Neurosurgery – Journal Articles
24/7/10
Mendelow, A.D., et al (2005) “ Early surgery versus initial conservative treatment in patient with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral haemorrhage (STICH): a randomised trial ” Lancet 365:387-397
- MRCT
- n = 1033 with acute supratentorial intracerebral haemorrhage
- early haematoma evacuation + medical treatment VS conservative treatment with delayed surgery if required
- exclusion criteria: suspected aneurysms or AVM and haemorrhages extending into brainstem/cerebellum
-> no difference in outcome @ 6 months
-> haematoma near cortex -> did better with decompression
-> haematoma not near cortex -> do badly with decompression
-> study criticised because surgical technique was not standardised, some patients in ‘early’ intervention not operated on for 12 hours.
Molyneux, A.J. et al (2002) “ International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups and aneurysm occlusion.
” Lancet 366:809-817
- MRCT
- n = 2413
- comparison of clipping vs coiling when both treatments were appropriate (small aneurysms
+ anterior circulation)
- coiling produced:
-> more independent survivors @ 1 year -> continues to 7 years.
-> slightly increase risk of re-bleeding
Pickard, J.D.,
- MRCT
- n = 554 et al (1989) “ Effects of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British Aneurysm Nimodipine Trial ” BMJ 298:636-642
- oral nimodpine (60mg Q4hrly for 21 days) vs placebo
-> reduce incidence of cerebral infarction
-> reduce poor neurological outcome @ 3 months
Jeremy Fernando (2011)