Abstract:
BACKGROUND:Recent studies have documented the high sensitivity of computed tomography angiography (CTA) in detecting a ruptured aneurysm in the presence of acute subarachnoid hemorrhage (SAH). The practice of digital subtraction angiography (DSA) when CTA does not reveal an aneurysm has thus been called into question. OBJECTIVE:We examined this dilemma from a cost-effectiveness perspective by using current decision analysis techniques. METHODS:A decision tree was created with the use of TreeAge Pro Suite 2012; in 1 arm, a CTA-negative SAH was followed up with DSA; in the other arm, patients were observed without further imaging. Based on literature review, costs and utilities were assigned to each potential outcome. Base-case and sensitivity analyses were performed to determine the cost-effectiveness of each strategy. A Monte Carlo simulation was then conducted by sampling each variable over a plausible distribution to evaluate the robustness of the model. RESULTS:With the use of a negative predictive value of 95.7% for CTA, observation was found to be the most cost-effective strategy ($6737/Quality Adjusted Life Year [QALY] vs $8460/QALY) in the base-case analysis. One-way sensitivity analysis demonstrated that DSA became the more cost-effective option if the negative predictive value of CTA fell below 93.72%. The Monte Carlo simulation produced an incremental cost-effectiveness ratio of $83 083/QALY. At the conventional willingness-to-pay threshold of $50 000/QALY, observation was the more cost-effective strategy in 83.6% of simulations. CONCLUSION:The decision to perform a DSA in CTA-negative SAH depends strongly on the sensitivity of CTA, and therefore must be evaluated at each center treating these types of patients. Given the high sensitivity of CTA reported in the current literature, performing DSA on all patients with CTA negative SAH may not be cost-effective at every institution.
journal_name
Neurosurgeryjournal_title
Neurosurgeryauthors
Jethwa PR,Punia V,Patel TD,Duffis EJ,Gandhi CD,Prestigiacomo CJdoi
10.1227/NEU.0b013e318282a578subject
Has Abstractpub_date
2013-04-01 00:00:00pages
511-9; discussion 519issue
4eissn
0148-396Xissn
1524-4040pii
00006123-201304000-00011journal_volume
72pub_type
杂志文章相关文献
NEUROSURGERY文献大全abstract::This article represents the first of a 2-part exploration of quantum dots (Qdots) and their application to neurological surgery. Spanning from materials science to immunology, this initial review traces the marriage of imaging physics to biochemical specificity. Qdot science now stands poised to dramatically advance t...
journal_title:Neurosurgery
pub_type: 杂志文章,评审
doi:10.1227/01.NEU.0000347889.62762.3F
更新日期:2009-06-01 00:00:00
abstract:PURPOSE:To compare a newly released vascular clip system (Vascular Clip-applier System; Auto Suture Company, Norwalk, CT) designed for sutureless vessel closures and anastomoses with standard suture closure of carotid arteriotomies after carotid endarterectomies. PATIENTS AND METHODS:Sixteen consecutive patients with ...
journal_title:Neurosurgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00006123-199803000-00024
更新日期:1998-03-01 00:00:00
abstract:OBJECTIVE:Tumor necrosis factor alpha (TNFalpha) is elevated in some models of traumatic brain injury (TBI). However, it is unclear how TNFalpha messenger ribonucleic acid (mRNA) expression and protein levels are affected by injury severity and posttraumatic temperature modification. This study determined the regional ...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.neu.0000130036.52521.2c
更新日期:2004-08-01 00:00:00
abstract::Samples of ventricular cerebrospinal fluid, tumor cyst fluid, and subdural fluid were obtained from 30 patients at operation. The protein concentration and the specific gravity of each sample were measured and the corresponding mean absorption numbers were calculated from the numerical printout of the preoperative com...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/00006123-197907010-00003
更新日期:1979-07-01 00:00:00
abstract::Twenty-three of 538 patients undergoing elective craniotomy had a seizure within 24 hours after operation. The lesion had been located extra-axially in 15 patients and intra-axially in 8 patients. Except for 1 patient who had a parietal craniotomy for an arteriovenous malformation, all patients had a frontal or tempor...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/00006123-198301000-00003
更新日期:1983-01-01 00:00:00
abstract:BACKGROUND:Epilepsy surgery involving the cingulate gyrus has been mostly presented as case reports, and larger series with long-term follow-up are not published yet. OBJECTIVE:To report our experience with focal epilepsy arising from the cingulate gyrus and surrounding structures and its surgical treatment. METHODS:...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/NEU.0b013e318237aaa3
更新日期:2012-04-01 00:00:00
abstract:OBJECTIVE:Many children with cerebral palsy have chronic ventriculomegaly as a consequence of perinatal intraventricular hemorrhage or periventricular leukomalacia, without symptoms of hydrocephalus. Children with cerebral palsy who are treated with intrathecal baclofen have a higher rate of cerebrospinal fluid (CSF) l...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.neu.0000144779.32401.a2
更新日期:2005-01-01 00:00:00
abstract::During radiofrequency (RF) heating of trigeminal rootlets, we regularly measured blood pressure rises to 250 to 300 mm Hg, confirming two previous reports. We also found abnormally increased bleeding times in 12% of 127 patients awaiting operation for trigeminal neuralgia. These two facts probably explain 6 fatalities...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/00006123-198511000-00022
更新日期:1985-11-01 00:00:00
abstract::Positron emission computed tomographic (PECT) scanning studies have demonstrated that high grade gliomas exhibit increased 2-[18F]fluoro-2-deoxyglucose (18FDG) uptake compared to cerebral white matter and low grade gliomas. Hexokinase catalyzes the phosphorylation of glucose, as well as 18FDG and 2-deoxyglucose (2DG),...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/00006123-198510000-00001
更新日期:1985-10-01 00:00:00
abstract:OBJECTIVE:Transsphenoidal surgery for Cushing's disease from a pituitary adenoma is an effective and safe treatment. Definitive preoperative diagnosis of Cushing's disease caused by a pituitary adenoma is often difficult, particularly in patients with normal imaging studies and a normal sella turcica. We present the ou...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1097/00006123-200003000-00005
更新日期:2000-03-01 00:00:00
abstract:BACKGROUND AND IMPORTANCE:We present a unique case of an anterior cranial base von Hippel-Lindau disease (VHL)-associated microcystic neoplasm. To determine the lesion's relationship with VHL and its appropriate management, we discuss its salient clinical, pathological, and molecular features. CLINICAL PRESENTATION:A ...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/NEU.0b013e318223b7a7
更新日期:2011-10-01 00:00:00
abstract:BACKGROUND:Improved understanding of rod fracture (RF) in adult spinal deformity could be valuable for implant design, surgical planning, and patient counseling. OBJECTIVE:To evaluate symptomatic RF after posterior instrumented fusion for adult spinal deformity. METHODS:A multicenter, retrospective review of RF in ad...
journal_title:Neurosurgery
pub_type: 杂志文章,多中心研究
doi:10.1227/NEU.0b013e3182672aab
更新日期:2012-10-01 00:00:00
abstract:OBJECTIVE:Our previous studies demonstrated that simvastatin promotes neurological functional recovery after traumatic brain injury (TBI) in rat; however, the underlying mechanisms remain poorly understood. The purpose of this study was to investigate the anti-inflammatory effect of simvastatin by measuring the level o...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.NEU.0000346272.76537.DC
更新日期:2009-07-01 00:00:00
abstract::The management of adult hydrocephalus spans a broad range of disorders and ages. Modern management strategies include endoscopic and adjustable cerebrospinal fluid shunt diversionary techniques. The assessment and management of the following clinical conditions are discussed: 1) the adult patient with congenital or ch...
journal_title:Neurosurgery
pub_type: 杂志文章,评审
doi:10.1227/01.neu.0000316269.82467.f7
更新日期:2008-02-01 00:00:00
abstract:BACKGROUND:The International Study of Intracranial Aneurysms found that for patients with no previous history of subarachnoid hemorrhage, small (< 7 mm) anterior circulation and posterior circulation aneurysms had a 0% and 2.5% risk of subarachnoid hemorrhage over 5 years, respectively. OBJECTIVE:To determine whether ...
journal_title:Neurosurgery
pub_type: 杂志文章,多中心研究
doi:10.1227/NEU.0b013e3181ff357c
更新日期:2011-01-01 00:00:00
abstract:INTRODUCTION:Three-dimensional computed tomographic angiography (3-D-CTA) can be used to evaluate cerebrovascular disease. A potential limitation of this technology is obscuration of vascular anatomy by bone. In view of this, we developed a method for bone-free rendering using iterative relative fuzzy connectedness (IR...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1097/00006123-200207000-00044
更新日期:2002-07-01 00:00:00
abstract::Three cases of osteomyelitis of the skull base with associated problems in diagnosis and therapy are discussed. Patients with atypical skull base osteomyelitis are difficult to diagnose as they have no ear abnormalities, but they often develop multiple cranial nerve deficits mimicking symptoms of a posterior fossa mas...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/00006123-199203000-00021
更新日期:1992-03-01 00:00:00
abstract:OBJECTIVE:Neurenteric cysts (NCs) typically arise as benign ventral intradural extramedullary developmental malformations of the spine which contain heterotopic epithelium resembling the intestinal or respiratory tracts. Intracerebral NCs are extremely rare, though the frequency of symptomatic reports and incidental fi...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.NEU.0000361998.93841.C3
更新日期:2010-01-01 00:00:00
abstract:OBJECTIVE:Cerebral autoregulation maintains a relatively stable cerebral blood flow over a range of perfusion pressures. During exercise, regional cerebral blood flow may be elevated in particular areas of the brain. This case report presents the impact of aerobic exercise on intracranially measured pressure and brain ...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.NEU.0000371976.21043.C8
更新日期:2010-08-01 00:00:00
abstract::The notion of nanotechnology has evolved since its inception as a fantastic conceptual idea to its current position as a mainstream research initiative with broad applications among all divisions of science. In the first part of this series, we reviewed the structures and principles that comprise the main body of know...
journal_title:Neurosurgery
pub_type: 杂志文章,评审
doi:10.1227/01.NEU.0000217016.79256.16
更新日期:2006-06-01 00:00:00
abstract:OBJECTIVE:An excruciating headache of instantaneous onset is known as a thunderclap headache. A subarachnoid hemorrhage is the prototypical cause, but other serious disorders may also present with a thunderclap headache, including cerebral venous sinus thrombosis, carotid artery dissection, and pituitary apoplexy. We r...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1097/00006123-200103000-00009
更新日期:2001-03-01 00:00:00
abstract:OBJECTIVE:Carotid endarterectomy with a patch graft (Patch CEA) has been our standard treatment for patients with carotid artery stenosis, but carotid artery stenting (CAS) has emerged as an alternative. The purpose of this study was to compare the postoperative changes in the configurations and the flow velocities of ...
journal_title:Neurosurgery
pub_type: 临床试验,杂志文章
doi:10.1227/01.NEU.0000358952.12917.DF
更新日期:2009-11-01 00:00:00
abstract::The object of this study was to determine whether the addition of information on brain stem reflexes improves the prognostic precision of the Glasgow coma scale for patients with severe head trauma. The study is based on 109 patients with a Glasgow coma score of 7 or less during the first 24 hours after injury. The av...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/00006123-198505000-00002
更新日期:1985-05-01 00:00:00
abstract:OBJECTIVE:We sought to determine the duration of cognitive impairment after sports concussion. METHODS:We conducted a study with a prospective design in which 729 athletes underwent preseason baseline testing by being administered a computerized neuropsychological test battery, followed by retesting at regular interva...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.neu.0000118820.33396.6a
更新日期:2004-05-01 00:00:00
abstract:BACKGROUND:Stress-induced cardiomyopathy (SIC) is a poorly understood condition associated with periods of emotional and physical stress. The clinical approaches for management of SIC are supportive and reactive to patient symptoms. OBJECTIVE:To utilize next-generation exome sequencing to define genetic variation asso...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/NEU.0000000000001152
更新日期:2016-06-01 00:00:00
abstract:OBJECTIVE:Total brain water content changes in several cerebral pathological conditions and the measurement of brain water content are important for the selection of appropriate therapeutic procedures. We present a quantitative, in vivo, bioelectrical impedance analysis (BIA) method and propose its use for the accurate...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1097/00006123-200205000-00023
更新日期:2002-05-01 00:00:00
abstract:OBJECTIVE:Although the necessity of craniotomy for an unruptured cerebral aneurysm (UCA) is controversial, surgery is warranted if surgical risks are less than the risks of natural history. In this study, we investigated the need for craniotomy for UCAs on the basis of surgical risk. METHODS:History of cerebrovascular...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1227/01.neu.0000148897.28828.85
更新日期:2005-02-01 00:00:00
abstract:OBJECTIVE:Surgical treatment of odontoid fractures that do not allow interfragmentary fracture compression involves either posterior atlantoaxial arthrodesis or additional anterior stabilization using a plate construct. The purpose of this study was to determine the clinical and radiographic outcome after anterior plat...
journal_title:Neurosurgery
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1227/01.NEU.0000339117.60613.8C
更新日期:2009-04-01 00:00:00
abstract:OBJECTIVE:Major steps in the evolution of advanced neurosurgical techniques include microneurosurgery, neuroendoscopy and its minimally invasive variations, neuronavigation, and advanced intraoperative imaging. With traditional neuroendoscopic techniques (e.g., freehand endoscopy or the use of mechanical arms), definit...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:
更新日期:2002-12-01 00:00:00
abstract::A patient who sustained a gunshot wound to the neck and subsequent blunt trauma is presented. No angiogram was performed after the initial injury. Subsequently, the patient developed a cerebral embolus from a thrombus dislodged from a pseudoaneurysm of the cervical carotid artery, resulting in complete occlusion of th...
journal_title:Neurosurgery
pub_type: 杂志文章
doi:10.1097/00006123-199002000-00020
更新日期:1990-02-01 00:00:00