Randomized clinical trials in the evaluation of surgical innovation

Randomized clinical trials are widely accepted as the standard for evaluation of therapeutic innovation in many fields of medicine. The three basic components of such trials (concurrent comparison, random allocation, and objective observation) are designed to control four forms of bias (chronology bias, susceptibility bias, compliance bias, and observation bias) that may interfere with the interpretation of the results of a study. Only 2% of the articles evaluating therapeutic maneuvers published in the Journal of Neurosurgery have attempted to use concurrent controls. Only one of 863 such articles met the criteria for a randomized clinical trial. Reasons for underutilization of such trials in neurosurgery are discussed and suggestions for their wider use are offered.

Calvarial hemangioendothelioma with intracranial hemorrhage: case report

A case of a hemangioendothelioma of the occipital bone that presented clinically as an acute epidural hematoma is reported. The literature regarding this rare bone tumor is reviewed. The treatment of choice seems to be wide surgical excision, but life-threatening hemorrhage may occur due to extreme tumor vascularity. The role of radiotherapy remains uncertain.

Arterial cross compression of the trigeminal nerve at the pons in trigeminal neuralgia. Case report with autopsy findings

The autopsy findings in a patient with trigeminal neuralgia who died from unrelated causes are presented. Arterial cross compression of the appropriate trigeminal nerve at the pons was demonstrated. The relationship of arterial cross compression to trigeminal neuralgia is briefly discussed.

Supratentorial intracerebral hemorrhage following posterior fossa surgery

Five cases of supratentorial intracerebral hemorrhage following posterior fossa surgery are reported. Possible etiologies are discussed, but in only one case can a definite etiology (hypertension) be found. The differential diagnosis of declining level of consciousness after posterior fossa surgery must include supratentorial intracerebral hemorrhage, and computerized tomography seems to be the diagnostic method of choice.