The role of evidence-based medicine in neurosurgery.

Evidence-based medicine (EBM) has become one of the pillars of modern medicine. There are many myths and misconceptions about EBM that retard its application into neurosurgical practice. We aim to dispel some of these. Neurosurgeons should cultivate sound EBM practice and strive to improve the available evidence base for neurosurgery. Although randomised controlled trials are not suitable to investigate many neurosurgical problems, this does not preclude practising EBM that requires consideration of the strongest available evidence at the time of clinical decision making. Although individualised analysis of primary sources of evidence gives the clearest analysis, the diversity and complexity of modern medicine means that it is difficult for clinicians to stay abreast of all EBM through this mechanism alone. The development of evidence-based practice guidelines by neurosurgeons is a practical alternative. We recommend that neurosurgical organisations and societies take up this challenge and develop EBM education programs, encouraging the practise of EBM by neurosurgeons and neurosurgical trainees.