OBJECTIVEMicrovascular decompression (MVD) is commonly used in the treatment of trigeminal neuralgia (TN) with positive clinical outcomes. Fully endoscopic MVD (E-MVD) has been proposed as an effective minimally invasive alternative, but a comparative review of the two approaches has not been conducted. The authors performed a meta-analysis of studies, comparing patient outcome rates and complications for the open versus the endoscopic technique.METHODSThe PubMed/MEDLINE and Ovid databases were searched for studies published from database inception to 2017. The search terms used included, but were not limited to, “open microvascular decompression,” “microvascular decompression for trigeminal neuralgia,” and “endoscopic decompression for trigeminal neuralgia.” Criteria for inclusion of studies in the meta-analysis were established as follows: adult patients, clinical studies with ≥ 10 patients (excluding case studies to obtain a higher volume of outcome rates), utilization of open MVD or E-MVD to treat TN, craniotomy and retrosigmoid incision, English-language studies, and articles that listed pain relief outcomes (complete, very good, partial, or absent), recurrence rate (number of patients), and complications (paresis, hearing loss, CSF leakage, cerebellar damage, infection, death). Relevant references from the chosen articles were also included.RESULTSFrom a larger pool of 1039 studies, 23 articles were selected for review: 13 on traditional MVD and 10 on E-MVD. The total number of patients was 6749, of which 5783 patients (and 5802 procedures) had undergone MVD and 993 patients (and procedures) had undergone E-MVD. Analyzed data included postoperative pain relief outcome (complete or good pain relief vs partial or no pain relief), and rates of recurrence and complications including facial paralysis, weakness, or paresis; hearing loss; auditory and facial nerve damage; cerebrospinal fluid leakage; infection; cerebellar damage; and death.Good pain relief was achieved in 81% of MVD patients and 88% of E-MVD patients, with a mean recurrence rate of 14% and 9%, respectively. Average rates of reported complications were statistically lower in E-MVD than in MVD approaches, including facial paresis or weakness, hearing loss, cerebellar damage, infection, and death, whereas cerebrospinal fluid leakage was similar. The overall incidence of complications was 19% for MVD and 8% for E-MVD.CONCLUSIONSThe reviewed literature revealed similar clinical outcomes with respect to pain relief for MVD and E-MVD. The recurrence rate was lower in E-MVD studies, though not significantly so, and the incidence of complications, notably facial paresis and hearing loss, were statistically higher for MVD than for E-MVD. Based on these results, the use of endoscopy to perform MVD for TN appears to offer at least as good a surgical outcome as the more commonly used open MVD, with the possible added advantages of having a shorter operative time, smaller craniotomy, and lower recurrence rates. The authors advise caution in interpreting these data given the asymmetry in the sample size between the two groups and the relative novelty of the E-MVD approach.

(Lancet. 2018;391:1197–204) Among patients who undergo lumbar puncture, up to 35% return to the hospital with a postdural puncture headache, which is caused by continuing leakage of the cerebrospinal fluid (CSF) from the dural defect created by the spinal needle. Conventional needles are most frequently used in clinical practice by nonanesthesiologists and have a sharp slanted tip designed to cut through the dura with a distal opening for injection of drugs or collection of CSF. As these needles cut through tissues, they cause irregular lacerations that can increase the potential for CSF leakage. In contrast, atraumatic needles are blunt with a closed pencil point tip and a side port for drug injection or CSF collection. They separate and dilate dural fibers rather than cutting through the fibers; thus they have been postulated to reduce the incidence of postdural puncture headache because they limit the leakage of CSF after lumbar puncture. Although atraumatic needles are now commonly used by anesthesiologists for spinal anesthesia, they are infrequently used by other clinicians as they seem unaware of their existence. This systematic review and meta-analysis of randomized controlled trials was performed to compare atraumatic and conventional lumbar puncture needles.

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Occupational injuries which expose health-care professionals to blood-borne pathogens continue to be an important public health concern. Especially, dentists are at increased risk of exposure to Hepatitis B, Hepatitis C, and HIV. Dentists should remember and apply many precautions to prevent the broad spectrum of sharps and splash injuries that could occur during the delivery of dental care. This article updates and consolidates recommendations for the management of dental health-care personnel who have occupational exposure to blood and other body fluids.

We assume that prolonged hyperextended head position of iatrogenic origin can be the reason, in this case, for BPPV after direct lateral sinus lift procedure. There is also a possibility that the temporal relationship with the surgical area and surgical action by rotating tools during window preparation are also contributing factors.