Department of Neurosurgery, Neurosurgical Centre Amsterdam, Amsterdam University Medical Centres, Amsterdam, the Netherlands.
Department of Neurosurgery, Clinical Neuroscience Centre, University Hospital Zurich, Zurich, Switzerland.
World Neurosurg. 2022 May;161:432-440. doi: 10.1016/j.wneu.2022.02.049.
From a pathophysiological point of view, early neurosurgical treatment seems essential to prevent secondary brain injury and has been stated as the "time-is-brain" concept. However, the question immediately rises: "Is there an optimal time window for acute intracranial neurosurgical interventions?" In neurosurgery, treatment modality has been studied far more extensively than timing to surgery ("time-to-surgery"). The majority of acute intracranial neurosurgical interventions are carried out for traumatic brain injury and hemorrhagic or ischemic stroke. Current guidelines for traumatic brain injury, spontaneous intracerebral hemorrhage, aneurysmal subarachnoid hemorrhage, and middle cerebral artery infarction are reviewed and lessons learned from the randomized controlled trials mentioned are discussed. In acute intracranial neurosurgical interventions, "delayed consent" procedures could play an important role for this field of research. Whether there is an optimal time window for acute intracranial neurosurgical interventions seems difficult to be answered with randomized controlled trials referred to in the current guidelines. Observational designs, such as comparative effectiveness research, and special statistical techniques, may provide a better understanding in the optimal "time-to-surgery."
从病理生理学的角度来看，早期神经外科治疗似乎对于预防继发性脑损伤至关重要，这一理念被称为“时间就是大脑”。然而，问题立即出现：“急性颅内神经外科干预是否存在最佳的时间窗？” 在神经外科中，治疗方式的研究远比手术时机（“手术时间”）更为广泛。大多数急性颅内神经外科干预是针对创伤性脑损伤、出血性或缺血性卒中等疾病进行的。本文回顾了创伤性脑损伤、自发性脑内出血、颅内动脉瘤性蛛网膜下腔出血和大脑中动脉梗死的现有指南，并讨论了随机对照试验中得出的经验教训。在急性颅内神经外科干预中，“延迟同意”程序可能对此研究领域发挥重要作用。目前指南中提到的随机对照试验似乎难以回答急性颅内神经外科干预是否存在最佳时间窗的问题。观察性设计，如比较有效性研究和特殊的统计技术，可能为最佳“手术时间”提供更好的理解。
