Five Neurosurgery Treatments to Question

Neurology recommendations to patients and physicians cover five routine procedures that may not be needed

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) In an effort to connect doctors and patients, the American Board of Internal Medicine (ABIM) Foundation puts out updated recommendations on the best treatment options. The latest installation of the ABIM Choosing Wisely series focuses on neurology.

This Choosing Wisely list comes from the American Association of Neurological Surgeons (AANS) and Congress of Neurological Surgeons (CNS).

The list of recommendations include avoiding steroids after a traumatic head injury and giving second-thought to using CT scan on a child.

"Talk to your neurologist about the best treatment options."

This new list includes five specific neurological treatments developed with an eye on “identifying the right treatment for the right patient at the right time to eliminate unnecessary procedures, optimize outcomes and reduce healthcare costs,” according to a prepared statement from AANS President Robert Harbaugh, MD.

First, the Choosing Wisely list recommends that doctors should not administer steroids after a severe traumatic brain injuryInstead of reducing pressure inside the skull, a high steroid dose could increase the risk of complication and may result in increased death rate.

Second, neurologists should not recommend imaging (radiographs, magnetic resonance imaging, computed tomography scans or other advanced imaging) of the spine if the patient doesn’t have “red flags.” Those red flags can include weakness, numbness, dysfunction of the bowel or bladder, fever, history of cancer, history of intravenous drug use, immune system issues, steroid use or a history of osteoporosis.

Third, the authors of the new list recommend that physicians should not routinely order computed tomography (CT) scans for children with mild head injuries. A CT scan is an imaging method that uses X-rays to produce a cross-section of the body.

The Choosing Wisely list suggests that for patients under 2 years old, a CT scan is needed in cases of continuing altered brain function, loss of consciousness for five seconds or more, severe injury or skull fracture, among others. For patients older than 2, many of the same indicators prompt a CT scan along with history of vomiting and severe headache.

Fourth, the new recommendations discourage routine screening for brain aneurysms in patients without symptoms or without a family or personal history of brain aneurysms.

A brain aneurysm occurs when there is a ballooning in the wall of an artery in the brain. Symptoms usually take effect once the aneurysm presses on a nerve, which can cause changes in vision, pain above or behind the eye, a dilated pupil, a droopy eyelid or numbness/weakness on one side of the face or body.

Fifth, the new recommendations encourage physicians to avoid routinely administering anti-seizure medications to prevent seizures in patients who've had a stroke. Those medications may be necessary if patients have a seizure.

A stroke occurs when blood flow to a part of the brain stops, which can cause lasting damage.

The list was published online June 24.

The recommendations were reviewed by the AANS and CNS’s Joint Guidelines Committee, Quality Improvement Workgroup and sub-specialists.

Daniel Resnick, MD, CNS president, said in a prepared statement, “A broad range of neurosurgeons, from across the spectrum of our specialty, reviewed the evidence and contributed to these recommendations. We anticipate that these will help neurosurgeons and their patients make informed decisions by promoting conversations about the most appropriate tests and treatments, and avoiding care whose potential harm may outweigh the benefits."

Review Date: 
June 25, 2014
Last Updated:
June 26, 2014