Resolving controversies in neurosurgery through randomized controlled trials.

More and more, the clinical practice of neurosurgery is molded by the results of randomized controlled trials (RCTs).[1] This trend is largely driven by the intense desire of neurosurgeons to understand the impacts of our clinical practices and the application of sophisticated statistical designs toward this end. The growing emphasis on high quality data as the basis of clinical decision making over clinical anecdotes or retrospective series is also demanded by our patient advocacy groups, government, and reimbursement agencies.[2]

Accordingly, the number of RCTs that examined the efficacy of various neurosurgical practices has increased dramatically over the past decade.[3] Thoughtful interpretation of the published RCTs result is now an integral part of the neurosurgical practice and an essential responsibility of any modern neurosurgeon. Only through awareness and careful scrutiny of the available and emerging RCTs data can we contribute meaningfully to the evolution of neurosurgical practices and participate in the ongoing conversation of healthcare reform.[45] The purpose of the series of articles published under the title “resolving controversies in neurosurgery through randomized controlled trials” is to provide a foundation for discourse directed toward these ends.

These articles are intended to provide concise summaries of the available RCTs data pertaining to fundamental questions in the clinical practice of neurosurgery. Each article will select a pertinent topic and begin with a concise description of the issue in question, followed by succinct summaries of the available RCTs data. We will invite commentary from experts in the pertinent fields. Finally, we will solicit input from our readers and publish selective responses from our readership in subsequent issues.

We hope that this collection of articles will be of value to the field of Neurosurgery. For the residents, these articles may serve as a foundation for future learning and lend an appreciation of the spectrum of views in our field. The articles may also be of value to early stage neurosurgeons preparing for the oral board examination, by providing a collection of concise synopses of the landmark RCTs studies pertinent to neurosurgical practice. Finally, the articles should be of value to active clinical practitioners by providing summaries of the current RCT literature and a forum for their discussion.

We would also like to use these articles as a forum for surveying the views of the SNI readers. As such, each article will be accompanied by a single questionnaire to assess whether the RCTs data strongly, weakly, or fail to support changes in surgical practice. The first hundred responses will be recorded, and the results of these surveys will be reported in future issues. Along with this questionnaire, the reader will have an opportunity to voice his/her thoughts on the subject matter. Select inputs may also be published. The questionnaire and solicitation for opinion can be found at: http://neurosurgery.ucsd.edu/survey/

The inaugural article for this series addresses the clinical value of extended resection in glioblastoma patients. We hope that the SNI readership enjoy this article and look forward to reader comments on the subject matter.