Roth Christian, Salehi Merdhad, Deinsberger Wolfgang, Kaestner Stefanie, Engel Holger
Department of Neurology, DRK-Kliniken Nordhessen, Kassel, Germany; Department of Neurology, University of Marburg, Germany.
Department of Neurosurgery, Klinikum Kassel, Germany.
Clin Neurol Neurosurg. 2019 Nov;186:105502. doi: 10.1016/j.clineuro.2019.105502. Epub 2019 Aug 27.
Decision making for surgical therapy in patients with intracerebral hemorrhage is still controversial among neurologists and neurosurgeons. Whereas neurologists may favor conservative treatments, surgeons may opt for operations. This might lead to different therapy decisions.
Between 2017 and 2018, we conducted a survey among the neurological and neurosurgical societies in Germany. An online questionnaire consisting of 10 fictive patients with spontaneous supratentorial intracerebral hemorrhage (including CT scans and brief case descriptions) was administered to the members of the societies. The participants were asked to decide whether conservative or surgical treatment would be preferred. Furthermore, the results from the neurosurgeons were compared to the results of our previous surveys in 1999 and 2009.
A total of 157 answers were collected (response rate of 16.2%). Nineteen had to be excluded, leaving 138 for analysis (84 neurosurgeons and 54 neurologists). There were no significant differences in therapy decisions between neurologists and neurosurgeons in all ten cases. Comparing the answers from neurosurgeons with our previous results, there were no significant differences between the results from 1999, 2009 and 2017.
Against common prejudices, the process of decision making for or against surgery in patients with spontaneous intracerebral hemorrhage is comparable among conservative physicians (neurologists) and neurosurgeons in Germany. This might be the result of joint efforts in spontaneous intracerebral hemorrhage (ICH) therapy, such as joint guidelines or a society of neurointensive care medicine.
脑出血患者手术治疗的决策在神经科医生和神经外科医生之间仍存在争议。神经科医生可能倾向于保守治疗，而外科医生可能选择手术。这可能导致不同的治疗决策。
2017年至2018年期间，我们在德国的神经科和神经外科协会进行了一项调查。向协会成员发放了一份包含10例自发性幕上脑出血虚拟患者（包括CT扫描和简要病例描述）的在线问卷。要求参与者决定是选择保守治疗还是手术治疗。此外，将神经外科医生的结果与我们1999年和2009年之前的调查结果进行了比较。
共收集到157份答案（回复率为16.2%）。19份答案被排除，剩下138份用于分析（84名神经外科医生和54名神经科医生）。在所有10个病例中，神经科医生和神经外科医生在治疗决策上没有显著差异。将神经外科医生的答案与我们之前的结果进行比较，1999年、2009年和2017年的结果之间没有显著差异。
与常见偏见相反，在德国，保守医生（神经科医生）和神经外科医生在自发性脑出血患者手术与否的决策过程是可比的。这可能是自发性脑出血（ICH）治疗中共同努力的结果，如联合指南或神经重症监护医学协会。
