bluuebunny/crossref_metadata_2025 huggingface dataset:
T cell clonal expansions in ileal Crohn’s disease are associated with smoking behaviour and postoperative recurrence
Authors: Allez Matthieu , Auzolle Claire , Ngollo Marjolaine , Bottois Hugo , Chardiny Victor , Corraliza Ana Maria , Salas Azucena , Perez Kevin , Stefanescu Carmen , Nancey Stéphane , Buisson Anthony , Pariente Benjamin , Fumery Mathurin , Sokol Harry , Tréton Xavier , Barnich Nicolas , Seksik Philippe , Le Bourhis Lionel
Published: February 2019

T cell clonal expansions are present in the inflamed mucosa of patients with Crohn’s disease (CD) and may be implicated in postoperative recurrence after ileocolonic resection.

Methods

T cell receptor (TCR) analysis was performed in 57 patients included in a prospective multicentre cohort. Endoscopic recurrence was defined by a Rutgeerts score >i0. DNA and mRNA were extracted from biopsies collected from the surgical specimen and endoscopy, and analysed by high throughput sequencing and microarray, respectively.

Results

TCR repertoire in the mucosa of patients with CD displayed diverse clonal expansions. Active smokers at time of surgery had a significantly increased proportion of clonal expansions as compared with non-smokers (25.9%vs17.9%, p=0.02). The percentage of high frequency clones in the surgical specimen was significantly higher in patients with recurrence and correlated with postoperative endoscopic recurrence (area under the curve (AUC) 0.69, 95% CI 0.54 to 0.83). All patients with clonality above 26.8% (18/57) had an endoscopic recurrence. These patients with a high clonality were more frequently smokers than patients with a low clonality (61% vs 23%, p=0.005). The persistence of a similar TCR repertoire at postoperative endoscopy was associated with smoking and disease recurrence. Patients with high clonality showed increased expression of genes associated with CD8 T cells and reduced expression of inflammation-related genes. Expanded clones were found predominantly in the CD8 T cell compartment.

Conclusion

Clonal T cell expansions are implicated in postoperative endoscopic recurrence. CD patients with increased proportion of clonal T cell expansions in the ileal mucosa represent a subgroup associated with smoking and where pathogenesis appears as T cell driven.

Trial registration number

NCT03458195.
Using ‘allergy tests’ in cases of canine dermatitis
Authors: Foster Aiden
Published: February 2019

Veterinary clinicians and owners have access to a variety of commercial serological tests that purport to measure immunoglobulin (Ig) E, and in some situations IgG, antibodies to various allergens. However, there is considerable confusion about how to use these tests and a great potential for misusing them and for wasting clients’ money. The aim of this article is to provide an overview of how these tests can be used to help the diagnosis and treatment of allergic skin conditions in dogs.
Clinical presentation, natural history and outcomes of intramedullary spinal cord cavernous malformations
Authors: Goyal Anshit , Rinaldo Lorenzo , Alkhataybeh Redab , Kerezoudis Panagiotis , Alvi Mohammed Ali , Flemming Kelly D , Williams Lindsy , Diehn Felix , Bydon Mohamad
Published: February 2019

Objective

There is a paucity of literature investigating the clinical course of patients with spinal intramedullary cavernous malformations (ISCMs). We present a large case series of ISCMs to describe clinical presentation, natural history and outcomes of both surgical and conservative management.

Methods

We retrospectively reviewed the clinical course of patients diagnosed with ISCMs at our institution between 1995 and 2016. Haemorrhage was defined as clinical worsening in tandem with imaging changes visualised on follow-up MRI. Outcomes assessed included neurological status and annual haemorrhage rates.

Results

A total of 107 patients met inclusion criteria. Follow-up data were available for 85 patients. While 21 (24.7%) patients underwent immediate surgical resection, 64 (75.3%) were initially managed conservatively. Among this latter group, 16 (25.0%) suffered a haemorrhage during follow-up and 11 (17.2%) required surgical resection due to interval bleeding or neurological worsening. The overall annual risk of haemorrhage was 5.5% per person year. The rate among patients who were symptomatic and asymptomatic on presentation was 9.5% and 0.8%, respectively. Median time to haemorrhage was 2.3 years (0.1–12.3). Univariate analysis identified higher ISCM size (p=0.024), history of prior haemorrhage (p=0.013) and presence of symptoms (p=0.003) as risk factors for subsequent haemorrhage. Multivariable proportional hazards analysis revealed presence of symptoms to be independently associated with haemorrhage during follow-up (HR 9.39, CI 1.86 to 170.8, p=0.013).

Conclusion

Large, symptomatic ISCMs appear to be at increased risk for subsequent haemorrhage. Surgery may be considered in such lesions to prevent rebleeding and subsequent neurological worsening.
WM1-2 SFX-01 after subarachnoid haemorrhage: protocol of a multi-centre, phase II, double-blinded, randomised controlled trial
Authors: Zolnourian A , Holton P , Galea I , Bulters D
Published: February 2019

Objectives

To assess the safety and efficacy of SFX-01 after subarachnoid haemorrhage.

Design

SFX-01 is a synthetic agent that contains sulforaphane that has been shown to be neuroprotective in animal models of subarachnoid haemorrhage. This is a phase II double-bilinded, placebo-controlled randomised clinical trial.

Subjects

Target of 90 patients with fisher 3 or 4 subarachnoid haemorrhage.

Methods

Patients admitted to the three recruiting centres within 48 hours of ictus will be randomly allocated to placebo or SFX-01. The randomisation is stratified into WFNS 1–3 or 4–5. Participants will receive the trial medication in a capsule format twice-daily for 28 days. Patients will have transcranial dopplers (TCD) on alternate daily basis for at least 7 days. The maximum mean MCA flow velocity as well as safety are the two primary end-points. All patients will have paired blood and CSF taken at day 7 either through an LP or via EVD sampling. Follow-ups are performed at day 28, 3 months and 6 months which include safety bloods, functional questionnaires, mRS, GOSE and MRI.

Results

64 (71% of the target) patients have been enrolled. 35 patients have completed the study. Statistical analysis of the TCD data will be performed at the end of the trial. The mortality is at 9.5% (6). DSMB have met twice since the start of the trial and there have been no safety concerns.

Conclusions

The trial is recruiting on the planned trajectory and at this rate we are projected to complete the trial by the end of the year.
P35 Ability to quantify stereoelectroencephalography (SEEG) electrode trajectory proximity to vessels across imaging protocols
Authors: Sparks R , Vakharia V , Rodionov R , Vos S , McEvoy A , Miserocchi A , Duncan J , Ourselin S
Published: February 2019

Objectives

Automated planning of stereoelectroencephalography (SEEG) electrode trajectories is dependent on vessel segmentation.1We quantify imaging protocols ability to measure trajectory-to-vessel distance.

Design

Retrospective analysis.

Subjects

Ten consecutive patients were selected whom had SEEG implantation (95 electrodes) and Digital Catheter Subtraction Angiography (DSA) with catheterization of carotid or vertebral arteries, post-gadolinium T1-weighted (GAD), phase-contrast MR angiography and MR venography (MR) acquired.

Methods

SEEG trajectories were planned manually with DSA. Minimum distance to vessels and risk1were computed for each trajectory using vessel segmentation from GAD, MR, or DSA. Vessel size was considered by including DSA vessels diameters above 1, 2, 3, or 4 mm.

Results

Minimum distance to a vessel was 6.2±3.9 mm (GAD), 2.5±1.6 mm (MR), and 1.5±1.2 mm (DSA). Based on DSA vessel size minimum distances were 2.0±1.5 mm (DSA >1 mm), 3.4±2.6 (DSA >2 mm), 6.6±4.6 mm (DSA >3 mm), and 11.8±7.9 mm (DSA >4 mm). Risk was 0.4±0.4 (GAD), 0.8±0.4 (MR), and 1.1±0.2 (all DSA), 1.0±0.2 (DSA >1 mm), 0.7±0.4 (DSA >2 mm), 0.4±0.5 (DSA >3 mm), and 0.2±0.3 (DSA >4 mm).

Conclusions

DSA is best able to segment vessels. MR has metrics similar to DSA vessels above 2 mm. GAD has metrics similar to DSA vessels above 3 mm.
P37 Do all notochordal lesions require proton beam radiotherapy? A case series of ecchordosis physaliphora
Authors: Sooltangos A , Giamouriadis A , Barazi S , Barkas K , Thomas N , Bodi I , Ghimire P , Maratos E
Published: February 2019

Objectives

Ecchordosis physaliphora (EP) is a benign, usually asymptomatic, notochord tumour but may also present with a spontaneous CSF fistula. Differentiating EP from its more aggressive counterpart, chordoma is challenging but important as the clinical course and management differ significantly, with the latter requiring proton beam radiotherapy. This case series aims to further inform this discussion.

Design

Case series.

Subjects

Patients with suspected EP from 2015–2018.

Methods

Retrospective analysis.

Results

Six patients were identified. Four presented with suspected CSF leak. MRI revealed a T1-hypointense and T2-hyperintense clival lesion without enhancement. CT showed pneumocephalus, a clival defect and no mass lesion. All underwent endoscopic endonasal repair of CSF fistula with biopsy. Histology revealed physaliphorous cells with no mitoses; immunohistochemistry confirmed notochord origin (EMA, S100, CD10 and/or MNF116) and low proliferation index. In 2 patients, EP was found incidentally on imaging and these lesions have remained static on follow-up.

Conclusions

In the absence of a clival mass, notochord remnant lesions with benign histopathology can be treated as EP and patients can avoid radiotherapy. The diagnosis of EP, however, remains challenging as no distinctive histopathological marker exists to differentiate it from chordoma and until a genetic or immunohistochemical marker is identified, the diagnosis rests solely on the presence or absence of a mass on imaging.
WP1-9 Treatment implications of parkinson’s disease in normal pressure hydrocephalus
Authors: Funnell JP , Craven CL , D’Antona L , Thorne L , Watkins LD , Toma AK
Published: February 2019

Objectives

Patients with Parkinson’s disease (PD) presenting with worsening gait and ventriculomegaly could have underlying normal pressure hydrocephalus (NPH). We aim to identify features of concurrent PD and NPH, assess investigations and benefits of intervention.

Design

Single-centre retrospective cohort study of patients diagnosed with PD and NPH, presenting to neurosurgery between April 2004 – April 2018.

Subjects

24 patients (20M: 4F) with concurrent PD and NPH, mean age 74.5±6.49 years (mean ±SD). 22 patients were diagnosed with PD prior to NPH diagnosis.

Methods

Medical records were studied for demographics, symptoms, and response to ventriculoperitoneal (VP) shunting. Chi-square test was used to compare frequency of post-operative symptoms against a local database of NPH patients.

Results

All patients presented to neurosurgery with gait disturbances, 21/24 with cognitive impairment, and 18/24 with urinary incontinence. 19 patients underwent VP shunt insertion; 5 patients were not suitable having failed a lumbar drain trial. Patients with PD and NPH improved in walking test outcomes and in urinary continence similarly to other NPH patients. Cognitive impairment did not respond well to VP shunting in patients with concurrent PD, significantly less than NPH patients without PD (p<0.01).

Conclusions

Diagnosis of NPH in patients with PD is a complex clinical problem due to frequent overlap of symptoms. Benefits may be gained if this subset of patients do reach neurosurgical services and receive intervention.
P43 Parasellar capillary haemangioma with intrasellar extension
Authors: Low J , Maratos E , Kumar A , King A , Al-Sarraj S , Barazi S
Published: February 2019

Objectives

Capillary haemangioma is a benign vascular tumour that typically arises from skin and mucosal surfaces at birth and in infants. Central nervous system (CNS) capillary haemangioma in adults is extremely rare. We describe a case of capillary haemangioma located within the parasellar region extending into the sella.

Design

Case report.

Results

We report a 64-year-old patient who presented with a short history of ptosis and left sided headaches. CT showed a 3 cm by 2.5 cm para-sellar lesion extending into the sella. MRI showed a homogenously hyperintense lesion on T2-weighted MRI and FLAIR, which was isointense with adjacent brain parenchyma on T1-weighted MRI. This lesion also demonstrated contrast enhancement. The patient underwent an initial endoscopic transsphenoidal biopsy, which was inconclusive, followed by a craniotomy and debulking. Histological examination revealed fibrous tissue containing numerous thin walled and irregular vascular channels of varying sizes. There was a mild associated inflammatory infiltrate, mainly formed of small mononuclear chronic inflammatory cells, and occasional histiocytes. The histological appearances were in keeping capillary haemangioma.

Conclusions

The present case describes a capillary haemangioma located in the sella. The rarity of this vascular entity and the absence of any pathognomonic imaging features make it difficult to diagnose based on radiological appearances alone. Although rare, CH should be a differential when considering a sella or parasellar lesion.
P47 30 day readmission is not an accurate measure of morbidity in cranial meningioma surgery
Authors: James Z , Leach P , Hayhurst C
Published: February 2019

Objectives

30 day readmission rate is a widely adopted marker of quality and performance of acute care, but validity is not well demonstrated. We analysed readmission data following cranial meningioma surgery to assess risk factors for readmission.

Design

Retrospective cohort study.

Subjects

All adult patients who underwent cranial meningioma resection from January 2015 to December 2017 in a single institution.

Methods

Using Welsh Clinical Portal electronic data to identify readmission within and beyond 30 days to both the index hospital and regional hospitals. Causes of readmission were recorded.

Results

160 patients were included (76% female, median age 58). 28 cases were emergency admissions, median length of initial admission 7 days. 26% had seizures at presentation. Total readmission rate was 13.5% (median age 54.5, pre-operative seizure rate 40.1%, median length of readmission 9 days). 13 (59%) patients presented within 30 days and 9 (41%)>30 days. Readmission causes were seizure, neurological deficit, thromboembolic, infection, CSF, bleeding and social. Causes after 30 days were the same except social or neurological deficit.

Conclusions

Readmission rates are not associated with age, admission route or initial length of stay. Those who have had seizures are more likely to be readmitted. 41% of readmissions presented outside of the 30 day post-operative time. 30 day readmission rates may not be the most suitable method to demonstrate neurosurgical unit performance in meningioma surgery.
P52 Prescription of patient’s regular medications on admission to neurosurgical unit
Authors: Su Z , Khan R , Toma A
Published: February 2019

Objectives

Timely and correct prescription of patients’ regular medications on admission to neurosurgical unit is noticed not to be fully compliant with set standards. This audit aims to review the practice of medication prescription by junior doctors during patient admission to a national neurosurgical unit, and to identify areas of improvement for prompt and accurate prescription.

Design

Prospective clinical audit.

Subjects

130 patients admitted to the neurosurgical unit in 2 weeks.

Methods

Prescription of patient’s regular medications on admission was audited. The prescription practice was compared against the set standards, and between different settings (in-hour vs. out-of-hour, emergency vs. elective, experienced vs. new SHOs).

Results

18% of patients had no regular medications prescribed by clerking doctors, the majority of which were elective admissions during in-hour clerking and performed by experienced SHOs. Of the patients who had their regular medications prescribed on admission, 29% were prescribed inaccurately, and 16% in wrong doses. Total percentage of missed and error prescription was 46%, in which only 18% were corrected within 24 hours and 21% corrected up to 48 hours after admission.

Conclusions

Areas of improvement identified: prescription practice of experienced SHOs during elective admissions, medication and dose check on prescription in both elective and emergency settings, medication reconciliation within 24 hours and thereafter. Changes (e.g. an alert system) are being implemented and re-audit is in plan.
WP1-10 Prevalence of normal pressure hydrocephalus in falls clinic patients
Authors: Sennik S , Craven C , D’Antona L , Asif H , Dawes W , Thorne L , Toma A , Watkins L
Published: February 2019

Objectives

Patients with idiopathic Normal Pressure Hydrocephalus (iNPH) present with Hakim Adams triad and radiological findings suggestive of iNPH. We compare the presence of clinical and radiological signs of iNPH present in patients presenting to falls clinic at a District General Hospital with the general population.

Design

Retrospective analysis of patients referred to falls clinic (January 2017 to December 2017) and interpretation of CT or MRI head imaging with Evans index.

Subjects

Falls clinic patients presenting to a District General Hospital outpatient clinic.

Methods

Retrospective cohort of patients admitted to a single District General Hospital with falls and recent CT or MRI head. An Evans Index above 0.35 was used as an indicator of hydrocephalic ventricular enlargement.

Results

371 patients were seen in one year. 216 had previous CT or MRI head. 6.75% of all patients seen in falls clinic (11.6% who have had brain imaging) have hydrocephalic ventricular enlargement. This is compared to 4.5% in a study of patients aged 70 and over in a normal population.1

Conclusions

Patients seen in Falls clinic have an increased probability of having radiological signs consistent with idiopathic normal pressure hydrocephalus.

Reference

Jaraj D, Marlow T, Jensen C, Skoog I, Wikkelso C. Prevalence of idiopathic normal-pressure hydrocephalus. Neurology2014April 22;82(16):1449–1454.
P58 Setting up an encephalitis multidisciplinary meeting in a tertiary neurology centre
Authors: Bharucha T , Brown R , Bamford A , Kaliakatsos M , Hoskote C , Breuer J , Manji H , Zandi M
Published: February 2019

Objectives

To improve the outcome of encephalitis in the region.

Design

Service evaluation of the introduction of monthly encephalitis meetings attended by specialist neuroradiologists, neurologists and infection doctors.

Subjects

Patient referred at the discretion of the clinician from local hospitals and the tertiary referral centre.

Methods

Diagnosis confirmed at the MDT or as a direct result of the MDT discussion.

Results

To be presented.

Conclusions

Encephalitis is a rare and complex clinical syndrome that requires close communication between neurologists and infection doctors. Setting up an MDT established this interaction, and streamlines patient care. Further, it provides access to novel technologies such as metagenomic diagnostic approaches.
P59 Acute varicella zoster encephalitis? Don’t forget the treatment!
Authors: Sun B , Singh N , Wroe S
Published: February 2019

Objectives

Educate physicians on the need for monitoring of Aciclivir levels in renal failure.

Design

Retrospective case report.

Subjects

59 year old woman presented with acute psychosis following recent herpes zoster treated with oral Aciclovir.

Methods

Data collection from; original casenotes, electronic laboratory records, electronic picture archiving and communication system (PACS).

Results

Lumbar puncture showed raised protein (0.92 g/L), CSF:serum glucose ratio(0.9), 36 WBCs/cmm(72% polymorphs) and detection of VZV DNA. MRI brain only revealed intracranial-hypotension secondary to lumbar puncture. Despite absence of VZV DNA on surveillance lumbar puncture, she remained minimally responsive. Aciclovir levels were significantly elevated post-dose at 32.7 mg/L (cutoff 10.8 mg/L) and a sedation hold revealed temporal correlation of pre-dose levels (6.4 mg/L) with improvement of GCS, strongly implicating Aciclovir as causative agent. Rapid resolution of encephalopathy occurred upon cessation with no residual neurological compromise.

Conclusions

Aciclovir neurotoxicity mimics zoster-related encephalitis and VZV DNA is commonly detected in cerebrospinal fluid of patient’s with herpes zoster (Rudzeket al. 2007). Our case highlights the need for vigilance of Aciclovir-neurotoxicity in renal failure patients.

Reference

Rudzek D, Piskunova N, Zampachova E. High variability in viral load in cerebrospinal fluid from patients with herpes simplex and varicella-zoster infections of the central nervous system. Clinical Microbiology and Infection2007;13(12):1217–1219.
P65 Implementing a pain scale to improve botulinum toxin practice for cervical dystonia
Authors: Jesuthasan Aaron , Batla Amit , Bhatia Kailash
Published: February 2019

Objectives

To evaluate the effectiveness of introducing a pain scale to improve cervical dystonia (CD) patient satisfaction rates in the National Hospital for Neurology and Neurosurgery (NHNN) Botox clinic.

Design

Case control study.

Subjects

Subjects included CD patients attending the NHNN Botox clinic to receive injections.

Methods

Injectors were educated about the Toronto Western Spasmodic Torticollis Rating pain subscale (TWSTRS) and subsequently incorporated it into their standard assessment of CD patients prior to injections. Surveys were created and disseminated to patients immediately following their appointment to assess their opinions of the clinical team. Information was entered into Microsoft Excel and analysed using appropriate statistical methods. Results were compared with a previous NHNN Botox clinic audit.

Results

42 surveys were collected in total from CD patients over a 4 week period. 36 patients (85.7%) reported pain associated with the condition. In comparison to an audit conducted in 2016, involving a similar sample size (n=40, with 28 reporting pain), a higher proportion of CD patients felt their pain was well understood by the clinical team (89.3% vs 94.4%). Furthermore, a higher proportion felt the team were competent in managing their pain (67.9% vs 94.4%).

Conclusions

Our study supports the use of a TWSTRS pain subscale to improve CD patient satisfaction rates in the Botox clinic. Further studies are encouraged to validate these findings and determine other suitable pain scales for implementation.
P66 Should we be screening for depression and quality of life in all patients attending botulinum toxin injection clinics or just those with cervical dystonia?
Authors: Mozdiak R , Lally R , Osei-Poku F , Alty J
Published: February 2019

Objectives

Cervical dystonia (CD) is known to be associated with depression and low quality of life (QoL) but we know little about these measures in non-CD patients attending botulinum toxin clinics. The objective was to evaluate the prevalence of depression and low QoL in both CD and nonCD patients.

Design

Cross-sectional pilot study.

Subjects

Consecutive patients attending teaching hospital botulinum toxin clinic.

Methods

Patients completed the Beck’s Depression Inventory (BDI) questionnaire and a Recovering Quality of Life (ReQoL) scale. BDI and ReQoL scores of ≥17 and≤24 indicated depression and impaired QoL respectively.

Results

48 patients (30 female; age 45–75 years) were evaluated; 33:15 CD:non-CD. The non-CD group comprised hemifacial spasm, upper limb dystonia/tremor, blepharospasm and Meige syndrome. 23% (11/48) of all patients had depression: 27% (9/33) of CD and 13% (2/15) of non-CD. Depression rates were more frequent amongst females and males (27%; 17%) (p=0.43). 34% of all patients had low QoL – 36% (12/33) and 27% (4/15) in the CD and non-CD groups respectively (p=0.51). Low QoL scores were more frequent in females (40%) than males (22%) but this difference was not significant (p=0.21).

Conclusions

Depression and low quality of life were common in all patients in this pilot study. This suggests that screening of all patients attending botulinum toxin clinics, regardless of their diagnosis, may be clinically important. A larger study is required to validate these findings.
WP1-12 Reducing infection rates in an intrathecal baclofen service; closing the audit cycle
Authors: Donnelly A , Balaratnam M , Murphy M , Bahadur S , Padilla H , Keenan E , Farrell R , Stevenson V
Published: February 2019

Objectives

Intrathecal baclofen (ITB) is a recognised treatment strategy for the management of spasticity. We have 30 years of experience, and 160 patients currently receiving treatment.

Design

An audit (Jan 13 – Jul 15) demonstrated complication rates of 4.4% (infection) and 4.92% (catheter). After this we recommended 1 vancomycin wash of the pump pocket, 2 occlusive dressing of pressure sores, 3 timely MRSA pre-screening, and this was introduced June-August 2016. We present a re-audit of the service.

Subjects

All patients admitted for ITB pump surgery between June 2016 and June 2018.

Methods

The database of patients was used, from which the patient notes were reviewed with information relating to each surgical procedure recorded.

Results

There were 92 surgical procedures and 78 patients (M 30, F 48). 12 patients had complications, requiring 18 surgical procedures. Out of 18 surgical procedures, 10 were catheter- and 7 pump-related). Our infection rate was lower at 1% of all surgeries (compared with 4.4%), or 0.6% of all ITB pump patients per year (compared with 3.4%), and our catheter complication rate was 6.25% of all patients per year. Our annual incidence rate of all complications was 5.6% in both groups.

Conclusions

The infection risk is lower and complication rate remains stable. We will discuss factors which may influence the risk of complication, and consider recommendations for the future.
WPI-13 Lack of association of cranial lacunae with intracranial hypertension in children with crouzon syndrome and apert syndrome: a 3D morphometric quantitative analysis
Authors: Mondal A , Rodriguez-Florez N , O’Hara JL , Ong J , Jeelani NuO , Dunaway DJ , James G
Published: February 2019

Objectives

Cranial lacunae on CT is equivalent to the plain X-ray ‘copper beating’ seen in craniosynostosis. Copper beating has not been shown to correlate to intracranial hypertension (IH). However it is a purely quantitative assessment – can qualitative measurement of CT cranial lacunae more accurately predict IH in children with craniosynostosis?

Design

Retrospective cohort study.

Subjects

18 consecutive children with Crouzon and 17 with Apert syndrome were identified.

Methods

Patients were divided into IH and non-IH groups defined on an intention to treat basis. 3D software was used to analyse% of calvarial lacunae.

Results

Mean age at CT scan was 380 days (range 6–1778). Of the 35 children, 21 required surgery for raised ICP (17 posterior vault expansion 2 ventriculo-peritoneal shunts (VPS), 1 spring-assisted cranioplasty and 1 fronto-orbital advancement) at mean age of 512 days (range 38–1710). Of the 21 children with raised ICP, 15 had lacunae with mean lacuna/calvarium percentage of 3% (0%–28%). Of the 14 non-raised ICP children, 8 had lacunae with mean lacuna/calvarium percentage of 2% (0%–8%). T-test demonstrated no significant difference between the 2 groups. For both groups, parietal bones were most likely to show lacunae (IH 14/21, non-IH 9/14), followed by occipital (IH 8/21, non-IH 3/14), followed by frontal (IH 6/21, non-IH 2/14).

Conclusions

Results suggest that cranial lacunae, measured using quantitative 3D methods, do not predict IH, in agreement with evidence from qualitative plain skull radiograph studies.
P84 Cauda equina syndrome – an assessment of long-term outcomes following surgery
Authors: Hazelwood JE , Hoeritzauer I , Demetriades A
Published: February 2019

Objectives

Data regarding long-term outcomes following surgery for cauda equina syndrome (CES) is scarce, especially concerning bowel and sexual function. This study aimed to assess long-term bladder, bowel, sexual and physical function in a CES cohort.

Design

Descriptive.

Subjects

A pre-existing ethically approved database was used to identify patients who had undergone surgery for CES between August 2013-November 2014.

Methods

Patients were contacted over a one month period and completed validated questionnaires via telephone. These assessed bladder (Urinary Symptom Profile), bowel (Neurogenic Bowel Dysfunction Score), sexual (Arizona Sexual Experiences Scale) and physical function (SF-12). Patients were also asked which of their current symptoms they would most value treatment for and which NHS services they had accessed post-operatively.

Results

Forty-six of 77 patients (response rate 72%, inclusion rate 59%) with a mean age of 45 years (21–83) and mean time since admission of 43 months (range 36–60) took part in the follow up study. The prevalence of bladder dysfunction was 76%, bowel dysfunction 41% with the majority (87%) reporting very minor symptoms, sexual dysfunction 39% and physical dysfunction 48%. Pain was the most deleterious current symptom in 57% but only 7% reported post-operative pain-management referral.

Conclusions

These findings confirm the high prevalence of long-term bladder, bowel, sexual and physical dysfunction in CES patients and provide useful data to guide the expectations of patients and clinicians.
P86 Surgical management of spinal cavernous malformations
Authors: Arora M , Sadek AR , Nader-Sepahi A
Published: February 2019

Objectives

Evaluation of the presentation, demographics, pathology and outcomes associated with the surgical management of spinal cavernous malformations [sCM].

Design

A retrospective single-centre case series of surgically managed cavernous malformations over a 3 year period.

Subjects

Ten patients were identified to have a diagnosis of sCM.

Methods

Cases were identified from electronic and theatre records at a single centre. All patients underwent pre-operative assessment and radiographic evaluation.

Results

10 patients with a mean age of 52.6 years [SD ±14.1] and a male to female ratio of 1:1 with a mean follow-up of 14.1 months [SD ±7.9] were identified. Spinal CM spanned two vertebral levels in 9 out 10 cases with 3 cervical, 1 cervico-thoracic and 6 within the thoracic region. Duration of the symptoms prior to surgical intervention was 17 months [SD ±24], with three cases presenting with an acute [<2 week] history. Of those that underwent surgery [n=7] pain [85%, n=6], sensory/motor changes [85% n=6] and sphincteric disturbance [43%, n=3] were the commonest presenting signs and symptoms. Acute haemorrhage was a presenting factor in 3 cases. Post-operatively motor and sensory scores improved in 4 patients, 2 patients remained unchanged and 1 patient was worse. Recent haemorrhage was associated with increased likelihood in improvement in motor scores following resection.

Conclusions

In selected cases surgical management of sCM is associated with improvement in motor and sensory function postoperatively.
P92 What is a benign notochordal cell tumour?
Authors: Usher I , Choi D
Published: February 2019

Objectives

Characteristics from a large systematic review.

Design

The first systematic review of benign notochordal cell tumours.

Subjects

All studies, in any language, published at any time, identified using specified search terms.

Methods

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Results

So-called benign notochordal cell tumours exhibited the following features: pain was the sole presenting symptom in 37/81 (45.7%) and neurological deficit in 36/81 (44.4%). Incidental discovery upon imaging was reported in 8/81 (9.9%). Radiologically, lesions were small, (≤30 millimetres at their maximum diameter) in 57/65 (87.7%), hypointense on T1 sequences and hyperintense on T2 sequences on magnetic resonance imaging (106/130; 81.5%), did not enhance following contrast administration (62/74; 83.8%) and were non-lytic (80/160; 50.0%). Histologically, these tumours lacked myxoid matrix (66/84; 78.6%) and nuclear atypia (100/112; 89.3%). In those managed conservatively, follow up was between 8.5 and 120 months. Most were stable at follow up (22/25; 88.0%), one lesion grew (4.0%), one patient died of an unrelated cause (4.0%) and outcome was not stated in one case (4.0%).

Conclusions

BNCTs exhibit a spectrum of features, none of which are pathognomonic and diagnosis is subjective. The majority of reports describe small, non-progressive, non-lytic lesions that lack contrast enhancement, intercellular myxoid matrix and nuclear atypia. They are nevertheless difficult to distinguish from small chordomas.
WP1-14 A systematic review to evaluate different management strategies for incidental intracranial meningiomas
Authors: Mohan M , Islim A , Moon RDC , Srikandarajah N , Brodbelt AR , Mills SJ , Jenkinson MD
Published: February 2019

Objectives

Evaluate the outcomes of differing management strategies for incidental intracranial meningiomas.

Design

Systematic review.

Subjects

Studies with ≥10 patients≥16 years of age diagnosed radiologically with an incidental intracranial meningioma.

Methods

PRISMA compliant methods were used to scan 6 databases up to September 2017. PROSPERO ID: CRD42017077928.

Results

Twenty retrospective studies (n=2130 patients) were included. Initial management strategies at diagnosis were: 27% (n=560) surgery, 22% (n=450) SRS and 51% (n=1040) active monitroing with a mean follow-up of 49.5 months (SD=29.3). 21% (n=220) of patients in the active monitoring cohort eventually had or were recommended an intervention due to: radiological progression (n=153), development of symptoms (n=66) and patient preference (n=1). Mean time-to-intervention was 24.8 months (SD=18.2). 94% (n=207) of interventions were within 5 years. The definition of ‘growth’ and the radiological surveillance regimens varied widely. Morbidity rates following surgery and SRS, accounting for cross over, were 15% and 22% respectively. Surgery revealed benign histology in 94% of the cases. Quality of life is improperly examined.

Conclusions

The management of patients with incidental intracranial meningiomas varies widely. Most patients who develop clinical or radiological progression will do so within 5 years of diagnosis. Intervention at diagnosis may result in unnecessary overtreatment. Prospective data is needed to develop a risk calculator for managing incidental meningioma.
P99 Neonatal subdural haematoma following forceps-assisted delivery: a systematic review of the literature
Authors: Zaben M , Manivannan S , Petralia T , Leach P
Published: February 2019

Objectives

Subdural haematoma (SDH) is a recognised complication of forceps-assisted delivery (FAD). There are no guidelines regarding its management. This study aims to provide a better insight into the management and outcomes of neonatal SDH post FAD.

Design

Retrospective review of our neonatal database and systematic review of the literature.

Subjects

Neonatal cases presented with SDH after FAD.

Methods

Retrospective database search of cases managed in our unit between January 20 111 and January 2018. Systematic review of the literature was performed using PRISMA guidelines. Inclusion criteria: (i) neonates, (ii) forceps-assisted delivery, (iii) evidence of SDH on imaging, with or without other traumatic lesions.

Results

A literature search yielded 9 studies with 30 patients meeting our inclusion criteria, In addition three cases were identified from our institutional database. 42% (n=14) had their SDH managed surgically, with subsequent full neurological recovery in 57%. In comparison, 95% (n=18) of the conservatively managed patients made a full recovery. Hydrocephalus was present in 1 and 11 of the conservatively managed and surgically managed patients, respectively.

Conclusions

Conservative management can lead to a full neurological recovery in SDH following FAD in neonates. However, a significant number may still need neurosurgical intervention for the SDH or subsequent hydrocephalus, therefore we advocate early transfer to a specialist neuroscience centre.
P100 Removing the orbital bar in fronto-orbital advancement and reconstruction
Authors: Sheikh A , Schramm M , Carter P , Russell J , Liddington M , Chumas P
Published: February 2019

Objectives

To describe our technique of using reverse frontal bone graft for FOAR for patients with metopic or coronal synostosis.

Design

Retrospective analysis of digital records for operation notes and radiological images.

Subjects

Since April 2014, 16 patients underwent FOAR without using orbital bar.

Methods

We plan a frontal bone graft using Marchac template and increase the angles on side by 1 cm. This graft is then reversed and supra orbital margins are drilled out. The orbital bar is then removed and drilled down to make bone dust which is then used to fill gaps on exposed dura. The reversed frontal graft is then placed in front and secured via absorbable sutures, plate and screws.

Results

All 16 patients who underwent this technique have shown excellent cosmetic results with no complications or non healing. Removing orbital bar does not cause any cosmetic defect since orbital rims are drilled out in reverse frontal bone graft. The removed orbital bar provides an excellent source of bone dust to cover gaps on exposed dura.

Conclusions

We present our technique of FOAR without using orbital bar, which is drilled down to bone dust to fill gaps. This has shown excellent cosmetic results so far with no complications. This addresses the issue of temporal thinning.
P101 The leeds paediatric brain arteriovenous malformation (BAVM) outcomes
Authors: Kalra N , Solanki SP , Tyagi AK
Published: February 2019

Objectives

The commonest cause of stroke in a paediatric population is a ruptured brain ateriovenous malformation (bAVM). We aim to assess the functional outcomes of patients who have undergone operative intervention at our unit for ruptured and non-ruptured bAVMs.

Design

A single centre retrospective cohort analysis of paediatric bAVM patients.

Subjects

10 paediatric patients at time of surgery between January 2007 – December 2017 mean age at follow up 15.9 years, range 2–26 years, mean time to follow up 6.3 years, range 1.5–11.2 years.

Methods

Patients with bAVMs were identified via the paediatric neurovascular database. They were contacted via telephone and the Paediatric Quality of Life (PedsQL) questionnaire administered via parent proxy if the patient was under 18, and by the patient if above 18. Functional outcomes were assessed using the PedsQL questionnaire score and converted in to a health-related quality of life (HRQOL) score.

Results

10 patients underwent resection of their bAVMS, 9 survived and 7 were contactable. The mean HRQOL score 88.9 points, range 65.2–100. Only one patient had a HRQOL score below the mean of a child with chronic disease.

Conclusions

The mean HRQOL outcome score of operated paediatric bAVM was similar to that of healthy children. Patients having bAVM surgery within our unit have had a good functional outcome. Although there are small numbers in this series, there is a low incidence of operated paediatric bAVMs. Our findings suggests that such operations should be undertaken in units with expertise.
WP1-15 Computer-assisted versus manual planning for stereotactic brain biopsy: retrospective comparative pilot study
Authors: Marcus HJ , Vakharia VN , Sparks R , Rodionov R , Kitchen N , McEvoy A , Miserocchi A , Thorne L , Ourselin S , Duncan JS
Published: February 2019

Objectives

Stereotactic brain biopsy is among the most common neurosurgical procedures. Planning a safe surgical trajectory requires careful attention to a number of features including:

traversing the skull perpendicularly;

avoiding critical neurovascular structures; and

minimising trajectory length.

The aim of this study was to develop a platform, SurgiNav, for automated trajectory planning in stereotactic brain biopsy.

Methods

A prospectively maintained database was searched between February and August 2017 to identify all adult patients that underwent stereotactic brain biopsy in whom post-operative imaging was available. In each case, the standard pre-operative T1-weighted gadolinium-enhanced MRI was used to generate models of the cortex and vasculature. A surgical trajectory was then generated using automated computer-assisted planning (CAP) and metrics compared to the trajectory of the implemented manual plan (MP) using the paired T-test.

Results

15 consecutive patients were identified; who had a diagnostic biopsy and there were no immediate complications. Feasible trajectories were generated using CAP in 12 patients, and in these the mean trajectory length using CAP was comparable to MP (31.7 mm vs. 37.1 mm; p=0.3), and mean angle was similarly perpendicular from orthogonal (9.3° vs. 15.3° p=0.1), but the risk-metric was significantly lower (0.16 vs. 0.48; p=0.03).

Conclusions

Computer-assisted planning for stereotactic brain biopsy appears feasible in most cases and may be safer in selected cases.
P103 Chiari malformation type I: a review of literature to compare bony posterior fossa decompression with and without duraplasty
Authors: Tam KP , Foroughi M
Published: February 2019

Objectives

Two main surgical approaches for symptomatic Chiari type I malformation (CM-I) patients are posterior fossa decompression (PFD) involving craniectomy alone, and posterior fossa decompression with duraplasty (PFDD). The aim of this review was to outline the indications, advantages and disadvantages of each surgical approach, with guidance regarding surgical decisions.

Methods

We reviewed pertinent articles. Data on the clinical improvement, radiological improvement, complications and reoperations were compared.

Results

Seventeen articles containing data on 3713 paediatric and adult participants met the inclusion criteria. PFDD was associated with more favourable clinical improvement in CM-I patients with syringomyelia (RR 1.59, 95% Cl, 1.09 to 2.31; p<0.05), but had a higher complication rate (RR 3.34, 95% Cl, 1.66 to 6.73; p<0.05) when compared with PFD. Regarding radiological improvement and reoperation rates, no significant differences were observed between the two surgical approaches.

Conclusions

Both PFD and PFDD are effective and safe surgical strategies for symptomatic CM-I associated with posterior fossa volume mismatch, in the absence of hydrocephalus and craniocervical region instability. Bony PFD has a lower complication rate and seems to be good option when carried out in those without major tonsillar impaction and in the absence of a syrinx. However, these patients should be adequately counseled regarding the requirement for possible further intra-dural decompression.
P112 Management and outcome of subarachnoid haemorrhage (SAH) in older people: a centre series
Authors: Boumrah T , Fahmy J , Trippier S , Hainsworth A , Madigan J , Pereira E , Minhas P , Shtaya A
Published: February 2019

Objectives

To study the management and factors associated with outcomes in SAH in elderly over 80 years of age.

Design

Retrospective records review.

Subjects

All Patients with SAH confirmed on head CT admitted Jan 2012-Dec 2017.

Methods

We admitted 1079 patients with SAH, 32 were aged ≥80 y (3%). We subdivided the patients into a poor outcome group (POG) (Modified Rankin Scale (mRS) 4–6), (n=24, 14F/10M, mean age 83.7±0.7 y) and good outcome group (GOG) (mRS 0–3) (n=8, 7F/1M, mean age 82.6±0.6 y). Spearman’s rank-order test evaluated correlation between outcome (mRS) and all other variables (WFNS grade, GCS, Motor score of GCS, age, sex, smoking, hypertension, intraventricular haemorrhage (IVH) and intracerebral haemorrhages (ICH)).

Results

9 patients (38%) of POG were WFNS grades IV – V versus 1 patient (13%) in GOG. More POG than GOG patients had IVH (83% vs 38%, rs=−0.44 p=0.011). 20% of POG had ICH vs none in GOG. GOG patients had better GCS (rs=−0.37, p=0.04), lower WFNS grade (rs=0.43, p=0.01) and did not need external ventricular drain (EVD) (rs=0.51, p=0.003). There was no significant correlation between outcome and sex, smoking, hypertension, size of aneurysm (4.9 mm ±1.0 in GOG vs 5.4 mm ±1.1 in POG, rs=−0.29, p=0.28), percentage receiving coiling or clipping, GCS motor score, procedure complications and general medical complications.

Conclusions

75% of patients’ aged ≥80 y with SAH had poor outcome. WFNS grade (I-III), higher GCS patients who did not need EVD had better outcome.
P115 Subarachnoid haemorrhage with negative initial vascular imaging: a single unit experience
Authors: Rasul F , Silva G , Fitzpatrick T , Derakshani S , Ghosh A , Vindlacheruvu R
Published: February 2019

Objectives

To investigate the incidence of vascular abnormality and clinical outcomes in a group of patients presenting with spontaneous subarachnoid haemorrhage (SAH) and negative initial vascular investigation.

Design

Single centre prospective cohort study.

Subjects

All adult patients with SAH admitted to our unit over a 12 month period.

Methods

Prospective collection of data on secure electronic database. Information pertaining to gender, age, mode of initial and subsequent vascular investigations was acquired. Details regarding clinical outcomes at 30 days and complications were documented.

Results

118 consecutive patients with SAH were admitted to our unit over the 12 month study period. 37 patients had negative initial vascular imaging (37/118=31.4%). M:F=19:18, age range 26–76 years. 32 patients underwent a high quality CT angiogram as initial vascular investigation, 5 patients underwent catheter cerebral angiogram (DSA). The most common modality of further vascular imaging was DSA. 5 vascular abnormalities were detected on subsequent vascular imaging (5/37=13.5%). Hydrocephalus and vasospasm were the commonest complications. Clinical outcomes were very good; all patients had a GOS of 5 at 30 days.

Conclusions

Patients with SAH and negative initial vascular investigation are an important subset of patients with SAH. There is no uniformity in the type of subsequent vascular investigations selected. Our experience is consistent with previously published studies.
WP1-16 Does time to diagnosis influence surgical decision making in primary malignant brain tumours?
Authors: Zienius K , Grant R , Brennan P
Published: February 2019

Objectives

To assess whether time to diagnosis influenced surgical procedure and survival in primary malignant brain tumours

Design

Retrospective cohort study of adult patients newly diagnosed with a primary intra-cerebral tumour April 2010 – March 2015 referred to neuro-oncology centre in South-East Scotland

Subjects

400 patients with primary malignant intracerebral tumours

Methods

Univariate logistic regression analysis and multivariate Cox regression survival analysis were performed

Results

Our dataset included 229 Males (57.7%), mean age 62.05 (SD14.01). Time to diagnosis did affect choice of surgical procedure. Patients undergoing biopsy had significantly longer TtD than those undergoing resection (28 vs 21 days, MWU test, p=0.035). 233 (58.3%) patients were deceased at 12 months. Having a cognitive first symptom (e.g confusion/memory changes) predicted not getting any surgical procedure (OR 2.95 [95% CI 1.8–4.8]). Where surgery was performed, first cognitive symptom was not predictive of type of surgery (biopsy vs debulking/excision) (OR 1.5 [95% CI 0.8–2.9] norhaving tumour in the frontal lobe (OR 0.9 [95% CI 0.5–1.7]. In multivariate analysis, increased hazard ratio of death at 12 month was significantly associated with a cognitive first symptom (HR 1.4 [95% CI 1.0–1.9] and KPS <70 (HR 1.69 [95% CI 1.2–2.4]).

Conclusions

Earlier diagnosis is associated with getting debulking surgery rather than biopsy, and patient’s presenting symptoms influence surgical decision making and outcome.