bluuebunny/crossref_metadata_2025 huggingface dataset:
Labour market marginalisation among refugees from different countries of birth: a prospective cohort study on refugees to Sweden
Authors: Helgesson Magnus , Wang Mo , Niederkrotenthaler Thomas , Saboonchi Fredrik , Mittendorfer-Rutz Ellenor
Published: February 2019

Background

The aim was to elucidate if the risk of labour market marginalisation (LMM), measured as long-term unemployment, long-term sickness absence, disability pension and a combined measure of these three measures, differed between refugees and non-refugee migrants with different regions of birth compared with native Swedes.

Methods

All non-pensioned individuals aged 19–60 years who were resident in Sweden on 31 December 2009 were included (n=4 441 813, whereof 216 930 refugees). HRs with 95% CIs were computed by Cox regression models with competing risks and time-dependent covariates with a follow-up period of 2010–2013.

Results

Refugees had in general a doubled risk (HR: 2.0, 95% CI 1.9 to 2.0) and non-refugee migrants had 70% increased risk (HR: 1.7, 95% CI 1.7 to 1.7) of the combined measure of LMM compared with native Swedes. Refugees from Somalia (HR: 2.7, 95% CI 2.6 to 2.8) and Syria (HR: 2.5, 95% CI 2.5 to 2.6) had especially high risk estimates of LMM, mostly due to high risk estimates of long-term unemployment (HR: 3.4, 95% CI 3.3 to 3.5 and HR: 3.2, 95% CI 3.1 to 3.2). African (HR: 0.7, 95% CI 0.6 to 0.7) and Asian (HR: 1.0, 95% CI 1.0 to 1.1) refugees had relatively low risk estimates of long-term sickness absence compared with other refugee groups. Refugees from Europe had the highest risk estimates of disability pension (HR: 1.9, 95% CI 1.8 to 2.0) compared with native Swedes.

Conclusion

Refugees had in general a higher risk of all measures of LMM compared with native Swedes. There were, however, large differences in risk estimates of LMM between subgroups of refugees and with regard to type of LMM. Actions addressing differences between subgroups of refugees is therefore crucial in order to ensure that refugees can obtain as well as retain a position on the labour market.
Shorter pulse width reduces gait disturbances following deep brain stimulation for essential tremor
Authors: Kroneberg Daniel , Ewert Siobhan , Meyer Anne-Christiane , Kühn Andrea A
Published: February 2019

Objective

Gait disturbances are frequent side effects occurring during chronic thalamic deep brain stimulation (DBS) in patients with essential tremor (ET). Adapting stimulation settings to shorter pulse widths has been shown to reduce side effects of subthalamic DBS. Here, we assess how a reduction of pulse width changes gait performance of affected patients.

Methods

Sensor-based gait assessment was performed to record spatiotemporal gait parameters in 10 healthy subjects (HS) and 7 patients with ET with gait disturbances following thalamic DBS. Patients were tested during standard DBS, after 72 hours of stimulation withdrawal and at least 30 days after adjusting DBS settings to a shorter pulse width of 40 µs (DBS40PW).

Results

Patients with ET on standard DBS showed significantly higher variability of several spatiotemporal gait parameters compared with HS. Variability of stride length and range of motion of the shanks significantly decreased OFF DBS as compared with standard DBS. This improvement was maintained over 30 days with DBS40PW while providing effective tremor suppression in six out of seven patients.

Conclusion

Shorter pulse widths may reduce gait disturbances in patients with ET that are induced by DBS while preserving a level of tremor suppression equal to standard stimulation settings.
P31 Optimising trajectories in computer assisted planning for cranial laser interstitial thermal therapy: a machine learning approach
Authors: Li K , Vakharia VN , Sparks R , França LGS , McEvoy A , Miserocchi A , Ourselin S , Duncan J
Published: February 2019

Objectives

Optimal trajectory planning for cranial laser interstitial thermal therapy (cLITT) in drug resistant focal mesial temporal lobe epilepsy (MTLE).

Design

A composite ablation score of ablated AHC minus ablated PHG volumes were calculated and normalised. Random forest and linear regression were implemented to predict composite ablation scores and determine the optimal entry and target point combinations to maximize this.

Subjects

Ten patients with hippocampal sclerosis were included.

Methods

Computer Assisted Planning (CAP) cLITT trajectories were generated using entry regions that include the inferior occipital gyri (IOG), middle occipital gyri (MOG), inferior temporal gyri (ITG) and middle temporal gyri (MTG). Target points were varied by sequential erosions and transformations of the centroid of the amygdala. In total 760 trajectory combinations were generated per patient and ablation volumes were calculated based on a conservative 15 mm maximum ablation diameter.

Results

Linear regression was superior to random forest predictions. Linear regression indicated that maximal composite ablation scores were associated with entry points that clustered around the junction of the IOG, MOG and MTG. The optimal target point was a translation of the centroid of the amygdala anteriorly and medially.

Conclusions

Machine learning techniques accurately predict composite ablation scores with linear regression outperforming the random forest approach. Optimal CAP entry points for cLITT maximize ablation of the AHC and spare the PHG.
P33 On lambs, DBS, and diathermy
Authors: Tipper G , Low H , Taqvi A , Singh A , Pohl U
Published: February 2019

Objectives

Over 1 50 000 patients have been treated with deep brain stimulation (DBS), but some aspects of their ongoing management are poorly defined. Guidelines for the use of electrocautery in patients undergoing further surgery are vague, suggesting the use of bipolar cautery only. However there is likely to be a safe limit for the use of monopolar electrocautery, a useful if not necessary adjunct for most surgeons. Establishing this would be valuable.

Design

Literature review, correspondence with equipment representatives, and animal cadaveric model.

Methods

PubMed, the Cochrane Database, and Google Scholar were used for the literature review. Technical team advisers were approached for DBS systems and electrocautery devices. A commercially available freshly slaughtered lamb was prepared in a room with constant ambient temperature. A DBS system was implanted in tandem with a thermocouple at depths and distances matching patient practice. Monopolar electrocautery was employed in coagulation and cutting modes at set distances and levels with constant temperature recording. The implant site was examined microscopically post procedure.

Results

The current ‘ban’ on monopolar use appears to be extrapolated from the use of medical diathermy, a very different modality. At no point did the implant site temperature rise more than 2.4°C. Microscopic analysis post procedure revealed no thermal damage.

Conclusions

Electrocautery in the context of DBS is safer than previously thought.
P56 Virtual reality simulation in neurosurgical training: a single blinded randomised controlled trial & review of all available training models
Authors: Ansaripour A , Haddad AR , Maratos E , Zebian B
Published: February 2019

Objectives

Virtual reality (VR) simulators are one of the training models allowing the practice of surgical skills for trainees. We aim to assess the benefit of VR training in neurosurgery.

Design

A single-blinded randomised controlled trial and a literature review.

Subjects

Trainees (n=12), Fellows and Consultant Neurosurgeons (n=4) and Medical Students (n=6) with no experience of VR.

Methods

Participants were randomised according to their grades. Both groups completed microsurgical tasks and duration and quality of each task was recorded at the start and the endpoint of the study. Questionnaires were used to assess the participants’ confidence in microsurgical skills. The intervention group underwent structured training using a VR simulator (NeuroVR). The primary outcome measure was microsurgical performance assessed by three independent assessors blinded to trainee status. The secondary outcome measure was performance time and confidence levels.

Results

Observed improvements in the primary outcome were not significant. The performance time in the intervention group improved significantly with a mean difference of 79.8 s (8–178 s) (p<0.05). The intervention group reported significantly improved confidence levels in all microsurgical skills (8.8%, p<0.001). Less experienced trainees had the greatest reductions in time and improved confidence levels.

Conclusions

VR training in neurosurgery, particularly in less experienced trainees, can prove useful. Future studies should assess the effect of VR training on clinical procedures.
P71 Neurosurgical presentation of hereditary transthyretin (ATTR) amyloidosis: early recognition for earlier genetic therapies
Authors: Kapoor M , Quaegebeur Annelies , Shah Sachit , Carr AS , Reilly MM
Published: February 2019

Objectives

Hereditary Transthyretin (ATTR) amyloidosis is a genetic disorder where insoluble amyloid fibrils deposit in heart, nerves and various musculoskeletal tissues. Early recognition of TTR-FAP is important as new genetic therapies become available.

Design

We present one confirmed and one clinical case of ATTR deposition in ligamentum flavum causing lumbar canal stenosis.

Subjects

The first case is a 44-year-old female with TTR 184S heterozygous mutation who developed urinary urgency and bilateral leg pain exacerbated by walking. Neurological examination was normal. MRI lumbar spine showed a disc bulge in combination with ligamentum flavum thickening at L2/3 causing stenosis of the vertebral canal. She had a laminectomy of the L2/3 level. Histopathological analysis of the surgical tissue was positive on Congo red staining for amyloid and immunohistochemically identified as TTR type. The second case is a 68-year-old man with TTR V122I heterozygous mutation. He presented with paraesthesia from the knees to dorsum of the feet. On examination, power was normal and he had a length dependent neuropathy. A CT myelogram demonstrated spondylosis at L4/5 and L3/4 from disc bulge and marked flaval hypertrophy causing canal stenosis. He was placed on the waitlist for L4-5 decompression but unfortunately died prior to surgery.

Conclusions

Identifying ATTR in surgical specimens may diagnose hereditary amyloidosis in otherwise asymptomatic patients and in the future, provide early access to effective therapies.
P93 Randomised controlled trial to determine the role of endoscopic clot lavage after intraventricular haemorrhage in neonates ENLIVEN
Authors: Dawes W , James G , Aquilina K
Published: February 2019

Objectives

Clot lavage following intraventricular haemorrhage (IVH) in premature neonates has been shown to reduce rates of hydrocephalus1and improve neurodevelopmental outcome at 2 years and beyond.2The aim of the ENLIVEN trial (IRAS: 198936 Rec Ref: 16/LO/1792) is to determine the efficacy of Endoscopic clot lavage after intraventricular haemorrhage in Neonates.

Design

Single centre prospective randomised controlled clinical trial comparing standard treatment with subgaleal shunt (control arm) to endoscopic washout plus standard treatment (intervention arm).

Subjects

Power calculation based on published literature1 2: 50 neonates recruited over 4 years – enrolment commenced January 2018 – current recruitment 3 neonates.

Methods

Neonates with radiological evidence of IVH (ventricular index >99 th centile +4 mm). Primary outcome is the rate of permanent shunting, secondary outcomes include advanced MRI at term and six months, behavioural assessment at early middle and late infancy, biochemical analysis of CSF and blood.

Results

Preliminary data from the ENLIVEN trial is presented including a full description of the radiological analysis and behavioural assessment.

Conclusions

Determining how endoscopic clot lavage impacts on clinical outcome is of paramount importance in the management of neonatal IVH, the ENLIVEN trial will afford us the possibility of objectively assessing its safety and efficacy.

References

Schulz M, Buhrer C, Pohl-Schickinger A, et al. Neuroendoscopic lavage for the treatment of intraventricular hemorrhage and hydrocephalus in neonates. J Neurosurg Pediatr2014;13(6):626–35.

Whitelaw A, Jary S, Kmita G, et al. Randomized trial of drainage, irrigation and fibrinolytic therapy for premature infants with posthemorrhagic ventricular dilatation: developmental outcome at 2 years. Pediatrics2010;125(4):e852–e58.
P95 Surgical approach and morbidity of paediatric fourth ventricular tumours: analysis of a large institutional series
Authors: Toescu SM , Samarth G , Horsfall HL , Phipps K , Jeelani O , Thompson D , Aquilina K
Published: February 2019

Objectives

To characterise the surgical management of paediatric 4th ventricular tumours and their attendant neurological complications.

Design

Retrospective cohort study.

Subjects

Children referred to our institution with tumours of the 4th ventricle between 2008–2017 inclusive.

Methods

Clinical notes and imaging review. Two-tailed Fisher’s test used to determine differences between proportions.

Results

95 patients were seen (53 males, mean 5.81y). The commonest presenting symptom was vomiting (63.3%). The commonest tumour type was medulloblastoma (54 cases)>pilocytic astrocytoma (20)>anaplastic ependymoma (12)>ATRT(4)>Teratoma (2), with 3 miscellaneous lesions. 55 pts presented with hydrocephalus. 27.4% of patients had an EVD (30.8% of these prior to tumour surgery), and 23.3% a VP shunt sited. The surgical approach was either via telovelar (50%) or transvermian (50%) routes; 29.5% were done in the sitting position. In the first 5y of the series, 7/31 cases used the telovelar approach, whilst in the latter 5y, this proportion was 30/51 (p=0.0015). New post-operative deficit was evident in 68% of cases (42.4% gait abnormality, 23.9% cranial neuropathy, 16.3% diplopia). There was no significant difference in the rates of cerebellar mutism syndrome between telovelar or transvermian approaches (p=0.62). There was 1 mortality within 30d of operation.

Conclusions

Resection of paediatric 4th ventricular tumours is increasingly performed by the telovelar route, and carries significant morbidity, although surgical mortality remains low.
P110 External ventricular drain-related infections: a single centre study
Authors: Duddy JC , O’Sullivan MGJ , Lim C , Kaar GF
Published: February 2019

Objectives

To quantify the External Ventricular Drain-related infection (ERI) rate in a one year period at Cork University Hospital, and to identify any risk factors for infection.

Design

A retrospective audit of all External Ventricular Drains (EVDs) inserted in a one year period.

Subjects

All patients who had an EVD inserted between February 2017 and February 2018.

Methods

Patients were identified from operating theatre logbooks. All relevant data was obtained from a retrospective review of medical and operative records. ERI was defined as evidence of positive CSF culture.

Results

41 EVDs were inserted in a total of 30 patients during the study period. The average age was 52.9 years. 46.6% of patients were female. The average length of EVD insertion was 8.85 days. The most common reason for EVD insertion was subarachnoid haemorrhage (31.7%) followed by supratentorial tumour (24.4%). 78% of EVDs were antibiotic-impregnated. Average EVD sampling rate was 0.7. ERI rate was 1/41 (2.4%). The infection occurred in a patient who had an EVD inserted for haemorrhage secondary to an AVM which had remainedin situfor 13 days. The patient subsequently developed problems with repeated shunt infections resulting in a nine-month hospital stay.

Conclusions

The ERI rate in our patient cohort was 2.4%. We recommend using a strict EVD sampling protocol to minimise manipulation of EVDs and where possible to limit the length of time an EVD remainsin situ. EVD-related infections can result in lengthy hospital stays and increased healthcare costs.
P113 Efficacy, safety and long-term durability of endovascular treatment of MCA aneuryms: a review of 161 treated aneurysms
Authors: Hannan C , Sunderland G , Zakaria R , Niven S , Nahser H , Putharan M , Chandran A , Javadpour M
Published: February 2019

Objectives

The aim of this study was to assess the long-term outcomes of endovascular treatment of MCA aneurysms and identify factors associated with recurrence.

Subjects

161 aneurysms in 147 patients treated between January 2008 and August 2011.

Methods

A retrospective case note review was performed. Aneurysm occlusion was assessed using the Raymond-Roy classification. Clinical outcome was graded using the mRS.

Results

The minimum period of follow up was 65 months, with a maximum follow up period of 120 months. 49% of aneurysms were ruptured at the time of treatment. Morbidity was observed in 15% of the unruptured aneurysms (6% permanent neurological deficit), and in 33% of ruptured aneurysms (15% permanent neurological deficit). 84% of aneurysms were fully occluded following first treatment. Of these, 34% demonstrated angiographic recurrence and 10% required re-intervention. 25% of aneurysms≤7 mm in maximal diameter demonstrated angiographic recurrence, as compared with 50% of aneurysms>7 mm. Aneurysm size >7 mm was associated with a significantly shorter time to recurrence (log rank=9.655, p=0.002).

Conclusions

This is a large series of MCA aneurysms with a long period of follow up. Our results demonstrate that endovascular treatment of MCA aneurysms is associated with a low morbidity and mortality. Given the increasing use of adjunctive devices (stents, web devices) full occlusion of ruptured aneurysms in the acute phase is not necessary, and deliberate staged treatment a reasonable strategy.
P117 Predictive factors of outcome in poor grade subarachnoid haemorrhage (SAH)
Authors: Fahmy J , Boumrah T , Trippier S , Hainsworth A , Madigan J , Pereira E , Shtaya A , Minhas P
Published: February 2019

Objectives

To study the factors associated with outcome in poor grade SAH in a busy tertiary centre.

Design

Retrospective records review.

Subjects

All Patients with SAH WFNS grades IV and V admitted Jan 2016-Dec 2017.

Methods

We admitted 379 SAH patients, 84 (22%) were poor grade (n=84, 33M/51F mean age 60.7±1.4 y). Outcome was assessed by Modified Rankin Scale (mRS) scores before surgery and at latest follow up (3–6 months). mRS was dichotomised as good (0–3) and poor (4–6).Spearman’s rank-order test evaluated correlation between latest mRS and all other variables (WFNS grade, GCS, Motor score of GCS, age, sex, smoking, hypertension, intraventricular haemorrhage (IVH) and intracerebral haemorrhages (ICH)).

Results

63 patients (75%) had poor outcome, of which 46 (55%) died (44 with 30 days), versus 21 (25%) had good outcome. Spearman’s correlation analysis revealed that patients with smaller aneurysms (3.3±0.4 mm in good outcome patients vs 11.3±1.2 mm in poor outcome) (rs=0.37, p=0.009), who are younger (rs=0.24, p=0.03), have higher GCS (rs=−0.24, p=0.03), higher motor score (rs=0.25, p=0.02), lower WFNS grade (rs=0.3, p=0.007) and received coiling of aneurysms vs no treatment (rs=−0.39, p<0.0001) had better outcome. There was no significant correlation in outcome with ICH, IVH, external ventricular drain insertion, location of aneurysms, smoking, hypertension, other co-morbidities or sex.

Conclusions

In poor grade SAH, younger patients with smaller aneurysms, higher GCS and higher motor score who received endovascular coiling had better outcome.
WP1-17 Risk factors and patterns of progression in a surgical cohort of low grade glioma patients
Authors: Acharya S , Lavrador J , Visagan R , Narbad V , Jung J , Vergani F , Bhangoo R , Ashkan K
Published: February 2019

Objectives

To understand the risk factors for and patterns of progression of low grade glioma (LGG).

Design

Single centre retrospective cohort study.

Subjects

Patients undergoing at least two neurosurgical procedures for LGG, the first being for diffuse LGG (WHO 2). 22 patients included (14M; 8F); mean age at time of first operation 37.7±2.7 years. 20 patients had a Performance Status (PS) 0–1 and 2 patients had a PS 2.

Methods

All patients with LGG diagnosed in between 2009–2018 were retrospectively evaluated. Variables of interest included demographics, staging, performance status, time to re-operation (TTR), extent of resection, molecular genetics (1p19q co-deletion, IDH status). Tumour volumes were estimated from MRI images by the validated ABC/2 equation. Statistical analyses were performed by Stata13.0.

Results

The tumour progressed in WHO grade in 18 patients (WHO grade 3 (n=15); WHO grade 4 (n=3). Mean time to re-operation after the first surgery was 7.0±1.2 years following gross total resection (GTR) and 3.2±0.7 years following subtotal resection (STR). Non-adjusted analysis of risk factors for time to re-operation (TTR) showed absence of 1p19q co-deletion as a risk factor (p=0.021). Adjusted analysis revealed that GTR, 1p19q mutation, PS 0 at 1 st surgery and tumour volumetric change decrease the risk for re-intervention (p<0.05). Chemo-radiotherapy was not associated with TTR.

Conclusions

In our cohort, TTR in LGG was influenced by the amount of initial resection, 1p19q deletion, PS and post-operative volumetric change.
WP1-25 Improving neurological examination in acute admission: the INSPECT method
Authors: Islam M
Published: February 2019

Objectives

Clerking proforma in the trust includes a detailed neurology examination which is mandatory to fill up according to the trust guideline. Incomplete neurological examination at the time of admission significantly increases length of hospital stay and hamper the overall prognosis.

Design

A retrospective study was conducted for 2 weeks on 60 patients clerked in AMU. A general survey was conducted among 26 doctors to detect the possible reasons and suggestions.To ensure every patient gets a quick and accurate neurological examination during clerking, we suggested a new mnemonic method called ‘INSPECT’: I – Inspection ( GCS, GAIT), N- Neck Rigidity, S –Speech, sensory P- Pupil E- Eye movement, C –Cerebellar and Cranial Nerves, T- (Tone, Power, Reflexes).

Results

The primary audit revealed that the neurology proforma completed in 18.3% notes, Partially completed – 43.2% Not completed – 38.5% and frequently missed examinations were Cranial Nerve examination: 68.3%, Sensory: 56.2% Cerebellar: 42.1%, Motor power: 21% Doctor’s survey revealed reasons behind examinations not being carried out: Time consuming: 46.1%, Not relevant: 23.07%. Not enough training 15.38%.

Conclusions

Results showed that only 18.3% patients had complete neurological examination, mostly missed cranial nerves examination ( 68.3% ) Survey suggested time constraint is a major issue ( 46.1% ) and quicker assessment and concise proforma will help. The suggested method will be re-audited in 3 months time.
TM2-2 Analysis of adverse events in the management of chronic headache by occipital nerve stimulation
Authors: Miller S , Watkins L , Matharu M
Published: February 2019

Objectives

To analyse long-term adverse events of occipital nerve stimulation (ONS).

Design

Prospective open-label observational study.

Subjects

134 patients with refractory headaches implanted between 2007–2014 in a single specialised centre.

Methods

Information was collected on ONS device, implantable pulse generator (IPG) site and adverse event rates. The impact of implanter experience and the association between IPG site and adverse event rates was also explored.

Results

Mean follow up was 46 months (6–108 months). A total of 139 adverse events were recorded in 75 patients (56%). A total of 59 additional surgeries were needed in 39 patients. A significant difference was seen in the rates of adverse events recorded between 2007–2010 and 2011–2014 (60.7% vs 42.6%, p=0.002). A significant reduction in ONS revision was seen over time (25.7% vs 5.9%, p=0.002). Analysis of adverse events with IPG site showed those with abdominal implants recorded higher adverse event rate that those with an IPG in the chest (65.8% vs 40.3%, p=0.004).

Conclusions

In specialist centres, adverse event rates of ONS can be much lower than reported in the literature. Our results suggest implanter experience and IPG site both have an effect on adverse event rate.
TM2-5 Percutaneous electrical nerve stimulation (PENS) therapy for refractory primary headache disorders: a pilot study
Authors: Weatherall MW , Nandi D
Published: February 2019

Objectives

Primary headache disorders are common, but many patients are refractory to medical treatment. PENS therapy involves the stimulation of one or more individual nerves or dermatomes using needle probes. We assessed whether a ‘single shot with single probe’ strategy would benefit patients with refractory headache disorders, including chronic migraine (CM), and chronic cluster headache (CCH).

Design

Service evaluation of 36 patients treated with PENS therapy between September 2012 and June 2016. Follow-up data was available for 33 patients.

Subjects

16 patients with CM, nine with CCH, and one with hemicrania continua. Secondary headaches comprised occipital neuralgia, cervicogenic headache, and trigeminal neuropathy.

Methods

PENS was given using Algotec® disposable 21 gauge PENS therapy probes (8 cm) to the occipital nerve ipsilateral to the pain (or bilaterally in cases of bilateral pain). Stimulation was delivered at 2 Hz/100 Hz, at 3 cycles/second, between 1.2–2.5 V depending on patient tolerability, for 25–28 min.

Results

6/9 patients with CCH improved significantly after the first session. In all patients with CCH, PENS therapy was well tolerated, with no significant adverse events reported. One patient with CCH reverted to episodic cluster. Only four patients with CM experienced any benefit.

Conclusions

PENS therapy shows potential as a relatively non-invasive, low-risk, and inexpensive component of the treatment options for refractory primary headache disorders, particularly chronic cluster headache.
WP1-2 Labial gland biopsy for the investigation of neurological sjogrens
Authors: Jebril A , Lavin T
Published: February 2019

Objectives

Nervous System involvement in Sjogren’s Syndrome (SS) commonly affects the peripheral nerves, though central nervous manifestations such as myelitis can occur. Peripheral Neuropathy has of 2%–10% of SS cohorts.1Involvement of different segments of the peripheral nervous system leads to a widespread spectrum of neuropathic manifestations including dorsal root gangliopathy (DRG), small fibre neuropathy (SFN), sensorimotor neuropathy (SMN), trigeminal neuropathy (TN) and vasculitic mononeuropathy (VMN). Less commonly, the central nervous system can also be affected, causing various focal or multifocal CNS disorders. In the absence of antibodies, LGB remains central to validated diagnostic criteria2We aimed to ascertain the yield of labial gland biopsy (LGB) for suspected Neurological Sjogrens and identify predictive factors for positive and negative biopsies.

Methods

10 year retrospective case note review of patients referred for LGB for suspected Neurological Sjogrens, from during a period of October 2007 to 2017. Demographics, Clinical syndrome, Investigations and Biopsy Results were obtained.

Results

107 patients (73.8% female, mean age 55 years) had LGB for suspected Neurological Sjögren’s. Phenotypes were DRG 60/107 (56.1%), SFN 37/107 (34.6%), TM 4/107 (3.7%), TN 2/107 (1.9%), VMN 2/107 (1.9%) and SMN 1/107 (0.9%). Overall positive biopsy yield was 32/107 (29.9%). Yield in different phenotypes; DRG 11/60 (18.3%) and SFN 20/37 (54.1%). The presence or absences of SSA/SSB antibodies (p=0.35, chi) or Sicca symptoms (p=0.1, chi) were not significant in predicting a positive biopsy.

Conclusions

LGB remains a vital investigation in suspected neurological Sjogrens including small fibre neuropathy. Prior investigations and different phenotype did not predict positive biopsy. Our practice and biopsy yield is similar to other published series.3
TM3-9 Neurosarcoidosis presenting with normal pressure hydrocephalus: case series
Authors: Golahmadi AK , Craven CL , Thorne LT , Toma AK , Watkins LD
Published: February 2019

Objectives

Neurosarcoidosis is a rare condition with a high mortality. Early recognition of symptoms is important to enable prompt interventions. We report a case series of NS with ventriculomegaly that presented with symptoms resembling normal pressure hydrocephalus (NPH).

Design

Case series.

Subjects

Patients with ventriculomegaly on MR imaging and diagnosis of confirmed or probable NS.

Methods

Analysis of medical records for presenting clinical features, neuroradiology, intervention and clinical outcomes in patients with ventriculomegaly and confirmed or probable NS.

Results

Four patients (2M:2F) aged 49.0±3.01 years (mean ±SD) were identified. Three had definite NS and one probable. Three presented with gait disturbance and one with memory impairment. MR Imaging (with gadolinium) demonstrated ventriculomegaly with leptomeningeal enhancement. One patient underwent 24 hour ICPM, with a median ICP of 3.47 mmHg and pulse amplitude of 4.35 mmHg. CSF showed mild increase in chronic inflammatory cells in the absence of infection. Patients underwent medical management plus ventriculoperionteal shunt insertion (with adjustable valves set to 5 cm H2O and anti-siphon devices). There was a propensity for transient development of slit-like ventricles but without other features of over-drainage. All patients showed symptom improvement following CSF diversion at mean follow-up of 27 months.

Conclusions

NS can present similarly to NPH. Early combined treatment of CSF diversion and medical management is effective for symptom management.
TP3-1 Memory impairment in epilepsy
Authors: Wieshmann UC , Chawira A , Keller S , Baker G
Published: February 2019

Objectives

Memory impairment is an extremely common complaint in people with epilepsy (PWE). The purpose of our cross sectional study was to identify factors associated with self-reported memory impairment in PWE.

Methods

514 PWE and 52 controls completed the Liverpool Adverse Event Profile, a 19 item questionnaire which includes items on memory and depression and provided clinical data on age, sex, medication, seizure onset, frequency and severity. For memory impairment, sleep disturbance, depression and seizure type scores were dichotomised into minor deficits (Likert scores 1 and 2), and major deficits (Likert scores 3 and 4).

Results

In univariate analysis we found significant associations for mono vs polytherapy (χ2=14.85, p<0.001); minor/major depression (χ2=29.41, p<0.001); minor/major sleep disturbance (χ2=65.34, p<0.001); seizure freedom/persistence (χ2=14.40, p<0.001), the number of seizures in the last four weeks (p<0.001, U=17530.50, z=−5.11, but not sex, mean age of onset, mean duration of epilepsy or seizure type. Multinomial logistic regression revealed that sleep disturbance (p<0.001), AED poly therapy (p=0.004), depression (p<0.001) all retained significance whereas seizure persistence did not (p=0.377). Applying ANOVA to examine mean age with memory deficit outcomes, older age was significantly linked to poorer memory (F=3.34, p=0.002).

Conclusions

Sleep disturbance, poly therapy and depression are potentially treatable factors associated with self-reported memory impairment in PWE.
TP3-7 Sleep-disordered breathing as a consequence of vagal nerve stimulation
Authors: Pérez-Carbonell L , Higgins S , Koutroumanidis M , Leschziner G
Published: February 2019

Objectives

Vagal nerve stimulation (VNS) is a neuromodulatory therapy indicated in drug-resistant epilepsy (DRE). Its side effects are frequently minor, however, sleep-disordered breathing (SDB) has been previously reported.1Obstructive sleep apnoea (OSA) is highly prevalent in individuals with refractory epilepsy, and may be a cause of poor control of seizures.2

Methods

Three DRE patients with active VNS underwent a video-polysomnography with 21-channel montage electroencephalography in our centre.

Results

First and second patients showed OSA at the time of VNS activation. In the first patient, the apnoeic-induced arousals triggered VNS auto-firing and consequent respiratory events, perpetuating the SDB. The third patient had episodes of stridor, and an increased respiratory rate, coinciding with VNS activation. Our cases are representative of different forms of SDB that occurred as a consequence of the switch-on phase of the VNS device.

Conclusions

Sleep-related breathing disturbances should be considered before VNS implantation, and should be routinely assessed after having started the therapy. Changes in stimulation parameters, and positive airway pressure therapy, may be required to treat the SDB.
TP3-11 Sir geoffrey jefferson, a father of the SBNS, a remarkable life
Authors: Hope T
Published: February 2019

Objectives

The foundation of a Society of Neurological Surgeons was Jefferson`s idea. How did this come about? The objective is to research this period of our history and its development.

Design

A review of papers and articles held in the University of Manchester, The University of Oxford and abstracts from a biography of Jefferson by Peter Schurr, enables an historic presentation to the SBNS and the ABN.

Subjects

In 1926 Sir Geoffrey Jefferson was closely connected to the leading minds in British neurology and neurological surgery. His friendship and correspondence with Cushing was a major force in his drive for a specialist society. These players on the neurosurgical stage are the subjects of this presentation.

Methods

As in the design, the author will survey all available material including photography and handwritten manuscripts.

Results

On the very next day after being appointed a consultant neurological surgeon at the Manchester Royal Infirmary, Jefferson arranged a meeting at the Athenaeum Club to consider the formation of our society. This was held on December the 2nd 1926 and the first formal scientific meeting was held on the 3rd at Queen Square!

Conclusions

The formation of this small society was crucial in presenting British neurosurgery as a specialty in its own right to medicine in the United Kingdom. No other neurosurgical society existed in Europe at this stage. Jefferson is indeed the father figure of our society today.
WP1-4 Bilateral laminotomy through a unilateral approach (minimally invasive) vs open laminectomy for lumbar spinal stenosis
Authors: Horan J , Husein MB , Bolger C
Published: February 2019

Objectives

The purpose of our prospective randomised study is to compare safety and functional outcomes in traditional laminectomy versus minimally invasive (MI) bilateral laminectomy via unilateral approach for lumbar spinal stenosis (LSS).

Design

This is a prospective randomised trial comparing two procedures for LSS.

Subjects

62 patients were treated for LSS and randomised to one of two groups over a 6 month period.

Methods

Group A comprised 37 patients that underwent MI intersegmental unilateral decompression. Group B comprised 25 patients that underwent traditional laminectomy. Follow-up duration was 3 years. The primary outcomes were walking distance, the visual analogue scale (VAS) pain outcome score and the Oswestry Disability Index (ODI).

Results

VAS pain outcome was reduced from 9 to 2 and 8 to 5 in MI and open, ODI improved from 56.5 to 13 and 58 to 24 in MI and open respectively. Complication rates were lower in MI compared to open (8% vs 56%) and consisted of CSF leak, temporary leg pain, TIA, urinary retention and wound infections. Length of stay was 1–3 days compared to 7–30 days in MI against open respectively.

Conclusions

Bilateral laminectomy through a unilateral approach (MI) and traditional laminectomy are both effective in improving pain, ODI and walking distance in LSS. MI procedures have an advantage in shorter hospital stays, sparing of more bony structures and lower complication rates. We conclude that MI unilateral decompression is at least as good as laminectomy in the treatment of pain and disability in LSS.
FP2-6 Modelling neonatal intraventricular haemorrhage using organotypic samples from the wall of the lateral ventricle
Authors: Dawes WJ , Obernier K , Tisdall M
Published: February 2019

Objectives

Intraventricular Haemorrhage (IVH) impacts on ependyma and neural stem cells (NSC) within the subventricular zone.1Developing therapeutic interventions to curtail this impact is a key research goal. Organotypic models from the wall of the lateral ventricle (LV) of mice2and humans have the potential to offer unique insight into the dynamic impact of IVH.

Design

Basic science research using whole mount preparations (WMP) from the wall of the LV from mice and humans (SOLVe trial: IRAS ID 247936).

Subjects

Transgenic mouse line: Fucci:hGFAPCreER:TomatoTD. Human samples from children undergoing surgery for medically intractable epilepsy.

Methods

Using a published protocol2WMP of the LV were prepared. Two samples of human CSF were acquired: a ‘haemorrhagic’ sample from a neonate with IVH and a ‘clean’ sample from a newborn undergoing repair of myelomeningocele. 72 hours time-lapse confocal microscopy was undertaken from multiple wells.

Results

Colocalisation of GFP (Fucci+ve) in hGFAP +ve (RFP +ve) cells revealed dividing NSC within the wall of the LV. Quantification of fucci +ve cells revealed ‘haemorrhagic’ CSF caused a significant reduction in proliferation whilst ‘clean’ CSF caused a significant increase in early proliferation.

Conclusions

Organotypic slice preparation from mice and human lateral ventricle represents a novel approach to investigating the impact of IVH on the wall of the lateral ventricle.

References

Back SA, Miller SP. Brain injury in premature neonates: A primary cerebral dysmaturation disorder? Ann Neurol 2014 April;75(4):469–86.

Obernier K, Cebrian-Silla A, Thomson M, Parraguez JI, Anderson R, Guinto C, Rodas Rodriguez J, Garcia-Verdugo JM, Alvarez-Buylla A. Adult neurogenesis is sustained by symmetric self-renewal and differentiation. Cell Stem Cell2018February 1;22(2):221–234.
P2 A clinical pathway for the investigation and follow-up of incidental pineal cysts
Authors: Raza-Knight SR , Mathur S , Lekka E
Published: February 2019

Objectives

Pineal cysts (PCs) may be incidentally found on intracranial imaging. They are typically quiescent, benign and asymptomatic. However, imaging alone cannot exclude an underlying pineal malignancy. This study reviewed our hospital’s experience of managing PCs in order to develop a clinical pathway to guide their investigation and follow-up.

Design

Single-centre retrospective review of cases.

Subjects

Patients referred to our hospital with a PC.

Methods

Case notes and imaging from patients referred to our hospital with a clinically-coded ‘pineal cyst’ between 2007 and 2017 were reviewed.

Results

43 cases were included. The most common indication for intracranial imaging was headache (12/43), followed by seizures (4/43). No symptoms were attributable to the PC. Follow-up imaging to monitor the PC was performed in 13/43 cases; in a further 10/43 cases, it was carried out for an indication unrelated to the PC. Follow-up was arranged by the neurosurgical team in 12 cases. Uncertainty about the diagnosis led to an endoscopic biopsy in one case, which confirmed a PC. There was no consistent clinical rationale underlying the decision to undertake follow-up imaging, nor its interval or duration.

Conclusions

Clinical practice varied widely for the management of incidental PCs. We propose that all PCs should be investigated with standardised MRI, reported by a neuroradiologist and repeated at 6–12 months. Further follow-up and its duration should be guided by the patient’s clinical condition and the radiological features of the PC.
WP1-6 The syndrome of the trephined
Authors: Shah AM , Hayes L , Weston P , Lowe A , Liu C , Watkins L , Greenwood R
Published: February 2019

Objectives

Syndrome of the Trephined (SoT) or sinking skin flap syndrome is characterised by neurological deterioration occurring after a delay post-craniectomy, with or without a significant postural component, that may improve with cranioplasty. The symptoms and signs seen are heterogeneous and can be readily missed. With increasing numbers of patients surviving after decompressive craniectomies, and often a long delay before cranioplasty, we think it important that awareness of this potentially lethal but reversible condition is raised.

Design

Case Series.

Subjects

Cases with suspected SoT were identified retrospectively from all admissions to a Level 1 Neurorehabilitation Unit over 2 years.

Methods

Cases were identified by their treating clinicians. Their clinical features are described, and outcomes after cranioplasty are discussed.

Results

From 36 patients admitted after craniectomy over 2 years, 4 patients with suspected SoT were identified, with a latency of 4–12 months post-injury. Late neurological deterioriation included reduced alertness and mobility, cognitive decline and headache. Two patients had a clear postural component to their symptoms. Coexisting hydrocephalus was sometimes seen, and complicated neurosurgical management. All cases improved after cranioplasty.

Conclusions

SoT is an under-reported and under-recognised complication of craniectomy. It is a potentially reversible cause of significant late deterioration following craniectomy. Further research into the optimal timing for cranioplasty is needed.
P11 Which factors influence the decision to transfer patients with traumatic brain injury to a neurosurgery unit in a major trauma network?
Authors: Rajwani KM , Lavrador JP , Ansaripour A , Maratos E , Tolias C
Published: February 2019

Objectives

To identify factors that influence the decision to transfer patients with traumatic brain injury (TBI) to a neurosurgical centre.

Design

Retrospective data collected as part of TrIBAL study.

Subjects

All patients with TBI referred to our neurosurgery unit from regional acute hospitals over a 4 month period.

Methods

Our primary outcome was transfer to a neurosurgical centre. We identified the following factors that may predict decision to transfer: patient demographics, transfer distance, anticoagulation therapy and severity of TBI (initial GCS and Marshall score). A multivariable logistic regression analysis was performed.

Results

A total of 347 patients were referred from regional hospitals with TBI and of these, 53 (15%) were transferred. The mean age of patients referred was 69.6 years, 62.5% were men and 43% on antiplatelets or anticoagulated. Similar number of patients were referred from hospitals within 30 miles (54%) and those more than 30miles away (46%). Eighty-four percent of patients had mild TBI (GCS 13–15) on initial assessment and 67% had a Marshall CT score of 2. After regression analysis, younger age, male gender and higher Marshall score predicted transfer to our neurosurgical centre (p<0.05).

Conclusions

Many patients with TBI have relatively ‘minor’ injuries and remain at their local hospital. In our cohort higher Marshall score, younger age and male gender predicted transfer to a neurosurgicial centre. Transfer distance, anticoagulation therapy and initial GCS did not influence decision to transfer.
Optimizing the entrance location for a fish pass facility with limited attraction flow in a large river — A case study of the Jinsha River, China
Authors: Li Guangning , Sun Shuangke , Liu Haitao , Zheng Tiegang
Published: February 2019

The fish pass facility of the Suwalong hydropower project (SHP) is one of the fish pass facilities in the Jinsha River with limited attraction flow. The bed elevation was raised and a shunt wall was added to optimize aggregation zones in the tailrace channel of the SHP. The flow field, fish migration corridors, and aggregation zones were analyzed using computational fluid dynamics software Flow-3D. Raising the bed elevation can accelerate the water, and new velocity barriers can be formed. Adding a shunt wall can split the flow. These two methods are effective for creating fish migration corridors and aggregation zones in the tailrace discharge. As the fish pass facility attraction flow cannot compete with the main current of the river, it is reasonable to first attract the fish from the river into the aggregation zone in the tailrace channel through the tailrace discharge and then set the entrance within the zone. These two methods were utilized to enhance the attraction efficiency through optimizing the entrance location.
Do genomics and sex predict migration in a partially migratory salmonid fish,Oncorhynchus mykiss?
Authors: Kelson Suzanne J. , Miller Michael R. , Thompson Tasha Q. , O’Rourke Sean M. , Carlson Stephanie M.
Published: February 2019

Partial migration is a common phenomenon wherein populations include migratory and resident individuals. Whether an individual migrates or not has important ecological and management implications, particularly within protected populations. Within partially migratory populations of Oncorhynchus mykiss, migration is highly correlated with a specific genomic region, but it is unclear how well this region predicts migration at the individual level. Here, we relate sex and life history genotype, determined using >400 single nucleotide polymorphisms (SNPs) on the migratory-linked genomic region, to life history expression of marked juvenile O. mykiss from two tributaries to the South Fork Eel River, northern California. Most resident fish were resident genotypes (57% resident, 37% heterozygous, 6% migratory genotype) and male (78%). Most migratory fish were female (62%), but were a mixture of genotypes (30% resident, 45% heterozygous, 25% migratory genotype). Sex was more strongly correlated with life history expression than genotype, but the best-supported model included both. Resident genotypes regularly migrated, highlighting the importance of conserving the full suite of life history and genetic diversity in partially migratory populations.
Vertical distribution and aggregation patterns of krill (Crustacea: Euphausiacea) in the Bay of Biscay: interannual and seasonal variability
Authors: Peña M. , González-Quirós R. , Munuera-Fernández I. , González F. , Romero-Romero S. , Nogueira E.
Published: February 2019

Studies of krill (Crustacea: Euphausiacea) in oceanic waters of the Bay of Biscay are scarce and restricted to the epipelagic zone, overlooking vertical dynamics such as diurnal vertical migration (DVM). There is a growing interest in acoustically evaluating the biomass of krill in this area, but this requires a good knowledge of its vertical dynamics and aggregation patterns. In this work we employed acoustic data and net samples from two consecutive annual surveys covering a wide off-shelf area of the Bay of Biscay (JUVENA surveys of 2013 and 2014) and four seasonal surveys covering slope and oceanic waters in the Cantabrian Sea (SCAPA surveys of 2015). Vertical dynamics of krill were analyzed in the frame of the environmental seascape. High interannual and seasonal variations in the vertical distribution and aggregation patterns (small swarms, dense aggregations, or loose layers) of krill were observed. The vertical distribution covaried with dissolved oxygen and salinity. According to our findings, the best season to acoustically evaluate krill in the Bay of Biscay is spring, with the bulk of the biomass located above 600 m depth. Moreover, extending the acoustic recording beyond the epipelagic zone is mandatory for any season.