World Neurosurg
-
Clinical trials are performed to determine the safety, efficacy, or effectiveness of a medical or surgical intervention. A clinical trial is, by definition, prospective in nature with a uniform treatment of a defined patient cohort. The outcomes assessment should also be uniform. ⋯ However, in the present report, we have focused exclusively on prospective clinical trials. An urgent need exists to understand how clinical trials have been performed in the past and how they can be improved to advance our neurosurgical practice. In the present review, we have discussed the barriers, successes, and failures regarding prospective clinical trials in neurosurgery with an outlook to the future.
-
Review
Advancing the Surgical Treatment of Intracerebral Hemorrhage: Study Design and Research Directions.
In this narrative review, we discuss aspects of study design for research in the surgical treatment of patients with spontaneous acute intracerebral hemorrhage (ICH). We emphasize the importance of carefully defining the primary end point relevant to the intervention under investigation, whether this is technical (i.e., residual hematoma volume) or clinical (i.e., mortality or functional outcome), and the timing of its assessment. Compared with patients with acute ischemic stroke, patients with spontaneous acute ICH may take longer to fully recover. ⋯ The definition of minimally invasive surgery, and its use and timing in relation to ICH, requires urgent assessment. Future studies could be better designed and executed as part of a large (inter)national ICH trials consortium, consisting of dedicated interdisciplinary teams of neurologists, neurosurgeons, intensivists, and epidemiologists. We advocate studies to be pragmatic and adhere to the IDEAL recommendations and CONSORT guidelines.
-
Clinical trials are essential for assessing the advancements in spine tumor therapeutics. The purpose of the present study was to characterize the trends in clinical trials for primary and metastatic tumor treatment during the past 2 decades. ⋯ The number of clinical trials for spine tumor therapies has rapidly increased during the past 15 years, owing to studies at U.S. academic medical institutions investigating radiosurgery for the treatment of metastases. Targeted therapies for tumor subtypes and sequelae have updated international best practices.
-
Dr. Nathan Rifkinson (1912-2010) was an influential neurosurgeon who dedicated his entire career to the people of Puerto Rico. In 1948, he became the first formally trained neurosurgeon to practice in Puerto Rico. Driven by incredible tenacity and with the help of several other neurosurgery professors, he created a world-class neurosurgery residency training center. ⋯ In Puerto Rico, Dr. Rifkinson discovered a new niche that helped him grow to a unique iconic figure, advising physicians and government leaders on the Island. Together with all the other neurosurgery pillars and their extraordinary dedication, our professors have established an incredible legacy. Without the extreme goodness of our neurosurgery professors, neurosurgery in Puerto Rico would not be what it is now.