BACKGROUND AND OBJECTIVES: Ventriculoperitoneal shunt (VPS) is usually the primary choice for cerebrospinal fluid shunting for most neurosurgeons, while ventriculoatrial shunt (VAS) is a second-line procedure because of historical complications. Remarkably, there is no robust evidence claiming the superiority of VPS over VAS. Thus, we aimed to compare both procedures through a meta-analysis. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, the authors systematically searched the literature for articles comparing VAS with VPS. The included articles had to detail one of the following outcomes: revisions, infections, shunt-related mortality, or complications. In addition, the cohort for each shunt model had to encompass more than 4 patients. RESULTS: Of 1872 articles, 16 met our criteria, involving 4304 patients, with 1619 undergoing VAS and 2685 receiving VPS placement. Analysis of revision surgeries showed no significant difference between VAS and VPS (risk ratio [RR] = 1.10, 95% CI: 0.9-1.34; I ² = 84%, random effects). Regarding infections, the analysis also found no significant difference between the groups (RR = 0.67, 95% CI: 0.36-1.25; I ² = 74%, random effects). There was no statistically significant disparity between both methods concerning shunt-related deaths (RR = 2.11, 95% CI: 0.68-6.60; I ² = 56%, random effects). Included studies after 2000 showed no VAS led to cardiopulmonary complications, and only 1 shunt-related death could be identified. CONCLUSION: Both methods show no significant differences in procedure revisions, infections, and shunt-related mortality. The literature is outdated, research in adults is lacking, and future randomized studies are crucial to understand the profile of VAS when comparing it with VPS. The final decision on which distal site for cerebrospinal shunting to use should be based on the patient's characteristics and the surgeon's expertise.

BACKGROUND AND OBJECTIVES: Craniectomy is a commonly performed procedure in severe traumatic brain injury (TBI) to control intracranial hypertension and reduce mortality. The optimal timing for cranioplasty after craniectomy remains a topic of debate. The aim of this study was to investigate the ideal timing for cranioplasty after severe TBI, focusing on complications associated with temporal aspects and materials used in cranioplasty. METHODS: Multiple databases, including PubMed, Embase, Cochrane, and Web of Science, were searched for studies reporting on the subject. Inclusion criteria involved randomized and observational studies comparing early and late cranioplasty procedures. Quality assessment was performed using the Methodological Index for Non-Randomized Studies scale. Results were pooled in a single-arm meta-analysis and presented as mean and 95% confidence interval. RESULTS: Early cranioplasty was associated with a lower likelihood of subdural effusion (odds ratio [OR] 0.3735 [0.1643; 0.8490], P = .0187). However, no differences were detected for the presence of infection between both groups (OR 0.7460 [0.2065; 2.6945], P = .6548). Cranioplasties performed within or equal to 3 months from the TBI incident were associated with a reduced likelihood of minor complications (OR 0.4471 [0.2467; 0.8102], P = .0080). Paradoxically, this time frame exhibited an elevated risk of hydrocephalus (OR 3.2035 [1.4860; 6.9059], P = .0030), as well as total complications (OR 1.4190 [1.0453; 1.9262] P = .0248). CONCLUSION: This comprehensive review highlights the current lack of consensus on the optimal timing for cranioplasty after severe TBI. Early cranioplasty, within 35 days, showed a reduced risk of subdural effusion, but no disparity in the odds of infection was found. A reduced incidence of minor complications was observed in the earlier approach, however with an elevated risk for hydrocephalus and total complications. The association between timing and complications, including hydrocephalus, highlights the need for further research and standardization in this critical aspect of TBI management.

Extramedullary plasmacytoma (EMP) is an uncommon disorder characterized by the development of abnormal plasma cell tumors outside the bone marrow. These tumors are typically observed in various locations, including the upper respiratory tract, gastrointestinal tract, and other soft tissues. Among the less explored manifestations of EMP is intracranial EMP, which remains poorly understood due to the limited literature available on the subject. The objective was to comprehend the population characteristics, localization, type, treatment, and outcomes of intracranial EMP. A systematic review of the literature for EMPs was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The strategy “extramedullary plasmacytoma AND multiple myeloma” was used for the search. The search terms were queried using PubMed, Embase, Scopus, Cochrane, and Web of Science databases. We included only those studies that presented clinical studies with patients diagnosed with intracranial plasmacytomas. In this study, a total of 84 patients from 25 studies were analyzed. The average age of diagnosis was 57.25 years, with a slightly higher proportion of females (57%) compared to male patients (43%). The most common locations of intracranial plasmacytomas were the clivus (29.7%), frontal lobe (18.9%), parietal lobe (8.1%), occipital lobe (6.7%), temporal lobe (6.7%), and sphenoid (4%). Chordoma and meningioma were the most common differential diagnoses encountered during clinical investigations. Treatment modalities included radiotherapy (RT), chemotherapy (QT), surgical resection (SR), and conservative approaches. The most frequent treatment combinations were SR + RT (19%) and RT only (17.8%). Mortality was reported in 48% of the cases, with complete resolution observed in 10 cases and partial resolution in 3 cases. The average follow-up duration was 37.5 months. The clivus is the most frequently reported site of extramedullary intracranial plasmacytoma (EMIP) occurrence, representing 29.7% of cases. Chordomas were commonly observed alongside EMIPs and emerged as the primary differential diagnosis. RT was the predominant treatment modality, with SR considered when feasible. RT alone demonstrated the highest effectiveness in managing EMIPs (30%), while QT as a sole intervention showed lower efficacy. However, a combination of dexamethasone, lenalidomide, and targeted RT displayed promising results, offering improved tumor response and increased safety.