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Liu T, Liu M, Sha Z, Wu C, Zhao Z, Yuan J, Feng D, Nie M, Jiang R. Chinese Neurosurgical Randomized Controlled Trials: Dynamics in Trial Implementation and Completion. Neurosurgery 2024; 94:497-507. [PMID: 37796000 DOI: 10.1227/neu.0000000000002702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/03/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The focus on evidence-based neurosurgery has led to a considerable amount of neurosurgical evidence based on randomized controlled trials (RCTs) being published. Nevertheless, there has been no systematic appraisal of China's contribution to RCTs. Information about the changes in characteristics of Chinese neurosurgical RCTs before and during the COVID-19 pandemic is limited. This study aims to perform a detailed examination and comprehensive analysis of the characteristics of Chinese neurosurgical RCTs and to examine the differences before and during the COVID-19 pandemic. METHODS We conducted a comprehensive database search including PubMed, Web of Science, Embase, and Cochrane Library up to March 2023, with a criterion of inclusion based on an impact factor above 0. We subsequently examined the design and quality parameters of the included RCTs and assessed the differences before and during the COVID-19 pandemic (based on follow-up ending before or after January 2020). Moreover, we investigated potential factors that may affect the quality and developmental trends of neurosurgical RCTs in China. RESULTS The main focus of the 91 neurosurgical RCTs was vascular disease (47.3%) and trauma (18.7%). Over half of the trials used Consolidated Standards of Reporting Trial diagrams (69.2%), and the majority compared nonsurgical treatments (63.7%). Larger trials tended to have better quality scores, but those with significant efficacy were less likely to have power calculations. Over time, there was an increase in the use of Consolidated Standards of Reporting Trial diagrams and well-specified outcomes. The COVID-19 pandemic may have hindered the completion of neurosurgical RCTs in China, but it has had little impact on the design and quality so far. CONCLUSION Chinese neurosurgeons have made significant progress in advancing neurosurgical RCTs despite challenges. However, shortcomings in sample size and power calculation need attention. Improving the rigor, rationality, and completeness of neurosurgical RCT design is crucial.
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Affiliation(s)
- Tao Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin , China
- Key Laboratory of Post Neuro-Injury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Ministry of Education, Tianjin , China
| | - Mingqi Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin , China
- Key Laboratory of Post Neuro-Injury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Ministry of Education, Tianjin , China
| | - Zhuang Sha
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin , China
- Key Laboratory of Post Neuro-Injury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Ministry of Education, Tianjin , China
| | - Chenrui Wu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin , China
- Key Laboratory of Post Neuro-Injury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Ministry of Education, Tianjin , China
| | - Zhihao Zhao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin , China
- Key Laboratory of Post Neuro-Injury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Ministry of Education, Tianjin , China
| | - Jiangyuan Yuan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin , China
- Key Laboratory of Post Neuro-Injury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Ministry of Education, Tianjin , China
| | - Dongyi Feng
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin , China
- Key Laboratory of Post Neuro-Injury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Ministry of Education, Tianjin , China
| | - Meng Nie
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin , China
- Key Laboratory of Post Neuro-Injury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Ministry of Education, Tianjin , China
| | - Rongcai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin , China
- Key Laboratory of Post Neuro-Injury Neuro-Repair and Regeneration in Central Nervous System, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Ministry of Education, Tianjin , China
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McClenahan BJ, Lojacono M, Young JL, Schenk RJ, Rhon DI. Trials and tribulations of transparency related to inconsistencies between plan and conduct in peer-reviewed physiotherapy publications: A methodology review. J Eval Clin Pract 2024; 30:12-29. [PMID: 36709480 DOI: 10.1111/jep.13810] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 01/30/2023]
Abstract
RATIONALE The physiotherapy profession strives to be a leader in providing quality care and strongly recognizes the value of research to guide clinical practice. Adherence to guidelines for research reporting and conduct is a significant step towards high-quality, transparent and reproducible research. AIM/OBJECTIVE Assess integrity between planned and conducted methodology in randomized controlled trials (RCTs) and systematic reviews (SRs) published in physiotherapy journals. METHODS Eighteen journals were manually searched for RCTs and SRs published from 1 July 2021 through 31 December 2021. Studies were included if the journal or specific study was indexed in PubMed and published/translated in English. Descriptive statistics determined congruence between preregistration data and publication. RESULTS Forty RCTs and 68 SRs were assessed. Forty-three SRs included meta-analysis (MA). Of the 34 registered RCTs, 7 (20.6%) had no discrepancy between the registration and publication. Two trials (5.9%) addressed all discrepancies, 4 (11.8%) addressed some and 21 (61.8%) did not address any discrepancies. Of the 36 registered MAs, 33 (91.7%) had discrepancies between the registration and publication. Two (5.6%) addressed all discrepancies and three (8.3%) had no discrepancies. Eight SRs without MA published information not matching their registration, and none provided justification for the discrepancies. CONCLUSION Most RCTs/SRs were registered; the majority had discrepancies between preregistration and publication, potentially influencing the outcomes and interpretations of findings. Journals should require preregistration and compare the submission with the registration information when assessing publication suitability. Readers should be aware of these inconsistencies and their implications when interpreting and translating results into practice.
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Affiliation(s)
- Brian J McClenahan
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, Wisconsin, USA
- Doctor of Physical Therapy Program, Tufts University School of Medicine, Boston, Massachusetts, USA
- Rehabilitation Department, WellSpan, York, Pennsylvania, USA
| | - Margaux Lojacono
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, Wisconsin, USA
- Doctor of Physical Therapy Program, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Jodi L Young
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, Wisconsin, USA
| | - Ronald J Schenk
- Doctor of Physical Therapy Program, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Daniel I Rhon
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, Wisconsin, USA
- Department of Rehabilitation Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
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3
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Takroni R, Sharma S, Reddy K, Zagzoog N, Aljoghaiman M, Alotaibi M, Farrokhyar F. Randomized controlled trials in neurosurgery. Surg Neurol Int 2022; 13:379. [PMID: 36128088 PMCID: PMC9479513 DOI: 10.25259/sni_1032_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 08/04/2022] [Indexed: 11/04/2022] Open
Abstract
Randomized controlled trials (RCTs) have become the standard method of evaluating new interventions (whether medical or surgical), and the best evidence used to inform the development of new practice guidelines. When we review the history of medical versus surgical trials, surgical RCTs usually face more challenges and difficulties when conducted. These challenges can be in blinding, recruiting, funding, and even in certain ethical issues. Moreover, to add to the complexity, the field of neurosurgery has its own unique challenges when it comes to conducting an RCT. This paper aims to provide a comprehensive review of the history of neurosurgical RCTs, focusing on some of the most critical challenges and obstacles that face investigators. The main domains this review will address are: (1) Trial design: equipoise, blinding, sham surgery, expertise-based trials, reporting of outcomes, and pilot trials, (2) trial implementation: funding, recruitment, and retention, and (3) trial analysis: intention-to-treat versus as-treated and learning curve effect.
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Affiliation(s)
- Radwan Takroni
- Department of Neurosurgery, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Sunjay Sharma
- Department of Neurosurgery, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Kesava Reddy
- Department of Neurosurgery, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Nirmeen Zagzoog
- Department of Neurosurgery, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Majid Aljoghaiman
- Department of Neurosurgery, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Mazen Alotaibi
- Department of Neurosurgery, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Forough Farrokhyar
- Department of Health, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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4
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Mukherjee A, Grayling MJ, Wason JMS. Adaptive Designs: Benefits and Cautions for Neurosurgery Trials. World Neurosurg 2022; 161:316-322. [PMID: 35505550 DOI: 10.1016/j.wneu.2021.07.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/11/2021] [Accepted: 07/12/2021] [Indexed: 10/18/2022]
Abstract
BACKGROUND It is well accepted that randomized controlled trials provide the greatest quality of evidence about effectiveness and safety of new interventions. In neurosurgery, randomized controlled trials face challenges, with their use remaining relatively low compared with other clinical areas. Adaptive designs have emerged as a method for improving the efficiency and patient benefit of trials. They allow modifications to the trial design to be made as patient outcome data are collected. The benefit they provide is highly variable, predominantly governed by the time taken to observe the primary endpoint compared with the planned recruitment rate. They also face challenges in design, conduct, and reporting. METHODS We provide an overview of the benefits and challenges of adaptive designs, with a focus on neurosurgery applications. To investigate how often an adaptive design may be advantageous in neurosurgery, we extracted data on recruitment rates and endpoint lengths for ongoing neurosurgery trials registered in ClinicalTrials.gov. RESULTS We found that a majority of neurosurgery trials had a relatively short endpoint length compared with the planned recruitment period and therefore may benefit from an adaptive trial. However, we did not identify any ongoing ClinicalTrials.gov registered neurosurgery trials that mentioned using an adaptive design. CONCLUSIONS Adaptive designs may provide benefits to neurosurgery trials and should be considered for use more widely. Use of some types of adaptive design, such as multiarm multistage, may further increase the number of interventions that can be tested with limited patient and financial resources.
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Affiliation(s)
- Aritra Mukherjee
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, United Kingdom
| | - Michael J Grayling
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, United Kingdom
| | - James M S Wason
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle upon Tyne, United Kingdom.
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5
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Volovici V. Neurosurgical Study Design: Looking Toward the Future. World Neurosurg 2022; 161:222-223. [PMID: 35505537 DOI: 10.1016/j.wneu.2022.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Medical research is increasing in complexity with every year. The breadth of possibilities is expanding with every new methodologic and statistical innovation. Because of the pace at which this process evolves, it can feel impossible to keep up with developments. Neurosurgery has had a slow start in terms of clinical research and innovations, relying on small, single-center studies and underpowered randomized controlled trials. Lately, owing to serious improvements made to study design quality, the neurosurgical evidence base is growing. The special section on neurosurgical study design highlights the most important methodologic concepts to date and illustrates the most important methodologic advancements, which will shape the future of neurosurgical study design.
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Affiliation(s)
- Victor Volovici
- Department of Neurosurgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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6
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Oliveira JVMP, Oliveira Júnior ALF, Kolias AG, Paiva WS, Fontoura Solla DJ. Spin in the neurosurgical trauma literature: prevalence and associated factors - a systematic review protocol. BMJ Open 2022; 12:e046602. [PMID: 34987034 PMCID: PMC8734005 DOI: 10.1136/bmjopen-2020-046602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Spin is defined as an inaccurate interpretation of results, intentionally or not, leading to equivocal conclusions and misdirecting readers to look at the data in an overly optimistic way. Previous studies have shown a high prevalence of spin in scientific papers and this systematic review aims to investigate the nature and prevalence of spin in the neurosurgical trauma literature. Any associated factors will be identified to guide future research practice recommendations. METHODS AND ANALYSIS The Preferred Reporting Item for Systematic Reviews and Meta-Analyses recommendations will be followed. Randomised clinical trials (RCTs) that enrolled only patients with traumatic brain injury and investigated any type of intervention (surgical or non-surgical) will be eligible for inclusion. The MEDLINE/PubMed database will be searched for articles in English published in 15 top-ranked journals. Spin will be defined as (1) a focus on statistically significant results not based on the primary outcome; (2) interpreting statistically non-significant results for a superiority analysis of the primary outcome; (3) claiming or emphasising the beneficial effect of the treatment despite statistically non-significant results; (4) conclusion focused in the per-protocol or as-treated analysis instead of the intention-to-treat results; (5) incorrect statistical analysis; (6) republication of a significant secondary analysis without proper acknowledgement of the primary outcome analysis result. Traditional descriptive statistics will be used to present RCT characteristics. Standardised differences between the groups with or without spin will be calculated. The variables with a standardised difference equal or above 0.2 and 0.5 will be considered weakly and strongly associated with spin, respectively. ETHICS AND DISSEMINATION This study will not involve primary data collection and patients will not be involved. TRIAL REGISTRATION NUMBER 10.17605/OSF.IO/H3FGY.
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Affiliation(s)
| | | | - Angelos G Kolias
- Department of Neurosurgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
| | - Wellingson S Paiva
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
- Division of Neurosurgery, University of São Paulo, São Paulo, São Paulo, Brazil
| | - Davi Jorge Fontoura Solla
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK
- Division of Neurosurgery, University of São Paulo, São Paulo, São Paulo, Brazil
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7
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Lubelski D, Hersh A, Azad TD, Ehresman J, Pennington Z, Lehner K, Sciubba DM. Prediction Models in Degenerative Spine Surgery: A Systematic Review. Global Spine J 2021; 11:79S-88S. [PMID: 33890803 PMCID: PMC8076813 DOI: 10.1177/2192568220959037] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES To review the existing literature of prediction models in degenerative spinal surgery. METHODS Review of PubMed/Medline and Embase databases was conducted to identify articles between January 1, 2000 and March 1, 2020 that reported prediction model performance for outcomes following elective degenerative spine surgery. RESULTS Thirty-one articles were included. Twenty studies were of thoracolumbar, 5 were of cervical, and 6 included all spine patients. Five studies were externally validated. Prediction models were developed using machine learning (42%) and logistic regression (42%) as well as other techniques. Web-based calculators were included in 45% of published articles. Various outcomes were investigated, including complications, infection, length of stay, discharge disposition, reoperation, readmission, disability score, back pain, leg pain, return to work, and opioid dependence. CONCLUSIONS Significant heterogeneity exists in methods used to develop prediction models of postoperative outcomes after degenerative spine surgery. Most internally validate their scores, but a few have been externally validated. Areas under the curve for most models range from 0.6 to 0.9. Techniques for development are becoming increasingly sophisticated with different machine learning tools. With further external validation, these models can be deployed online for patient, physician, and administrative use, and have the potential to optimize outcomes and maximize value in spine surgery.
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Affiliation(s)
- Daniel Lubelski
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew Hersh
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tej D. Azad
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jeff Ehresman
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Kurt Lehner
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Daniel M. Sciubba
- Johns Hopkins University School of Medicine, Baltimore, MD, USA,Daniel M. Sciubba, Department of Neurosurgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 5-185A, Baltimore, MD 21287, USA.
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8
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Griswold DP, Khan AA, Chao TE, Clark DJ, Budohoski K, Devi BI, Azad TD, Grant GA, Trivedi RA, Rubiano AM, Johnson WD, Park KB, Broekman M, Servadei F, Hutchinson PJ, Kolias AG. Neurosurgical Randomized Trials in Low- and Middle-Income Countries. Neurosurgery 2021; 87:476-483. [PMID: 32171011 PMCID: PMC7426187 DOI: 10.1093/neuros/nyaa049] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 12/28/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The setting of a randomized trial can determine whether its findings are generalizable and can therefore apply to different settings. The contribution of low- and middle-income countries (LMICs) to neurosurgical randomized trials has not been systematically described before. OBJECTIVE To perform a systematic analysis of design characteristics and methodology, funding source, and interventions studied between trials led by and/or conducted in high-income countries (HICs) vs LMICs. METHODS From January 2003 to July 2016, English-language trials with >5 patients assessing any one neurosurgical procedure against another procedure, nonsurgical treatment, or no treatment were retrieved from MEDLINE, Scopus, and Cochrane Library. Income classification for each country was assessed using the World Bank Atlas method. RESULTS A total of 73.3% of the 397 studies that met inclusion criteria were led by HICs, whereas 26.7% were led by LMICs. Of the 106 LMIC-led studies, 71 were led by China. If China is excluded, only 8.8% were led by LMICs. HIC-led trials enrolled a median of 92 patients vs a median of 65 patients in LMIC-led trials. HIC-led trials enrolled from 7.6 sites vs 1.8 sites in LMIC-led studies. Over half of LMIC-led trials were institutionally funded (54.7%). The majority of both HIC- and LMIC-led trials evaluated spinal neurosurgery, 68% and 71.7%, respectively. CONCLUSION We have established that there is a substantial disparity between HICs and LMICs in the number of published neurosurgical trials. A concerted effort to invest in research capacity building in LMICs is an essential step towards ensuring context- and resource-specific high-quality evidence is generated.
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Affiliation(s)
- Dylan P Griswold
- Stanford University School of Medicine, Stanford, California.,Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Ahsan A Khan
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.,Neuroscience Institute, INUB-MEDITECH Research Group, El Bosque University, Bogotá, Colombia
| | - Tiffany E Chao
- Stanford University School of Medicine, Stanford, California.,Department of Surgery, Santa Clara Valley Medical Center, San Jose, California
| | - David J Clark
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.,Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Karol Budohoski
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.,Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - B Indira Devi
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.,Department of Neurosurgery, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Tej D Azad
- Stanford University School of Medicine, Stanford, California.,Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland
| | - Gerald A Grant
- Stanford University School of Medicine, Stanford, California
| | - Rikin A Trivedi
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.,Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Andres M Rubiano
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.,Neuroscience Institute, INUB-MEDITECH Research Group, El Bosque University, Bogotá, Colombia
| | - Walter D Johnson
- Emergency and Essential Surgical Care Programme, World Health Organization, Geneva, Switzerland
| | - Kee B Park
- Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts
| | - Marike Broekman
- Department of Neurosurgery, Leiden University Medical Center, Leiden and Haaglanden Medical Center, the Hague, the Netherlands
| | - Franco Servadei
- Department of Neurosurgery, Humanitas Research Hospital, Humanitas University, Milan, Italy
| | - Peter J Hutchinson
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.,Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Angelos G Kolias
- NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.,Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
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9
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Ota HCU, Smith BG, Alamri A, Robertson FC, Marcus H, Hirst A, Broekman M, Hutchinson P, McCulloch P, Kolias A. The IDEAL framework in neurosurgery: a bibliometric analysis. Acta Neurochir (Wien) 2020; 162:2939-2947. [PMID: 32651707 PMCID: PMC7593304 DOI: 10.1007/s00701-020-04477-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/29/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The Idea, Development, Exploration, Assessment and Long-term study (IDEAL) framework was created to provide a structured way for assessing and evaluating novel surgical techniques and devices. OBJECTIVES The aim of this paper was to investigate the utilization of the IDEAL framework within neurosurgery, and to identify factors influencing implementation. METHODS A bibliometric analysis of the 7 key IDEAL papers on Scopus, PubMed, Embase, Web of Science, and Google Scholar databases (2009-2019) was performed. A second journal-specific search then identified additional papers citing the IDEAL framework. Publications identified were screened by two independent reviewers to select neurosurgery-specific articles. RESULTS The citation search identified 1336 articles. The journal search identified another 16 articles. Following deduplication and review, 51 relevant articles remained; 14 primary papers (27%) and 37 secondary papers (73%). Of the primary papers, 5 (36%) papers applied the IDEAL framework to their research correctly; two were aligned to the pre-IDEAL stage, one to the Idea and Development stages, and two to the Exploration stage. Of the secondary papers, 21 (57%) explicitly discussed the IDEAL framework. Eighteen (86%) of these were supportive of implementing the framework, while one was not, and two were neutral. CONCLUSION The adoption of the IDEAL framework in neurosurgery has been slow, particularly for early-stage neurosurgical techniques and inventions. However, the largely positive reviews in secondary literature suggest potential for increased use that may be achieved with education and publicity.
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Affiliation(s)
| | - Brandon G Smith
- Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
| | - Alexander Alamri
- Department of Neurosurgery, The Royal London Hospital, London, UK
| | - Faith C Robertson
- Department. of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
| | - Hani Marcus
- The Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Allison Hirst
- IDEAL Collaboration, Nuffield Department of Surgical Sciences, University of Oxford and John Radcliffe Hospital, Oxford, UK
| | - Marike Broekman
- IDEAL Collaboration, Nuffield Department of Surgical Sciences, University of Oxford and John Radcliffe Hospital, Oxford, UK
- Department of Neurosurgery, Haaglanden Medical Center/Leiden University Medical Center, The Hague, Netherlands
| | - Peter Hutchinson
- Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK
| | - Peter McCulloch
- IDEAL Collaboration, Nuffield Department of Surgical Sciences, University of Oxford and John Radcliffe Hospital, Oxford, UK
| | - Angelos Kolias
- Department of Clinical Neurosciences, University of Cambridge & Addenbrooke's Hospital, Cambridge, UK.
- IDEAL Collaboration, Nuffield Department of Surgical Sciences, University of Oxford and John Radcliffe Hospital, Oxford, UK.
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10
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To MS, Jukes A. Reporting trends of p values in the neurosurgical literature. J Neurosurg 2020; 132:662-670. [PMID: 30738384 DOI: 10.3171/2018.8.jns172897] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 08/28/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the trends in reporting of p values in the neurosurgical literature from 1990 through 2017. METHODS All abstracts from the Journal of Neurology, Neurosurgery, and Psychiatry (JNNP), Journal of Neurosurgery (JNS) collection (including Journal of Neurosurgery: Spine and Journal of Neurosurgery: Pediatrics), Neurosurgery (NS), and Journal of Neurotrauma (JNT) available on PubMed from 1990 through 2017 were retrieved. Automated text mining was performed to extract p values from relevant abstracts. Extracted p values were analyzed for temporal trends and characteristics. RESULTS The search yielded 47,889 relevant abstracts. A total of 34,324 p values were detected in 11,171 abstracts. Since 1990 there has been a steady, proportionate increase in the number of abstracts containing p values. There were average absolute year-on-year increases of 1.2% (95% CI 1.1%-1.3%; p < 0.001), 0.93% (95% CI 0.75%-1.1%; p < 0.001), 0.70% (95% CI 0.57%-0.83%; p < 0.001), and 0.35% (95% CI 0.095%-0.60%; p = 0.0091) of abstracts reporting p values in JNNP, JNS, NS, and JNT, respectively. There have also been average year-on-year increases of 0.045 (95% CI 0.031-0.059; p < 0.001), 0.052 (95% CI 0.037-0.066; p < 0.001), 0.042 (95% CI 0.030-0.054; p < 0.001), and 0.041 (95% CI 0.026-0.056; p < 0.001) p values reported per abstract for these respective journals. The distribution of p values showed a positive skew and strong clustering of values at rounded decimals (i.e., 0.01, 0.02, etc.). Between 83.2% and 89.8% of all reported p values were at or below the "significance" threshold of 0.05 (i.e., p ≤ 0.05). CONCLUSIONS Trends in reporting of p values and the distribution of p values suggest publication bias remains in the neurosurgical literature.
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Affiliation(s)
- Minh-Son To
- 1School of Medicine, Flinders University, Bedford Park
| | - Alistair Jukes
- 2Department of Neurosurgery, Royal Adelaide Hospital, Adelaide.,3Department of Otolaryngology, Head and Neck Surgery, The Queen Elizabeth Hospital, Woodville; and.,4School of Medicine, University of Adelaide, South Australia, Australia
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Reply to the letter to the editor «Controlled clinical trials and efficacy: Report of a neurosurgical study». NEUROLOGÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.nrleng.2018.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Azad TD, Feng AY, Mehta S, Bak AB, Johnson E, Mittal V, Esparza R, Veeravagu A, Halpern CH, Grant GA. Randomized Controlled Trials in Functional Neurosurgery-Association of Device Approval Status and Trial Quality. Neuromodulation 2019; 23:496-501. [PMID: 31828896 DOI: 10.1111/ner.13083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/07/2019] [Accepted: 10/30/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Randomized controlled trials (RCTs) have been critical in evaluating the safety and efficacy of functional neurosurgery interventions. Given this, we sought to systematically assess the quality of functional neurosurgery RCTs. METHODS We used a database of neurosurgical RCTs (trials published from 1961 to 2016) to identify studies of functional neurosurgical procedures (N = 48). We extracted data on the design and quality of these RCTs and quantified the quality of trials using Jadad scores. We categorized RCTs based on the device approval status at the time of the trial and tested the association of device approval status with trial design and quality parameters. RESULTS Of the 48 analyzed functional neurosurgery RCTs, the median trial size was 34.5 patients with a median age of 51. The most common indications were Parkinson's disease (N = 20), epilepsy (N = 10), obsessive-compulsive disorder (N = 4), and pain (N = 4). Most trials reported inclusion and exclusion criteria (95.8%), sample size per arm (97.9%), and baseline characteristics of the patients being studied (97.9%). However, reporting of allocation concealment (29.2%), randomization mode (66.7%), and power calculations (54.2%) were markedly less common. We observed that trial quality has improved over time (Spearman r, 0.49). We observed that trials studying devices with humanitarian device exemption (HDE) and experimental indications (EI) tended to be of higher quality than trials of FDA-approved devices (p = 0.011). A key distinguishing quality characteristic was the proportion of HDE and EI trials that were double-blinded, compared to trials of FDA-approved devices (HDE, 83.3%; EI, 69.2%; FDA-approved, 35.3%). Although more than one-third of functional neurosurgery RCTs reported funding from industry, no significant association was identified between funding source and trial quality or outcome. CONCLUSION The quality of RCTs in functional neurosurgery has improved over time but reporting of specific metrics such as power calculations and allocation concealment requires further improvement. Device approval status but not funding source was associated with trial quality.
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Affiliation(s)
- Tej D Azad
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.,Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Austin Y Feng
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Swapnil Mehta
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Alex B Bak
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Eli Johnson
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Vaishali Mittal
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Rogelio Esparza
- Department of Neurosurgery, New York University School of Medicine, New York, NY, USA
| | - Anand Veeravagu
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Casey H Halpern
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Gerald A Grant
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
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Darsaut T, Roy D, Weill A, Bojanowski M, Chaalala C, Bilocq A, Findlay J, Rempel J, Chow M, O’Kelly C, Ashforth R, Kotowski M, Magro E, Lemus M, Fahed R, Arikan F, Arrese I, Sarabia R, Altschul D, Chagnon M, Guilbert F, Shankar J, Proust F, Nolet S, Gevry G, Raymond J. A randomized trial of endovascular versus surgical management of ruptured intracranial aneurysms: Interim results from ISAT2. Neurochirurgie 2019; 65:370-376. [DOI: 10.1016/j.neuchi.2019.05.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/09/2019] [Accepted: 05/30/2019] [Indexed: 01/08/2023]
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Staartjes VE, Molliqaj G, van Kampen PM, Eversdijk HAJ, Amelot A, Bettag C, Wolfs JFC, Urbanski S, Hedayat F, Schneekloth CG, Abu Saris M, Lefranc M, Peltier J, Boscherini D, Fiss I, Schatlo B, Rohde V, Ryang YM, Krieg SM, Meyer B, Kögl N, Girod PP, Thomé C, Twisk JWR, Tessitore E, Schröder ML. The European Robotic Spinal Instrumentation (EUROSPIN) study: protocol for a multicentre prospective observational study of pedicle screw revision surgery after robot-guided, navigated and freehand thoracolumbar spinal fusion. BMJ Open 2019; 9:e030389. [PMID: 31501123 PMCID: PMC6738706 DOI: 10.1136/bmjopen-2019-030389] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Robotic guidance (RG) and computer-assisted navigation (NV) have seen increased adoption in instrumented spine surgery over the last decade. Although there exists some evidence that these techniques increase radiological pedicle screw accuracy compared with conventional freehand (FH) surgery, this may not directly translate to any tangible clinical benefits, especially considering the relatively high inherent costs. As a non-randomised, expertise-based study, the European Robotic Spinal Instrumentation Study aims to create prospective multicentre evidence on the potential comparative clinical benefits of RG, NV and FH in a real-world setting. METHODS AND ANALYSIS Patients are allocated in a non-randomised, non-blinded fashion to the RG, NV or FH arms. Adult patients that are to undergo thoracolumbar pedicle screw instrumentation for degenerative pathologies, infections, vertebral tumours or fractures are considered for inclusion. Deformity correction and surgery at more than five levels represent exclusion criteria. Follow-up takes place at 6 weeks, as well as 12 and 24 months. The primary endpoint is defined as the time to revision surgery for a malpositioned or loosened pedicle screw within the first postoperative year. Secondary endpoints include patient-reported back and leg pain, as well as Oswestry Disability Index and EuroQOL 5-dimension questionnaires. Use of analgesic medication and work status are recorded. The primary analysis, conducted on the 12-month data, is carried out according to the intention-to-treat principle. The primary endpoint is analysed using crude and adjusted Cox proportional hazards models. Patient-reported outcomes are analysed using baseline-adjusted linear mixed models. The study is monitored according to a prespecified monitoring plan. ETHICS AND DISSEMINATION The study protocol is approved by the appropriate national and local authorities. Written informed consent is obtained from all participants. The final results will be published in an international peer-reviewed journal. TRIAL REGISTRATION NUMBER Clinical Trials.gov registry NCT03398915; Pre-results, recruiting stage.
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Affiliation(s)
- Victor E Staartjes
- Department of Neurosurgery, Bergman Clinics Amsterdam, Amsterdam, The Netherlands
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Amsterdam UMC, Vrije Universiteit Amsterdam, Neurosurgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Granit Molliqaj
- Department of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
| | - Paulien M van Kampen
- Department of Epidemiology, Bergman Clinics Amsterdam, Amsterdam, The Netherlands
| | - Hubert A J Eversdijk
- Department of Neurosurgery, Bergman Clinics Amsterdam, Amsterdam, The Netherlands
| | - Aymeric Amelot
- Department of Neurosurgery, La Pitié Salpétrière Hospital, Paris, France
| | - Christoph Bettag
- Department of Neurosurgery, Medical Center, Georg August University of Göttingen, Göttingen, Germany, Göttingen, Germany
| | - Jasper F C Wolfs
- Department of Neurosurgery, Bergman Clinics Amsterdam, Amsterdam, The Netherlands
- Department of Neurosurgery, Haaglanden Medical Center, Den Haag, The Netherlands
| | - Sophie Urbanski
- Center for Spinal Surgery and Pain Therapy, Ortho-Klinik Dortmund, Dortmund, Germany
| | - Farman Hedayat
- Center for Spinal Surgery and Pain Therapy, Ortho-Klinik Dortmund, Dortmund, Germany
| | | | - Mike Abu Saris
- Department of Neurosurgery, Martini Hospital, Groningen, Groningen, Netherlands
| | - Michel Lefranc
- Department of Neurosurgery, Amiens University Hospital, Amiens, Picardie, France
| | - Johann Peltier
- Department of Neurosurgery, Amiens University Hospital, Amiens, Picardie, France
| | - Duccio Boscherini
- Department of Neurosurgery, Clinique de la Source, Lausanne, Switzerland
| | - Ingo Fiss
- Department of Neurosurgery, Medical Center, Georg August University of Göttingen, Göttingen, Germany, Göttingen, Germany
| | - Bawarjan Schatlo
- Department of Neurosurgery, Medical Center, Georg August University of Göttingen, Göttingen, Germany, Göttingen, Germany
| | - Veit Rohde
- Department of Neurosurgery, Medical Center, Georg August University of Göttingen, Göttingen, Germany, Göttingen, Germany
| | - Yu-Mi Ryang
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
- Department of Neurosurgery, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Nikolaus Kögl
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Pierre-Pascal Girod
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Jos W R Twisk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam, The Netherlands
| | - Enrico Tessitore
- Department of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
| | - Marc L Schröder
- Department of Neurosurgery, Bergman Clinics Amsterdam, Amsterdam, The Netherlands
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Staartjes VE, Klukowska AM, Sorba EL, Schröder ML. Conflicts of interest in randomized controlled trials reported in neurosurgical journals. J Neurosurg 2019; 133:855-864. [PMID: 31419788 DOI: 10.3171/2019.5.jns183560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/14/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Randomized controlled trials (RCTs) form the basis of today's evidence-based approach to medicine, and play a critical role in guidelines and the drug and device approval process. Conflicts of interest (COIs) are commonplace in medical research, but little is known about their influence. The authors aimed to evaluate the extent and influence of COIs in recent RCTs published in core neurosurgical journals using a cross-sectional analysis. METHODS Through review of 6 general neurosurgical journals, all interventional RCTs published from January 2009 to January 2019 were identified. Because it is difficult to objectively assess study outcome, the authors opted for a strict rating approach based on the statistical significance of unambiguously reported primary endpoints, and the reported statistical protocol. RESULTS A total of 129 RCTs met the inclusion criteria. During the study period, the Journal of Neurosurgery published the largest number of RCTs (n = 40, 31%). Any potential COI was disclosed by 57%, and a mean of 12% of authors had a personal COI. Nonfinancial industry involvement was reported in 10%, while 31% and 20% received external support and sponsoring, respectively. Study registration was reported by 56%, while 51% of studies were blinded. Registration showed an increasing trend from 17% to 76% (p < 0.001). The median randomized sample size was 92 (interquartile range 50-153), and 8% were designed to investigate noninferiority or equality. Sixty-three RCTs (49%) unambiguously reported a primary endpoint, of which 13% were composite primary endpoints. In 43%, study outcome was positive, which was associated with a noninferiority design (31% vs 3%, p = 0.007) and a composite primary endpoint (46% vs 9%, p = 0.002). Potential COIs were not significantly associated with study positivity (69% vs 59%, p = 0.433). In the multivariate analysis, only a composite primary endpoint remained predictive of a positive study outcome (odds ratio 6.34, 95% confidence interval 1.51-33.61, p = 0.017). CONCLUSIONS This analysis provides an overview of COIs and their potential influence on recent trials published in core neurosurgical journals. Reporting of primary endpoints, study registration, and uniform disclosure of COIs are crucial to ensure the quality of future neurosurgical randomized trials. COIs do not appear to significantly influence the outcome of randomized neurosurgical trials.
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Affiliation(s)
- Victor E Staartjes
- 1Department of Neurosurgery, Bergman Clinics, Amsterdam
- 2Amsterdam UMC, Vrije Universiteit Amsterdam, Neurosurgery, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- 3Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland; and
| | - Anita M Klukowska
- 1Department of Neurosurgery, Bergman Clinics, Amsterdam
- 4School of Medicine, University of Nottingham, United Kingdom
| | - Elena L Sorba
- 1Department of Neurosurgery, Bergman Clinics, Amsterdam
- 3Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Switzerland; and
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Azad TD, Pendharkar AV, Pan J, Huang Y, Li A, Esparza R, Mehta S, Connolly ID, Veeravagu A, Campen CJ, Cheshier SH, Edwards MSB, Fisher PG, Grant GA. Surgical outcomes of pediatric spinal cord astrocytomas: systematic review and meta-analysis. J Neurosurg Pediatr 2018; 22:404-410. [PMID: 30028275 DOI: 10.3171/2018.4.peds17587] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Pediatric spinal astrocytomas are rare spinal lesions that pose unique management challenges. Therapeutic options include gross-total resection (GTR), subtotal resection (STR), and adjuvant chemotherapy or radiation therapy. With no randomized controlled trials, the optimal management approach for children with spinal astrocytomas remains unclear. The aim of this study was to conduct a systematic review and meta-analysis on pediatric spinal astrocytomas. METHODS The authors performed a systematic review of the PubMed/MEDLINE electronic database to investigate the impact of histological grade and extent of resection on overall survival among patients with spinal cord astrocytomas. They retained publications in which the majority of reported cases included astrocytoma histology. RESULTS Twenty-nine previously published studies met the eligibility criteria, totaling 578 patients with spinal cord astrocytomas. The spinal level of intramedullary spinal cord tumors was predominantly cervical (53.8%), followed by thoracic (40.8%). Overall, resection was more common than biopsy, and GTR was slightly more commonly achieved than STR (39.7% vs 37.0%). The reported rates of GTR and STR rose markedly from 1984 to 2015. Patients with high-grade astrocytomas had markedly worse 5-year overall survival than patients with low-grade tumors. Patients receiving GTR may have better 5-year overall survival than those receiving STR. CONCLUSIONS The authors describe trends in the management of pediatric spinal cord astrocytomas and suggest a benefit of GTR over STR for 5-year overall survival.
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Affiliation(s)
| | | | | | | | - Amy Li
- Departments of1Neurosurgery and
| | | | | | | | | | - Cynthia J Campen
- 2Neurology, Stanford University School of Medicine, Stanford, California
| | | | | | - Paul G Fisher
- 2Neurology, Stanford University School of Medicine, Stanford, California
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Karsy M, Brock AA, Rolston JD. Hiding in Plain Sight. Neurosurgery 2018; 83:E96. [DOI: 10.1093/neuros/nyy297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Azad TD, Grant GA. In Reply. Neurosurgery 2018; 83:E139. [DOI: 10.1093/neuros/nyy284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ruiz-Juretschke F, González-Quarante LH. Reply to the letter to the editor «Controlled clinical trials and efficacy: Report of a neurosurgical study». Neurologia 2018; 35:137-138. [PMID: 29861188 DOI: 10.1016/j.nrl.2018.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 03/01/2018] [Indexed: 11/16/2022] Open
Affiliation(s)
- F Ruiz-Juretschke
- Servicio de Neurocirugía, Hospital General Universitario Gregorio Marañón, Madrid, España.
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