Tag: Conservative treatment

Posted on

From conservative to interventional management in unruptured intracranial aneurysms

J Neurosurg 142:619–625, 2025

• Study Focus: Management of unruptured intracranial aneurysms (UIAs) from conservative to interventional.

• Objective: Identify patterns and predictors for revising UIA management strategy.

• Methodology: Retrospective review of cases diagnosed between 2006-2022 with conservative management.

• Results: 10 of 144 cases shifted to interventional treatment due to aneurysm growth.

• UIA Growth: Most frequent reason for changing treatment strategy.

• Size Threshold: UIAs > 3 mm at diagnosis more likely to require intervention.

• Conservative Management: Regular radiographic follow-ups recommended, especially for UIAs > 3 mm.

• Guidelines: ESO and American Heart Association guidelines emphasize monitoring UIA growth.

• Statistical Analysis: Cox regression and Kaplan-Meier curves used for data analysis.

• Risk Factors: No significant effect of potential risk factors on treatment change.

• Imaging: DSA as confirmative modality for revising conservative management.

• Study Limitations: Low statistical power due to limited cases of treatment change.

• Conclusion: Regular monitoring crucial for conservatively managed UIAs, especially > 3 mm.

Posted on

Reappraisal of Intracerebral Hemorrhages and Intracerebral Hemorrhage Grading Scale Score in Surgically and Medically Managed Cerebellar Intracerebral Hemorrhage

 

Neurosurgery 92:1021–1028, 2023

As compared with supratentorial intracerebral hemorrhages (ICH), bleeds that occur within the cerebellum require special consideration given the nature of the posterior fossa.

OBJECTIVE: To validate ICH and ICH grading scale (ICH-GS) scores in patients with cerebellar hemorrhage and examine the outcomes of patients managed surgically as compared with those who underwent conservative treatment.

METHODS: This observational multicenter study included 475 patients with cerebellar hemorrhage from 9 different neurosurgical departments in Germany between 2005 and 2021. The prognostic accuracy of ICH and ICH-GS scores were calculated by the area under the curve of the receiver operating characteristic curves. Analyzed outcomes were the inhospital mortality, mortality at 6 months, in-hospital outcome, and outcome at 6 months.

RESULTS: Of 403 patients, 252 patients (62.5%) underwent surgical treatment and 151 patients (37.5%) conservative treatment. Both ICH and ICH-GS scores demonstrated good prognostic accuracy regarding both overall mortality and functional outcomes. In those patients presenting with severe cerebellar hemorrhages, ie, ICH score >3 and ICH-GS score >11, overall mortality was significantly lower in surgically treated patients. Mortality was significantly higher in those patients managed surgically who presented with ICH scores ≤3; in such patients, improved outcomes were noted when the hematoma was treated conservatively.

CONCLUSION: ICH and ICH scores are useful tools for prediction of survival and outcome in patients with cerebellar ICH. Surgical management may be beneficial for those who present with severe cerebellar ICH as reflected by ICH scores >3, while conservative management seems reasonable in patients with lower ICH scores.

Posted on

Surgery for adult spondylolisthesis: a systematic review of the evidence

spondylolistesis

Eur Spine J (2016) 25:2359–2367

Surgery for isthmic and degenerative spondylolisthesis (SL) in adults is carried out very frequently in everyday practice. However, it is still unclear whether the results of surgery are better than those of conservative treatment and whether decompression alone or instrumented fusion with decompression should be recommended. In addition, the role of reduction is unclear.

Four clinically relevant key questions were addressed in this study: (1) Is surgery more successful than conservative treatment in relation to pain and function in adult patients with isthmic SL? (2) Is surgery more successful than conservative treatment in relation to pain and function in adult patients with degenerative SL? (3) Is instrumented fusion with decompression more successful in relation to pain and function than decompression alone in adult patients with degenerative SL and spinal canal stenosis? (4) Is instrumented fusion with reduction more successful in relation to pain and function than instrumented fusion without reduction in adult patients with isthmic or degenerative SL?

A systematic PubMed search was carried out to identify randomized and nonrandomized controlled trials on these topics. Papers were analyzed systematically in a search for the best evidence.A total of 18 studies was identified and analyzed: two for question 1, eight for question 2, four for question 3, and four for question 4.

Surgery appears to be better than conservative treatment in adults with isthmic SL (poor evidence) and also in adults with degenerative SL (good evidence). Instrumented fusion with decompression appears to be more successful than decompression alone in adults with degenerative SL and spinal stenosis (poor evidence). Reduction and instrumented fusion does not appear to be more successful than instrumented fusion without reduction in adults with isthmic or degenerative SL (moderate evidence).

Proudly powered by WordPress