Risk factors for the rupture of intracranial aneurysms: a systematic review and meta-analysis.

Purpose: The study aimed to identify potential risk factors for aneurysm rupture by performing a systematic review and meta-analysis. Materials and methods: We systematically searched the PubMed, Embase, and Cochrane Library electronic databases for eligible studies from their inception until June 2023. Results: Eighteen studies involving 17,069 patients with unruptured intracranial aneurysm (UIA) and 2,699 aneurysm ruptures were selected for the meta-analysis. Hyperlipidemia [odds ratio (OR): 0.47; 95% confidence interval (CI): 0.39-0.56; p < 0.001] and a family history of subarachnoid hemorrhage (SAH) (OR: 0.81; 95% CI: 0.71-0.91; p = 0.001) were associated with a reduced risk of aneurysm rupture. In contrast, a large-size aneurysm (OR: 4.49; 95% CI: 2.46-8.17; p < 0.001), ACA (OR: 3.34; 95% CI: 1.94-5.76; p < 0.001), MCA (OR: 2.16; 95% CI: 1.73-2.69; p < 0.001), and VABA (OR: 2.20; 95% CI: 1.24-3.91; p = 0.007) were associated with an increased risk of aneurysm rupture. Furthermore, the risk of aneurysm rupture was not affected by age, sex, current smoking, hypertension, diabetes mellitus, a history of SAH, and multiple aneurysms. Conclusion: This study identified the predictors of aneurysm rupture in patients with UIAs, including hyperlipidemia, a family history of SAH, a large-size aneurysm, ACA, MCA, and VABA; patients at high risk for aneurysm rupture should be carefully monitored. Systematic Review Registration: Our study was registered in the INPLASY platform (INPLASY202360062).

Early diagnostic value of optical coherence tomography in the clinical prediction model for optic nerve injury in saddle space occupying patients.

In this study, 50 patients with anterior ischemic optic neuropathy due to saddle block were selected as the experimental group, and 50 healthy subjects were used as the control group to conduct a study. The best corrected visual acuity examination, optical coherence tomography and visual evoked potential examination were performed on the two groups. The results of the study showed that the majority of patients were middle-aged and older people over the age of 50, but the youngest patients were only 37 years old. After various examinations, it was found that patients with optic nerve injury had a significant reduction in the best corrected visual acuity compared with healthy people. After the onset of the disease, the optic nerve fiber layer will first increase and then decline. During the course of the disease, the patient's optic nerve fiber layer will gradually thin to a much lower level than healthy people. And in comparing the thickness of the optic nerve fiber layer in patients with systemic disease and no systemic disease, it is found that the degree of optic nerve damage is more serious in patients with systemic diseases. After the VEP examination, the difference between the P100 wave latency and the N75-P100 amplitude of the diseased eye and the unaffected eye was statistically significant. Moreover, the difference between the patient's diseased eye and the healthy human eye is almost the same as that of the unaffected eye.

Endoscopic Versus Microscopic Transsphenoidal Surgery in the Treatment of Pituitary Adenoma: A Systematic Review and Meta-Analysis.

BACKGROUND: Inconsistent findings have been reported regarding the efficacy and safety of endoscopic and microscopic transsphenoidal surgery for pituitary adenoma. This study aimed to assess the benefits and shortcomings of these surgical methods in patients with pituitary adenoma. METHODS: The electronic databases PubMed, Embase, and the Cochrane Library were systematically searched, as well as proceedings of major meetings. Eligible studies with a retrospective or prospective design that evaluated endoscopic versus microscopic methods in patients with pituitary adenoma were included. Primary outcomes included gross tumor removal, cerebrospinal fluid leak, diabetes insipidus, and other complications. RESULTS: Overall, 23 studies (4 prospective and 19 retrospective) assessing 2272 patients with pituitary adenoma were included in the final analysis. Endoscopic transsphenoidal surgery was associated with a higher incidence of gross tumor removal (odds ratio, 1.52; 95% confidence interval, 1.11-2.08; P = 0.009) than those with microscopic transsphenoidal surgery. In addition, endoscopic transsphenoidal surgery had no significant effect on the risk of cerebrospinal fluid leak, compared with microscopic transsphenoidal surgery. Furthermore, endoscopic transsphenoidal surgery was associated with a 22% reduction in risk of diabetes insipidus compared with microscopic transsphenoidal surgery, but the difference was not statistically significant. Endoscopic transsphenoidal surgery significantly reduced the risk of septal perforation (odds ratio, 0.29; 95% confidence interval, 0.11-0.78; P = 0.014) and was not associated with the risk of meningitis, epistaxis, hematoma, hypopituitarism, hypothyroidism, hypocortisolism, total mortality, and recurrence. CONCLUSIONS: Endoscopic transsphenoidal surgery is associated with higher gross tumor removal and lower incidence of septal perforation in patients with pituitary adenoma. Future large-scale prospective randomized controlled trials are needed to verify these findings.

Efficient delivery of docetaxel for the treatment of brain tumors by cyclic RGD-tagged polymeric micelles.

The treatment of glioblastoma, and other types of brain cancer, is limited due to the poor transport of drugs across the blood brain barrier and poor penetration of the blood­brain­tumor barrier. In the present study, cyclic Arginine­Glycine­Aspartic acid­D­Tyrosine­Lysine [c(RGDyK)], that has a high binding affinity to integrin αvß3 receptors, that are overexpressed in glioblastoma cancers, was employed as a novel approach to target cancer by delivering therapeutic molecules intracellularly. The c(RGDyK)/docetaxel polylactic acid­polyethylene glycol (DTX­PLA­PEG) micelle was prepared and characterized for various in vitro and in vivo parameters. The specific binding affinity of the Arginine­Glycine­Aspartic acid (RGD) micelles, to the integrin receptor, enhanced the intracellular accumulation of DTX, and markedly increased its cytotoxic efficacy. The effect of microtubule stabilization was evident in the inhibition of glioma spheroid volume. Upon intravenous administration, c(RGDyK)/DTX­PLA­PEG showed enhanced accumulation in brain tumor tissues through active internalization, whereas non­targeted micelles showed limited transport ability. Furthermore, RGD­linked micelles showed marked anti­glioma activity in U87MG malignant glioma tumor xenografts, and significantly suppressed the growth of tumors without signs of systemic toxicity. In conclusion, the results of the present study suggest that ligand­mediated drug delivery may improve the efficacy of brain cancer chemotherapy.