Gamma knife radiosurgery for orbital cavernous hemangioma: a systematic review and single-arm meta-analysis.

PURPOSE: Gamma knife radiosurgery (GKRS) for orbital cavernous hemangioma (OCH) has emerged as a promising method due to its significant clinical improvement and low incidence of complications. This study aimed to evaluate the safety and efficacy of GKRS for the treatment of OCH. METHODS: In accordance with the PRISMA framework, we searched PubMed, Cochrane Central, and Embase for studies reporting outcomes of GKRS for OCH. Studies reporting complications, visual improvement, proptosis, tumor reduction rate, and tumor progression rate for OCH following GKRS were included. RESULTS: Six studies, out of 1856 search results, with 100 patients were included. Among them, only 5 minor complications were related to GKRS, including 3 with orbital pain and 2 with periorbital chemosis. Thus, the complication rate was 13% (95% CI, 7-25%). Visual acuity and visual field improvement rates after GKRS were 80% (95% CI, 63-96%) and 71% (95% CI, 47-95%) respectively. Proptosis improved in 94% of cases (95% CI, 83-100%). The tumor reduction rate was 77% after GKRS (95% CI, 69-85%). CONCLUSION: GKRS for OCH appears to be a safe technique, as evidenced by the rate of clinical improvement and radiological improvement. However, studies are limited by an absence of a control group. Additional studies are needed to evaluate the relative efficacy of GKRS as compared with alternative surgical modalities for OCH.

History of pediatric neurosurgery in Latin America: the early years.

PURPOSE: Pediatric neurosurgical history in Latin America possesses rich and fascinating origins; the large number of neurosurgical societies that form the continent and the inspiring achievements of the pioneers in the field in every single Latin American country are described here. This unique text explores the aspects of this neurosurgical specialty since its beginnings by neurosurgeons trained outside Latin America, who brought the pediatric practice to their home countries, writing a new chapter in the neurosurgical history, constructing the foundations for the present pediatric practice and the few fellowships found in the continent. METHODS, RESULTS AND CONCLUSION: A formal search was performed in PubMed, Embase, and national libraries focused on the historical and biographical aspects of pioneers' pediatric neurosurgeons of Argentina, Brazil, Colombia, Venezuela, Peru, Chile, and Ecuador, with an important session that describes the fellowships' opportunities in pediatric neurosurgery found in the continent, dividing all the programs according to the countries that offer the subspecialty education.

How to become a pediatric neurosurgeon in Latin America: training opportunities, current status, and future challenges.

PURPOSE: To provide an analysis of pediatric neurosurgery educational opportunities in Latin America in order to characterize and evaluate the strengths, weaknesses, and limitations to assume a career in pediatric neurosurgery. METHODS: An online survey was distributed to pediatric neurosurgeons in Latin America to assess aspects of pediatric neurosurgical education, working conditions, and training opportunities. The survey was open to neurosurgeons that treat pediatric patients, whether or not they had completed fellowship training in pediatrics. A descriptive analysis was done with a subgroup analysis stratified the results among certified pediatric neurosurgeons and non-certified pediatric neurosurgeons. RESULTS: In total, 106 pediatric neurosurgeons completed the survey, of whose the vast majority completed their training in a Latin American pediatric neurosurgery program. A total of 19 accredited academic programs in pediatric neurosurgery were found in Latin America distributed in 6 different countries. On average, the pediatric neurosurgical training in America Latina has a duration of 278 years, ranging from 1 to > 6 years. CONCLUSIONS: This study is the first of its kind to review pediatric neurosurgical training in Latin America, in which both pediatric and general neurosurgeons provide neurosurgical care to children in the continent; however, we found that in the majority of the cases, children are treated by certified pediatric neurosurgeons, of whose the vast majority were trained in Latin American programs. On the other hand, we found areas of improvement in the specialty in the continent, including regulation of training opportunities, increased support for funding, and more opportunities for education among all countries.

Early vs. Delayed Surgical Management of Ruptured Arteriovenous Brain Malformations in a Tertiary Referral Center in Colombia, South America.

INTRODUCTION: Surgical timing after rupture of brain arteriovenous malformations (AVMs) is controversial. There is scarce literature on AVM surgical outcomes from developing countries. This study aims to determine if there is a difference between early and delayed surgical resection for patients with ruptured brain AVMs. METHODS: This single-center retrospective review included patients who underwent surgical resection for ruptured brain AVMs in Colombia. Patients were stratified by the timing of surgical intervention relative to the rupture into early (≤72 hours of bleeding) and delayed (>72 hours) resection. Continuous variables were analyzed using an independent t-test, and dichotomous variables were analyzed using a chi-square test. A linear-regression analysis was performed with the final mRankin score at 2 years as the dependent variable; p<0.05 was considered significant. RESULTS: Thirty-one patients were identified. The early treatment group included 14(45.2%) patients, and the delayed group, 17(54.8%) patients. The mean(SD) length of time between AVM rupture and surgical resection was 1.6±1.2 days and 12.4±8.4 days, respectively(p<0.001). There were no differences regarding demographics, perioperative variables and postoperative outcomes between groups. In the linear-regression analysis, the only variable that had a significant association with the final mRankin score was the initial GCS, which had a ß coefficient of -0.6341(95%CI-0.41,-0.017,p=0.035) CONCLUSION: In this case series of 31 patients from a developing country, there were no differences in clinical outcomes at the final follow-up between acute and delayed surgical interventions for ruptured AVMs. The most important factor associated with the final outcomes was the initial GCS.