Artigos e Materiais de Revistas Científicas - FM/MNE

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A coleção de Artigos e Materiais de Revistas Científicas engloba artigos originais, artigos de revisão, artigos de atualização, artigos técnicos, relatos de experiências, resenhas, ensaios, editoriais, cartas ao editor, debates, notas científicas e técnicas, depoimentos, entrevistas e pontos de vista. Consideram-se como artigos científicos originais os trabalhos redigidos para divulgação de informações e resultados sobre determinada pesquisa científica, publicados em periódico científico após avaliação por outros pesquisadores.

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Why did humans surpass all other primates? Are our brains so different? Part 1
(2024) NITRINI, Ricardo
ABSTRACT. This review is based on a conference presented in June 2023. Its main objective is to explain the cognitive differences between humans and non-human primates (NHPs) focusing on characteristics of their brains. It is based on the opinion of a clinical neurologist and does not intend to go beyond an overview of this complex topic. As language is the main characteristic differentiating humans from NHPs, this review is targeted at their brain networks related to language. NHPs have rudimentary forms of language, including primitive lexical/semantic signs. Humans have a much broader lexical/semantic repertory, but syntax is the most important characteristic, which is probably unique to Homo sapiens. Angular gyrus, Broca's area, temporopolar areas, and arcuate fascicle, are much more developed in humans. These differences may explain why NHPs did not develop a similar language to ours. Language had a profound influence on all other higher nervous activities.
Why did humans surpass all other primates? Are our brains so different? Part 2
(2024) NITRINI, Ricardo
ABSTRACT The second part of this review is an attempt to explain why only Homo sapiens developed language. It should be remarked that this review is based on the opinion of a clinical neurologist and does not intend to go beyond an overview of this complex topic. The progressive development of language was probably due to the expansion of the prefrontal cortex (PFC) and its networks. PFC is the largest area of the human cerebral cortex and is much more expanded in humans than in other primates. To achieve language, several other functions should have been attained, including abstraction, reasoning, expanded working memory, and executive functions. All these functions are strongly related to PFC and language had a profound retroactive impact on them all. Language and culture produce anatomic and physiological modifications in the brain. Learning to read is presented as an example of how culture modifies the brain.
Trans-Spinal Theta Burst Magnetic Stimulation in Parkinson's Disease and Gait Disorders
(2024) MENEZES, Janaina Reis; NUNES, Glaucia Aline; CARRA, Rafael Bernhart; SIMOES, Juliana da Silva; SOLLA, Davi Jorge Fontoura; OLIVEIRA, Jussan Rodrigues; TEIXEIRA, Manoel Jacobsen; MARCOLIN, Marco Antonio; BARBOSA, Egberto Reis; TANAKA, Clarice; ANDRADE, Daniel Ciampi de; CURY, Rubens Gisbert
BackgroundGait disorders in patients with Parkinson's disease (PD) can become disabling with disease progression without effective treatment.ObjectivesTo investigate the efficacy of intermittent theta burst trans-spinal magnetic stimulation (TsMS) in PD patients with gait and balance disorders.MethodsThis was a randomized, parallel, double-blind, controlled trial. Active or sham TsMS was applied at third thoracic vertebra with 100% of the trans-spinal motor threshold, during 5 consecutive days. Participants were evaluated at baseline, immediately after last session, 1 and 4 weeks after last session. Primary outcome was Total Timed Up and Go (TUG) values comparing active versus sham phases 1 week after intervention. The secondary outcome measurements consisted of motor, gait and balance scales, and questionnaires for quality of life and cognition.ResultsThirty-three patients were included, average age 68.5 (6.4) years in active group and 70.3 (6.3) years in sham group. In active group, Total TUG mean baseline was 107.18 (95% CI, 52.1-116.1), and 1 week after stimulation was 93.0 (95% CI, 50.7-135.3); sham group, Total TUG mean baseline was 101.2 (95% CI, 47.1-155.3) and 1 week after stimulation 75.2 (95% CI 34.0-116.4), P = 0.54. Similarly, intervention had no significant effects on secondary outcome measurements. During stimulation period, five patients presented with mild side effects (three in active group and two in sham group).DiscussionTsMS did not significantly improve gait or balance analysis in patients with PD and gait disorders. The protocol was safe and well tolerated. (c) 2024 International Parkinson and Movement Disorder Society.
Progressive hemorrhagic injury and ischemia after severe traumatic brain injury according to hemoglobin transfusion thresholds: a post-hoc analysis of the transfusion requirements after head trauma trial
(2024) GOBATTO, Andre L. N.; SOLLA, Davi; BRASIL, Sergio; TACCONE, Fabio S.; JR, Carlos G. Carlotti; MALBOUISSON, Luiz Marcelo S.; PAIVA, Wellingson S.
A promising therapeutic approach for cerebral vasospasm in patients with subarachnoid hemorrhage
(2024) WELLING, Leonardo C.; RABELO, Nicollas Nunes; BARBOSA, Mateus Gonsalves de Sena; CHERAIN, Luiz Gabriel Gonsalves; FIGUEIREDO, Eberval Gadelha
Brain tissue oxygen combined with intracranial pressure monitoring versus isolated intracranial pressure monitoring in patients with traumatic brain injury: an updated systematic review and meta-analysis
(2024) SANTANA, Lais Silva; DINIZ, Jordana Borges Camargo; SOLLA, Davi Jorge Fontoura; NEVILLE, Iuri Santana; FIGUEIREDO, Eberval Gadelha; TELLES, Joao Paulo Mota
Monitoring intracranial pressure (ICP) is pivotal in the management of severe traumatic brain injury (TBI), but secondary brain injuries can arise despite normal ICP levels. Cerebral tissue oxygenation monitoring (PbtO2) may detect neuronal tissue infarction thresholds, enhancing neuroprotection. We performed a systematic review and meta-analysis to evaluate the effects of combined cerebral tissue oxygenation (PbtO2) and ICP compared to isolated ICP monitoring in patients with TBI. PubMed, Embase, Cochrane, and Web of Sciences databases were searched for trials published up to June 2023. A total of 16 studies comprising 37,820 patients were included. ICP monitoring was universal, with additional placement of PbtO2 in 2222 individuals (5.8%). The meta-analysis revealed a reduction in mortality (OR 0.57, 95% CI 0.37-0.89, p = 0.01), a greater likelihood of favorable outcomes (OR 2.28, 95% CI 1.66-3.14, p < 0.01), and a lower chance of poor outcomes (OR 0.51, 95% CI 0.34-0.79, p < 0.01) at 6 months for the PbtO2 plus ICP group. However, these patients experienced a longer length of hospital stay (MD 2.35, 95% CI 0.50-4.20, p = 0.01). No significant difference was found in hospital mortality rates (OR 0.81, 95% CI 0.61-1.08, p = 0.16) or intensive care unit length of stay (MD 2.46, 95% CI - 0.11-5.04, p = 0.06). The integration of PbtO2 to ICP monitoring improved mortality outcomes and functional recovery at 6 months in patients with TBI. PROSPERO (International Prospective Register of Systematic Reviews) CRD42022383937; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=383937
Analysis of Thrombolytic Agents in Intraventricular Hemorrhage: A Systematic Review and Meta-Analysis
(2024) BOLENTINE, Felipe Soares; PORTELA, Elany Maria Ferreira; RODRIGUES, Iara Santos; ARAUJO, Laryssa Maria Ribeiro; SILVA, Anderson Eduardo Anadinho da; PIPEK, Leonardo Zumerkorn; BRITO, Josue da Silva; FIGUEIREDO, Eberval Gadelha; RABELO, Nicollas Nunes
AIM: To determine the effectiveness of extraventricular drainage (EVD) combined with fibrinolytics in reducing morbidity and mortality rates associated with intraventricular cerebral hemorrhage (IVH). MATERIAL and METHODS: A literature review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO registration number: CRD42022332152). Articles were selected from various sources, including PubMed, Trip Database, LILACS, Cochrane Library, and ScienceDirect. Clinical trials focusing on IVH treatment using EVD and/or fibrinolytics were considered. The Risk of Bias in Non-randomized Studies of Interventions (ROB 2) tool was employed for bias assessment. A fixed-effects regression model was used following heterogeneity analysis. Treatment effectiveness was evaluated based on mortality outcomes. RESULTS: A total of 531 patients from four studies were included. The use of fibrinolytics significantly decreased IVH mortality compared with a placebo. The odds ratio (OR) for recombinant tissue plasminogen activator (rtPA) or alteplase was 0.54 [0.36; 0.82]. For urokinase (UK), the OR was 0.21 [0.03; 1.54], rendering it statistically non-significant. The overall OR was 0.52 [0.35; 0.78], and CONCLUSION: While EVD alone is a common approach for managing hydrocephalus, its effectiveness is limited by potential blockages and infections. Combining EVD with UK or rtPA demonstrated improved patient outcomes. rtPA stands out as a reliable and effective option, while limited data are available regarding UK's effectiveness in reducing IVH mortality.
Gene replacement therapy for spinal muscular atrophy: safety and preliminary efficacy in a Brazilian cohort
(2024) MENDONCA, Rodrigo Holanda; ORTEGA, Adriana Banzzatto; JR, Ciro Matsui; LINDEN, Vanessa van der; KERSTENETZKY, Marcelo; GROSSKLAUSS, Luis Fernando; SILVEIRA-LUCAS, Elizabeth L.; POLIDO, Graziela Jorge; ZANOTELI, Edmar
Spinal muscular atrophy (SMA) is a motor neuron disease associated with progressive muscle weakness, ventilatory failure, and reduced survival. Onasemnogene abeparvovec is the first gene replacement therapy (GT) approved to treat this condition. An observational retrospective study was conducted to assess adverse events and efficacy of GT in SMA patients. Forty-one patients with SMA (58.5% females and 80.1% SMA type 1) were included. The mean age at GT dosing was 18 (+/- 6.4) months. Thirty-six patients (87.8%) were under previous treatment with nusinersen, and 10 (24.4%) continued nusinersen after GT. Mean CHOP-INTEND increased 13 points after 6 months and this finding did not differ between groups according to nusinersen maintenance after GT (p = 0.949). Among SMA type 1 patients, 14 (46.6%) reached the ability to sit alone. Liver transaminases elevation at least two times higher than the upper limit of normal value occurred in 29 (70.7%) patients. Thrombocytopenia occurred in 13 (31.7%) patients, and one presented thrombotic microangiopathy. Older age (>2 years) was associated with more prolonged use of corticosteroids (p = 0.021). GT is effective in SMA patients, combined nusinersen after GT did not appear to add gain in motor function and older age is associated with prolonged corticosteroid use.
Young-Onset Alzheimer Dementia Due to a Novel Pathogenic Presenilin 1 Variant Initially Misdiagnosed as Autoimmune Encephalitis
(2024) RONCHI, Nathalia Rossoni; CASTRO, Matheus A.; COUTINHO, Artur M.; LUCATO, Leandro T.; SILVA, Guilherme Diogo; BRUCKI, Sonia M.; KOK, Fernando; TRES, Eduardo Sturzeneker; NOBREGA, Paulo Ribeiro; FREUA, Fernando; NITRINI, Ricardo; SIMABUKURO, Mateus Mistieri
Objectives Pathogenic variants in presenilin 1 (PSEN1) are related to early-onset Alzheimer disease (AD) and may occur as de novo variants. In comparison with sporadic forms, it can present with psychiatric manifestations, seizures, myoclonus, and focal presentation. Because PSEN1 can occur in young patients who lack a family history of neurologic disorders and because these symptoms are also frequent in autoimmune encephalitis (AE), diagnosis may be overlooked. Our aim was to demonstrate the challenge in diagnosing young patients with neurodegenerative diseases that simulate AE. Methods We describe a case of a young patient with insidious progressive dementia, myoclonus, seizures, and aphasia, with no family history of dementia, along with signs suggestive of neuroinflammation on brain MRI and CSF examination. Results She was initially misdiagnosed as having AE. Further investigation was performed, leading to the discovery of a novel and de novo pathogenic variant in PSEN1. Discussion This case demonstrates the importance of considering PSEN1 in young patients with insidious progressive dementia with atypical clinical and neuroimaging features, even in patients without a family history of neurologic disorders. Not adhering to published criteria of possible and probable AE and overinterpretation of subtle inflammatory findings in CSF and MRI contribute to misdiagnosis.
Transtentorial Approach for Resection of Parahippocampal Gyrus Glioma: 3-Dimensional Operative Video
(2024) CARAMANTI, Ricardo Lourenco; EFFGEN, Erica Antunes; APRIGIO, Raysa Moreira; MORAES, Dionei Freitas de; ROCHA, Carlos Eduardo Dall Aglio; LAURENTI, Matheus Rodrigo; RIBAS, Eduardo Carvalhal; AGUIAR, Paulo Henrique Pires de; FIGUEIREDO, Eberval Gadelha; CHADDAD-NETO, Feres
The past, present and future of Alzheimer's disease - part 1: the past (vol 81, pg 1070, 2023)
(2024) NITRINI, Ricardo
Are ventriculopleural shunts the second option for treating hydrocephalus? A meta-analysis of 543 patients
(2024) OLIVEIRA, Leonardo B.; JR, Silvio Porto; ANDREAO, Filipi Fim; FERREIRA, Marcio Yuri; BOCANEGRA-BECERRA, Jhon E.; VERLY, Gabriel; PALAVANI, Lucca B.; BATISTA, Savio; GUTIERREZ-AGUIRRE, Salvador F.; TOLEDO, Otavio F. de; RABELO, Nicollas Nunes; WELLING, Leonardo C.; BERTANI, Raphael; FIGUEIREDO, Eberval G.
Background: Some centers utilize ventriculopleural shunt (VPLS) for treating hydrocephalus when conventional approaches are not feasible. Nonetheless, the literature regarding this approach is scarce. Purpose: Evaluate the outcomes of VPLS through a single-arm meta-analysis. Methods: Following PRISMA guidelines, the authors systematically searched for articles utilizing the VPLS in a cohort with more than four patients. Outcomes included: mortality, pleural effusion, number of patients who underwent revisions, obstructions, shunt migration, emphysema, and subdural hematoma. Results: A total of 404 articles were reviewed, resulting in the inclusion of 13 retrospective studies encompassing 543 patients, with the majority being children (62.6 %). The median average follow-up period was 35.4 months (10-64.1). After analysis, results yielded a revision rate of 54 % (95 % CI: 44 %-64 %; I2=73 %). The most common complication observed was pleural effusion, with a post-analysis incidence of 16 % (95 % CI: 11 %21 %; I2=63 %), followed by infections at 7 % (95 % CI: 4 %-10 %; I2=33 %). Shunt obstruction occurred in 13 % (95 % CI: 4 %-21 %; I2=84 %) of cases after analysis, while migrations, overdrainage, subdural hematoma, and cutaneous emphysema had minimal occurrence rates (0 %, 95 % CI: 0 %-1 %; I2=0 %). Notably, there were no reported cases of shunt-related mortality. Conclusion: VPLS can be considered when there are no other suitable options for placing the distal catheter. However, the notable rates of shunt revisions, pleural effusion, infections, and the inherent heterogeneity of outcomes currently limit the widespread adoption of VPLS. In this scenario, other alternatives should be given priority.
Partial Labyrinth Removal Restricted to the Superior Semicircular Canal in Focal Combined Transpetrosal Approach: Description and Illustrative Cases
(2024) VIDAL, Claudio H. F.; FIGUEIREDO, Eberval G.; HAZIN, Gabriela F.; HAHN, Yoav; LEAL, Mariana C.; COIMBRA, Caetano J.
BACKGROUND AND OBJECTIVES: The labyrinthine structures obstruct the surgical view of the deep petroclival region in the transpetrosal approach. Historically, labyrinthectomy and removal of all 3 semicircular canals, with resultant deafness, was used in patients with ipsilateral functional hearing deficits to improve access. The advent and systematization of superior and posterior semicircular canal removal (transcrusal approach) with good rates of hearing preservation has allowed a redefinition of the possibility of partial labyrinthectomy in patients without previous hearing deficits. The present manuscript is intended to describe a technical refinement of partial labyrinthectomy during focal combined petrosectomy, offering a customization of the approach through the selective removal of the superior semicircular canal for specific types of tumors. METHODS: The use of the technique is demonstrated through surgical drawings, pictures, and videos. The rationale to indicate this new approach is discussed based on clinical cases. RESULTS: Three illustrative clinical cases (petroclival meningiomas) are demonstrated. Functional hearing on the approach side has been preserved in all of them. CONCLUSION: The focal combined transpetrosal approach associated with the superior semicircular canal resection has been a promising surgical technique in the treatment of selected petroclival tumors. It has the potential to further decrease the risks of postoperative auditory and vestibular dysfunctions associated with labyrinthectomies.
Ventriculoatrial Shunt Versus Ventriculoperitoneal Shunt: A Systematic Review and Meta-Analysis
(2024) OLIVEIRA, Leonardo de Barros; HAKIM, Fernando; SEMIONE, Gabriel da Silva; BERTANI, Raphael; BATISTA, Savio; PALAVANI, Lucca B.; SOUSA, Marcelo Porto; GOMEZ-AMARILLO, Diego F.; MEJIA-MICHELSEN, Isabella; PINTO, Fernando Campos Gomes; RABELO, Nicollas Nunes; WELLING, Leonardo C.; FIGUEIREDO, Eberval Gadelha
BACKGROUND AND OBJECTIVES: Ventriculoperitoneal shunt (VPS) is usually the primary choice for cerebrospinal fluid shunting for most neurosurgeons, while ventriculoatrial shunt (VAS) is a second-line procedure because of historical complications. Remarkably, there is no robust evidence claiming the superiority of VPS over VAS. Thus, we aimed to compare both procedures through a meta-analysis. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, the authors systematically searched the literature for articles comparing VAS with VPS. The included articles had to detail one of the following outcomes: revisions, infections, shunt-related mortality, or complications. In addition, the cohort for each shunt model had to encompass more than 4 patients. RESULTS: Of 1872 articles, 16 met our criteria, involving 4304 patients, with 1619 undergoing VAS and 2685 receiving VPS placement. Analysis of revision surgeries showed no significant difference between VAS and VPS (risk ratio [RR] = 1.10, 95% CI: 0.9-1.34; I-2 = 84%, random effects). Regarding infections, the analysis also found no significant difference between the groups (RR = 0.67, 95% CI: 0.36-1.25; I-2 = 74%, random effects). There was no statistically significant disparity between both methods concerning shunt-related deaths (RR = 2.11, 95% CI: 0.68-6.60; I-2 = 56%, random effects). Included studies after 2000 showed no VAS led to cardiopulmonary complications, and only 1 shunt-related death could be identified. CONCLUSION: Both methods show no significant differences in procedure revisions, infections, and shunt-related mortality. The literature is outdated, research in adults is lacking, and future randomized studies are crucial to understand the profile of VAS when comparing it with VPS. The final decision on which distal site for cerebrospinal shunting to use should be based on the patient's characteristics and the surgeon's expertise.
Letter: Low and Borderline Ankle-Brachial Index Is Associated With Intracranial Aneurysms: A Retrospective Cohort Study
(2024) OLIVEIRA, Leonardo B.; CIESLAK, Pedro Henrique; BATISTA, Savio; RABELO, Nicollas Nunes; BERTANI, Raphael; WELLING, Leonardo C.; FIGUEIREDO, Eberval Gadelha
Efficacy and safety of neuroendoscopy surgery versus craniotomy for supratentorial intracerebral hemorrhage: an updated meta-analysis of randomized controlled trials
(2024) MONTEIRO, Gabriel de Almeida; MARINHEIRO, Gabriel; MUTARELLI, Antonio; ARAUJO, Beatriz; CAVALCANTE-NETO, Joaquim Francisco; BATISTA, Savio; LEAL, Paulo Roberto Lacerda; CRISTINO-FILHO, Gerardo; FIGUEIREDO, Eberval Gadelha; TELLES, Joao Paulo Mota
Neuroendoscopy (NE) surgery emerged as a promising technique for the treatment of spontaneous intracerebral hemorrhage (ICH). A previous meta-analysis of randomized controlled trials (RCTs) analyzed the efficacy and safety of NE compared to craniotomy, but NE did not present a significant improvement in functional outcomes. However, a new study provided an opportunity to update the current knowledge. We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials for RCTs reporting NE evacuation of spontaneous supratentorial ICH compared to craniotomy. The efficacy outcomes of interest were favorable functional outcome, functional disability, hematoma evacuation rate, and residual hematoma volume. The safety outcomes of interest were rebleeding, infection, and mortality. Seven RCTs were included containing 879 patients. The NE approach presented a significantly higher rate of favorable functional outcome compared with craniotomy (RR: 1.42; 95% CI 1.17, 1.73; p < 0.001). The evacuation rate was higher in patients who underwent the NE approach (MD: -8.36; 95% CI -12.66, -4.07; p < 0.001). NE did not show a benefit in improving the mortality rate (RR: 0.81, 95% CI 0.54, 1.22; p = 0.32). NE was associated with more favorable functional outcomes and lower rates of functional disabilities compared to craniotomy. Also, NE was superior regarding evacuation rate, while presenting a reduction in residual hematoma volume. NE might be associated with lower infection rates. Mortality was not improved by NE surgery. Larger, higher-quality randomized studies are needed to adequately evaluate the efficacy and safety of NE compared to craniotomy.
Large acute epidural hematoma from head pin fixation fracture
(2024) SILVA, Vinicius Trindade Gomes da; MAKAREM, Louise; SILVA, Rhuann Pontes dos Santos; TEIXEIRA, Manoel Jacobsen; PAIVA, Wellingson Silva
Regarding head immobilization practices in neurosurgery, secondary fixation fractures are rare, underscoring the importance of precise pin positioning and an adequate force in the three-point clamp to achieve adequate fixation. Attention should be given to factors such as changes in bone metabolism.
Comparison of Prognostic Performance between Fisher and Modified Fisher Scales for Patients with Aneurysmal Subarachnoid Hemorrhage
(2024) RABELLO, Pedro Henrique Mouty; RABELO, Nicollas Nunes; TELLES, Joao Paulo Mota; COELHO, Antonio Carlos Samaia da Silva; YOSHIKAWA, Marcia Harumy; TEIXEIRA, Manoel Jacobsen; FIGUEIREDO, Eberval Gadelha
Objective The present study aims to assess and compare the prognostic value of these two scales for predicting mortality.Method We reviewed 172 patients with aneurysmal subarachnoid hemorrhage, who were followed-up for 6 months. The Fisher and modified Fisher scales were evaluated for the prediction of mortality using logistic regressions.Results The Fisher scale was associated with mortality (odds ratio [OR]: 2; 95% confidence interval [CI]: 1.09-4.05) in the multivariate analysis. The modified Fisher scale was not associated with mortality in the multivariate analysis (OR: 1.39; 95% CI: 0.9-2.29), nor in the univariate analysis (OR: 1.24; 95%CI: 0.87-1.86). There was no significant association between Fisher score and unfavorable functional outcomes (mRS > 2) in the univariate analysis (OR: 1.33; 95%CI: 0.92-1.92), nor in the multivariate analysis (OR: 1.37; 95%CI: 0.92-2.05). There was no significant association between modified Fisher scores and unfavorable functional outcomes in the univariate analysis (OR: 1.16; 95%CI: 0.88-1.52). There was also no significant association in the multivariate analysis (OR: 1.18; 95%CI: 0.88-1.57).Conclusion Only the Fisher scale was associated with mortality. Neither of the two scales was associated with unfavorable functional outcomes (mRS > 2).
Efficacy and Safety of Atorvastatin for Chronic Subdural Hematoma: An Updated Systematic Review and Meta-Analysis
(2024) MONTEIRO, Gabriel de Almeida; QUEIROZ, Thomas Silva de; GONCALVES, Ocilio Ribeiro; CAVALCANTE-NETO, Joaquim Francisco; BATISTA, Savio; RABELO, Nicollas Nunes; WELLING, Leonardo Christiaan; FIGUEIREDO, Eberval Gadelha; LEAL, Paulo Roberto Lacerda; SOLLA, Davi Jorge Fontoura
Background: Chronic subdural hematoma (CSDH) is a common neurological condition, especially in the elderly population. Atorvastatin has shown the potential to reduce the recurrence of CSDH and improve overall outcomes. New studies have emerged since the last meta-analysis, increasing the sample size and the variety of outcomes analyzed. Methods: We searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials for studies comparing the use of atorvastatin in CSDH patients with a control group or placebo. The primary outcome was the recurrence of CSDH. Secondary outcomes of interest were hematoma volume, composite adverse effects, mortality, and neurological function, measured by the Glasgow Outcome Scale and Barthel index for activities of daily living. Results: Seven studies, of which 2 were randomized controlled trials, were included, containing 1192 patients. Overall recurrence significantly decreased compared to the control group (risk ratio [RR] 0.46; 95% confidence interval [CI] 0.25-0.83; P = 0.009). The benefits of atorvastatin were sustained in the subgroup analysis of patients who underwent initial conservative therapy (RR 0.40; 95% CI 0.22-0.70; P = 0.001). However, there was no significant difference when atorvastatin was combined with surgical intervention (RR 0.53; 95% CI 0.21-1.32; P = 0.17). Adverse effects were not increased by atorvastatin (RR 0.82; 95% CI 0.51-1.34; P = 0.44). Conclusions: Atorvastatin might be beneficial in reducing CSDH recurrence, especially in conservative treatment patients. Atorvastatin was not significantly associated with adverse effects. Larger, higher-quality randomized studies are needed to adequately evaluate the efficacy, safety, and optimal dose of atorvastatin in CSDH patients.
STA-MCA Double-Barrel Bypass: A Systematic Review of Technique and Single-Arm Meta-Analysis of Outcomes
(2024) OLIVEIRA, Leonardo B.; CIESLAK, Pedro Henrique; FERREIRA, Marcio Yuri; FUZIKI, Cassiano K.; MARTINS, Italo C.; SEMIONE, Gabriel; MARQUES, Guilherme Nunes; PALAVANI, Lucca B.; BATISTA, Savio; RABELO, Nicollas Nunes; KOESTER, Stefan W.; BERTANI, Raphael; WELLING, Leonardo C.; LAWTON, Michael T.; FIGUEIREDO, Eberval Gadelha
IntroductionConventionally, one branch of the superficial temporal artery (STA) is utilized to revascularize the middle cerebral artery (MCA). However, there is the possibility of utilizing both branches of the STA when performing the bypass, characterizing the double-barrel (DB) STA-MCA bypass. Notably, a lack of studies evaluating this technique led the authors to conduct a systematic review and single-arm meta-analysis.MethodsPubMed, Embase and Web of Science were searched systematically for publications of DB-STA-MCA bypass on November 1st, 2023. The findings were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Case reports were not included for statistical analysis purposes.ResultsThe review included 408 patients and 534 bypasses from 34 studies. The main etiology was Moyamoya disease (64.6%), followed by cerebral ischemia (22.2%) and aneurysms (12.5%). The median of the mean follow-ups of each study was 12.8 months (range 1.5-87.9). The postoperative patency was 100%. The follow-up patency was 98% (95% CI: 96%-100%; I2 = 0%). The procedure-related mortality was 0% (95% CI: 0%-1%; I2 = 0%). Aneurysms obtained 87% (95% CI: 72%-100%; I2 = 4%) of good clinical outcomes, while Moyamoya disease yielded a rate of 70% (95% CI: 10%-100%; I2 = 97%). Ischemic complications occurred at a rate of 6% (95% CI: 2%-11%; I2 = 36%), while hemorrhagic occurred at 6% (95% CI: 1%-11%; I2 = 56%). Hyperperfusion syndrome rate was calculated as 18% (7%-30%; I2 = 55%) for Moyamoya disease.ConclusionsThe procedure appears to be safe, with excellent patency rates. The clinical efficacy for ischemic and Moyamoya diseases warrants further standardized robust investigation with a broader number of patients, and aneurysm studies are required to enhance sample sizes. The main complication for the Moyamoya subgroup is hyperperfusion syndrome.

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