Put Down the Knife: A Fresh Look at Adult Brain Surgery

Introduction
Acknowledgments
Contents
About the Author
Part I: General Concepts and Errors in Thought About Adult Brain Surgery
	Chapter 1: General Concepts About Adult Brain Surgery
		Why Adult Brain Surgery Is Different
		Major Minimally Invasive Brain Surgery Interventions
		What Is the Purpose of Adult Brain Surgery?
		General Neurosurgical Insights
		Who Should Be the “Captain of the Ship”?
		Four General Classifications of Brain Surgery
		The Major Flaw in How Most Neurosurgeons View Adult Brain Surgery
	Chapter 2: Errors in Thought About Adult Brain Surgery
		“This Is How I Was Trained”
		“I Have Seen Patients Do Well After This Surgery”
		“The Patient Wanted the Surgery”
		“The Family Wanted Everything Done”
		“We Have Nothing to Lose by Operating”
		“Surgery Is Not Clearly Worse Than the Alternatives”
		“We Were There Anyway”
		“The Brain Issue Was the Presenting Problem, Therefore We Should First Perform Surgery on the Brain”
		“Brain Surgery Should Be Performed Because There Is Brain Edema or Mass Effect”
		“We Need an Invasive Diagnostic Procedure”
		“We Need Tissue”
		“The Tumor Board/Trauma Board/Stroke Board Recommended Surgery”
		“We Need To Do This Procedure to Satisfy Certain Volume Requirements”
		“This Is What Was Said at a National Conference”
		“This Patient Is a Very Important Person (VIP)”
		“This Is How Everyone Is Doing Things”
	Chapter 3: Errors in Thought About Published Studies on Adult Brain Surgery
		The Biases of the Authors
		The Biases of the Editors and Reviewers
		Mistaking “Statistical Significance” with “Clinical Significance”
		Looking at the Wrong Endpoints
		Drawing Conclusions That Do Not Follow from the Study’s Results
		Incorrect Assumptions About Lack of Proper Follow-Up Data
		Assuming That Published Data Is Representative of Typical Results/Not Recognizing the Selection Bias of Published Reports
		Minimizing or Ignoring Significant Complications
		Overstating the Benefits of Surgery
		Not Properly Factoring in Placebo Effects
		Resorting to Meta-analyses
		The Call for Endless Studies
		Not Recognizing That the Operation(s) Was No Better Than Less Risky Alternatives
		Not Recognizing That a Component of a Necessary Operation May Be Unnecessary
		Incorrectly Relying on Other People to Determine If Surgery Was Necessary
		Reliance on Post-Hoc Analyses
		Biases Due to Outside Funding
		Studies That Are Ended Early
		Studies Created to Justify a Preferred Conclusion: “Self-Serving Studies”
		Post-Hoc Ergo Propter Hoc Errors
		Studies with Impossible Results
		The Dismissal of a Large Good Study That Rejects Numerous Weak Studies
		The Study by an Author Who Is Not Familiar with the Alternative Treatments
		Studies with Inadequate Sample Size
		Studies with Inadequate Follow-Up
		Discrediting of Studies by Discrediting the Authors
		Incorrectly Concluding That Non-inferiority Is Validation
Part II: Specific Conditions for Which Brain Surgery Is Considered
	Chapter 4: Brain Hematomas
		Epidural Hematoma
		Subdural Hematoma: Acute
		Subdural Hematoma: Chronic
		Intracerebral Hematoma
		Intracerebellar Hematoma
		Intraventricular Hematoma
	Chapter 5: Brain Vascular Disease
		Brain Aneurysm: Ruptured
		Brain Aneurysm: Unruptured
		Brain Arteriovenous Malformations and Arteriovenous Fistulae (AVM/AVF): Ruptured
		Brain AVM/AVF: Unruptured
		Cavernous Malformations: Symptomatic
		Cavernous Malformations: Asymptomatic
		Stroke
			Stroke, with Large Vessel Occlusion
			Middle Cerebral Artery (MCA) Stroke
			Cerebellar Stroke
	Chapter 6: Brain Trauma
		Traumatic Bleeds/Contusions
		Penetrating Brain Injuries
		Skull Fractures
		Intracranial Pressure Monitors/“Bolts”
		Craniectomy for Trauma
	Chapter 7: Brain Tumors
		Pituitary Tumors
			Non-secretory
			Secretory
				Prolactinomas
				Cushing’s Disease
				Acromegaly/Gigantism
				Pituitary Apoplexy
				Lymphocytic Hypophysitis
		Acoustic Neuromas (Vestibular Schwannomas)
		Brain Meningiomas
		Brain Metastases
		Gliomas: Grades 1, 2, 3, 4
			Grade 1: Juvenile Pilocytic Astrocytoma (JPA)
			Grade 2: Intermediate Grade Gliomas
			Grade 3: Anaplastic Astrocytoma/High Grade Gliomas
			Grade 4: Glioblastoma/High Grade Gliomas
		Pineal Tumors
		Intraventricular Tumors
			Tumors of the Lateral Ventricle
			Tumors of the Third Ventricle
			Tumors of the Fourth Ventricle
		Hemangioblastoma
	Chapter 8: Brain Cysts
		Arachnoid Cysts
		Pituitary Cysts
		Rathke’s Cysts
		Pineal Cysts
		Colloid Cysts
		Neuroglial Cysts
	Chapter 9: Hydrocephalus
		Normal Pressure Hydrocephalus (NPH)
		Idiopathic Intracranial Hypertension
	Chapter 10: Pain Disorders
		Trigeminal Neuralgia
		Glossopharyngeal Neuralgia
		Occipital Neuralgia
		Pain Procedures for Other Cranio-facial Pains
	Chapter 11: Movement Disorders
		Hemifacial Spasm
		Tremor
		Other Movement Disorders
	Chapter 12: Brain Abscess
	Chapter 13: Chiari Malformation
	Chapter 14: Skull Base Disorders
	Chapter 15: Encephaloceles and Spontaneous CSF Leaks
	Chapter 16: Epilepsy
	Chapter 17: Psychosurgery
	Chapter 18: Non-surgical Management of Neurosurgery Patients
		Non-medical, Non-invasive Treatments
		Medical Management
		Procedures
Conclusion
References
Index