Arwa Jader

Objective: This systematic review and meta-analysis aimed to evaluate the efficacy and safety of repetitive transcranial magnetic stimulation (rTMS) in patients with anorexia nervosa (AN) and bulimia nervosa (BN), focusing on its impact on psychological, psychopathological, neurocognitive, and behavioral outcomes. Methods: A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and Cochrane CENTRAL from inception to May 2025. Eligible studies included clinical trials involving adult patients with AN or BN treated with rTMS. Data were pooled using fixed or random-effects models depending on heterogeneity. Mean differences (MD) or standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated. Risk of bias was assessed using Cochrane RoB 2.0 and NIH tools. Results: Thirteen studies were included, yielding a total of n = 195 active rTMS treatments and n = 132 sham treatments. Compared to sham, rTMS did not significantly improve BMI in AN patients (MD: 0.19; 95% CI: -0.50, 0.88; P = 0.59). A significant moderate reduction in eating disorder severity was found in single-arm analysis (31 patients, SMD: -0.50, 95% CI [-0.90, -0.10], p = 0.01). Depression improved with rTMS over sham (105 patients, SMD: -0.41, 95% CI [-0.81, -0.02], p = 0.04), while anxiety, binge frequency, and vomiting frequency did not. Urge to eat increased in AN (30 patients, MD: 1.20, 95% CI [0.20, 2.21], p = 0.02) and decreased in BN (25 patients, MD: -10.25, 95% CI [-15.88, -4.62], p = 0.0004). No serious adverse events were reported. Conclusions: rTMS shows potential in improving eating disorder severity and depressive symptoms in AN, with disorder-specific modulation of food-related urges. Its effects on BMI and behavioral symptoms remain inconclusive. rTMS was well tolerated.

Purpose : This systematic review and meta-analysis compares incidental dural tear rates between uniportal and biportal endoscopic lumbar surgeries. Uniportal and biportal techniques represent established minimally invasive approaches, though differential risks for complications such as dural tears warrant thorough investigation. Methods : A comprehensive literature search across Google Scholar, PubMed/MEDLINE, and Cochrane Library identified 67 studies, encompassing 10,491 patients (4,657 biportal, 5,834 uniportal). Results : Initial pooled analysis indicated a higher dural tear incidence in the biportal group (3.16%, 152/4,657) compared to the uniportal group (1.69%, 100/5,834), a statistically significant difference (p < 0.001). However, a more focused meta-analysis of 25 studies revealed no statistically significant difference in pooled dural tear incidences (uniportal: 1.4% [95% CI: 0.3-2.4%] vs. biportal: 1.1% [95% CI: 0.6-1.7%], p = 0.42). Secondary outcomes showed biportal endoscopy associated with slightly shorter operative times, while uniportal surgery correlated with shorter hospital stays. Both approaches yielded comparable functional outcomes. Conclusion : While initial data suggested a difference, the meta-analysis found no significant disparity in dural tear risk. Optimal technique selection, considering patient and surgical factors, remains important for minimizing complications.

Background: In 1955, the pioneering work of Robert Desproges-Gotteron greatly improved our understanding of the anatomy of the human vasculature, in particular the discovery of the Artery of Desproges-Gotteron (ADG). The aim of this study is to provide an in-depth analysis of the ADG through a comprehensive literature review and to provide information on its anatomy and neurosurgical implications. Method: This evaluation was conducted through a comprehensive analysis of the literature, focusing on publications related to the ADG. A search of electronic databases, including PubMed, ScienceDirect, and Web of Science, was performed from the inception of each database until July 2025. The search strategy employed specific keywords and phrases such as “Artery of Desproges-Gotteron,” “cone artery,” and “radiculomedullary arteries.” Results: The ADG is a branch of the internal iliac artery that supplies the conus medullaris. Eight articles met the inclusion criteria and investigated the clinical significance of the ADG. The main pathology involved was AVF in approximately 5 (62.5%) patients and lumbar disc prolapse in 2 (25%) patients. Three patients (37.5%) presented with cauda equina syndrome, while the others presented with a combination of motor weakness and sphincter dysfunction. Approximately 4 (50%) patients were treated by endovascular interventions, while 2 (25%) patients had disc prolapse resulting in ADG vascular compromise. Conclusion: The ADG is essential in neurosurgery and neuroradiology for precise intervention in spinal arteriovenous malformation surgery. Compression of the artery can lead to conus medullaris syndrome. Understanding its variability is critical for neurosurgeons to demonstrate continuous improvement in patient care.

Background Lumbar fusion is widely used to treat chronic lumbar degenerative pathology; however, its effectiveness and safety compared with nonoperative management remain controversial. Objectives This systematic review and meta-analysis aimed to evaluate and compare the effectiveness and safety of spinal fusion and conservative management in treating lumbar degenerative pathology. Method A systematic review and meta-analysis were conducted following the PRISMA guidelines. The PubMed, Scopus, Cochrane Central, Web of Science, and Embase databases were searched in October 2024. Eligible studies included randomized controlled trials (RCTs) and observational studies reporting pain reduction and functional disability outcomes. The primary outcomes were changes in the Oswestry Disability Index (ODI) and Visual Analog Scale (VAS) scores for back and leg pain. Data were analyzed using a random-effects model in RevMan 5.4.1, with subgroup and sensitivity analyses performed to address heterogeneity. Results Fourteen studies comprising 13 RCTs and one cohort study, involving 2,399 participants, were included. Spinal fusion showed significant improvements in ODI scores compared to conservative treatment (MD = -6.3; 95% CI [-12.02, -0.57]; p = 0.03), indicating reduced disability. VAS back pain scores also favored spinal fusion (MD = -3.02; 95% CI [-5, 1.04]; p = 0.003), with long-term outcomes showing consistent benefits (MD = -2.26; 95% CI [-3.16, 1.37]; p < 0.00001). However, spinal fusion did not significantly reduce leg pain compared to non-operative options (MD = -2.27; 95% CI [-8.37, 3.83]; p = 0.47). Conclusion Spinal fusion offers statistically significant benefits in reducing disability and back pain compared with conservative treatments for lumbar degenerative pathology. However, it does not confer substantial advantages to leg pain and carries a high surgical risk. These findings emphasize the importance of individualized treatment selection based on patient characteristics and clinical indications.

Spinal cord injuries (SCIs) pose significant challenges as complete nerve regeneration remains limited. The demand for improved technologies in SCI treatment is evident. One such emerging technology is three-dimensional printing (3DP), which, coupled with advancements in medical imaging and bioengineering, has significantly enhanced precision in surgical procedures. This systematic review aims to explore 3DP as a treatment option for SCIs, examining its cost, efficacy, safety, and the associated technological constraints. A systematic search of Medline was conducted through PubMed for literature published since 2019. The search results were exported to Rayyan for abstract and full-text screening following predefined criteria. The risk of bias in the selected studies was assessed using the RoB2 tool and the Newcastle-Ottawa Scale. From a total of 89 articles screened, 11 studies met the eligibility criteria, collectively assessing 237 individuals with various types of SCIs, including lumbar degeneration, en bloc resection of thoracolumbar metastasis, adult spinal deformity, and cervical degeneration. These studies examined the utilization of 3DP devices such as hand orthosis, interbody fusion cages, lamellar titanium cages, artificial vertebral bodies, and others. Most of the reviewed studies reported positive treatment outcomes, with the actual procedure costs varying from $65 to $5,000. Recent literature shows positive outcomes in the use of 3DP technologies for SCIs, highlighting its potential for enhancing both surgical and nonsurgical interventions. These advancements usher in a new era in SCI treatment, providing enhanced precision and a wider range of treatment options, ultimately leading to more comprehensive and effective patient care.