World Neurosurg
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The application and interpretation of P values have caused debate for several decades, and this debate has become particularly relevant in the past few years. The P value represents the probability of seeing results as extreme or more extreme than those observed in a data analysis, were the null hypothesis and other underlying assumptions to be true. While P values are useful in pointing out where an effect may be present, they have often been misused in an attempt to oversell "statistically significant" findings. ⋯ Only a minority of manuscripts that reported statistical significance described confounder adjustment, or effect sizes. A common, incorrect assumption often observed was that statistical significance equals clinical relevance. To enable correct interpretation of clinical significance, it is crucial that authors describe the clinical implications of their findings.
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Modern neurosurgery has established maximal safe resection as a cornerstone in the management of diffuse gliomas. Evaluation of the extent of resection (EOR), and its association with certain outcomes or interventions, heavily depends on an adequate methodology to draw strong conclusions. We aim to identify weaknesses and limitations that may threaten the internal validity and generalizability of studies involving the EOR in patients with glioma and to suggest methodological recommendations that may help mitigate these threats. ⋯ There is a current need to focus more attention to the methodological aspects of glioma research. Methodological inconsistencies may introduce weaknesses into the internal validity of the studies and hamper comparative analysis of cohorts from different institutions. We hope our recommendations will eventually help develop stronger methodological designs in future research endeavors.
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Carotid endarterectomy is a standard treatment for patients with symptomatic carotid artery stenosis.1 Surgical techniques require a full-thickness incision (longitudinal, diagonal, or transverse) through the carotid wall. This incision results in significant plaque disruption and precludes harvesting of intact specimens for research. The video demonstrates an endarterectomy technique for removal of intact plaques using an extra-intimal approach. ⋯ To date, this technique has been successfully used in 55 consecutive patients with no intraoperative or postoperative complications. This technique is fast, reproducible, and effective even in highly calcified lesions that are otherwise hard to cut. The approach requires minimal arterial wall and atheroma manipulation and procures intact specimens for high-quality research.
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Regression analysis quantifies the relationships between one or more independent variables and a dependent variable and is one of the most frequently used types of analysis in medical research. The aim of this article is to provide a brief theoretical and practical tutorial for neurosurgeons wishing to conduct or interpret regression analyses. ⋯ Regression analysis is a powerful and versatile instrument in data analysis. This material is intended as a starter for those wishing to critically interpret or perform regression analysis and we recommend multidisciplinary collaborations with trained methodologists, statisticians, or epidemiologists.