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• Surgical advancements drive growing interest in Same-Day Discharge (SDD). • This study is the first synthesis of the literature regarding SDD following craniotomies. • Single-arm meta-analysis (715 patients) identified a high SDD success rate with minimal readmissions. • Comparative analysis found no evidence of harm in SDD compared to normal discharge procedures. Traditionally, patients undergoing craniotomy were subject to extended hospital stays for intensive monitoring and management of potential complications. However, with the evolution of surgical methods, anesthesia, and postoperative protocols, the feasibility and interest in same-day discharge (SDD) are growing. This study aimed to evaluate whether same-day discharge is a safe and feasible approach in craniotomy through a meta-analysis of the available literature. Following PRISMA guidelines, a comprehensive search was conducted across Medline, Embase, Cochrane, and Web of Science databases from inception to December 2023. Eligible studies comprised reports in English with a minimum of 4 patients who underwent craniotomies and were discharged with same-day discharge, whether single-arm or comparative with normal discharge. Single proportion analysis with 95 % confidence interval (CI) was used to pool the studies and Odds Ratio (OR) with 95 % CI was used to measure effects in comparative analysis. A random-effects model was adopted. Endpoints included success and failure of pre-planned same-day discharge, and postoperative complications throughout the hospital stay (until discharge), these complications were further categorized into major and minor complications. Also, need for reoperation, readmission within 24 h, readmission after 24 h, and mortality. Seven observational studies were included. Five studies were included in the single-arm analysis, comprising data from 715 patients. Four studies comprising 731 patients were included in the comparative analysis, of whom 233 were discharged on SDD, and 498 were discharged normally. The analysis revealed a success rate of 88 % (95 % CI, 83 %–94 %), readmission to the hospital within the initial 24 h rate of 2 % (95 % CI, 1 %–2 %), readmission after 24 h rate of 1 % (95 % CI, 0 %–2 %;), total postoperative complications until discharge rate of 2 % (95 % CI, 1 %–4 %), major complications rate of 0 % (95 % CI, 0 %–0 %), minor complications rate of 2 % (95 % CI, 1 %–4 %), and mortality rate of 0 % (95 % CI, 0 %–0 %). Comparative analysis for complications and mortality showed no difference between both approaches. This systematic review and meta-analysis identified that same-day discharge in craniotomy for selected patients, as well as for tumor resection craniotomies, is highly feasible and safe, with a high success rate, low failure, and reoperation rates. Moreover, for selected patients, no evidence of harm in same-day discharge was identified when compared with normal discharge. Consequently, same-day discharge may be considered a viable option, provided appropriate selection criteria are employed. [ABSTRACT FROM AUTHOR]

Treating complex posterior circulation aneurysms poses challenges, and extracranial to intracranial (EC-IC) bypass techniques are potential therapeutic options. However, the safety and efficacy of this approach for posterior circulation aneurysms remain unclear. The study's objective was to assess the safety and efficacy of EC-IC bypass in these aneurysms. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we conducted a systematic review on EC-IC revascularization for posterior circulation aneurysms. Included studies had at least 4 patients and reported data on mortality, patency, complications, or clinical outcomes. Favorable clinical outcomes were defined as modified Rankin Scale below 3 or Glasgow Outcome Scale above 3, and complications were any issues related to the bypass procedure. From 3036 articles reviewed, 22 studies involving 196 patients who underwent 210 EC-IC bypass procedures for posterior circulation aneurysms were selected. The median follow-up period of 14 studies was 31.66 months (6–61 months). Final follow-up indicated a high bypass patency rate of 96% [95% confidence interval [CI]: 91%–100%; I2 = 12%], with a mortality rate of 5% [95% CI: 1%–9%; I2 = 0%]. Additionally, 83% [95% CI: 70%–96%; I2 = 77%] of patients showed good outcomes at the last follow-up. Complications were observed in 40% [95% CI: 26%–55%; I2 = 80%]. Heterogeneity was associated with specific studies. EC-IC bypass procedures are a viable treatment option for posterior circulation aneurysms, with high bypass patency rates and favorable clinical outcomes. However, complications, especially neurological deficits, exist. Open revascularization remains essential for neurovascular surgeons dealing with complex aneurysms. [ABSTRACT FROM AUTHOR]

Despite the recent increase in publications centered on intracranial-intracranial (IC-IC) bypasses for complex aneurysms, there is no systematic evidence regarding their outcomes. The purpose was to assess the outcomes of patients subjected to IC-IC bypass for aneurysms. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, a systematic review was conducted. Criteria for inclusion entailed studies with a cohort of at least 4 patients having undergone IC-IC bypass for aneurysms, detailing at least one outcome, such as patency, clinical outcomes, complications, and procedure-related mortality. When the study included patients who had undergone extracranial-intracranial (EC-IC) bypass, the authors extracted the patency and clinical data to juxtapose them with the results of IC-IC. Of the 2509 shortlisted studies, 22 met our inclusion criteria, encompassing 255 patients and 263 IC-IC bypass procedures. The IC-IC bypass procedure exhibited a patency rate of 93% (95% confidence interval [CI]: 89%–95%). The patency rate of IC-IC and EC-IC bypasses did not significantly differ (odds ratio = 0.60 [95% CI: 0.18–1.96]). Concerning clinical outcomes, 91% of the IC-IC patients had positive results (95% CI: 85%–97%), with no significant disparity between the IC-IC and EC-IC groups (odds ratio = 1.29 [95% CI: 0.43–3.88]). After analysis, the complication rate was 11% (95% CI: 5%–18%). Procedure-related mortality was 1% (95% CI: 0%–4%). IC-IC bypass is valuable for the treatment of complex intracranial aneurysms, boasting high patency and positive clinical outcomes. Complications are unusual, and procedure-related mortality is minimal. Comparing IC-IC and EC-IC led to no significant differences. [ABSTRACT FROM AUTHOR]

When traditional therapies are unsuitable, revascularization becomes essential for managing posterior inferior cerebellar artery (PICA) or vertebral artery aneurysms. Notably, the PICA-PICA bypass has emerged as a promising option, overshadowing the occipital artery-PICA (OA-PICA) bypass. The objective was to compare the safety and efficacy of OA-PICA and PICA-PICA bypasses. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, we conducted a systematic review and meta-analysis to evaluate the safety and efficacy of OA-PICA and PICA-PICA bypasses for treating posterior circulation aneurysms. We analyzed 13 studies for the PICA-PICA bypass and 16 studies on the OA-PICA bypass, involving 84 and 110 patients, respectively. The median average follow-up for PICA-PICA bypass was 8 months (2–50.3 months), while for OA-PICA, it was 27.8 months (6–84 months). The patency rate for OA-PICA was 97% (95% confidence interval [CI]: 92%–100%) and 100% (95% CI: 95%–100%) for PICA-PICA. Complication rates were 29% (95% CI: 10%–47%) for OA-PICA and 12% (95% CI: 3%–21%) for PICA-PICA. Good clinical outcomes were observed in 71% (95% CI: 52%–90%) of OA-PICA patients and 87% (95% CI: 75%–100%) of PICA-PICA patients. Procedure-related mortality was 1% (95% CI: 0%–6%) for OA-PICA and 1% (95% CI: 0%–10%) for PICA-PICA. Both procedures have demonstrated promising results in efficacy and safety. PICA-PICA exhibits slightly better patency rates, better clinical outcomes, and fewer complications, but with a lack of substantial follow-up and a smaller sample size. The choice between these procedures should be based on the surgeon's expertise and the patient's anatomy. [Display omitted] [ABSTRACT FROM AUTHOR]

Idiopathic Intracranial Hypertension (IIH) is a condition characterized by elevated intracranial pressure. Although several mechanisms have been proposed as underlying causes of IIH, no identifiable causative factor has been determined for this condition. Initial treatments focus on weight or CSF reduction, but severe cases may require surgery. This study compares outcomes in IIH patients treated with lumboperitoneal shunts (LPSs) versus ventriculoperitoneal shunts (VPSs). This systematic-review and meta-analysis follows Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and includes studies about VPS and LPS patients, reporting one of the outcomes of interest. We conducted searches on PubMed, Embase, Web of Science, and Cochrane Library. Our analysis involved twelve studies, comprising 5990 patients. The estimated odds ratio (OR) for visual improvement was 0.97 (95% CI 0.26–3.62; I2 = 0%) and for headache improvement was 0.40 (95% CI 0.20–0.81; I2 = 0%), favoring LPS over VPS. Shunt revision analysis revealed an OR of 1.53 (95% CI 0.97–2.41; I2 = 77%). The shunt complications showed an OR of 0.91 (95% CI 0.68–1.22; I2 = 0%). The sub-analyses for shunt failure uncovered an OR of 1.41 (95% CI 0.92–2.18; I2 = 25%) and for shunt infection events an OR of 0.94 (95% CI 0.50–1.75; I2 = 0%). The interventions showed general equivalence in complications, shunt failure, and other outcomes, but LPS seems to hold an advantage in improving headaches. Substantial heterogeneity highlights the need for more conclusive evidence, emphasizing the crucial role for further studies. The findings underscore the importance of considering a tailored decision between VPS and LPS for the management of IIH patients. [ABSTRACT FROM AUTHOR]