General Neurosurgery

RESCUE-ASDH trial found no difference in 12-month GOSE outcomes between craniotomy and decompressive craniectomy for acute subdural hematoma. Craniotomy patients required more reoperations for swelling, while craniectomy patients had more wound complications. When brain allows, consider replacing bone flap to avoid second surgery for cranioplasty.

This 2013 guideline review outlines a stepwise approach to iNPH diagnosis: comprehensive clinical evaluation, treatment of comorbidities, then specific CSF drainage testing. It emphasizes that gait impairment is nearly universal, and properly performed tap tests (30-50 mL removal with pre/post assessment) have high positive predictive value. All symptoms including dementia may improve with shunting in selected patients.

This RCT in South America found no difference in 6-month functional/cognitive outcomes between ICP monitoring and imaging/clinical exam-based management for severe TBI. Mortality and ICU length of stay were similar. The study challenges the universal necessity of ICP monitoring, suggesting protocolized care without monitoring may be equally effective in certain settings.