Neurosurgery Evidence Evolution

5 evidence evolution narratives tracing how landmark trials and guideline updates reshaped neurosurgery practice.

Decompressive Craniectomy in Stroke

A dramatic intervention with evidence

No surgical option → DECIMAL/DESTINY/HAMLET (2007) → age <60 → DESTINY-II elderly → timing

The coiling revolution

Clipping → ISAT (2002) → BRAT → long-term retreatment → patient selection

Less fusion, more conservative

Liberal fusion → SPORT → Cochrane → conservative non-inferior → refined indications

Preserving function through consciousness

GA default → awake mapping → extent of resection → functional preservation → supratotal

Expanding the neural targets

Parkinson's (1987) → tremor → dystonia → OCD → depression → neuropsychiatric