaodong Zhang
Keyword(s):  
Intracranial Aneurysms ◽  
Data Extraction ◽  
Meta Analysis ◽  
Neurological Complication ◽  
Neurological Deficits ◽  
Endovascular Coiling ◽  
Consecutive Series ◽  
Microsurgical Treatment ◽  
Microsurgical Clipping ◽  
Mesh Terms

Abstract Objective: We conducted a systematic review and meta-analysis of studies evaluating endovascular coiling or microsurgical clipping of very small intracranial aneurysms (IAs), including 126 patients treated in our center.Data Sources: The electronic database of PubMed, Embase, and Web of Science were systematically searched for studies on endovascular or microsurgical treatment of very small IAs. The search was performed by using the keywords and medical subject heading (MeSH) terms: “intracranial aneurysm,” “cerebral aneurysm,” “outcome,” “endovascular,” “coil,” “embolization,” “coiling,” “surgical,” “neurosurgical,” “microsurgical,” “clip,” “clipping,” “small,” and “tiny” in both AND and OR combinations.Study Selection: Only studies of very small (Size ≤ 3 mm) ruptured or unruptured IAs patients undergoing endovascular coiling or microsurgical clipping were included.Data Extraction: Data collection and quality assessment were conducted independently by two authors.Data Synthesis: A total of 6 studies provided data on 362 very small UIAs and 9 studies provided data on 703 very small RIAs. Of 362 patients with very small UIAs, 6 (1.7%) cases had operation-related neurological deficits, and no patient died. Of 731 patients with very small RIAs, the morbidity and mortality were 13.0% and 4.7%, respectively. Morbidity due procedure-related complications was 8.3% (95% CI, 3.5% to 13.1%) in coiled very small RIAs patients compared with 20.6% (95% CI, 10.5% to 30.8%) in clipped very small RIAs patients. Mortality due to procedure-related complications was 5.3% (95% CI, 2.9% to 7.7%) in coiled very small RIAs patients compared with 4.7% (95% CI, 2.0% to 7.3%) in clipped very small RIAs patients. No significant differences were found in the incidence of poor outcomes observed between microsurgical and endovascular treatment for very small RIA patients (RR, 1.38; 95% CI, 0.99 - 1.93; P = 0.06).Conclusions Very small UIAs can be treated effectively and safely with good long-term outcomes. However, very small RIAs patients are at high risk of poor outcome and the incidence of neurological complication should not be ignored.

The natural history of intracranial cavernous malformations

2011 ◽  
Vol 30 (6) ◽  
pp. E24 ◽  
Author(s):  
Bradley A. Gross ◽  
Ning Lin ◽  
Rose Du ◽  
Arthur L. Day
Keyword(s):  
Risk Factors ◽  
Natural History ◽  
Meta Analysis ◽  
Neurological Deficits ◽  
Cavernous Malformations ◽  
Female Ratio ◽  
Natural History Studies ◽  
Developmental Venous Anomalies ◽  
History Of ◽  
Male To Female

Literature reports on the natural history of cerebral cavernous malformations (CMs) are numerous, with considerable variability in lesion epidemiology, hemorrhage rates, and risk factors for hemorrhage. In this review, the authors performed a meta-analysis of 11 natural history studies. The overall male-to-female ratio was 1:1, and the mean age at presentation was 30.6 years. Overall, 37% of patients presented with seizures, 36% with hemorrhage, 23% with headaches, 22% with focal neurological deficits, and 10% were asymptomatic. Some patients had more than one symptom. Seizure presentation was most prevalent among supratentorial CMs, while focal neurological deficits were common in patients with infratentorial CMs. By location, CMs were in the cerebral hemispheres (66%), brainstem (18%), basal ganglia or thalamus (8%), cerebellum (6%), and other (2.5% [combined supra- and infratentorial, callosal or insular]). Overall, 19% of patients harbored multiple intracranial CMs, and 9% had radiographically apparent associated developmental venous anomalies. An overall annual hemorrhage rate of 2.4% per patient-year (range 1.6%–3.1%) was identified across 3 studies. Prior hemorrhage and female sex were risk factors for bleeding, while CM size and multiplicity did not affect hemorrhage rates. Although not impacting the hemorrhage rate itself, deep location was a risk factor for increased clinical aggressiveness.

A Meta-Analysis of Interviews and Cognitive Ability

2013 ◽  
Vol 12 (4) ◽  
pp. 157-169 ◽  
Author(s):  
Philip L. Roth ◽  
Allen I. Huffcutt
Keyword(s):  
Cognitive Ability ◽  
Meta Analysis ◽  
Incremental Validity ◽  
Employment Interviews ◽  
Moderator Analysis ◽  
The Future ◽  
Research Questions ◽  
Meta Analyses ◽  
The Relationship

The topic of what interviews measure has received a great deal of attention over the years. One line of research has investigated the relationship between interviews and the construct of cognitive ability. A previous meta-analysis reported an overall corrected correlation of .40 ( Huffcutt, Roth, & McDaniel, 1996 ). A more recent meta-analysis reported a noticeably lower corrected correlation of .27 ( Berry, Sackett, & Landers, 2007 ). After reviewing both meta-analyses, it appears that the two studies posed different research questions. Further, there were a number of coding judgments in Berry et al. that merit review, and there was no moderator analysis for educational versus employment interviews. As a result, we reanalyzed the work by Berry et al. and found a corrected correlation of .42 for employment interviews (.15 higher than Berry et al., a 56% increase). Further, educational interviews were associated with a corrected correlation of .21, supporting their influence as a moderator. We suggest a better estimate of the correlation between employment interviews and cognitive ability is .42, and this takes us “back to the future” in that the better overall estimate of the employment interviews – cognitive ability relationship is roughly .40. This difference has implications for what is being measured by interviews and their incremental validity.

Power-Enhanced Funnel Plots for Meta-Analysis

2020 ◽  
Vol 228 (1) ◽  
pp. 43-49 ◽  
Author(s):  
Michael Kossmeier ◽  
Ulrich S. Tran ◽  
Martin Voracek
Keyword(s):  
Statistical Power ◽  
Meta Analysis ◽  
Relevant Information ◽  
Selective Reporting ◽  
Graphical Display ◽  
Funnel Plot ◽  
Evidential Value ◽  
Graphical Displays ◽  
Funnel Plots ◽  
Meta Analyses

Abstract. Currently, dedicated graphical displays to depict study-level statistical power in the context of meta-analysis are unavailable. Here, we introduce the sunset (power-enhanced) funnel plot to visualize this relevant information for assessing the credibility, or evidential value, of a set of studies. The sunset funnel plot highlights the statistical power of primary studies to detect an underlying true effect of interest in the well-known funnel display with color-coded power regions and a second power axis. This graphical display allows meta-analysts to incorporate power considerations into classic funnel plot assessments of small-study effects. Nominally significant, but low-powered, studies might be seen as less credible and as more likely being affected by selective reporting. We exemplify the application of the sunset funnel plot with two published meta-analyses from medicine and psychology. Software to create this variation of the funnel plot is provided via a tailored R function. In conclusion, the sunset (power-enhanced) funnel plot is a novel and useful graphical display to critically examine and to present study-level power in the context of meta-analysis.

Which Data to Meta-Analyze, and How?

2019 ◽  
Vol 227 (1) ◽  
pp. 64-82 ◽  
Author(s):  
Martin Voracek ◽  
Michael Kossmeier ◽  
Ulrich S. Tran
Keyword(s):  
Empirical Research ◽  
Meta Analysis ◽  
Curve Analysis ◽  
Research Progress ◽  
Primary Data ◽  
Statistical Procedures ◽  
Graphical Displays ◽  
Primary Data Analysis ◽  
Meta Analyses ◽  
Data Analytic

Abstract. Which data to analyze, and how, are fundamental questions of all empirical research. As there are always numerous flexibilities in data-analytic decisions (a “garden of forking paths”), this poses perennial problems to all empirical research. Specification-curve analysis and multiverse analysis have recently been proposed as solutions to these issues. Building on the structural analogies between primary data analysis and meta-analysis, we transform and adapt these approaches to the meta-analytic level, in tandem with combinatorial meta-analysis. We explain the rationale of this idea, suggest descriptive and inferential statistical procedures, as well as graphical displays, provide code for meta-analytic practitioners to generate and use these, and present a fully worked real example from digit ratio (2D:4D) research, totaling 1,592 meta-analytic specifications. Specification-curve and multiverse meta-analysis holds promise to resolve conflicting meta-analyses, contested evidence, controversial empirical literatures, and polarized research, and to mitigate the associated detrimental effects of these phenomena on research progress.

The Orchard Plot: Cultivating a Forest Plot for Use in Ecology, Evolution and Beyond

2019 ◽  
Author(s):  
Shinichi Nakagawa ◽  
Malgorzata Lagisz ◽  
Rose E O'Dea ◽  
Joanna Rutkowska ◽  
Yefeng Yang ◽  
...  
Keyword(s):  
Meta Analysis ◽  
R Package ◽  
Effect Sizes ◽  
Forest Plot ◽  
Point Estimates ◽  
Aggregate Effect ◽  
The Individual ◽  
Meta Analyses ◽  
Heterogeneous Effect ◽  
Intuitive Interpretation

‘Classic’ forest plots show the effect sizes from individual studies and the aggregate effect from a meta-analysis. However, in ecology and evolution meta-analyses routinely contain over 100 effect sizes, making the classic forest plot of limited use. We surveyed 102 meta-analyses in ecology and evolution, finding that only 11% use the classic forest plot. Instead, most used a ‘forest-like plot’, showing point estimates (with 95% confidence intervals; CIs) from a series of subgroups or categories in a meta-regression. We propose a modification of the forest-like plot, which we name the ‘orchard plot’. Orchard plots, in addition to showing overall mean effects and CIs from meta-analyses/regressions, also includes 95% prediction intervals (PIs), and the individual effect sizes scaled by their precision. The PI allows the user and reader to see the range in which an effect size from a future study may be expected to fall. The PI, therefore, provides an intuitive interpretation of any heterogeneity in the data. Supplementing the PI, the inclusion of underlying effect sizes also allows the user to see any influential or outlying effect sizes. We showcase the orchard plot with example datasets from ecology and evolution, using the R package, orchard, including several functions for visualizing meta-analytic data using forest-plot derivatives. We consider the orchard plot as a variant on the classic forest plot, cultivated to the needs of meta-analysts in ecology and evolution. Hopefully, the orchard plot will prove fruitful for visualizing large collections of heterogeneous effect sizes regardless of the field of study.

Laser Influence on Dental Sensitivity Compared to Other Light Sources Used During In-office Dental Bleaching: Systematic Review and Meta-analysis

2020 ◽  
Vol 45 (6) ◽  
pp. 589-597
Author(s):  
BGS Casado ◽  
EP Pellizzer ◽  
JR Souto Maior ◽  
CAA Lemos ◽  
BCE Vasconcelos ◽  
...  
Keyword(s):  
Randomized Clinical Trials ◽  
Color Change ◽  
Meta Analysis ◽  
Present Review ◽  
Cochrane Library ◽  
Light Sources ◽  
Eligibility Criteria ◽  
Tooth Color ◽  
Significant Difference ◽  
Meta Analyses

Clinical Relevance The use of laser light during bleaching will not reduce the incidence or severity of sensitivity and will not increase the degree of color change compared with nonlaser light sources. SUMMARY Objective: To evaluate whether the use of laser during in-office bleaching promotes a reduction in dental sensitivity after bleaching compared with other light sources. Methods: The present review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and is registered with PROSPERO (CDR42018096591). Searches were conducted in the PubMed/Medline, Web of Science, and Cochrane Library databases for relevant articles published up to August 2018. Only randomized clinical trials among adults that compared the use of laser during in-office whitening and other light sources were considered eligible. Results: After analysis of the texts retrieved during the database search, six articles met the eligibility criteria and were selected for the present review. For the outcome dental sensitivity, no significant difference was found favoring any type of light either for intensity (mean difference [MD]: −1.60; confidence interval [CI]: −3.42 to 0.22; p=0.09) or incidence (MD: 1.00; CI: 0.755 to 1.33; p=1.00). Regarding change in tooth color, no significant differences were found between the use of the laser and other light sources (MD: −2.22; CI: −6.36 to 1.93; p=0.29). Conclusions: Within the limitations of the present study, laser exerts no influence on tooth sensitivity compared with other light sources when used during in-office bleaching. The included studies demonstrated that laser use during in-office bleaching may have no influence on tooth color change.

Identification of and Correction for Publication Bias: Comment

2019 ◽  
Author(s):  
Amanda Kvarven ◽  
Eirik Strømland ◽  
Magnus Johannesson
Keyword(s):  
Publication Bias ◽  
False Positive ◽  
Large Scale ◽  
Meta Analysis ◽  
False Positive Rate ◽  
Effect Sizes ◽  
Replication Studies ◽  
Moderate Reduction ◽  
Positive Rate ◽  
Meta Analyses

Andrews & Kasy (2019) propose an approach for adjusting effect sizes in meta-analysis for publication bias. We use the Andrews-Kasy estimator to adjust the result of 15 meta-analyses and compare the adjusted results to 15 large-scale multiple labs replication studies estimating the same effects. The pre-registered replications provide precisely estimated effect sizes, which do not suffer from publication bias. The Andrews-Kasy approach leads to a moderate reduction of the inflated effect sizes in the meta-analyses. However, the approach still overestimates effect sizes by a factor of about two or more and has an estimated false positive rate of between 57% and 100%.

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