Neurosurgery

ERAS for elective aneurysm clipping reduced pain, PONV, and improved early recovery

This single-center prospective nonrandomized study of 414 elective unruptured aneurysm clippings compared 234 pre-ERAS versus 180 ERAS patients. ERAS patients had significantly lower postoperative pain scores across PODs 0–3 and markedly reduced opioid use with earlier transition to oral nonopioid analgesics. PONV incidence was significantly lower on PODs 1–3 and QoR-40 scores were higher on POD 2 in the ERAS group. Hospital stay and overall complication rates were similar between groups, supporting ERAS feasibility without increasing complications. 1

Double negative control estimator reduces bias from non-compliance in surgical RCT simulations

Simulation study compared ITT, PP, AT, IV, DiD, and double negative control (DNC) estimators under realistic surgical crossover scenarios. Traditional estimators showed severe bias or high variability, while DNC maintained low bias (|bias|≤0.415), low MSE (≤2.515), and near-nominal coverage across scenarios. At n=100 with 40% crossover, DNC reduced MSE by >90% versus IV and achieved coverage of 97.7%, but performance depends on confounding structure and assumptions. 2

Ultra-early epilepsy surgery in infants linked to sustained seizure freedom and better development

Matched cohort study of 23 infants operated at a mean age of 3.5 months versus 115 controls assessed safety, seizure outcomes, and neurodevelopment. No perioperative deaths or permanent severe complications occurred; transient unilateral weakness occurred in 17.4% and hydrocephalus in 13.6%. Engel class Ia was achieved in 82.6% at 1 year and 78.2% at mean 44.4-month follow-up, with 69.6% off anti-seizure medications at last follow-up. Surgery was associated with higher developmental quotient scores versus controls (β=30.2), suggesting potential protection of neurodevelopment. 3