Beez Thomas, Steiger Hans-Jakob
Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany.
Neurosurg Rev. 2019 Mar;42(1):133-137. doi: 10.1007/s10143-018-0967-8. Epub 2018 Mar 19.
Randomized controlled trials (RCTs) are gold standard for comparing treatment modalities. Recently, RCTs transformed ischemic stroke care by first proving benefit of decompressive craniectomy (DC) and later of interventional mechanical thrombectomy. Aim of this study was to explore the impact of RCTs on neurosurgical practice. RCTs investigating DC and thrombectomy were identified. Annual numbers of DCs for ischemic stroke between 2000 and 2017 were determined and correlated with publication dates of RCTs. The initial RCTs demonstrating efficacy of DC were published in 2007, followed by an increase in DC numbers between 2008 and 2009. The first RCTs on mechanical thrombectomy were published in 2014 and 2015, with a decline in DCs observed between 2015 and 2016. There is a close temporal relationship between publication of these RCTs and changes in neurosurgical practice. Dynamics of annual DCs appear to correlate with the publication of RCTs. Significantly positive results of surgical and interventional RCTs were translated into clinical practice with a latency of 1 year, as reflected by shifts in annual DC numbers.
随机对照试验（RCTs）是比较治疗方式的金标准。最近，随机对照试验通过首先证明减压颅骨切除术（DC）的益处，以及后来证明介入性机械取栓术的益处，改变了缺血性中风的治疗。本研究的目的是探讨随机对照试验对神经外科实践的影响。确定了研究减压颅骨切除术和取栓术的随机对照试验。确定了2000年至2017年期间缺血性中风减压颅骨切除术的年度数量，并将其与随机对照试验的发表日期相关联。最初证明减压颅骨切除术疗效的随机对照试验于2007年发表，随后在2008年至2009年期间减压颅骨切除术数量增加。关于机械取栓术的首批随机对照试验于2014年和2015年发表，在2015年至2016年期间观察到减压颅骨切除术数量下降。这些随机对照试验的发表与神经外科实践的变化之间存在密切的时间关系。年度减压颅骨切除术的动态似乎与随机对照试验的发表相关。手术和介入性随机对照试验的显著阳性结果在1年后转化为临床实践，这一点从年度减压颅骨切除术数量的变化中可以看出。
