Current opinion in neurology
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To assess selected papers on surgery for glioma for their impact on clinical practice. ⋯ Despite amazing technical advances in the investigation, assessment and surgical management of patients with glioma, the lack of an evidence basis for 'aggressive' resective management continues to pose dilemmas for surgeons.
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Curr. Opin. Neurol. · Dec 2002
ReviewNeuroprotection and traumatic brain injury: theoretical option or realistic proposition.
Preclinical studies have shown that treatment to limit secondary cell damage can significantly improve outcome after traumatic brain injury. In contrast, neuroprotection trials in human traumatic brain injury have failed to convincingly demonstrate therapeutic benefit. Recent literature has begun to address this discrepancy between preclinical and clinical trials. ⋯ Recognition of these methodological differences between animal and human studies has led to new trial design proposals. For clinical studies, there should be better stratification of patients, a focus on moderate injury and earlier treatment, and larger sample sizes. Animal experiments should better parallel clinical studies and address therapeutic window and treatment optimization. Recognition of multiple cell death pathways should lead to new treatment strategies--including both combination drug treatment and drugs that affect multiple components of the secondary injury cascade.