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Background: Barbed sutures eliminate knots and may offer some advantages over conventional sutures. This meta-analysis compares clinical, surgical and economic outcomes of barbed sutures with standard closure techniques in spinal surgery., Methods: We systematically searched PubMed, Embase and Web of Science for studies comparing barbed and conventional suture for patients undergoing spinal surgery., Results: We included 6 studies in the analysis, totaling 965 patients. There was no significant difference between the groups in relation to deep infection (RR 0.49; 95% CI: 0.19-1.28; I 2 = 0%), hospital stay duration (MD -0.55; 95% CI: -1.11 to 0.01; I 2 = 8%), postoperative hematoma (RR 0.35; 95% CI: 0.04-3.00; I 2 = 0%), reintervention due to wound healing problems (RR 0.98; 95% CI: 0.49-1.94; I 2 = 5%), superficial infection (RR 0.49; 95% CI: 0.19-1.28; I 2 = 0%), total hospitalization cost (MD -440.81; 95% CI: -1118.90 to 237.29; I 2 = 63%) and wound dehiscence/seroma, (RR 0.81; 95% CI: 0.29-2.27; I 2 = 0%). There was a significant lower operating room time (MD -15.37; 95% CI: -29.43 to -1.32; I 2 = 87%) and suturing time (MD -16.17; 95% CI: -20.58 to -11.75; I 2 = 91%) in the barbed suture group, beyond a significantly lower risk of total infection (RR 0.55; 95% CI: 0.31-0.98; I 2 = 0%)., Conclusion: Our meta-analysis showed that barbed sutures were associated with reduced operating room time, suturing time, and infection rates. These results highlight the safety and potential efficacy of using barbed sutures., (Copyright © 2024. Published by Elsevier Inc.)

Background: Primary brainstem hemorrhage (PBSH) is a fatal condition related to hypertension. PBSH definitive treatment remains controversial, mainly when surgical options are discussed., Objective: To aid decision-making in PBSH scenarios, we aimed to perform a meta-analysis and evaluate the literature on stereotactic aspiration (SA) for PBSH in comparison to conservative management (CM)., Methods: The outcomes assessed were: 30-day mortality, mortality, 90-day good outcome (mRs ≤ 3), good outcome (mRs ≤ 3), good outcome (mRs ≤ 3 or GOS 4-5), 90-day poor outcome (mRs ≥ 4), poor outcome (mRs ≥ 4)., Results: We included 1189 patients from 9 studies. 433 (36,41 %) patients were treated with SA. The risk of 30-Day Mortality (RR 0.57; 95 % CI 0.41-0.81; p=0.002; I²=58 %), Mortality (RR 0.56; 95 % CI 0.41-0.75; p<0.001; I²=54 %), 90-Day Poor Outcome (mRS ≥ 4) (RR 0.83; 95 % CI 0.73-0.93; p=0.001; I²=25 %), Poor Outcome (mRS ≥ 4) (RR 0.83; 95 % CI 0.75-0.93; p=0.001; I²=0 %) and Poor Outcome (mRS ≥ 4 or GOS ≤ 3) (RR 0.82; 95 % CI 0.74-0.91; p<0.001; I²=12 %) were significantly lower in patients receiving SA treatment. Also, the risk of 90-Day Good Outcome (mRS ≤ 3) (RR 1.60; 95 % CI 1.06-2.39; p=0.024; I²=21 %), Good Outcome (mRS ≤ 3) (RR 1.48; 95 % CI 1.13-1.94; p=0.005; I²=0) and Good Outcome (mRS ≤ 3 or GOS 4-5) (RR 1.72; 95 % CI 1.17-2.53; p=0.006; I²=25 %) were significant higher in the SA group., Conclusion: SA demonstrated favorable outcomes, including reduced mortality rates and improved functional recovery. Further clinical trials are needed to validate these findings., Competing Interests: Declaration of Competing Interest The authors assert that there are no conflicts of interest or competing interests relevant to this meta-analysis., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Chiari Malformation Type I (CMI) is a prevalent neurosurgical condition characterized by the descent of cerebellar tonsils below the foramen magnum. Surgery, aimed at reducing symptomatology and syrinx size, presents risks, making intraoperative neuromonitoring (IONM) a potentially vital tool. Despite its widespread use in cervical spine surgery, the utility of IONM in CMI surgery remains controversial, with concerns over increased operative time, cost, restricted anesthetic techniques and tongue lacerations. This systematic review and meta-analysis followed the Cochrane Group standards and PRISMA framework. It encompassed an extensive search through PubMed, Embase, and Web of Science up to December 2023, focusing on clinical and surgical outcomes of IONM in CMI surgery. Primary outcomes included the use of various IONM techniques, complication rates, clinical improvement, reoperation, and mortality. The review, registered at PROSPERO (CRD42024498996), included both prospective and retrospective studies, with rigorous selection and data extraction processes. Statistical analysis was conducted using R software. The review included 16 studies, comprising 1358 patients. It revealed that IONM techniques predominantly involved somatosensory evoked potentials (SSEPs), followed by motor evoked potentials (MEPs) and Brainstem auditory evoked potentials (BAEPs). The estimated risk of complications with IONM was 6% (95% CI: 2-11%; I 2  = 89%), lower than previously reported rates without IONM. Notably, the clinical improvement rate post-surgery was high at 99% (95% CI: 98-100%; I 2  = 56%). The analysis also showed lower reoperation rates in surgeries with IONM compared to those without. Interestingly, no mortality was observed in the included studies. This systematic review and meta-analysis indicate that intraoperative neuromonitoring in Chiari I malformation surgery is associated with favorable clinical outcomes, including lower complication and reoperation rates, and high rates of clinical improvement., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: Meckel-Gruber Syndrome (MKS) is an autosomal recessive genetic disorder, notable for its triad of occipital encephalocele, polycystic renal dysplasia, and postaxial polydactyly. Identified by Johann Friederich Meckel in 1822, MKS is categorized as a ciliopathy due to gene mutations. Diagnosis is confirmed by the presence of at least two key features. The condition is incompatible with life, leading to death in the womb or shortly after birth. Recent studies have largely focused on the genetic aspects of MKS, with limited information regarding the impact of neurosurgical approaches, particularly in treating encephaloceles., Methods: A systematic review was performed according to the PRISMA statement. The PubMed, Embase, and Web of Science databases were consulted for data screening and extraction, which was conducted by two independent reviewers. The search strategy aimed to encompass studies documenting cases of MKS with published reports of encephalocele excisions, and the search strings for all databases were: Meckel-Gruber syndrome OR Meckel Gruber syndrome OR Meckel-gruber OR Meckel Gruber., Results: The study included 10 newborns with MKS associated with occipital encephalocele or meningocele, all of whom underwent surgical repair of the occipital sac. The mean gestational age at birth was 36 (± 2) weeks. The mean of birth weight was 3.14 (± 0.85) kilograms. The average head circumference at birth was 33.82 cm (± 2.17). The mean diameter of the encephalocele/meningocele was 5.91 (± 1.02) cm. Other common central nervous system abnormalities included hydrocephalus, Dandy-Walker malformation, and agenesis of the corpus callosum. 40% required shunting for hydrocephalus. Surgery to remove the occipital sac occurred at a median age of 2.5 days (1.5-6.5). The most common post-surgical complication was the need for mechanical ventilation. The most common cause of death was pneumonia and the median age at death was 6.66 (0.03-18) months., Conclusion: Our findings suggest that neurosurgical intervention, especially for managing encephaloceles, may offer some improvement in survival, albeit within a context of generally poor prognosis. However, these results should be interpreted with caution., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Craniosynostosis, a developmental craniofacial anomaly, can impair brain development and cause abnormal skull shape due to premature closure of one or more cranial sutures. Traditional surgical treatments have evolved from open operations to minimally invasive endoscopic techniques. This systematic review and meta-analysis aim to evaluate the effectiveness and safety of the endoscopic approach in craniosynostosis correction., Methods: Adhering to Cochrane Group standards and the PRISMA framework, this review utilized databases like PubMed, Embase, and Web of Science, focusing on clinical and surgical outcomes of endoscopic craniosynostosis operations up to December 2023. Inclusion criteria emphasized studies with at least five patients undergoing endoscopic procedures, while exclusion criteria involved non-English papers, incomplete texts, and overlapping data. Statistical analysis used R software with various packages, and methodological bias was assessed using the ROBINS-I framework., Results: The review included 30 studies (4 prospective, 26 retrospective) with 2561 patients. The median age at operation was 3.20 months. Findings showed a mean operative time of 68.06 min, median hospital stay of 1.28 days, and mean blood loss of 29.89 ml. Blood transfusion was required in 9.97% of cases. Helmet therapy post-operation was common, with a median duration of 9 months. The rate of postoperative complications was 1.86%, and the reoperation rate was 3.07%. No procedure-related mortality was observed. The study noted substantial variations in the handling of craniosynostosis and a lack of consensus on the optimal timing and surgical approach., Conclusion: Endoscopic techniques for craniosynostosis repair demonstrate safety and effectiveness, characterized by low complication risks and favorable surgical outcomes. However, due to the limitations of observational studies and inherent heterogeneity, further comprehensive and controlled trials are needed to validate these findings and understand the long-term outcomes of the endoscopic approach., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Intracranial pressure (ICP) monitoring plays a key role in patients with traumatic brain injury (TBI), however, cerebral hypoxia can occur without intracranial hypertension. Aiming to improve neuroprotection in these patients, a possible alternative is the association of Brain Tissue Oxygen Pressure (PbtO2) monitoring, used to detect PbtO2 tension., Method: We systematically searched PubMed, Embase and Cochrane Central for RCTs comparing combined PbtO2 + ICP monitoring with ICP monitoring alone in patients with severe or moderate TBI. The outcomes analyzed were mortality at 6 months, favorable outcome (GOS ≥ 4 or GOSE ≥ 5) at 6 months, pulmonary events, cardiovascular events and sepsis rate., Results: We included 4 RCTs in the analysis, totaling 505 patients. Combined PbtO2 + ICP monitoring was used in 241 (47.72%) patients. There was no significant difference between the groups in relation to favorable outcome at 6 months (RR 1.17; 95% CI 0.95-1.43; p = 0.134; I 2  = 0%), mortality at 6 months (RR 0.82; 95% CI 0.57-1.18; p = 0.281; I 2  = 34%), cardiovascular events (RR 1.75; 95% CI 0.86-3.52; p = 0.120; I 2  = 0%) or sepsis (RR 0.75; 95% CI 0.25-2.22; p = 0.604; I 2  = 0%). The risk of pulmonary events was significantly higher in the group with combined PbtO2 + ICP monitoring (RR 1.44; 95% CI 1.11-1.87; p = 0.006; I 2  = 0%)., Conclusions: Our findings suggest that combined PbtO2 + ICP monitoring does not change outcomes such as mortality, functional recovery, cardiovascular events or sepsis. Furthermore, we found a higher risk of pulmonary events in patients undergoing combined monitoring., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

Objective: To assess the efficacy and surgical outcomes of the simultaneous single-trajectory endoscopic biopsy and third ventriculostomy (ETV) in pineal region tumors., Methods: A systematic review and meta-analysis adhering to Cochrane Standards and PRISMA framework were conducted. PubMed, Embase, and Web Of Science databases were searched until December 2023. Outcomes included rate of histopathologic diagnosis success, ETV success, complications, required VPS, and mortality., Results: Seventeen studies (N = 388) met inclusion criteria. Histopathologic diagnosis success rate was 90% for general population (95% CI: 86%-95%; I 2  = 42%) and 94% for pediatric patients (95% CI: 89%-98%; I 2  = 19%). ETV Success rate was 93% (95% CI: 88%-97%; I 2  = 60%). An estimated risk of postoperative ETV complications was found to be 16% for the general population (95% CI: 5%-28%; I 2  = 90%) and 5% for pediatric patients (95% CI: 0%-13%; I 2  = 51%). The risk of requiring VPS was estimated as 2% (95% CI: 0%-4%; I 2  = 39%) and for the pediatric population it was 7% (95% CI: 0%-16%; I 2  = 69%). Mortality risk was found to be 1% (95% CI: 0%-3%; I 2  = 0%)., Conclusions: Simultaneous endoscopic biopsy and ETV demonstrated high diagnostic and therapeutic success rates. The procedure's safety profile, with low mortality and complications, supports its role in treating hydrocephalus associated to pineal region tumors. Subgroup analyses revealed higher diagnostic success rates and required VPS in the pediatric population, whilst it had lower complication rates., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Permanent liquor diversion is associated with a high risk of failure and often requires re-intervention. The ventriculo-gallbladder shunt (VGS) has been recognized as a last-resort alternative for treating hydrocephalus when the peritoneum or other distal sites are no longer suitable for receiving shunts. This article aims to report a case from a neurosurgery referral service in Brazil and review the literature on this issue., Methods: A systematic literature review was conducted in accordance with the PRISMA statement. The PubMed, Embase, and Web of Science databases were searched for data screening and extraction. The reported case was conducted with ethical approval from the neurosurgical hospital's ethics committee., Results: G.B.S, male, 43 years old, no comorbidities, who has been dealing with a 12-year history of hydrocephalus, with post-surgical chronic fungal meningitis. Two years ago, he underwent a ventriculoatrial shunt (VAS) placement due to multiple ventriculoperitoneal shunt (VPS) failures. Endocarditis was suspected, and the VAS was removed. As an alternative, VGS was implanted 6 months ago, and since then, there has been no need for a new system review. The gallbladder has an absorptive capacity of 1500 cc of liquid daily, which is more than the normal daily production of cerebrospinal fluid (CSF). Therefore, it is a good alternative when the ventriculoperitoneal shunt is not feasible due to postsurgical peritoneal adhesions or when there are contraindications for ventriculoatrial shunts., Conclusion: VGS is an alternative for patients who cannot undergo the most common surgical interventions, such as VPS., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background and Importance: Resection of olfactory groove meningiomas is challenging because of their close proximity with the anterior cerebral circulation. It is important to recognize the vascular variants in procedures at the anterior skull base because inadvertent maneuvers may result in the rupture of these arteries and unexpected bleeding., Clinical Presentation: We reported a type 2 persistent primitive olfactory artery with a dural branch of the elongated anterior cerebral artery directly to the ethmoid region, visualized during the surgical removal of an olfactory groove meningioma., Conclusion: This is the first report of bilateral persistent primitive olfactory artery demonstrated by operative visualization and confirmed with vascular study. Understanding and recognizing the possible variations of this vascular anatomy is of great importance for anterior skull base surgeries., (Copyright © Congress of Neurological Surgeons 2022. All rights reserved.)

Antimicrobial peptides (AMPs) are produced to control bacteria, fungi, protozoa, and other infectious agents. Sand fly larvae develop and feed on a microbe-rich substrate, and the hematophagous females are exposed to additional pathogens. We focused on understanding the role of the AMPs attacin (Att), cecropin (Cec), and four defensins (Def1, Def2, Def3, and Def4) in Lutzomyia longipalpis, the main vector of visceral leishmaniasis in the Americas. Larvae and adults were collected under different feeding regimens, in addition to females artificially infected by Leishmania infantum . AMPs' gene expression was assessed by qPCR, and gene function of Att and Def2 was investigated by gene silencing. The gene knockdown effect on bacteria and parasite abundance was evaluated by qPCR, and parasite development was verified by light microscopy. We demonstrate that L. longipalpis larvae and adults trigger AMPs expression during feeding, which corresponds to an abundant presence of bacteria. Att and Def2 expression were significantly increased in Leishmania -infected females, while Att suppression favored bacteria growth. In conclusion, L. longipalpis AMPs' expression is tuned in response to bacteria and parasites but does not seem to interfere with the Leishmania cycle.