Browsing by Author "Pichardo-Rojas, Pavel S."

Now showing 1 - 5 of 5

Intraoperative Magnetic Resonance Imaging (MRI)-Guided Resection of Glioblastoma: A Meta-Analysis of 1,847 Patients
(World Neurosurgery, 2024) Pichardo-Rojas, Pavel S.; Angulo-Lozano, Juan Carlos; Alvarez-Castro, José Alfonso; Vázquez-Alva, Diego; Osuna-Lau, Ricardo Alfonso; Choque-Ayala, Luz Camila; Tandon, Nitin; Esquenazi, Yoshua
Intraoperative ultrasound for surgical resection of high-grade glioma and glioblastoma: a meta-analysis of 732 patients
(Neurosurgical Review, 2024) Pichardo-Rojas, Pavel S.; Zarate, Carlos; Arguelles-Hernández, Julieta; Barrón-Lomelí, Aldo; Sanchez-Velez, Roberto; Hjeala-Varas, Amir; Gutierrez-Herrera, Ernesto; Tandon, Nitin; Esquenazi, Yoshua
Pituitary Apoplexy and the Current Understanding of Its Management: A Meta-Analysis of 908 Patients
(World Neurosurgery, 2024) Marin-Castañeda, Luis A.; Gorbachev, Jowah; Lopez-Zepeda, Perla de Teresa; Camila Choque-Ayala, Luz; Shubhangi, Fnu; De Nigris Vasconcellos, Fernando; Pichardo-Rojas, Pavel S.
Background: Pituitary apoplexy (PA) is characterized by acute hemorrhage or infarction of the pituitary gland. Management can be either conservative or surgical. Evidence favoring either is still limited to observational studies. This meta-analysis evaluates the effectiveness of both approaches on patient outcomes. Methods: A systematic search was performed until February 2024. We included cohort studies of patients with PA. Patients were divided into 2 groups: a conservative management group and a surgery group, including early and late surgery. Outcomes of interest were assessed categorically using risk ratio (RR) and Mantel-Haenszel's random effects model. Results: Of the 273 published articles, 15 cohort studies comprising 908 patients were included. There was no statistically significant difference between groups in recovery of ophthalmoplegia (RR=1.09, confidence interval [CI]=1.00-1.18, P=0.05), visual field (RR=1.09, CI=0.91-1.3, P=0.35), visual acuity (RR=1.05, CI=0.87-1.26, P=0.61), hypopituitarism (RR=1.37, CI=0.81-2.32, P=0.25), and tumor recurrence (RR=0.74, CI=0.34-1.61, P=0.45). This was similar for conservative management versus early surgery in recovery of visual field (RR=0.92, CI=0.62-1.37, P=0.68), visual acuity (RR=1.01, CI=0.81-1.26, P=0.93), and ophthalmoplegia (RR=0.92, CI=0.53-1.61, P=0.77).
Simultaneous Parkinsonism and Dementia as Initial Presentation of Intracranial Dural Arteriovenous Fistulas: A Systematic Review
(World Neurosurgery, 2024) Pichardo-Rojas, Pavel S.; Marín-Castañeda, Luis A.; De Nigris Vasconcellos, Fernando; Flores-López, Shadia I.; Coria-Medrano, Adrian; López-Zepeda, Perla de Teresa; Sánchez-Serrano, Claudia D.; Escobar-López, Jesús M.; Choque-Ayala, Luz C.; Jowah, Gorbachev; Rangel-Castilla, Leonardo; Torres-Chávez, Mario C.
Surgical Management of Acute Subdural Hematoma: A Meta-Analysis
(Neurosurgery, 2024) Pichardo-Rojas, Pavel S.; Rodriguez-Elvir, Francisco A.; Hjeala-Varas, Amir; Sanchez-Velez, Roberto; Portugal-Beltrán, Emma; Barrón-Lomelí, Aldo; Freeman, Priscilla I.; Dono, Antonio; Kitagawa, Ryan; Esquenazi, Yoshua
Abstract Background and objective: Traumatic acute subdural hematoma (ASDH) is a medical emergency that requires prompt neurosurgical intervention. Urgent surgical evacuation may be performed with craniotomy (CO) and decompressive craniectomy (DC). However, a meta-analysis evaluating confounders, pooled functional outcomes, and mortality analyses at different time points has not been performed. Methods: A systematic search was conducted until August 28, 2023. We identified studies performing ASDH evacuation with CO or DC. Outcomes included Glasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS), GOS-Extended, mortality, procedure-related complications, and reoperation. Variables were assessed using risk ratio (RR) and mean difference. Results: Among 684 published articles, we included the Randomized Evaluation of Surgery with Craniectomy for Patients Undergoing Evacuation of ASDH (RESCUE-ASDH) trial, 4 propensity score-matched (PSM) cohorts, and 13 observational cohort studies. A total of 8886 patients underwent CO or DC. GCS at admission in unmatched cohorts was significantly worse in the DC group (mean difference = 2.20 [95% CI = 1.86-2.55], P < .00001). GOS-Extended scores were similar among CO and DC (RR = 1.10 [95% CI = 0.85-1.42], P = .49), including the RESCUE-ASDH trial. GOS at the last follow-up in unmatched cohorts significantly favored CO (RR = 1.66 [95% CI = 1.02-2.70], P = .04). Similarly, while short-term mortality favored CO over DC (RR = 0.69 [95% CI = 0.51-0.93], P = .02), both the RESCUE-ASDH trial and the PSM-cohorts yielded similar mortality rates among groups (P > .05). Mortality at the last follow-up in unmatched patients favored CO (RR = 0.60 [95% CI = 0.47-0.77], P < .0001). Procedure-related complications (RR = 0.74 [0.50-1.09], P = .12) and reoperation rates (RR = 0.74 [0.50-1.09], P = .12) were similar.