bluuebunny/crossref_metadata_2025_split huggingface dataset:
FP1-6 Factors influencing clinician’s participation in neurosurgical research – a multicentre cross-sectional study
Authors: Ansaripour A , Burford C , Hanrahan J , Korkor A , Ashkan K , Zebian B 
Published: February 2019

ObjectivesResearch remains a foundation in advancing the field of neurosurgery. We explore attitudes and perceived barriers to conducting research in neurosurgery globally.DesignA 29-item questionnaire, consisting of multiple-choice questions, Likert scales and short answers.SubjectsClinicians at various stages of the Neurosurgical career.MethodsThe questionnaire was distributed through the Society of British Neurological Surgeons (SBNS) and European Association of Neurosurgical Societies (EANS).ResultsA total of 324 responses from 29 countries consisted of Clinical Fellows (n=26), Junior Trainees (n=48), Senior Trainees (n=46), Sub-specialty Fellows (n=18), Consultants (n=128) and Professors of Neurosurgery (n=58). Whilst 83% of participants believe research is a crucial aspect of a neurosurgeons’ career, only a third (33%) believed that neurosurgery as a speciality fosters a culture that promotes research. The top three perceived barriers to conducting research were lack of time (78%), insufficient access to funding (58%) and lack of mentorship (49%). Despite these, more than 87% of participants are interested in formal academic roles with 58% willing to interrupt clinical training to pursue research opportunities. The region of clinical practice had no correlation with respondents’ research output or their perceptions towards research barriers.ConclusionsThis study identified important barriers to research, elucidating which, allows the neurosurgical community to improve integration of research into clinical practice.
FM2-1 A smartphone camera can detect functional tremor
Authors: Williams S , Fang H , Shepherd S , Alty J , Graham CD 
Published: February 2019

ObjectivesFunctional neurological disorders are common, but there is a lack of objective tests for these conditions. Although accelerometry can distinguish functional from other tremor types, it is not routinely used at the bedside. Computer vision describes the processing of camera images by computer. It requires only ubiquitous hardware (e.g. smartphone, laptop) and standard clinical assessment, i.e. simple observation. We investigated computer vision to detect tremor distraction/entrainment in functional tremor.DesignEarly results comparing computer analysis of video from a functional tremor and an essential tremor.Methods30 s (60 fps) video of extended forearm was recorded using a smartphone, for a functional tremor and an essential tremor patient. From 15 s, each participant tapped in time with a 3 Hz metronome using the contralateral hand (outside the video frame). Computing algorithms amplified the magnitude of video pixel movement and then measured the direction and size of pixel movement over time.ResultsAfter the metronome onset, there was a marked change in video pixel movement for the functional tremor patient, with the frequency concentrating at 3 Hz, and this was statistically significant by linear discriminant analysis. There was no significant change in pixel movement after the metronome for the essential tremor patient (frequency remained 8–12 Hz).ConclusionsSmartphone video pixel movement can detect functional tremor entrainment, suggesting a possible new objective, bedside test.
FM2-5 Shell shock or neurasthenia? The queen square experience in the first world war
Authors: Howard RD , Howard RS 
Published: February 2019

ObjectivesThe neurological response to psychological trauma during the Great War changed between the initial engagements, the final offensive and the later reflections of the Southborough enquiry.DesignAt Queen Square, neurasthenia was a recorded diagnosis from 1890 and, for the next 30 years, between 4%–8% of all admissions were so described. The term ‘shell shock’ was first used in 1914 but the diagnosis burgeoned until, by 1918, it amounted to 25% of all admissions.SubjectsEarly in the war, affected soldiers were rapidly evacuated to the UK, but attitudes changed after the Somme, because of the need to expedite return to the frontline. The use of ‘Electrical Therapy’ at Queen Square was an example of this imperative (Linden 2013).ResultsReview of the case records suggests that ‘Shell Shock’ became an increasingly pejorative term as the condition was seen as a ‘contagious psychological response of the weak.’ The records show it was largely restricted to the lower ranks whilst officers were generally considered to have neurasthenia requiring a more gentle psychotherapeutic approach, occasionally involving transfer to specialist facilities.ConclusionsUltimately, at Queen Square, the diagnosis and management of acute traumatic neurosis was driven by the needs of war but also by popular prejudice.
FM2-6 Cell delivery for intracerebral cell transplantation
Authors: Abdulla MAH , Jathoul AP , Rosser AE , Gray WP 
Published: February 2019

ObjectivesClinical trials of intracerebral cell replacement therapy (CRT) yield inconsistent results owing to poor graft survival and ectopic graft placement. A paucity of available CE marked specialised delivery systems and a lack of reliable delivery protocols could be major contributing factors to both phenomena. Here, we aimed to investigate current needle delivery strategiesin-vitroand in a large animal model in pigs.DesignIn-vitrolaboratory andin-vivopigs experiments.SubjectsIn-vitroAgarose gelIn-vivo: 4 white Landracer pigs.MethodsIn-vitro: Human Embryonic Kidney cells expressing luciferase and 0.6% agarose gel were used to test 3 delivery strategies:Bracelet deposit,Large deposit in a pre–formed tract,Multiple deposits in a pre–formed tract.In-vivo: Pigs underwent MRI- guided Human Foetal Luciferase-transduced cell transplantation into the putamen and thalamus. Post-operative MRI, Bioluminescence imaging (BLI) and histology were used to identify graft location and viability.ResultsUsing a commercially available needle delivery system, significant reflux of deposits was noted in all 3 delivery strategies duringin-vitrotesting. Depositing into a preformed tract yielded the best delivery, and was therefore used forin-vivotesting. Studies in pigs using MRI and BLI confirmed significant reflux and ectopic deposition of grafts.ConclusionsSimple needle delivery systems appear to suffer from significant reflux and ectopic cell deposition. This may adversely affect the outcomes of CRT trials in humans.
FM2-7 Paediatric robot-assisted DBS surgery: electrode problems and revision techniques
Authors: Oviedova A , Ellenbogen J , Hasegawa H , Kaminska M , Perides S , Lumsden D , Lin J , Ashkan K , Selway R 
Published: February 2019

ObjectivesWe review our cases of hardware problems requiring revision surgery and consider the technical aspects of revising the electrodes, including a frameless technique using the Renishaw Guide tubes.DesignRetrospective Review.SubjectsChildren (≤18 years old) who presented with hardware problems following implantation of a DBS for dystonia at King’s College Hospital between May 2005 and April 2018.MethodsInformation was obtained from a prospectively kept database.ResultsOf 166 paediatric patients with DBS, 25 patients had hardware problems, and of these 21 (13%) patients had specifically electrode problems requiring replacement/revision of one or more electrodes. 7 patients had high impedances requiring revision, without obvious lead migration of fracture. 7 patients had lead migration and a further 7 patients had a lead fracture with or without lead migration. 15 patients had original DBS insertion with the Leksell Stereotactic System utilising the Medtronic Stimlock for lead fixation. 6 patients had DBS inserted with the Renishaw Sterotactic Robot and utilised the Renishaw Guide Tubes, in these patients who required lead replacement it was possible to revise the electrode without using stereotactic apparatus. As the guide tubes are implanted in the correct trajectory it is possible to measure the distance required to advance/implant the lead within this to target without the need for full stereotactic reimplantation.ConclusionsElectrode dysfunction is relatively common in children with DBS and a systematic approach is required to identify the cause. When an electrode requires repositioning or replacement, the procedure can be performed in the conventional manner with a stereotactic frame, or freehand without a frame if a Renishaw Guide tube is used at time of first insertion.
P3 Outcomes following diagnostic brain biopsy: a 1 year case review
Authors: Ingleton R , Gorgun B , Gorgun N , Hayder M , Vindlacheruvu RR 
Published: February 2019

ObjectivesStereotactic brain biopsy is an established neurosurgical procedure utilised in times of diagnostic or therapeutic uncertainty. Achieving a definitive tissue diagnosis allows tailored surgical, medical or oncological management. We present a 1 year case review of brain biopsies and compare suspected pre-operative diagnosis with final tissue outcome.DesignRetrospective analysis of all brain biopsies performed in 2017 in an adult-only neurosurgical unit.SubjectsAll patients undergoing brain biopsy.MethodsTheatre records were retrospectively analysed to identify patients undergoing brain biopsy in 2017. Further information was obtained using electronic patient records and radiology reports.Results41 patients underwent brain biopsy in 2017. Only 1 proved inconclusive and required repeat procedure. 26 patients had a suspected diagnosis documented pre-operatively based on radiological/clinical evidence. The most commonly suspected pathologies were low grade and high grade gliomas (9 and 15 patients). Of 25 patients with both a pre-operative differential and subsequent conclusive tissue diagnosis, 10 (40%) were ultimately given diagnoses which did not match the suspected pathology. Significantly, 1 biopsy diagnosed cerebral lymphoma.ConclusionsBrain biopsy is a relatively safe and simple neurosurgical procedure which can reliably provide a definitive tissue diagnosis. We have demonstrated how it remains a crucial component in formally establishing diagnosis prior to determining optimum management plans.
P9 Impact of the relocation of a regional neuroscience service on major trauma patients
Authors: Cabaret C , Nelson M , Foroughi M 
Published: February 2019

ObjectivesEvaluating the impact of relocating a regional neuroscience service on major trauma patients.DesignRetrospective analysis of prospectively collected data from 01/08/2013 to 31/07/2017.SubjectsPatients≥20 years with a TBI in the 2 years pre-relocation (cohort 1) and 2 years post-relocation (cohort 2).MethodsPatients were identified using the TARN registry. Comparison of the cohorts for demographics, type of neurosurgical input, site of first presentation and the times to first CT head and operation was conducted using cross-tabulation, percentages and statistical analysis (SPSS).Results30% of patients in cohort 1 (112 or 373) were admitted in neurosurgery. This increased to 40% of patients in cohort 2 (181 of 450). There was an increase in admissions for monitoring (70% vs 82%). Patients<60 years had a higher increment in admission (+16 points) than patients≥60 years (+8 points). A strong association was found between the relocation of the neuroscience service and the increase in proportion of patients first transported to the major trauma centre (63% vs 74%; p=0.037). There was a significant decrease in the mean time to operation (3.9 hour vs 2.0 hour; p=0.008) and no significant difference in the mean time to first CT head (1.3 hour vs 1.4 hour; p=0.689).ConclusionsThe relocation of neurosurgery has resulted in a significant increase in admission of patients<60 years with TBI in neurosurgery for monitoring, an increase in the proportion of patients first transported to the MTC and a reduction in the time to operation.
P10 Traumatic brain injury outcomes in older adults: is there an age-dependent cut off?
Authors: Lavrador JP , Rajwani KM , Ansaripour A , Maratos E , Tolias C 
Published: February 2019

ObjectivesTo assess the outcomes in patients>60 years with traumatic brain injury (TBI) and determine if there is an age cut-off for worse prognosis.DesignSingle centre retrospective study. Data collected as part of TrIBAL study.SubjectsAll patients with TBI admitted to our hospital over a 4 month period.MethodsPatients were divided into 6 groups based on their age; group 0 included patients<60 years, 60≤Group 1<65, 65≤Group 2<70, 70≤Group 3<75, 75≤Group 4<80 and Group 5>80. Data was collected on various factors that influence outcomes in TBI patients including presenting GCS, hypotension, hypoxia, antithrombotic therapy and Marshall CT score. Glasgow outcome score (GOS) at discharge from hospital was used. A multinomial logistic regression analysis was performed.ResultsOver the 4 month period 144 patients with TBI were admitted. There were no significant differences in baseline characteristics including presenting GCS and Marshall CT scores between the groups. The GOS at discharge was significantly worse only in Group 5 when Group 0 was considered as the base outcome (p<0.001). Groups 1 to 5 had a significant increased number of patients on antithrombotic therapy when compared with Group 0 (p<0.05). The adjusted analysis for GOS at discharge revealed the use of antithrombotic therapy in Group 5 was the only factor that influenced outcome (p=0.014).ConclusionsIn this cohort, age >80 years was the cut off for worse prognosis. In this age group anticoagulation was the only factor we found that influenced outcome.
P14 Management of traumatic skull base fractures and their complications – a seven-year experience
Authors: Matloob SA , Hanrahan J , McKenna GS , Uff C , Paraskevopoulos D 
Published: February 2019

ObjectivesWe aim to present our experience of managing traumatic base of skull fractures and our outcomes.DesignRetrospective case note review.SubjectsAll patients in our trauma database with radiographic evidence of a skull base fracture from January 2010 to June 2017.MethodsSkull base fractures were classified according to their anatomical location. Evidence of vascular injury, CSF leak or cranial nerve injury were recorded. The mechanism of injury, length of follow up, interventions and outcomes were documented.Results872 cases had a skull base fracture diagnosed by head CT scan, of which 760 had sufficient radiological and clinic data to analyse. 79.4% of the cohort were male, with a mean age of 43 years. Median length of stay was 8 days and median length of follow up was 114 days. 40.1% were lost to follow up. The mortality rate was 14.9%. Injuries predominantly affected the middle cranial fossa. Vascular injury was the commonest complication (n=87), followed by CSF leak (n=38). 28 patients sustained injury to the facial nerve. Complications were managed conservatively in most cases.ConclusionsThere is little reported literature on the long term outcomes of patients who sustain CSF leak, vascular injury or cranial nerve deficit following a base of skull fracture. In our experience, many of these patients are lost to follow up and indeed, the nature of this study is limited by it’s retrospective nature. Further prospective work must be done in this patient group to better understand the history of these patients.
P16 Relation of timing of surgery to outcome from traumatic acute subdural haematoma
Authors: Paranathala M , Quake S , Prasad M 
Published: February 2019

ObjectivesAcute subdural haemorrhage (ASDH) is a neurosurgical emergency with high mortality and morbidity rates. Time to surgical intervention is implicated as an important factor affecting patient outcomes, however, more recent studies do not support this. We aimed to determine the correlation between time interval to surgery and outcome of patients with traumatic ASDH.MethodsWe retrospectively reviewed consecutive ASDH patients who underwent haematoma evacuation in the period between 2010 and 2016 at this tertiary neurosurgical centre. 49 patients were included for the analysis. Patient data was extracted from theatre records, patient notes and electronic records.ResultsThe median time interval from injury to surgery was 403 min (6 hours 43 min) with road traffic accident being the commonest mechanism of injury. 20 of 49 (34.7%) patients underwent evacuation within five hours from time of injury. Of these, 12 (41.4%) had good recovery (GOS 5), versus 15 (51.7%) amongst the 29 patients who underwent operation after five hours. Spearman rank correlation test (rs=0.07375) showed no statistically significant correlation between time interval to surgery and patient outcomes as measured by GOS. The overall mortality rate of evacuated patients at JCUH was 8.16% and the majority had good functional status, 55.1% with GOS 5.ConclusionsLonger time interval of more than four hours from injury to surgical intervention was not associated with higher mortality rate, or worse functional outcome.
P17 Evaluation of new orleans criteria for cranial CT scan in mild traumatic brain injury at an emergency trauma unit of a developing country
Authors: Yusuf AS , Mahmud MR , Dalhat NK , Olayiwola AI , Alfin JD , Abimbola AI 
Published: February 2019

ObjectivesTo assess compliance to New Orleans Criteria for cranial CT scan and its predictive value for intracranial pathology in mild TBI.DesignA retrospective review.SubjectsAll patients with mild traumatic brain injury presenting at the emergency unit of a National Trauma Centre of a Developing Country over 24 months.MethodsPatients information were retrieved from medical record and entered into SPSS spreadsheet. The New Orleans Criteria (NOC) was used to determine indications for brain CT scan. Compliance to the criteria was determined. The CT scan findings were evaluated in all patients that had scan and the findings were compared between those met NOC and those who did not.ResultsOne-hundred and eighteen patients were studied. Majority were males 92 (82%) with mean age of 27 year. Most injuries (66.9%) resulted from road traffic crashes. Among 65 (55.1%) patients who met NOC only 41 (63.1%) had CT scan while 25 (47.2%) patients who did not had CT giving a compliance rate of 58.5%. Twenty three (56.1%) patients who met NOC had abnormal CT compared to 9 (36%) patients that did not. The most common abnormal CT findings in both groups were skull vault fractures (9 for NOC group and 2 for non NOC group) only two patients had surgical intervention and both met NOC criteria.ConclusionsThe compliance for NOC guideline was below average in our Centre. NOC guideline is useful in predicting abnormal CT findings. There is a need for continuous education of emergency physicians to ensure optimal CT scan utilisation in mild TBI.
P18 The role of decompressive craniectomy for traumatic brain injury: should we be leaving the lid off?
Authors: Saukila LF , Little B , Phillips NI , Anderson IA 
Published: February 2019

ObjectivesThe RESCUEicp study has not culminated in consensus about the role of decompressive craniectomy following head injury. Another study (RESCUE-ASDH) also questions craniectomy for patients with ASDH. We examined our own practice over 5 years.DesignRetrospective analysis at a single UK unit. Comparison of outcomes with RESCUEicp results and national data obtained from the Neurosurgical National Audit Programme (NNAP).Subjects82 patients over 5 years. 87% male. 90% adults (age >16).MethodsLocal data: demographics, CT features, pre-op GCS/pupil reaction/ICP, primary/secondary craniectomy, operative timings, length of stay (critical care/overall), Extended Glasgow Outcome Scores, discharge location. NNAP data analysis.Results43% had ASDH with MLS >5 mm (91% primary decompression). Median time to primary surgery from referral 1 h37. 11 primary, 6 secondary decompressions/year; no change over 5 years 3 extensions of craniectomy, 3 had previous craniotomy converted. 30 day mortality 28%. Overall GOS-E: death 33%, lower severe disability 6%, upper severe disability 6%, moderate disability 16%, good recovery 37% (improved by better presentation GCS). 75% had cranioplasty. Median length of stay 41 days.ConclusionsOur practice has not changed over time, despite RESCUEicp. Good outcomes observed may be due to local specialist management of these patients, or reflect judicious case selection. Case-by-case decisions are crucial and may explain why large trials fail to change real-world management strategies. NNAP data comparison ongoing.
P23 Investigating synaptopathy following traumatic brain injury in a preclinical model
Authors: Jamjoom AAB , Qui Z , Rhodes J , Andrews PJD , Grant SGN 
Published: February 2019

ObjectivesThe impact of Traumatic Brain Injury (TBI) on the synapse is poorly understood. We examined the impact of TBI on the distribution of two postsynaptic density proteins (PSD95 and SAP102) at single-synapse resolution.Subjects44 male transgenic knock-in mice, aged 8–16 weeks, expressing fluorescently labelled PSD95 and SAP102.MethodsMice were randomised to a mild lateral fluid percussion injury (LFPI) or sham treatment and brain sections were examined at 7 and 28 days. Using high resolution confocal microscopy and machine learning algorithms, the synaptic puncta density, size and intensity were mapped across 222 brain regions. Microglia and presynaptic changes were indexed using Iba1 and SV2A immunostaining. Pearson correlation and t-tests were used (significance p<0.05).ResultsWe found a significant reduction in synaptic puncta density at 28 days post-injury in brain regions distal to the injury site including the hippocampus. PSD95 and SAP102 density changes had a strong positive correlation at 28 days (r=0.8; p<0.0001). We also observed evidence of synapse recovery in the ipsilateral cortex between 7 and 28 days. Puncta density had a positive correlation with SV2A (r=0.7; p<0.01) and a negative correlation with (r=−0.6; p<0.001) Iba1 count.ConclusionsFocal LFPI induced progressive region-specific loss of synapses for which microglia may play a role. Our study highlights the value of brain-wide synaptome mapping technology and suggests a capacity for synaptic recovery which could be a therapeutic target.
Farming tasks and the development of rheumatoid arthritis in the agricultural health study
Authors: Parks Christine G , Meyer Armando , Beane Freeman Laura E , Hofmann Jonathan N , Sandler Dale P 
Published: February 2019

ObjectivesFarming has been associated with rheumatoid arthritis (RA). Some studies have evaluated the effects of pesticides, but other agricultural exposures may also affect immune response.MethodsWe investigated non-pesticide agricultural exposures in relation to RA in licensed pesticide applicators (n=27 175, mostly male farmers) and their spouses (n=22 231) in the Agricultural Health Study (AHS) cohort (1993–1997) who completed at least one follow-up survey through 2015. Incident RA cases (n=229 applicators and 249 spouses) were identified based on self-report confirmed by use of disease-modifying antirheumatic drugs or medical records. Hazard Ratios (HRs) and 95% Confidence Intervals (CIs) were estimated by Cox proportional hazard models adjusting for applicator status, state, smoking, education and specific pesticide use, allowing estimates to vary by median age when hazards assumptions were not met.ResultsOverall, RA was associated with regularly applying chemical fertilisers (HR=1.50; 95% CI 1.11 to 2.02), using non-gasoline solvents (HR=1.40; 95% CI 1.09 to 1.80), and painting (HR=1.26; 95% CI 1.00 to 1.59). In older applicators (>62 years), RA was associated with driving combines (HR=2.46; 95% CI 1.05 to 5.78) and milking cows (HR=2.56; 95% CI 1.01 to 6.53). In younger participants (≤62 years), RA was inversely associated with raising animals as well as crops (HR=0.68; 95% CI 0.51 to 0.89 vs crops only). Associations with specific crops varied by age: some (eg, hay) were inversely associated with RA in younger participants, while others (eg, alfalfa) were associated with RA in older participants.ConclusionThese findings suggest several agricultural tasks and exposures may contribute to development of RA.