Journal of neurosurgery
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Journal of neurosurgery · Oct 2017
CommentRandomized controlled trials in neurosurgery: an observational analysis of trial discontinuation and publication outcome.
OBJECTIVE This study aimed to determine the trial discontinuation and publication rate of randomized controlled trials (RCTs) in neurosurgery. METHODS Trials registered from 2000 to 2012 were identified on the website clinicaltrials.gov using a range of key words related to neurosurgery. Any trials that were actively recruiting or had unknown status were excluded. ⋯ For secondary outcome measures, complete reporting occurred in only 11 (33.3%) of 33. CONCLUSIONS More than a fifth (26.6%) of neurosurgical RCTs are discontinued early and almost a third of those that are completed remain unpublished. This result highlights significant waste of financial resources and clinical data.
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Journal of neurosurgery · Oct 2017
Observational StudySafety and efficacy of the Pipeline embolization device for treatment of intracranial aneurysms: a pooled analysis of 3 large studies.
OBJECTIVE The authors performed a pooled analysis of 3 studies-IntrePED (International Retrospective Study of the Pipeline Embolization Device), PUFS (Pipeline for Uncoilable or Failed Aneurysms Study), and ASPIRe (Aneurysm Study of Pipeline in an Observational Registry)-in order to assess angiographic outcomes and clinical safety of the Pipeline embolization device (PED). METHODS IntrePED was a retrospective study, while PUFS and ASPIRe were prospective studies. For each patient included in these studies, the authors collected baseline demographic data, aneurysm characteristics, and procedural details. ⋯ CONCLUSIONS Endovascular treatment of intracranial aneurysms with the PED is safe and effective. Angiographic occlusion rates progressed with follow-up. Rates of stroke, hemorrhage, morbidity and mortality, and retreatment were low, especially given the fact that the aneurysms treated were generally large and wide necked.
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Journal of neurosurgery · Oct 2017
Case ReportsMultiple nerve and tendon transfers: a new strategy for restoring hand function in a patient with C7-T1 brachial plexus avulsions.
C7-T1 brachial plexus palsies result in a loss of finger motion and hand function. The authors have observed that finger flexion motion can be recovered after a brachialis motor branch transfer. However, finger flexion strength after this procedure merely corresponds to Medical Research Council Grades M2-M3, lowering the grip strength and practical value of the reconstructed hand. ⋯ Additionally, the supinator motor branch was transferred for finger extension, and the brachioradialis muscle was used for thumb opposition recovery. Through this new strategy, the patient could successfully accomplish grasping and pinching motions. Moreover, compared with previous cases, the patient in the present case achieved stronger finger flexion and grip strength, suggesting practical improvements to the reconstructed hand.
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Journal of neurosurgery · Oct 2017
Multicenter Study Observational StudyThe management and outcome for patients with chronic subdural hematoma: a prospective, multicenter, observational cohort study in the United Kingdom.
Symptomatic chronic subdural hematoma (CSDH) will become an increasingly common presentation in neurosurgical practice as the population ages, but quality evidence is still lacking to guide the optimal management for these patients. The British Neurosurgical Trainee Research Collaborative (BNTRC) was established by neurosurgical trainees in 2012 to improve research by combining the efforts of trainees in each of the United Kingdom (UK) and Ireland's neurosurgical units (NSUs). The authors present the first study by the BNTRC that describes current management and outcomes for patients with CSDH throughout the UK and Ireland. This provides a resource both for current clinical practice and future clinical research on CSDH. ⋯ This is the largest prospective CSDH study and helps establish national standards. It has confirmed in a real-world setting the effectiveness of placing a subdural drain. This study identified a number of modifiable prognostic factors but questions the necessity of some common aspects of CSDH management, such as enforced postoperative bed rest. Future studies should seek to establish how practitioners can optimize perioperative care of patients with CSDH to reduce morbidity as well as minimize CSDH recurrence. The BNTRC is unique worldwide, conducting multicenter trainee-led research and audits. This study demonstrates that collaborative research networks are powerful tools to interrogate clinical research questions.
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Journal of neurosurgery · Oct 2017
Comparative StudyAutomatic estimation of extent of resection and residual tumor volume of patients with glioblastoma.
OBJECTIVE In the treatment of glioblastoma, residual tumor burden is the only prognostic factor that can be actively influenced by therapy. Therefore, an accurate, reproducible, and objective measurement of residual tumor burden is necessary. This study aimed to evaluate the use of a fully automatic segmentation method-brain tumor image analysis (BraTumIA)-for estimating the extent of resection (EOR) and residual tumor volume (RTV) of contrast-enhancing tumor after surgery. ⋯ BraTumIA showed a tendency to overestimate contrast-enhancing tumors, leading to moderate agreement with expert raters with respect to the literature-based, survival-relevant threshold values for EOR. CONCLUSIONS BraTumIA can generate volumetric estimates of EOR and RTV, in a fully automatic fashion, which are comparable to the estimates of human experts. However, automated analysis showed a tendency to overestimate the volume of a contrast-enhancing tumor, whereas manual analysis is prone to subjectivity, thereby causing considerable interrater variability.