Browsing by Autor "Garcia-Torrico, Fabricio"

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    Evaluating the effectiveness and complications of the Retrosigmoid, Translabyrinthine and Middle Fossa approaches in vestibular Schwannoma surgical management: a comprehensive systematic review and meta-analysis of 6,889 patients.
    (2025) Garcia-Torrico, Fabricio; Mendieta, Cristian D; De Nigris Vasconcellos, Fernando; Salolin Vargas, Vanessa Pamela; Scalise, Marcos; Mamani-Julian, Kevin; Dias Vilela, Marcos Antônio; Binello, Emanuela; Benjamin, Carolina
    Surgical resection stands as one of the potential therapeutic methods for vestibular schwannomas (VS). However, in the management of patients with VS, there is limited literature directly comparing the Retrosigmoid approach (RSA) with the Translabyrinthine Approach (TLA) and Middle Fossa Approach (MFA). This gap arises because the MFA is typically reserved for smaller intracanalicular tumors, while the RSA and TLA are preferred for larger lesions. Our objective was to assess and compare the outcomes and safety profile of these three different surgical approaches. A comprehensive search was performed on PubMed, Embase, and Cochrane Library for studies comparing RSA with TLA and MFA in patients with VS. The main outcomes of interest were hearing preservation, facial nerve function, extent of resection, and postoperative complications. Statistical analyses were performed using Review Manager. The I2 test was employed for heterogeneity assessment, while the risk of bias was evaluated utilizing ROBINS-I. We included 6,889 patients from 32 observational studies. RSA was used to manage VS in 3,352 (48,7%) patients. Our comparative hearing preservation analysis revealed no significant difference in patient improvement between RSA and MFA, with a risk ratio (RR) of 1.18 (95% CI: 0.76-1.85, p = 0.46, I2:0%). Late facial nerve preservation comparing RSA and TLA showed RR = 0.91(95% CI: 0.77-1.07, p = 0.25, I2:32%), while RSA with MFA a RR = 0.98 (95% CI: 0.92-1.04, p = 0.53, I2:87%). The cerebrospinal fluid (CSF) leak showed no significant difference in risk RR = 1.18 (95% CI: 0.92-1.51, p = 0.21; I2:0%) and RR = 1.14 (95% CI: 0.70-1.83; p = 0.60, I2:26%) comparing RSA with TLA and MFA respectively. The evidence synthesized in this meta-analysis suggests equivalent hearing preservation and facial nerve function in managing VS patients across the different RSA and MFA surgical approaches analyzed. However, in comparison to TLA and MFA, RSA stood out exhibiting fewer occurrences of postoperative complications consisting of hydrocephalus, and CSF leaks.
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    Telerehabilitation and cost analysis in global neurosurgery: a systematic review and meta-analysis of 40,537 patients.
    (2025) Razak, Shahaan S; Garcia-Torrico, Fabricio; Smith, Caitlyn J; Khiralla, Amal H; Kothagundla, Soneesh; Ochoa Hernandez, Diana L; Choi, Bryan D; Shankar, Ganesh M; Aziz-Sultan, Mohammad A; Nahed, Brian V
    OBJECTIVE: Postoperative rehabilitation is crucial for neurosurgical patients' rehabilitation, but access in low- and middle-income countries (LMICs) is often limited. Telerehabilitation offers a cost-effective, accessible alternative by providing remote therapy through digital platforms. This study compared telerehabilitation with traditional methods in LMICs, focusing on cost-effectiveness, clinical outcomes, and patient satisfaction. METHODS: A systematic review was conducted using PRISMA guidelines, with searches across PubMed, Embase, IEEE Xplore, and Web of Science. Studies were included if they focused on telerehabilitation for neurosurgical patients in LMICs and assessed cost-effectiveness or cost savings, along with clinical outcomes. Data extraction and quality assessments were performed using Covidence, with risk of bias evaluations conducted with the ROBINS-I tool. RESULTS: The authors' review included 20 studies with 40,537 neurosurgical patients, demonstrating telemedicine's role in patient care, from initial consultations to postoperative follow-ups. Cost analysis revealed specific savings such as $61.80 per patient in India for neurosurgical follow-ups, $888 to $1501 per visit in the US for patients from underserved areas, and $3.8 million in stroke and injury care in France. Patient satisfaction showed an average rate of 97% (95% CI 94%-98%, p = 0.06). Additionally, the combined analysis estimated an 88% probability of achieving a favorable outcome (95% CI 68%-96%, p < 0.01). Intervention efficiency revealed a rate of 97% (95% CI 96%-99%, p < 0.0001). CONCLUSIONS: Telerehabilitation in neurosurgical care for LMICs offers a transformative solution, dramatically reducing healthcare costs, improving access, and maintaining the quality of care. With proven effectiveness across large patient populations, telemedicine bridges critical gaps in neurosurgical treatment, highlighting an urgent global need to scale its implementation. This technology could revolutionize healthcare in resource-limited settings, mitigating the geographic, financial, and infrastructural barriers that have long hindered equitable neurosurgical care worldwide.