bluuebunny/crossref_metadata_2025 huggingface dataset:
P97 Utility of computer technology in management of non-syndromic craniosynostosis- is it cost effective?
Authors: Kaliaperumal C , Gallo P , Campbell D , Stewart K , Kandasamy J , Rose M
Published: February 2019

Objectives

To discuss the utility of Computer technology for non-syndromic craniosynostosis (Metopic craniosynostosis) in the form of 3D printed models that could be utilised intraoperatively to aid fronto-orbital remodelling.

Design

Prospective study form 2015–2017.

Subjects

Paediatric non-syndromic metopic craniosynostosis cohort.

Methods

We present a series of 7 patients with non-syndromic metopic craniosynostosis operated on by the craniofacial team Edinburgh over a three year period. The Edinburgh Craniofacial service is supported by the Managed Service Network (MSN) for Neurosurgery, Scotland as a part of nationally delivered Craniofacial service. We utilised 3D printing models of the orbital bar to plan a fronto-orbital advancement technique. The models were then subsequently sterilised and used intra operatively. 3D printer utility is available to us as a part of the NHS Lothian craniomaxillofacial and plastics surgery service.

Results

No intra-operative or post operative complications were noted in our series. All patients undergo standardised pre and post operative 3D CT and photography follow up to objectively measure the outcome.

Conclusions

The utility of Computer technology is a useful and safe adjunct for non-syndromic craniosynostosis, particularly metopic craniosynostosis. A careful pre-operative planning and 3D printed model is helpful to achieve the desired bespoke surgical outcome and to reduce operative time. Post operative 3D CT and 3D photography were utilised to objectively measure the outcome. No extra costs were incurred to our service. We believe that this could be incorporated in preoperative planning as an essential tool.
P98 A decade of primary tumours of the spine in the paediatric population
Authors: Millward CP , Foster M , Tonder LV , Williams D , Pizer B , Pettorini B , Parks C , Mallucci C
Published: February 2019

Objectives

Primary spinal tumours in children are rare and poorly understood; we review 10 years of surgical experience.

Design

Retrospective review of prospectively maintained database.

Subjects

Children receiving surgical management of primary spinal tumours in a single, tertiary paediatric neurosurgery centre.

Methods

Operations for primary spinal tumours were abstracted from our prospectively maintained surgical database and supplemented with data from case notes, operative records, and imaging studies.

Results

Between 2008 and 2017, 37 procedures were performed on 29 patients (19 male; Median age 7.5 years, IQR 2–11.25). 28 had their primary procedure in our unit: 21 excisions, and 7 biopsies (of which 5 proceeded to further surgery). Tumours were classified as extradural (10), intradural extramedullary (3), intradural intramedullary (11) or bony (4). Tumours were found at the following levels: Cervical (8; 29%), Cervicothoracic (2; 7.1%), Thoracic (10; 36%), Thoracolumbar (3; 11%), Lumbar (2; 7.1%), Lumbosacral (2; 7.1%) and Sacral (1; 3.6%). Histology comprised: Pilocytic Astrocytoma (6), Other Astrocytoma (4), Schwannoma (3), Ewing Sarcoma (2), Langerhans cell histiocytosis (2), Lymphoma (2), Neurofibroma (2), and others (7) including one Myxopapillary Ependymoma.

Conclusions

The rarity and heterogeneity of paediatric spinal tumours makes treatment challenging. We propose a national online registry including a tissue bank, and invite collaboration with other units.
P104 One year failure rates for de novo ventriculo-peritonealshunts in under 3- month-old children
Authors: Bentley E , Ved R , Amato-Watkins A , Lang J , Zilani G , Bhatti I , Leach P
Published: February 2019

Objectives

Historically VPS failure and infection rates are higher for neonates than for older children. We compared our one year VPS failure and infection rates in under 3-month-olds with those of older children.

Design

A retrospective, single centre study comparing 1 year survival and infection rates of VPS in under 3-month-olds verses older children.

Subjects

58 children under 3 months of age underwent VPS insertion between January 2007 and December 2016.

Methods

Data was collected by three independent reviewers from electronic files and case notes. Data was analysed using descriptive statistics and one year shunt survival curves were produced.

Results

For children under 3 months there was a 29.3% one-year shunt failure rate, of which 2 were shunt infections (3.4%). In patients greater than 3 months, the shunt malfunction rate was 23.4% and the infection rate was 4.3%. There were no shunt-related mortalities in either group.

Conclusions

Children under 3-months-old undergoing VPS insertion should not automatically expect an increased 1 year failure or infection rate compared with older children. Reasons for this may be increased sub-specialisation, improved neonatal care and use of antibiotic impregnated catheters.
P105 Shunt migration in ventriculoperitoneal shunting: a comprehensive review of literature
Authors: Srinivasan HL , Chatterjee S , Sharma A
Published: February 2019

Objectives

The mechanical shunt complication- shunt migration is roughly noted in 1 in 1000 patients with shunt. Most of the literature on shunt migration is case reports. In this narrative review we analyze about presentation, complications and management options for each site of shunt migration.

Design

Narrative review.

Subjects

In total 239 articles were reviewed in this narrative review which includes a total of 396 shunt migrations.

Methods

Literature search was performed using PubMed Central for all articles containing the term Ventriculoperitoneal shunt migration. All articles published through 2016 were included in this review.

Results

Sites of migration were – perforation of the bowel in 139 patients; abdominal wall (57); scrotum (55); chest (32); intracranial (30); cardiac/intravascular (28); genitourinary (15); breast (13); subgaleal (12) and miscellaneous (15).

Conclusions

Migration to bowel, heart, intracranial and subgaleal space are associated with 20% chance of shunt dysfunction Any extrusion (irrespective of the site) where the shunt catheter is exposed to the external environment is associated with around 50% chance of shunt infection.
P108 Acetazolamide for obstructive hydrocephalus in the pregnant female: a case report and literature review.
Authors: Strachan EL , Tsang K
Published: February 2019

Objectives

This study presents a case report and literature review of acetazolamide use in the pregnant patient to further delineate its role and controversies in the treatment of symptomatic hydrocephalus. Here we present a case from our neurosurgical service which demonstrated safe use and efficacy of acetazolamide in refractory hydrocephalus secondary to a space-occupying lesion.

Design

Case report and literature review.

Subjects

33-year-old, primigravid female treated at Charing Cross Hospital, London.

Methods

Adaptation of the PRISMA guideline to facilitate an initial PubMed database search for all available full-text, peer-reviewed publications in English. Papers were screened for relevance to pregnant patients with hydrocephalus receiving acetazolamide therapy, as well as relevant papers describing related disorders of cerebrospinal fluid flow.

Results

There exist no prospective, randomised-controlled trials for the use of acetazolamide to treat hydrocephalus in pregnancy. Retrospective data in patients with related conditions suggest no significant link between acetazolamide use and teratogenicity in humans.

Conclusions

Acetazolamide can be a safe and efficacious therapy in the pregnant patient with refractory hydrocephalus as a bridge to delivery. We agree with the consensus and its appropriate use in the pregnant neurosurgical patient.
WM1-4 Decompressive craniectomy versus strokectomy for malignant middle cerebral artery (MCA) infarction
Authors: Moughal S , Boeris D , Hainsworth A , Pereira E , Shtaya A , Minhas P
Published: February 2019

Objectives

To compare the outcomes of decompressive craniectomy (DC) with craniotomy and debulikng of stroke tissue (Strokectomy (SC)) for malignant MCA infarction at our centre.

Design

Retrospective records review.

Subjects

All Patients with malignant MCA infraction that underwent DC and SC between Jan 2012 and Sep 2017.

Methods

20 patients had DC (11F/9M, mean age 44.7±1.8 y) and four patients had SC (1F/3M) 51.5±5.9 7 y). Outcomes were 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). Craniotomy size was measured by antero-posterior (AP) diameter and compared between the groups.

Results

18 patients (90%) of the DC group had mRS 4–6 before surgery versus 100% in the SC group. Post-surgery 15 patients (75%) of the DC group had poor outcome with 7 mortalities (35%) in comparison to one patient (25%) with poor outcome in the SC group and no mortalities. The average craniotomy size in DC was 120.1±4.1 mm versus 85.5±13.1 mm in the SC, p=0.003 students t test). Six patients of the DC group underwent cranioplasty where two developed post-operative seizures. There was no significant difference in age, sex and side of craniotomy (7 Left/13 Right in DC vs 2 Left/2 Right in SC).

Conclusions

Strokectomy is comparable to decompressive craniectomy in outcomes without taking the extra risks and costs of cranioplasty. Further studies are required to promote this approach.
WP1-22 DuraGen™ as an encapsulating material for neural stem cell delivery
Authors: Finch L , Harris S , Adams C , Sen J , Tickle J , Tzerakis N , Chari DM
Published: February 2019

Objectives

Achieving neural regeneration after spinal cord injury (SCI) represents a significant challenge. Neural stem cell (NSC) therapy offers replacement of damaged cells and delivery of pro-regenerative factors, but >95% of cells die when transplanted to sites of neural injury. Biomaterial scaffolds provide cellular protective encapsulation to improve cell survival. However, current available scaffolds are overwhelmingly not approved for human use, presenting a major barrier to clinical translation. Surgical biomaterials offer the unique benefit of being FDA-approved for human implantation. Specifically, a neurosurgical grade material, DuraGen™, used predominantly for human duraplasty has many attractive features of an ideal biomaterial scaffold. Here, we have investigated the use of DuraGen™ as a 3D cell encapsulation device for potential use in combinatorial, regenerative therapies.

Methods

Primary NSCs were seeded into optimised sheets of DuraGen™. NSC growth and fate within DuraGen™ were assessed using 3D microscopic fluorescence imaging techniques.

Results

DuraGen™ supports the survival (ca 95% viability, 12 days) and 3D growth of NSCs. NSC phenotype, proliferative capacity and differentiation into astrocytes, neurons and oligodendrocytes were unaffected by DuraGen™.

Conclusions

A ‘combinatorial therapy’, consisting of NSCs protected within a DuraGen™ matrix, offers a potential clinically translatable approach for neural cell therapy.
WP1-23 Vascular collagen 4A1 in subcortical white matter of older people and primates
Authors: Shtaya A , Yeo NE , Whittaker M , Pereira E , Bridges LR , Zamboni G , Esiri MM , Farris CW , Rosene DL , Hainsworth AH
Published: February 2019

Objectives

To test whether collagen 4A1 in cerebral small arteries associated with age, hypertension or small vessel disease (SVD).

Design

Neuropathology cohort study.

Subjects

Older people age >65 years with minimal Alzheimer’s Disease.

Methods

We examined subcortical white matter in archived brain tissue from older people (n=34, 15F/19M, median age 84, range 65–99 y) and from experimental non-human primates (NHP, Macaca mulatta) that were young adults (n=9, age 6.2–8.3 y) or older adults (n=8, age 17.0–22.7 y). Some of the primates (5 young, 3 older) were chronically hypertensive. Vascular collagen 4A1 immunohistochemical labelling was examined qualitatively and quantified as percent area fraction.

Results

Collagen 4A1 labelling was common in arterial myocytes and in the adventitial layer in human and primate brain arteries, as well as in basement membrane, which frequently exhibited replication. Among older people, collagen 4A1 associated with neuropathological SVD severity (sclerotic index; r=−0.461, p=0.0409, least squares) and with radiological SVD severity (leukoaraiosis; p=0.0455, 1-way ANOVA) but not with age or clinical history of hypertension. In NHP, age but not hypertension was significantly associated with collagen-4A1 labelling (p=0.0396, 0.232 respectively, 2-way ANOVA).

Conclusions

In this small cohort, vascular collagen 4A1 was related to SVD severity in older humans, in accord with genetic associations of COL4A1 with SVD phenotypes.
TM1-4 Verbal fluency test in patients with a newly diagnosed brain tumour
Authors: Zienius K , Brennan P , Grant R
Published: February 2019

Objectives

Utility of a simple 1 min cognitive screening tool, verbal fluency test, as a potential risk assessment tool for GPs for a suspected brain tumour.

Design

Case-control study; patients with new diagnosis of brain tumour with a history of headache and patients referred for direct-access-CT for headache without a brain tumour.

Subjects

102 brain tumour patients: 34.3% HGG, meningioma 21.6%, cerebrals metastases 17.6%, LGG 11.8%, others (pituitary, schwannoma, haemangioblastoma) 11.8%, and CNS lymphoma 2.9%.

Methods

Group differences analysed with ANCOVA with age/gender as covariates.

Results

Mean age was similar across both groups. There were more females in the control group. Tumour patients obtained significantly lower scores on fluency test measures. The largest effect size difference was observed for semantic total and phonemic total scores (Cohen’s d=−0.97 and −0.47, respectively. Brain tumour patients named on average 4.9 animals less (95% CI −6.32,–3.42) (p<0.001) than controls. On letter P task, there was a 2.2 word-mean difference (95% CI −3.6,–0.86)(p=0.001). Forty-eight (47.1%) tumour patients and 22 (23.4%) controls had subjective memory disturbance. Tumour patients performed equally on both fluency tasks regardless of memory complaints (p>0.5).

Conclusions

Semantic test is more reliable to discriminate patients with a brain tumour. In contrasts to patients without a brain tumour, subjective memory impairment is not associated with a reduced performance on verbal fluency tasks.
WM1-5 Predictors of retreatment of anterior communicating artery aneurysms after endovascular embolisation
Authors: Borg A , Grover P , Schmitt A
Published: February 2019

Objectives

To establish recurrence and retreatment rates of anterior communicating artery aneurysms (ACom) after endovascular embolization and the complication rate of retreatment. To establish predicting morphological characteristics that would favour surgery or endovascular coiling.

Design

Retrospective review of all ACom aneurysms treated at a single neurological centre over a thirteen-year period.

Subjects

Patients undergoing endovascular treatment of ACom aneurysms.

Methods

Aneurysm and patient characteristics were recorded for retreated patients. Analysis of retreatment predictors on imaging was made.

Results

Between 2005 and 2018, 510 Acom aneurysms were treated, of which 456 presented with SAH and 54 were elective. Out of these, 36 underwent re-treatment. Out of the re-treated aneurysms 33 were identified from radiological follow up and three presented with a re-bleed. The complication rate from the second endovascular procedure was 5.6%. Four patients underwent surgical clipping after failed coiling. Retreatment was more likely in ruptured aneurysms. The dome shape, size (mm) and orientation, were recorded for both aneurysms requiring retreatment and aneurysms successfully excluded after the first procedure. Other parameters reported included time interval, coiling technique (balloon-assisted/stent-assisted).

Conclusions

Recurrence of Acom aneurysms after coiling carries significant morbidity. Recognising predictors of recurrence would help identify those aneurysms that are better treated with surgery.
TM1-6 Intramedullary spinal cord tumours – a single centre 10 year retrospective review
Authors: Richards O , Goacher E , Derham C
Published: February 2019

Objectives

To identify clinically relevant predictors of progression free survival by retrospectively analysing the anatomical location, pre- and post-operative function and histology in intramedullary spinal cord tumours from a single neurosurgical centre over 10 years.

Design

Retrospective review.

Methods

49 patients were identified from a surgical database. Variables collected included pre-and post-operative Frankel Grade and Modified McCormick Scale assessments, tumour histology, extent of resection and length of follow up. Chi-Squared, Kaplan-Mier Survival and Mann-Whitney U-Tests were completed.

Results

There was a statistically significant relationship between identification of the tumour plane and extent of resection (p<0.01), along with the extent of resection and recurrence (p<0.01). Compared to the other histological subtypes, ependymoma’s demonstrated a significantly greater extent of resection (p=0.02). There was a significant relationship between the grade of tumour and progression free survival (p<0.01). We did not find a significant relationship between pre- and post-operative neurological function and survival.

Conclusions

Tumour plane and the extent of tumour resection are significant determinants of progression free survival. Ependymoma, whilst being the commonest histology in our series were also the most resectable. Whilst complete resection reduces the rate of recurrence, tumour grade is the most important predictor of outcome.
TP1-2 Treatment of dural and direct caroticocavernous fistulas via the transorbital approach
Authors: Ilyas M , Rennie A
Published: February 2019

Objectives

To analyse the outcome of this novel approach in patients with Caroticocavernous fistulas (CCFs) and to compare it with the commonly used transvenous pathway.

Design

Retrospective analysis of patients with CCFs treated using the transorbital approach.

Subjects

10 patients were identified following review of inpatient databases and collection of information for those treated offsite.

Methods

Analysis of Angiography findings and follow up imaging alongwith review of outcomes from patient records (Using TO approach, coils were used over liquid embolic due to risk of reflux of liquid from perforators).

Results

No failure to puncture No orbital hematoma requiring drainage/canthotomy Occlusion rate 100% Commonest symptoms of eye pain and proptosis (all subjects) with chemosis, opthalmoplegia and reduced visual acuity (fairly common) in the patients studied improved significantly post the TO procedure with transient 3rd and 4th Nerve palsy being the only complication.

Conclusions

Transorbital approcah (TO) is a safer, acceptable alternative to the catheter transveous approaches for CCFs (dural and direct) With greater numbers and experience, TO could be considered as a 1 st line approach.
TP1-8 Decompressive craniectomy for paediatric traumatic brain injury: a systematic review
Authors: Tang AR , Ardissino M , Tsang K
Published: February 2019

Objectives

Managing raised intracranial pressure (ICP) in traumatic brain injury (TBI) has been the centre of debate. Recent publications (such as RescueICP) have helped our understanding of the role of decompressive craniectomy (DC) in adults but no such data is available for the paediatric population. We aim to assess the current literature on the role of DC in this group of patients.

Design

Systematic review of this subject.

Subjects

260 paediatric patients within 12 studies were included within our criteria.

Methods

A comprehensive search of the MEDLINE and EMBASE databases led to the screening of 212 studies, with 12 studies included. We collected data on age, GCS at presentation, treatment protocols and their short- and long-term outcomes.

Results

Nine studies looked at ICP as an outcome and these all reported that it was successfully controlled by DC (69.4%–100% reduction, p<0.05). Only two studies looked at mortality, both found that it was lower in the DC group (p<0.05). The 6–12 month outcome, based on the Extended Glasgow Outcome Scale (GOS-E) and a range of other pre-defined daily activities, were overall positive, or superior to those of medically treated (p<0.05) in 10 of the studies. One study suggested no difference in outcome.

Conclusions

The currently available evidence appears to supports the beneficial role of DC in the treatment of children with refractory high ICP (>20 mmHg) and a GCS score of <8 at the time of presentation. However the quality of each of these studies is poor and further research is required.
WM1-7 Brain parenchymal oxygen monitoring in delayed cerebral ischaemia
Authors: Craven CL , Reddy U , Asif H , Watkins LD , Toma AK
Published: February 2019

Objectives

At this single centre, tri-modal monitoring of ICP, temperature and direct brain tissue oxygen tension (PbtO2) is used to guide management of delayed cerebral ischaemia (DCI). We describe our experience of PbtO2 monitoring and its relationship with symptoms of DCI, regional cerebral blood flow (rCBF, perfusion imaging), intra-arterial chemical angioplasty and CSF diversion.

Design

Prospective cohort.

Subjects

Patients with aSAH who underwent over 24 hours of multi-modal PbtO2, temperature and intracranial pressure (ICP) monitoring via a Raumedic NEUROVENT-PTO probe.

Methods

Longitudinal analysis of PbtO2 values, presented as mmHg (mean±SD).

Results

Analysis of 1392 hours of tri-modal monitoring in 13 SAH patients. PbtO2 decreases >50% consistently reproduced focal neurological deficit. Symptomatic PbtO2 values ranged from 12–20 mmHg. Of the six patients who had reduced rCBF, all had a mean PbtO2 <15 mmHg. Five patients underwent intra-arterial chemical angioplasty (10 mg Verapamil in 100 ml NaCl over 30–40 mins). PbtO2 increased by at least 30% for 3.4±0.47 hours. CSF diversion resulted in a sustained mean increase in PbtO2 of 7.6±2.94 mmHg over the first 5 min (p=0.034).

Conclusions

PbtO2 <15 mmHg may predict development of a clinical deficit. Chemical angioplasty resulted in a pronounced but short-lived increase in PbtO2. CSF diversion resulted in a persistent increase in PbtO2. PbtO2 targeted management may be a valuable addition to the clinicians’ arsenal against DCI.
TM2-4 Long term outcome of percutaneous balloon compression for trigeminal neuralgia
Authors: Bhargava D , Cristaldi P , Franceschini P , Eldridge P , Osman-Farah J
Published: February 2019

Objectives

Percutaneous balloon compression (PBC) can be offered to medically refractory patients with trigeminal neuralgia who are unsuitable for microvascular decompression. Its associated with up to 4% risk of anaesthesia dolorosa which increases with duration and severity of compression and is more common with repeat procedures. We audited our outcomes for this procedure over last 7 years.

Design

Retrospective audit of prospectively collected data.

Subjects

All patients undergoing PBC at our centre.

Methods

Theatre and radiology records reviewed to identify patients. Case notes and radiology reviewed for history, diagnosis, details of procedure, immediate symptom relief, complications, further procedures and last follow up. Descriptive, comparative Kaplan Meir analysis undertaken.

Results

Total 93 patients (4 b/l), 165 procedures. Average follow up 36 months. 24 patients had MS, 17 patients had atypical pain. All except 4 patients had good immediate pain relief. No patient developed anaesthesia dolorosa, 2 patients had transient diplopia, 1 maxillary hematoma and 1 infection. 56 experienced recurrence, 43 needed further surgical intervention. 25 PBC twice, 11 thrice, 4 four times and 1 five times. Average time to first recurrence=32 months. 85% pain free at 1 year and 70% at 2 years.

Conclusions

PBC is an effective procedure. With conservative approach, this procedure can be safely repeated.
TP2-3 Long-term survival and five year hospital resource usage following traumatic brain injury in scotland from 1997–2015: a population-based retrospective cohort study
Authors: Loan JJM , Scott NW , Jansen JO
Published: February 2019

Aim

To determine if survival and hospital resource usage differ following traumatic brain injury (TBI) compared with head injury without neurological injury(HI).

Methods

This retrospective population-based cohort study included all 25 319 patients admitted to a Scottish NHS hospital from 1997–2015 with TBI. Participants were identified using previously validated ICD-10 based definitions. For comparison, all 194 049 HI cases were identified. Our main outcome measures were hazards of all-cause mortality after TBI, compared with HI, over 18 years follow-up period; and odds of mortality at one month post-injury. Number of days spent as inpatients and number of outpatient attendances per surviving month post-injury were used as measures of resource utilisation.

Results

The adjusted odds ratio for mortality in the first month post-injury for TBI was 7.12 (95% confidence interval [CI] 6.73–7.52; p<0.001). For the remaining 18 year study period, the hazards of morality after TBI were 0.93 (CI 0.90–0.96; p<0.001). TBI was associated with 2.15 (CI 2.10–2.20; p<0.001) more days spent as inpatient and 1.09 times more outpatient attendances (CI 1.07–1.11; p<0.001) than HI.

Conclusions

Although initial mortality following TBI is high, survivors of the first month can achieve comparable long-term survival to HI. However this is associated with increased utilisation of hospital services in the TBI group.
TM3-3 Correlation of lumbar puncture opening pressure with 24 hours intraparenchymal ICP monitoring: the effects of position on ICP
Authors: D’Antona L , Craven L , Thompson D , Sennik S , Ramos J , Thorne L , Toma K , Watkins D
Published: February 2019

Objectives

Lumbar Puncture opening pressure in lateral decubitus has been considered the gold standard method of intracranial pressure (ICP) measurement for many years. The use of continuous intraparenchymal ICP monitoring is more recent and there is no consensus regarding what can be considered normal ICP with this method of measurement. A conversion factor between lumbar puncture opening pressure and 24 hours ICP monitoring could provide a better insight on the interpretation of ICP. This study investigates the differences between 24 hours ICP and ICP in lumbar puncture position.

Design

Single centre prospective observational study.

Subjects

Fifty-four patients (42F:12M, mean age 38±12 years) were included.

Methods

Patients investigated with 24 hours ICP monitoring who underwent a short exercise battery during the monitoring period were included. The exercise battery was standardised; patients were asked to stay in a supine, sitting, standing and lumbar puncture position for 2 min each.Mean ICP and pulse amplitude were calculated for each position.

Results

The mean 24 hours ICP was 4.9 mmHg (±6.9 SD) and the mean ICP in lumbar puncture position was 14.1 mmHg (±8.9 SD). The average increase in lumbar puncture position was 9.1 mmHg (±5.9 SD). Patients with normal lumbar puncture position ICP (<12 mmHg) had an average 24 hours ICP of 1.4 mmHg (±2.81 SD).

Conclusions

Our results suggest that ICP measured in lumbar puncture position is on average 9.1 mmHg higher than 24 hours ICP results. Larger studies will be needed to confirm these findings.
TM3-5 Venous sinus stenting for IIH: what are the long-term outcomes?
Authors: Asif H , Craven C , Thorne L , Watkins L , Toma A
Published: February 2019

Objectives

Idiopathic intracranial hypertension (IIH) is associated with dural venous sinus stenosis (DVSS). This is increasingly treated with endovascular insertion of stents. Clinical and manometric improvements after stent placement have been described. However, there is little data reporting further need for CSF diversion, complication rates and sustained improvements in ICP.

Design

Single centre case series.

Subjects

Twenty-four IIH patients underwent stent insertion on discovery of DVSS with medical management ongoing.

Methods

Clinical notes, radiographic reports and 24 hour ICP monitoring data before and after stent placement was collected.

Results

After 1089.2±107.1 days, 6 patients remained symptomatic and went onto require CSF diversion, 75.0% did not require CSF diversion. One patient developed stent thrombosis requiring VKA anticoagulation for 3 months, this patient also developed new stenosis proximal to the stent at 2 years. A second patient developed in-stent stenosis requiring balloon angioplasty at 2 years and subsequent repeat stenting at 3 years. Eleven patients had 24 hour ICP monitoring at baseline and a mean of 231.9±129.5 days after DVSS stent placement. The mean reduction in ICP was 7.92±1.80 mmHg (p<0.01) and PA was 2.84±0.84 mmHg (p<0.01).

Conclusions

DVSS stenting is a viable endovascular therapy for IIH with modest long-term patency and ICP reduction. However, a quarter of stented patients required subsequent CSF diversion to manage their symptoms.
TM3-6 Symptomatic intracranial arachnoid cysts: a centre series
Authors: Perera A , Rajashekar D , Pereira E , Shtaya A
Published: February 2019

Objectives

To study the presentation, management and outcomes of symptomatic intracranial arachnoid cysts.

Design

Retrospective records review.

Subjects

All cases coded as intracranial cysts.

Methods

Patients admitted between Jan-2012 and Sep 2017. Of 56 cases, only 24 were arachnoid cysts. Median age 57 (range 8–81). Mean 49.1±5.0 years, 8 males and 16 females.

Results

Males were significantly younger (34.3±9.1 vs 56.5±5.2 year-old, p=0.03) and outnumbered females. Mean size of cysts was 58.8±6.1 mm (range 18.5–126 mm). Five were located frontally, one fronto-temporal and another fronto-parietal, two parietal and two parieto-occipital, two within third ventricle, one intraventricular, one supra sellar and one intra sellar while eight were posterior fossa. 12 patients had headache, five presented with cognitive and memory issues, five had visual problems, four with limb weakness and two had cerebellar signs. Eight had open fenestration, five endoscopic fenestration, four had aspiration with reservoir, two aspiration only, two marsupialisation, two received ICP monitor and one had no treatment. One reservoir was aspirated three times and another open fenestration had another surgical fenestration. Two had transient infection, two needed VP shunts and one had cysto-peritoneal shunt. mRS (0–2) improved significantly after the treatment (62.5% pre-surgery to 91.7% post-surgery, p=0.016).

Conclusions

Symptomatic arachnoid cysts are more common in young males. In the literature, the most common location is middle cranial fossa which is not the case in symptomatic arachnoid cysts as in our series. Although intervention is variable, they are associated with very good outcomes.
TM3-8 Use of adjustable anti-gravity devices in NPH patients with delayed post-shunt deterioration
Authors: Funnell JP , Craven CL , D’Antona L , Thorne L , Watkins LD , Toma AK
Published: February 2019

Objectives

A subset of idiopathic Normal Pressure Hydrocephalus (NPH) patients respond to VP shunt insertion temporarily. Adjustable anti-gravity devices are designed to control position-induced CSF drainage changes; we aim to assess to effect of using these devices to achieve controlled overdrainage in temporary shunt responders.

Design

A single-centre retrospective study of patients undergoing VP shunt valve revision from an adjustable differential pressure valve with fixed anti-siphon (ProGAV +Shuntassistant) to a system incorporating an adjustable anti-siphon valve (ProGAV +ProSA) (April 2013-April 2018).

Subjects

21 patients diagnosed with temporary shunt-responsive NPH who improved on high volume shunt reservoir tap (10M: 11F). Mean age at first VP shunt insertion was 74.5±7.87 years.

Methods

Medical records were retrospectively reviewed for demographics, interventions and clinical outcomes.

Results

Mean duration until revision with a ProSA valve was 31.5±16.8 months (mean ±SD). Mean follow up was 31.4±15.9 months. Of 20 patients with sufficient follow-up, 12 made objective improvements in walking and/or neuropsychological test outcome. 15 patients made subjective improvements in mobility or cognitive impairment.

Conclusions

VP shunting with adjustable differential pressure valves and fixed antigravity devices may not drain sufficient CSF for optimum management of low pressure hydrocephalus. Addition of adjustable anti-gravity devices at lower shunt settings in temporary shunt responders may improve outcome.
TM3-10 National survey and experimental evaluation of commonly used external ventricular drain (EVD) securement methods in a porcine model; recommendations to improve practise
Authors: Akarca D , Durnford A , Ewbank F , Hempenstall J , Sadek A , Gould A , Bulters D
Published: February 2019

Objectives

External ventricular drain (EVD) dislodgement is common and can lead to significant morbidity and mortality. UK trial data suggests dislodgement as high as 12%. This study aimed to establish the range of methods used nationally and determine the most secure method in a porcine model.

Design

Survey and experimental study.

Subjects

23 neurosurgical units surveyed. Porcine cadaver experimental model.

Methods

Survey distribution was made through the British Neurosurgical Trainee Research Collaborative. 15 securement methods were tested on the porcine model and peak pull-out force before EVD failure was measured. Failure was defined as catheter displacement 1 cm from the insertion site, catheter fracture or suture fracture.

Results

Nationally, five EVD securement methods were in common use. There were considerable differences in peak pull-out force between methods. The most secure methods were a construct consisting of anchoring suture, further multiple sutures around a coil of catheter followed by either a soft (25.85N, 95% CI 24.95 N-26.75N) or hard plastic flange (29.05N, 95% CI 25.69 N-32.41N). Individually, anchoring sutures, soft flanges, VentriFix and staples were least secure, whilst multiple sutures and hard flanges were most secure.

Conclusions

An anchoring suture followed by a coil of catheter and a flange is the most secure method for securing EVDs, withstanding up to 8.2 times the force of a single anchoring suture. It is easily employed and may decrease the likelihood of EVD dislodgement and associated complications.
TP3-2 Epilepsy surgery outcomes in a paediatric population – a single centre 10 year experience
Authors: Pope O , Chadwick A , Pringle C , Josan V
Published: February 2019

Objectives

To analyse the efficacy of epilepsy surgery in reducing the burden of seizures in a paediatric population – a single centre 10 year experience.

Design

Single centre retrospective review of medical records.

Subjects

74 consecutive paediatric patients who underwent epilepsy surgery between 2008–2017 by one neurosurgeon at a single centre.

Methods

Seizure history, pre-operative investigations, surgical interventions, seizure outcomes, complications and long term anti-epileptic drug (AED) use were evaluated. Seizure outcomes at 1 year post surgery to the last available follow up (up to 5 years) were documented and classified using the Engel System. Engel I and II were classified as a good seizure outcome and Engel III and IV were classified as a poor seizure outcome.

Results

The mean duration of follow up was 41 months. 62.2% of patients achieved seizure freedom (Engel I) at their latest follow up, with 82.4% of patients achieving a good seizure outcome (Engel I/II). 13.5% of patients achieved worthwhile improvement (Engel III) and only 4.1% of patients had no worthwhile improvement in seizure burden (Engel IV). More favourable outcomes were observed in children with temporal lobe epilepsy. Post-surgery AED use was reduced or discontinued in 41.4% of all patients; 41.4% of the 29 patients with AED data at their 5 year follow up were completely free of AEDs.

Conclusions

Epilepsy surgery is an efficacious treatment with low morbidity and no mortality that is underutilised in children with medically intractable seizures.
TP3-9 Assessment of seizures in over 75-year olds: a clinical audit
Authors: Ahmed ZT , Rather A
Published: February 2019

Objectives

This audit evaluates the assessment of first seizures in over 75-year-olds within our centre using NICE guidance (CG137) as our standard. This is in response to the National Audit of Seizure management in Hospitals which revealed significant deficits in current practice.

Design

A retrospective audit design was used.

Subjects

We reviewed patient records of 74 patients over the age of 75 who presented to A+E with their first seizure between 1 st January and 30th April 2017.

Methods

Data entry took place between 14th November and 22nd January when follow-up information should have been available. A proforma based on current NICE guidance was used to evaluate initial assessment, investigations and specialist review.

Results

38 females and 36 males were assessed with an average age of 83 years (range 76–95). NICE recommends that all patients are seen by a specialist within 2 weeks, however only 38% of our patients met this standard. Only 65% of patients indicated for an EEG had one and 34% waited longer than the recommended 4 weeks. Neuroimaging was optimal with 95% of patients receiving an MRI within 4 weeks. In contrast, blood glucose was only measured in 47% of patients and only 51% had a 12-lead ECG despite recommendations that these investigations should be performed routinely.

Conclusions

There is a lack of comprehensive A+E assessments and specialist referral for older people both within our centre and nationally. A more thorough and integrated approach is needed to improve outcomes and optimise care.
FP1-7 Neurology – the european specialty
Authors: Howard RD , Howard RS
Published: February 2019

Objectives

The case records at Queen Square afford a unique opportunity to understand the evolution of neurological diagnosis between 1870 and 1920. This period witnessed a shift from the descriptive and observational to a sophisticated and detailed understanding of discrete disease patterns.

Results

By 1870, the introduction of microscopic pathological analysis of the nervous system had led to the recognition of disease processes including tumour, haemorrhage, infarction, meningitis and sclerosis. However, the most frequent diagnoses remained symptomatic (epilepsy, movement and functional disorders, visual loss and paralysis). Syphilis, paralysis agitans, and poliomyelitis were amongst the few specific diagnoses. The final decade of the 19th century saw the description of disease patterns, particularly in France, Germany and the US. These included disseminated and amyotrophic lateral sclerosis, myasthenia gravis and latterly eponymous disorders and signs attributed to Dejerine, Duchenne, Sanger Brown, Huntington, Marie, Romberg, Wernicke, Babinski and Charcot as well as Bright, Jackson, Gowers and Wilson in the UK.

Conclusions

The case record diagnoses, as well as the writings of Gowers and others, show how rapidly neurological thought evolved over 50 years. Queen Square was able to systematise neurological disease but was also remarkably responsive in understanding, accepting and adopting the neurological advances made across Europe.
FM2-2 Exploratory analysis whether wearable sensor data can correlate with aspects of non-motor symptoms in parkinson’s: a real life study with the parkinson’s kinetigraphTM
Authors: Hota S , Podlewska A , Rizos A , Wamelen DV , Chaudhuri K
Published: February 2019

Objectives

To determine the association between the range and nature of non-motor symptoms (NMS) in people with Parkinson’s (PwP) and validated Parkinson’s KinetigraphTM (PKG) outcome measures.

Design

Cross-sectional retrospective study of participants enrolled in the Non-motor Longitudinal International Study (NILS, UKCRN No: 10084) at King’s College Hospital, London.

Subjects

108 PwP with a PKG recording within 4 months of a NILS assessment were included in the analysis.

Methods

PKG is a validated accelerometery-based measure for motor function in PwP, reporting scores for global bradykinesia (BKS) and dyskinesia (DKS). NMS were assessed by the NMS scale (NMSS).

Results

Using multiple linear regression, BKS was predicted by NMSS domains 6 (gastrointestinal tract; p=0.006) and 8 (sexual function; p=0.003). DKS was predicted by domains 3 (mood/cognition; p=0.016), domain 4 (perceptual problems; p=0.025), domain 6 (gastrointestinal tract; p=0.029) and domain 9 (miscellaneous, p=0.003). In these domains, anxiety, delusions, dysphagia, hyposmia, weight change and hyperhidrosis significantly predicted DKS. In addition, carbidopa dose predicted NMSS total scores (p=0.037), but not total LEDD (p=0.91).

Conclusions

In PwP, measures of BK and DK were mainly associated with gastrointestinal problems, underpinning the importance of gastric absorption of oral medications and constipation and the related motor effects in PwP. Interestingly, carbidopa appears to have a role in non-motor symptoms in PwP, which deserves further investigation.
FM2-3 Slave to the rhythm: seasonal differences in non-motor symptoms in parkinson’s
Authors: Wamelen DV , Podlewska A , Leta V , Rizos A , Chaudhuri K
Published: February 2019

Objectives

To determine the effect of the change of season on non-motor symptoms in Parkinson’s disease (PD).

Design

Cross-sectional retrospective study.

Subjects

364 consecutive Parkinson’s patients in the London area taking part in the Non-motor Longitudinal International Study (NILS) study at King’s College Hospital London between November 2011 and April 2018.

Methods

Participants were divided into three groups based on their assessment date, using a simplified ecological seasonal model:

November until February;

March until 15 June;

16 June until October.

The primary outcome was a seasonal difference in non-motor symptom scale (NMSS) total scores and the secondary outcomes were NMSS subscores. Outcomes were adjusted for multiple testing using formal Bonferroni correction.

Results

102 patients were allocated to group 1, 105 patients to group 2 and 157 patients to group 3. Seasonal differences were present in NMSS total scores (p=0.042), especially between groups 1 and 3 (p=0.037). Differences were also present for NMSS domain 1 (cardiovascular and falls; p=0.004), 2 (sleep and fatigue; p=0.049), 4 (hallucinations; p=0.003) and 9 (miscellaneous; p=0.031). Within domain 9 there was only a significant difference for question 28 (smell; p=0.008).

Conclusions

These results indicate that non-motor symptoms in Parkinson’s fluctuate throughout the year with lowest scores in the summer months and highest in the winter months. These variations need to be taken into account to avoid inappropriate changes in medication regimes.
WP1-5 Surgical management of spinal meningiomas and appraisal of possible association with oestrogen receptor positive breast carcinoma
Authors: Wang D , Sadek AR , Nader-Sepahi A
Published: February 2019

Objectives

Evaluation of the presentation, demographics, pathology and outcomes associated with surgical management of spinal meningiomas and review of an association with a history of preceding breast carcinoma.

Design

A retrospective single-centre case series of surgically managed meningiomas over a 4 year period.

Subjects

184 cases of surgically managed intradural lesions from 2014 to 2018.

Results

48 patients were identified as having a spinal meningioma [26% of all spinal tumours]. 42 [88%] were female with a cumulative mean age of 69 years [SD ±10]. Most lesions were located in the thoracic spine [n=41]. The cohort had a Charlson comorbidity index of 3. Weakness [median MRC grade 3], neuropathic pain [mean NPS of 26/100] and problems with gait [median mJOA score of 2] were the commonest presenting symptoms. Post-operatively improvements in MRC, NPS, mJOA and SF36 scores were observed. 16% [n=7] of cases had a preceding history of oestrogen-receptor positive breast carcinoma, with a mean interval time between diagnoses of 8.1 years [SD ±5.1]. Risk analysis using baseline data from national cancer registries demonstrates that the likelihood of both diagnoses to be 4.9%, this is considerably lower than the observed 16% (p=0.01).

Conclusions

Analysis of our cohort has demonstrated an association between a preceding diagnosis of oestrogen-receptor positive breast carcinoma and spinal meningiomas that cannot be explained by chance alone.
FP2-1 Prognostic value of leucocytosis in paediatric traumatic brain injury
Authors: Mukherjee S , Sivakumar G , Goodden J , Tyagi A , Chumas P
Published: February 2019

Objectives

We assessed leucocytosis and evaluated its prognostic value in isolated paediatric traumatic brain injury (TBI).

Design

Retrospective analysis.

Subjects

106 consecutive paediatric patients with isolated TBI admitted between June 2008 and June 2016.

Methods

Initial blood leucocyte count (WCC), Glasgow Coma Score (GCS), computed tomographic (CT) findings, duration of hospital stay, and Paediatric Cerebral Performance Category Scale (PCPCS) scores were analysed.

Results

Mean age was 4.2 years. For patients with GCS 3–8, 9–13 and 14–15, WCC was 20, 15.9 and 10.7 × 109/L respectively. Differences in WCC were significant between the different GCS groups (p<0.01). Length of hospital stay, extent of midline shift on CT and poor 6 month PCPCS rating were each significantly correlated with WCC (p<0.05). Multivariate regression analysis revealed a cut-off WCC of 16.1 × 109/L, above which GCS, CT findings, length of hospital stay and PCPCS were less favourable. Application of the International Mission on Prognosis and Analysis of randomized Controlled Trials in TBI (IMPACT) adult TBI prediction model to our paediatric cohort, using area under the operating curve (AUROC) and coefficient analyses, demonstrated increased accuracy with incorporation of WCC as a risk factor.

Conclusions

High initial leucocytosis (>16.1×109/L) is predictive for poor GCS, severe CT findings, lengthy hospital stay and poor PCPCS in isolated paediatric TBI. Incorporating WCC into TBI prediction models may increase the accuracy of prognostication.
FP2-3 Ten years of paediatric neuro-oncology surgery: quantifying and predicting complications after surgery for intracranial tumour excision
Authors: Foster MT , Grayston R , Hennigan D , Harishchandra LS , Tonder LV , Millward CP , Pettorini B , Sinha A , Parks C , Burn S , Pizer B , Mallucci C
Published: February 2019

Objectives

To measure complications of paediatric neurooncology surgery using the Clavien Dindo grading scale, and identify predictors of surgical morbidity.

Design

Retrospective review of prospectively collected data.

Subjects

All paediatric patients treated with craniotomy for excision of intracranial tumour between 2008 and 2017 in a single tertiary paediatric neurosurgery centre.

Methods

Demographics, surgical details and perioperative complications were prospectively recorded between 0 and 30 days post operatively. These were retrospectively graded using the CD scale. Data analysis was done in R using logistic regression. Significance was defined as p<0.05

Results

Between 3/1/2008 and 21/12/2017 there were 322 operations, on 254 patients (142 Male). Median age at surgery was 9 years (IQR 4–13 years). 48% were without complication on the CD scale. Maximum CD grade complication for each procedure was 1 in 11%, 2 in 19%, 3A in 2%, 3B in 14%, and 4 in 0.6% of operations. 30 day mortality was 0.9%. CD grade of 3B or over was associated with infratentorial tumours (OR 2.24; CI 1.10–4.68; p=0.004) and WHO grade III tumours (OR 4.12; CI 1.56–10.86; p=0.028).

Conclusions

Complications in paediatric neurooncology surgery are common overall, but our results are favourable in comparison to the literature. The CD scale has limitations in neurosurgery but gives insight into the health economic impact of complications. Infratentorial tumours, and WHO grade III tumours were associated with increased morbidity.