Neurosurgery Literature Summaries

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 [PMID 15680453]

  • 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 criticized 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 [PMID 16139655]

  • 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., et al (1989) “Effects of oral nimodipine on cerebral infarction and outcome after subarachnoid haemorrhage: British Aneurysm Nimodipine Trial” BMJ 298:636-642 [PMC1835889]

  • MRCT
  • n = 554
  • oral nimodpine (60mg Q4hrly for 21 days) vs placebo
    -> reduce incidence of cerebral infarction
    -> reduce poor neurological outcome @ 3 months

CCC Neurocritical Care Series

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the  Clinician Educator Incubator programme, and a CICM First Part Examiner.

He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.

His one great achievement is being the father of three amazing children.

On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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