Pediatric Dilemma: Endovascular versus Surgical Intervention for Spinal Vascular Malformations.

OBJECTIVE: Spinal arteriovenous malformations (AVM) manifest in the pediatric population very differently from the ones in adulthood. Despite that fact, the treatment strategy is quite the same, which provokes a question - whether some of the therapies have an advantage and if so, in which age group. METHODS: For this reason, the authors searched the world literature between 1989 and 2018 for spinal AVM in children and further categorized the studies into two age groups: < 12 and ≥12. RESULTS: The total number of included studies in this meta-analysis is 35. Seventeen of them are on the subject of AVM and 15 on the subject of arteriovenous fistula. Three studies encompass both types of lesions. CONCLUSION: After processing the data, we observed that there is no relationship between age group and the utilized management, except for the endovascular AVF in children less than 12 years of age. Because of this, it should be strongly considered in further management planning.

The Clock Is Ticking - Brain Atrophy in Case of Acute Trauma?

OBJECTIVE: Brain atrophy and brain herniation are gaining a lot of attention separately, but a limited amount of studies connected them together, and because of this, we are going to review and examine the subject in the current meta-analysis. METHODS: The authors collected data reporting brain atrophy of alcoholic and schizophrenic cause, as well as data on control patients, all of which was published on MEDLINE between 1996 and 2018. The included 11 articles were processed with a statistical program. RESULTS: We found that the pericerebral space is unequal among the groups, while the intracranial volume is strongly correlated to the biggest foramen of the body. The effect of this inequality, however, is expressed in emergency cases, where the patients with brain atrophy will have more time before the final stage of brain herniation. CONCLUSION: The current study raises a controversial issue that requires careful investigation and high attention from the health care personnel.