The use of implants in pediatric cranioplasty is still debatable. Many surgeons prefer to use autologous bone grafts than implants due to previous concerns that implants have a higher risk of infection, allergic response, and are not biocompatible as an autologous bone graft. However, recent studies showed that several implant materials have a similar infection rate following cranioplasty or might be lower compared to autologous bone. Moreover, several studies also reported a high rate of bone flap resorption in autograft cranioplasty, particularly in patients below the age of 8 years, thus requiring revision surgery with an implant as a substitute in most cases. Implant materials also have advantages in several conditions that make them more suitable than autologous bone grafts. This literature review is expected to give information about the type of implant materials that can be used as an alternative to substitute autologous bone grafts in certain conditions.

Background: Peripheral glucocorticoid receptors (GRs) are altered by peripheral nerve injury and may modulate the development of neuropathic pain. Two central pathogenic mechanisms underlying neuropathic pain are neuroinflammation and N-methyl-D-aspartate receptor (NMDAR)-dependent neural plasticity in the spinal cord. Objectives: This study examined the effect of the non-competitive NMDAR antagonist dextromethorphan on partial sciatic nerve ligation (PSL)-induced neuropathic pain and the spinal expression of the glucocorticoid receptor (GR). Methods: Male mice were randomly assigned into a sham group and two groups receiving PSL followed by intrathecal saline vehicle or dextromethorphan (iDMP). Vehicle or iDMP was administered 8 - 14 days after PSL. The hotplate paw-withdrawal latency was considered to measure thermal pain sensitivity. The spinal cord was then sectioned and immunostained for GR. Results: Thermal hyperalgesia developed similarly in the vehicle and iDMP groups prior to the injections (P = 0.828 and 0.643); however, it was completely mitigated during the iDMP treatment (P < 0.001). GR expression was significantly higher in the vehicle group (55.64 ± 4.50) than in the other groups (P < 0.001). The iDMP group (9.99 ± 0.66) showed significantly higher GR expression than the sham group (6.30 ± 1.96) (P = 0.043). Conclusions: The suppression of PLS-induced thermal hyperalgesia by iDMP is associated with the downregulation of GR in the spinal cord, suggesting that this analgesic effect is mediated by inhibiting GR-regulated neuroinflammation.

Background: Cranioplasty in pediatrics is quite challenging and intricated. The ideal material for it is still debatable until now due to the limited study comparing autologous and implant grafts. This meta-analytic study was conducted to evaluate the risk of infection and revision in pediatric patients after autograft and implant cranioplasty. Methods: A systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A thorough literature search was conducted on PubMed, Cochrane, Scopus, and ScienceDirect database. Articles published from 2000 to 2021 were selected systematically using PRISMA based on the predetermined eligibility criteria. The relevant data were, then, analyzed and discussed. Results: A total of four publications investigating the outcome of autograft and implant cranioplasty were included and reviewed. Postoperative infection and revision rate after 126 cranioplasty procedures (both autograft or implant) from 119 patients below 21 years during time frame of study were analyzed. This meta-analysis study showed that the rate of infection and revision after cranioplasty were not different between the autograft and implant groups. Conclusion: Autograft and implant cranioplasty have no significant difference in postoperatively infection and revision rate. This study showed that cranioplasty using implant is a plausible option in pediatric patients with cranial defects, depending on the patients’ condition due to similar outcome with autograft cranioplasty. Further studies with larger population and more specific details are necessary to determine the comparison of autograft and implant material in cranioplasty procedure.

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Highlights Some of piriformis syndrome intractable with conservative treatment. Surgery was indicated for intractable piriformis syndrome. Piriformis resection can be a feasible option for intractable piriformis syndrome. Piriformis resection decrease visual analog scale in intractable piriformis syndrome.

The use of corticosteroids in cases of brain tumors has become common to reduce brain edema. However, the use can cause adrenal insufficiency (AI) if used long-term and in large doses and with rapid withdrawal. In cases of pituitary macroadenoma that has undergone surgery, AI may also occur. AI also affects the treatment of brain tumor patients. Hence, AI is an important problem in brain tumors because almost all patients with brain tumors receive corticosteroids at some point in the course of their disease. The management is similar to another AI with focus of hydrocortisone treatment. The adjustment of hydrocortisone dosage in patients whom undergo brain surgery is similar with another major surgery, whether the adjustment for pituitary adenoma patients whom undergo excision is more complicated and careful due to the high risk and incidence of AI in these patients.

BACKGROUND: Meningioma is mostly benign tumor (World Health Organization Grade 1) and surgery remains the best option in treating symptomatic or enlarging meningiomas where total removal of the tumor is the goal of surgery. Radiation therapy has shown to be effective to cease the growth of the tumor, but not in tumor regression. Adjuvant therapy may treat patients with recurrence or unresectable meningiomas yet the uses of hormone therapy, immunotherapy, or chemotherapy had many results and were not consistently effective. Hydroxyurea has promising results in patients with meningiomas. AIM: This study analyzed the efficacy and safety of hydroxyurea for the treatments of recurrence or unresectable meningiomas. MATERIALS AND METHODS: The study adapted PRISMA guidelines by searching electronic databases, PUBMED, Cochrane, and JNS in August 2020 and was full-text observational study or randomized control trial presented as PICO and assessed using the risk-of-bias assessment tool. RESULTS: A total of six articles (157 patients with meningioma) were reviewed from the total of 425. Hydroxyurea was administered orally for 28 days continuously and repeated every 28 days or after recovery with various dosages in six studies. DISCUSSION: Administration of hydroxyurea showed a varied stable disease rate ranging from 30 to 69% with a median progression-free survival med varying between 2 and 27.75 months. The studies performed oral hydroxyurea administration at a dose of 20–30 mg/kg body weight/day or 1000 mg/m2/day. However, the adverse events (AEs) that appear also, based on literature, are not much different from other chemotherapy administrations. CONCLUSION: Patients with unresected and recurrent meningiomas have limited treatment options due to difficulty for surgical management. However, this study offers another perspective addressing the efficacy and safety results with the use of hydroxyurea. Overall, hydroxyurea showed good outcomes, particularly in low-grade meningioma, with relatively low AEs. Further combination treatment may be used as a multimodal therapy.

Introduction. Increased intracranial pressure (ICP) is a secondary event that mostly occurs following traumatic brain injury (TBI) and it correlates with poor outcome of the patients. Several studies have suggested that early decompressive craniectomy (DC; within 48 hours after injury) is recommended for severe TBI patients requiring removal of intracranial hemorrhage and early DC was able to reduce the complications of TBI caused by increased ICP. However, even early DC has been performed, increased ICP may still progress due to massive brain edema. Methods. We herein report a case report of patient admitted with severe TBI and intracranial hemorrhage. The patients were underwent DC and ICP monitor placement after the removal of the intracranial hemorrhage. During postoperative observation in ICU, the CSF of the patients was gradually drained if the ICP was over 15mmHg. Results. The ICP right after performed early DC was 30 cmH2O (22 mmHg). One day after surgery, the hemodynamic of the patient was stable and the GCS was 2X5 with the ICP of the patient was about 18 cmH2O. On day 2-5, patient was hemodynamically stable with improved GCS (3X5) and decreased of ICP (around 13-15 cmH2O). On day 6, the ICP monitor was removed and the patient discharged on day 19 after fully recovered. Conclusion. The placement of ICP monitor and the application of gradual release of CSF after DC might be helpful to reduce increased ICP in severe TBI patients, and thus reducing the morbidity and mortality.   Keywords: Traumatic brain injury, intracranial pressure monitor, decompressive craniectomy