Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20072, Milan, Italy.
Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano, 20089, Milan, Italy.
Acta Neurochir (Wien). 2024 Oct 15;166(1):411. doi: 10.1007/s00701-024-06289-3.
The process of grading and stratifying evidence in the extensive literature on neurosurgical guidelines has evolved significantly, ranging from high-quality standards to suggested options. However, the methodology for guideline development has become increasingly complex, leading to challenges in their application across various neurosurgical specialties and settings. This mini review aims to explore the practical implications of published suggestions for managing neurosurgical patients.
A critical and focused collection of published literature concerning guidelines in different neurosurgical topics, from Pubmed and other sources formed the basis of this non-systematic narrative review. Only guidelines produced by neurosurgeons in the era of evidence based medicine (after 1996) were included.
Neurosurgical guidelines often rely on a limited number of Randomized Controlled Trials (RCTs) and Class I evidence, particularly in surgical and emergency contexts where randomization of patient treatments may conflict with established clinical practices. Challenges also include the timely update of guidelines, which sometimes lags behind rapid shifts in evidence, and varying methodologies in guideline production that can result in divergent recommendations. Geographical disparities in disease burden and literature production further influence guideline applicability, suggesting a need for greater inclusion of authors from Low- and Middle-Income Countries (LMICs) to enhance realism and global relevance. Consensus conferences and expert reviews may serve as viable alternatives to address these challenges.
While Evidence-Based Medicine remains pivotal, critical appraisal and practical application of guidelines must consider these complexities to optimize patient care and outcomes.
神经外科指南相关的大量文献在分级和分层证据的过程中已经发生了重大变化，从高质量标准到建议选项都有涉及。然而，指南制定的方法学变得越来越复杂，导致它们在不同神经外科专业和环境中的应用面临挑战。本篇迷你综述旨在探讨发表的管理神经外科患者建议的实际意义。
从 Pubmed 和其他来源收集了不同神经外科主题的指南相关的已发表文献，作为本次非系统性叙述性综述的基础。仅纳入在循证医学时代（1996 年后）由神经外科医生制定的指南。
神经外科指南通常依赖于有限数量的随机对照试验（RCT）和 I 级证据，特别是在手术和急救环境中，对患者治疗的随机化可能与既定的临床实践相冲突。挑战还包括指南的及时更新，有时落后于证据的快速变化，以及指南制定中不同的方法学可能导致不同的建议。疾病负担和文献产出的地理差异进一步影响了指南的适用性，这表明需要更多来自中低收入国家（LMICs）的作者参与，以提高现实性和全球相关性。共识会议和专家审查可能是解决这些挑战的可行替代方案。
尽管循证医学仍然至关重要，但对指南的批判性评价和实际应用必须考虑到这些复杂性，以优化患者的护理和结果。
