Neurology News

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Tuesday, June 24, 2014

Neurosurgeons Offer Recommendations for 'Choosing Wisely'

As part of the American Board of Internal Medicine Foundation’s “Choosing Wisely” campaign, national organizations representing medical specialists have been asked to “choose wisely” by identifying five tests or procedures commonly used in their field, whose necessity should be questioned and discussed.

The American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) have just released their joint set of recommendations in the interest of improving patient care and reducing health care costs:


1. Don’t administer steroids after severe traumatic brain injury.

2. Don’t obtain imaging (plain radiographs, magnetic resonance imaging, computed tomography [CT], or other advanced imaging) of the spine in patients with non-specific acute low back pain and without red flags.

3. Don’t routinely obtain CT scanning of children with mild head injuries.

4. Don’t routinely screen for brain aneurysms in asymptomatic patients without a family or personal history of brain aneurysms, subarachnoid hemorrhage (SAH) or genetic disorders that may predispose to aneurysm formation.

5. Don’t routinely use seizure prophylaxis in patients following ischemic stroke.

“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,” said CNS president, Daniel K. Resnick, MD, in a press release.

Along with neurosurgeons, neurologists and other specialists who treat patients with neurological conditions can also use this list to guide decision making and patient care.

he American Academy of Neurology released their own list of Choosing Wisely recommendations last year, which included:
1. Don't perform electroencephalography (EEG) for headaches.
2. Don't perform imaging of the carotid arteries for simple syncope without other neurologic symptoms.

3. Don't use opioid or butalbital treatment for migraine except as a last resort.
4. Don't prescribe interferon-beta or glatiramer acetate to patients with disability from progressive, non-relapsing forms of multiple sclerosis (MS).
5. Don't recommend carotid endarterectomy for asymptomatic carotid stenosis unless the complication rate is low (less than 3 percent).

To learn more about Choosing Wisely and to view the complete lists and additional detail about the recommendations and evidence supporting them, visit


Read our previous stories on the Choosing Wisely initiative: Stay tuned for a full story on the recommendations for neurosurgeons.