bluuebunny/crossref_metadata_2025_split huggingface dataset:
WP1-16 Does time to diagnosis influence surgical decision making in primary malignant brain tumours?
Authors: Zienius K , Grant R , Brennan P 
Published: February 2019

ObjectivesTo assess whether time to diagnosis influenced surgical procedure and survival in primary malignant brain tumoursDesignRetrospective cohort study of adult patients newly diagnosed with a primary intra-cerebral tumour April 2010 – March 2015 referred to neuro-oncology centre in South-East ScotlandSubjects400 patients with primary malignant intracerebral tumoursMethodsUnivariate logistic regression analysis and multivariate Cox regression survival analysis were performedResultsOur dataset included 229 Males (57.7%), mean age 62.05 (SD14.01). Time to diagnosis did affect choice of surgical procedure. Patients undergoing biopsy had significantly longer TtD than those undergoing resection (28 vs 21 days, MWU test, p=0.035). 233 (58.3%) patients were deceased at 12 months. Having a cognitive first symptom (e.g confusion/memory changes) predicted not getting any surgical procedure (OR 2.95 [95% CI 1.8–4.8]). Where surgery was performed, first cognitive symptom was not predictive of type of surgery (biopsy vs debulking/excision) (OR 1.5 [95% CI 0.8–2.9] norhaving tumour in the frontal lobe (OR 0.9 [95% CI 0.5–1.7]. In multivariate analysis, increased hazard ratio of death at 12 month was significantly associated with a cognitive first symptom (HR 1.4 [95% CI 1.0–1.9] and KPS <70 (HR 1.69 [95% CI 1.2–2.4]).ConclusionsEarlier diagnosis is associated with getting debulking surgery rather than biopsy, and patient’s presenting symptoms influence surgical decision making and outcome.
WP1-18 Risk factors and patterns of recurrence of low grade glioma: a systematic review
Authors: Narbad V , Lavrador JP , Elhag A , Acharya S , Hanrahan J , Vergani F , Bhangoo R , Ashkan K 
Published: February 2019

ObjectivesTo review the risk factors and patterns of progression/recurrence of low grade glioma (LGG).DesignSystematic review of the published literature.SubjectsInclusion criteria were peer reviewed publications of cohort studies of recurrent/progressive LGG. Studies of wider populations were included if relevant LGG data could be analysed separately.MethodsMedline and Cochrane databases were searched using MeSH and non-MeSH terms, including ‘glioma’, ‘astrocytoma’, ‘oligoastrocytoma’, ‘diffuse glioma’, ‘oligodendroglioma’, ‘low grade’ and ‘disease recurrence’ by two independent reviewers.ResultsOverall, 917 studies were screened, of which 57 studies met the inclusion criteria. The most frequently described risk factor for recurrent LGG was suboptimal extent of resection (EOR) of the initial tumour (in 20 studies); recurrence was also associated with the patient’s age (2), tumour location (4), neurological status (3), tumour volume (6), bihemispherical tumour (3) and astrocytic histology (6). IDH mutation was associated with recurrence in 1 out of 3 studies, but TP53 mutation (2 of 4) and MGMT methylation status (4) were not. Malignant transformation was associated with TP53 mutations (3), IDH mutation (1) and EOR (1). Favourable progression free survival (PFS) and/or overall survival (OS) were associated with greater EOR (16), oligodendroglioma histology (2 of 4), initial KPS (3) and the use of adjuvant therapies (9 of 14). IDH mutation was associated with improved PFS and OS (3 of 4). TP53 mutation improved PFS in 1 of 3 studies. MGMT methylation and 1 p/19q codeletion may predict treatment response but their effects on survival are unclear.ConclusionsAstrocytoma histology, IDH and TP53 mutation statuses and surgical treatment (EOR) are essential in determining the time to recurrence or progression in LGG.
WP1-20 Investigating immunotherapy as an adjunct to surgery for brain metastases
Authors: Zakaria Rasheed , Jenkinson Michael D 
Published: February 2019

ObjectivesBrain metastases (BM) are more common due to improved survival from solid organ cancers. Immunotherapy is a promising treatment but little is known about the intracranial effects and there are no predictive biomarkers of response.DesignWe examined a prospective database of BM patients to compare those treated with surgery and immunotherapy versus surgery and standard adjuvant therapy.SubjectsWe identified 51 adult patients over 12 months operated for BM.MethodsOutcomes of 7 patients treated with surgery and immunotherapy were compared with matched controls, as well as examining the timing of surgery, radiation therapy and immunotherapy.ResultsPatients received ipilimumab or pembrolizumab alone or in combination. Median overall survival was greater in the group receiving immunotherapy (44 months vs. 14 months) despite no significant difference in primary, age or RPA score but there was no difference in intracranial progression. One patient with melanoma receiving ipilimumab prior to surgery underwent supra-marginal resection and peritumoral tissue showed growth pattern, macrophage and T-cell infiltration were all significantly different compared to matched melanoma cases not pre-treated with immunotherapy.ConclusionsImmunotherapy and surgery have been proposed to act synergistically on BM. Immunotherapy certainly influences the BM microenvironment and prolongs overall survival. A prospective biomarker study is planned to investigate the use of brain imaging as a predictor of systemic response to immunotherapy.
WP1-21 Maximum safe resection of large medial temporal intrinsic tumours: does the outcome justify the risk?
Authors: Kumaria A , Paterson A , Sitaraman M , Basu S 
Published: February 2019

ObjectivesTo analyse on the long-term outcomes in patients undergoing maximum safe resection (MSR) for large intrinsic temporal tumours.DesignCase seriesSubjectsAll patients undergoing MSR of large medial temporal intrinsic tumours between May 2006 and February 2012 at a tertiary neurosurgical centre with a minimum follow up of 6 years.MethodsRetrospective review of hospital records.ResultsFifty-one patients underwent MSR (28 male, 23 female); age range 20–80 years (mean age 55.3). There was no difference in laterality, although dysphasia was a feature in 32% of left-sided lesions. Presenting features in general included seizures (46%), headaches (27%), hemiparesis (12%) and visual field defects (6%). Surgery was generally well tolerated (median post-operative Karnofsky score 92.5). No patients developed new dysphasia or weakness, but there was transient worsening of existing hemiparesis (n=4) and dysphasia (n=2). Other complications included CSF leak/pseudomeningocoele (n=2), oculomotor palsy (n=1) and wound infection (n=1). Histopathological casemix was GBM (50%), WHO 3 gliomas (14%), WHO 2 gliomas (10%) and metastases (4%). In total, 57% of patients received radiotherapy and 35% received chemotherapy. Survival correlated with pathology; in glioblastoma patients it ranged from 2–19 months (mean 10.4 months). Survival in grade 3 tumours ranged from 10–38 months (mean 24.4 months). 60% of patients with Grade 2 tumours are surviving symptom free with no histological upscale at 8–10 years follow-up. No patient required a second debulking procedure.ConclusionsMSR did not result in survival benefit in glioblastoma. MSR is justified in lesions with pre-operative radiological features of Grade 2 glioma.
TM1-2 Diffuse low grade glioma after the 2016 WHO update, seizure characteristics, imaging correlates and outcomes
Authors: Roberts M , Hayhurst C , Shires J , Northmore T 
Published: February 2019

ObjectivesSeizures are a common presenting symptom in patients with low grade glioma (LGG). Exact mechanisms of epileptogenesis are unknown and the influence of radiological and histological characteristics are not well studied, particularly after the 2016 WHO reclassification of gliomas. We aimed to define predictors of seizure development and outcome in patients with LGG.DesignRetrospective single institution case series.Subjects63 patients who underwent resection of supratentorial LGG in a single institution, 45 presented with seizures.MethodsRetrospective analysis of patient records to assess seizure outcome and other demographics including radiological variables, tumour characteristics, type of surgery and histology based on the 2016 WHO update.ResultsAfter surgery, 33 patients (73%) who presented with seizures were Engel class I at median follow up of 43 months. Complete and near total resection were associated with improved Engel class compared to subtotal resection. Awake craniotomy gave improved seizure outcomes compared to under general anaesthesia (84% vs 65%). Molecular genetics did not predict seizure outcome. Updated histology did not predict seizures at diagnosis, only tumour heterogeneousity on initial MRI (p=0.043). Tumour volume at presentation impacted EOR but not seizure outcome.ConclusionsSeizure outcome is directly related to EOR. Tumour histology based on molecular genetics did not predict seizure development or outcome. Use of awake craniotomy results in greater EOR and improved Engel class.
TM1-3 Improved prediction of surgical resectability in patients with glioblastoma multiforme using an artificial neural network
Authors: Marcus A , Marcus HJ , Camp SJ , Nandi D , Kitchen N , Thorne L 
Published: February 2019

ObjectivesIn managing a patient with glioblastoma multiforme (GBM), a surgeon must weigh up whether sufficient tumour can be removed so that the patient can enjoy the benefits of decompression and cytoreduction, without impacting on the patient’s neurological status. In a previous study we identified the five most important anatomical features on a pre-operative MRI that are predictive of surgical resectability and used them to develop a grading system. The aim of this study was to apply an artificial neural network (ANN) to improve the prediction of surgical resectability.MethodsA prospectively maintained database was searched between February and August 2017 to identify all adult patients with supratentorial GBM that underwent resection. Pre-operative MRI scans were scored using the aforementioned grading system and post-operative scans assessed to determine the extent of resection. Performance of the standard grading system and ANN were then evaluated by analysing their Receiver Operator Characteristic curves; Area Under Curve (AUC) and accuracy were calculated and compared using the t-­test with a value of p<0.05 considered significant.ResultsIn all, 47 patients were included, of which 18 (38.3%) were found to have complete excision. The AUC and accuracy were significantly greater using the ANN compared to the standard grading system (0.87 vs. 0.79 and 0.81 vs. 0.77 respectively; p<0.01 in both cases).ConclusionsAn ANN allows for improved prediction of surgical resectability in patients with GBM.
TM1-5 Optimising observation strategies for incidentally discovered intracranial meningiomas
Authors: Islim AI , Mohan M , Moon RDC , Mills SJ , Brodbelt AR , Haylock BJ , Rathi N , Kolamunnage-Dona R , Jenkinson MD 
Published: February 2019

ObjectivesDevelop a model to identify incidental meningiomas at risk of observation failure.DesignRetrospective study (2007–2015).Subjects385 patients. Mean age 62.6 years.MethodsObservation failure was defined as: new symptoms, MRI progression (absolute growth rate 2 cm3/year or absolute growth rate 1 cm3/year +relative growth rate 30%/year) or loss of treatment options. A prognostic model was developed using MRI and patient comorbidity.ResultsOver a median of 36 months, 44 (10.9%) meningiomas failed observation. Median time to failure was 33 months. Model parameters were based on statistical and clinical considerations and included: increasing tumour size (HR=2.17 [95% CI=1.53–3.09], p<0.001), peritumoural signal change (HR=1.58 [95% CI=0.65–3.85], p=0.313), FLAIR/T2 hyperintense meningiomas (HR=10.6 [95% CI=5. 39–21.0], p<0.001) and proximity to neurovascular structures (HR=1.38 [95% CI=0.74–2.56], p=0.314). Patients were stratified based on the model into low, medium and high-risk groups and rates of failed observation at 5 years were 3%, 28% and 75% respectively. Low-risk patients had small meningiomas, free of all risk factors. After 5 years of follow-up the probability of failure plateaued in all risk groups. Older patients with comorbidities were 15-times more likely to die than to receive intervention at 5 years following diagnosis, regardless of risk group.ConclusionsMost meningiomas remain clinically and radiologically stable. Stratifying follow-up according to risk-group has the potential to reduce the cost to healthcare.
TP1-1 Endovascular versus surgical management of pericallosal artery aneurysms, single centre experience
Authors: Draz MS , Toma AK , Bezouich S , Grover P 
Published: February 2019

ObjectivesComparing surgical versus endovascular management of pericallosal artery aneurysm.DesignRetrospective case series.SubjectsPatients managed in our unit for pericallosal artery aneurysms.MethodsPatients medical and radiological records were reviewed collecting data about presentation, management, complications. Clinical outcome was assessed by mRS at 3,6 and 12 months. Imaging were reviewed to report aneurysm size and treatment outcome.ResultsAverage follow up period 3.3 years SD ±3.5. 38 patients had SAH and 19 were incidentally discovered. Initial CT showed SAH in 21 patients, IVH in 3,ICH in 3 IVH and ICH in 9. 33 patients treated using endovascularly, 13 patients conservatively and 2 by surgical clipping. 33% of endovascular group had stroke caused by approach related complications. 41.3% of the patients had mRS (0–2) at 3 months period. Increased to 46.5% at 12 months. Average imaging follow up was 1.5 years (SD ±1.6). 36.3% of endovascular group showed aneurysm remnant filling or recurrence.ConclusionsPericallosal artery aneurysms are complex in nature and both management modalities are challenging. Complications were high in endovascular group. Surgical intervention should be considered in selected patients where complex intervention is required.
TP1-4 In vitro induced cytokine response of astrocytes modelling conditions in human traumatic brain injury
Authors: Thelin EP , Hall CE , Frostell A , Tajsic T , Carpenter KLH , Hutchinson PJA , Patani R , Helmy A 
Published: February 2019

ObjectivesThe objective of this study was to investigate how in vitro astrocyte cultures respond to cytokine pro- and anti-inflammatory cytokine concentrations, corresponding to those seen in the aftermath of human TBI, by analysing downstream cytokine generation.DesignIn vitrostudy.SubjectsHuman induced pluripotent stem cells (iPSC)-derived astrocytes.MethodsThe astrocytes were exposed to levels of TNF (1–10,000 pg/ml), IL-6 (100–1,000,000 pg/ml), Interleukin-1β (IL-1β, 1–10,000 pg/ml), Interleukin-4 (IL-4, 1–10,000 pg/ml) and Interleukin-10 (IL-10, 1–10,000 pg/ml). Following 24, 48 and 72 hours, culture supernatant was extracted and analysed using a human cytokine/chemokine 39-plex luminex assay (ThermoFisher).ResultsThe astrocyte secretome revealed concentration-, time- or concentration*time-dependent production of downstream cytokines (12, 8 and 2 cytokines, respectively p<0.05). IL-1β and TNF exposure generated the most downstream cytokine production, while IL-6, IL-4 and IL-10 did not generally induce a robust response.ConclusionsiPSC-derived astrocytes exposed to cytokine concentrations reflecting those in TBI generate an increased downstream cytokine production, especially when exposed to IL-1β and TNF. This is in contrast to our previous work on neuronal cultures where IL-1β only produced a few down-stream cytokines.1More work is needed to better understand how different cells in the CNS respond to the neuroinflammatory milieu after TBI alone and in combination.
TP1-6 Pathological patterns of spinal cord blood flow after injury visualised with laser speckle contrast imaging
Authors: Gallagher MJ , Hogg FRA , Saadoun S , Papadopoulos MC 
Published: February 2019

ObjectivesIn humans the effect of spinal cord injury (SCI) on spinal cord blood flow (SCBF) is poorly understood. We imaged SCBF intraoperatively using laser speckle contrast imaging (LSCI).MethodsWe recruited 4 patients without SCI and 22 patients with SCI. Inclusion criteria for SCI patients are: AIS A–C, 18–70 years old, surgery within 72 hour of injury. In the SCI patients, we monitored spinal cord perfusion pressure and microdialysis from the injury site for 24 hour postoperatively. Mean patient follow-up after SCI was 7 m.ResultsLSCI signal is dampened by cerebrospinal fluid, but not dura. In patients without SCI we observed intact autoregulation, as well as SCBF variation with cardiac cycle, respiratory cycle and arterial pCO2. In SCI patients three pathological SCBF patterns were seen: necrosis-penumbra, patchy-perfusion and hyper-perfusion. Increase in MAP (>20 mmHg) increased overall injury site SCBF, but in 5/22 SCI patients there was a local steal effect where SCBF increased in some regions but decreased in others. In 7 SCI patients there was diastolic ischaemia, with regions only perfused in systole, but not diastole. Low injury site SCBF correlated with low spinal cord perfusion pressure, low tissue glucose, high tissue lactate and less improvement in combined sensory AIS score at follow-up.ConclusionsLSCI can be used to visualise SCBF non-invasively with high spatial-temporal resolution. We observed pathological SCBF patterns after SCI and some unanticipated SCBF responses to blood pressure changes.
TP1-7 Extended glasgow outcome scale – when would you rather die?
Authors: Hasan S , Uff C 
Published: February 2019

ObjectivesExtended Glasgow Outcome Scale is the primary outcome measure in trials involving neurotrauma patients. Conventional dichotomization characterises unfavourable outcomes as upper severe disability or worse, however RESCUE-ICP changed this to consider upper severe disability as a favourable outcome. As the recent consensus meeting in Cambridge proved, opinion of what constitutes acceptable recovery can vary widely between individuals.DesignTo survey patients with brain injury and compare them to the opinions of staff routinely involved in the care of such patients.SubjectsPatients with brain injuries, neurosurgery staff and ITU staff.MethodGOS-E sheets were given to neurotrauma patients and asked to circle the outcome they considered unfavourable and therefore would rather not survive. This was compared to the same question posed to neurosurgery staff members, and ITU staff members.Results67 responses collected (20 patients, 27 neurosurgery staff, 20 ITU staff). Mean GOS-E score deemed unfavourable and therefore not worth survival was 3.6, mode 3 (Patient mean 3.15, mode 3. Neurosurgery mean 3.63, mode 4. ITU mean 4.0, mode 5. p>0.05).ConclusionWhat constitutes unfavourable outcome varies between each group of people questioned. Patients who have experienced brain injuries were more likely to feel that upper severe disability was an acceptable outcome when compared to the staff that care for them. It is imperative we take this in to consideration when recommending treatment strategies in an acute setting.
TP1-9 Vestibular dysfunction in acute traumatic brain injury
Authors: Tsang K , Marcus HJ , Paine H , Sargeant M , Jones B , Smith R , Wilson MH , Seemungal BM 
Published: February 2019

ObjectivesVestibular dysfunction following traumatic brain injury (TBI) is a major cause of morbidity and unemployment and has impact on the patient’s ability to rehabilitate. Chronically, up to a quarter of TBI cases have cryptogenic dizziness and imbalance, possibly due to chronic brain adaptation that masks the diagnosis. Establishing the spectrum of vestibular diagnoses in acute TBI – when they may be more obvious – may aid diagnosis in chronic TBI cases.DesignProspective audit of referrals to specialist neuro-otology team.SubjectsConsecutive Major Trauma Ward TBI in-patients admitted between June 2014 and May 2015.MethodsAll cases were screened by the therapists for vestibular symptoms and/or signs and referred for specialist neuro-otology review.ResultsOf 111 patients screened, 96 had features of vestibular dysfunction. Of 96 cases, SYMPTOMS (i.e. subjective report) included: – imbalance (58.3%) – headache (50%) -dizziness (40%) Of 96 cases, SIGNS (i.e. examination) included: – gait ataxia (75.5%) – broken smooth pursuit (61.2%) – positive Hallpike (51%) – positive head impulse test (18%). The data indicate that BPPV affects 49% and headache with migraine-like features affect 40.8%. Acute peripheral unilateral vestibular loss affects 18% TBI cases.ConclusionsVestibular dysfunction in TBI is common, typically involving peripheral and central structures, often in the same case, and requires specialist neuro-otological management.
TP1-10 Non tumour brain biopsies in alder hey paediatric neurosurgery
Authors: Tonder LV , Foster M , Hennigan D , Kneen R , Iyer A , Parks C , Burn S , Mallucci C 
Published: February 2019

ObjectivesTo review the utility of non-tumour brain biopsies in Alder Hey Children’s NHS Foundation Trust Paediatric Neurosurgery Department.MethodsOperative records were searched for ‘biopsy’. Case notes were reviewed for referral source, histology, surgical complication and outcome. Tumour, epilepsy and non-brain biopsy cases were excluded.Results83 ‘biopsy’ cases were identified between 2008 and 2017. 31 tumour, 5 epilepsy, 2 infections and 28 non brain/other biopsies were excluded. 17 brain biopsies for non-tumour causes were seen. 15 patients were referred by neurology, 2 by rheumatology. 14 underwent a craniotomy/mini-craniotomy, 3 had burrholes.4 biopsies were non diagnostic, 2 were abnormal but inconclusive for diagnosis. Diagnoses included: 3 demyelinating lesions, 2 normal brain tissue, 1 neurosarcoidosis, 1 autoimmune encephalitis, 1 definite Rasmussen’s Encephalitis, 1 possible Rasmussen’s Encephalitis, 1 systemic lupus erythematosus associated CNS vasculitis, 1 inflammatory infiltrate (secondary to hydrocephalus/ventriculitis), 1 patient developed a late wound infection. No other surgical morbidities/mortalities were recorded. 11 of these cases had a change in management or the treating team were reassured due to the result of the biopsy (i.e. were able to start immunomodulatory drugs in the absence of infection).Conclusions65% of brain biopsies were diagnostic. 71% of biopsies either changed management or reassured the treating team about a line of management. The procedure is low risk with 0.06% morbidity and 0% mortality.