Is there too much variability in technical neurosurgery decision-making? Virtual Tumour Board of a challenging case.
Decades into the era of evidence-based medicine, most neurosurgeons are aware that the vast majority of our day-to-day patient care decisions are not guided by class I evidence, especially those related to surgical procedures. We rely on common sense, personal bias based on our residency training and personal experience. A 35-year-old man presented with a 6-month history of visual loss, cognitive decline and endocrine dysfunction. Imaging showed the culprit lesion to be a cystic suprasellar tumour with a mural nodule. Opinions regarding the optimal surgical approach were sought from 40 colleagues in the senior neurosurgeon's own hospital and other centres worldwide, who suggested 37 different approaches. A right pterional image-guided craniotomy successfully allowed for drainage of the cyst and resection of the nodule. The pathology was adamantinomatous craniopharyngioma. The patient had an excellent surgical recovery and a good outcome.
Bernstein
Mark
M
Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada. mark.bernstein@uhn.on.ca
Khu
Kathleen Joy
KJ
D002985:Clinical Protocols; D003397:Craniopharyngioma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D003399:Craniotomy / Q000379:methods* / Q000592:standards; D003657:Decision Making; D003661:Decision Support Techniques; D004700:Endocrine System Diseases / Q000209:etiology; D019317:Evidence-Based Medicine / Q000379:methods / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods* / Q000592:standards; D015588:Observer Variation; D010902:Pituitary Gland / Q000473:pathology / Q000601:surgery; D010911:Pituitary Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D012017:Referral and Consultation / Q000592:standards* / Q000639:trends; D012658:Sella Turcica / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D015354:Vision, Low / Q000209:etiology