bluuebunny/crossref_metadata_2025_split huggingface dataset:
P55 The neurosurgical physician: a new role in the UK
Authors: Stewart PJ , Martin J , Thomas J , Hayhurst C 
Published: February 2019

ObjectivesWith reduction in numbers of junior doctors and strict deanery requirements for training opportunities, the provision of ward cover and continuity has consistently fallen. Various methods of addressing this have been implemented in the UK, including increased nurse practitioners and physician associates. We introduced a new position of GP with a specialist neuroscience interest in line with the North American model of hospitalist and review the impact on patients and trainees.DesignQualitative descriptive study.Subjects14 core and speciality trainees.MethodsRetrospective review of the impact of a permanent neurosurgical physician on ward care and provision of training with a qualitative study of trainee experience. Saturation was reached at 14 interviews.ResultsA neurosurgical physician role was instituted in 2013, enabling a formal training rota to fulfil deanery requirements for core training and provide continuity of care at senior medical level, reducing medical ward consults to zero, improved communication with relatives and reduced the need for ST ward rounds. Qualitative assessment revealed a senior medical presence aided trainees own knowledge, resulted in better rapport and communication with patients and improved patient care through knowledge of best medical practice guidelines.ConclusionsThe addition of the neurosurgical physician role has positively impacted on the quality of patient care and junior doctor training. Senior medical care is provided with continuity, in contrast to other models.
P68 Activation of the geste antagoniste improves speed of finger tapping in organic and functional dystonia
Authors: Newby RE , Muhamed S , Smith S , Alty JE , Jamieson S , Kempster PA 
Published: February 2019

ObjectivesThe geste antagoniste is a typical feature of dystonia’s motor phenomenology. Gestes may also occur in functional dystonia. We investigated how gestes affect the kinematics of voluntary movement.DesignCross-sectional study.SubjectsTwenty-three patients with organic dystonia and three with functional dystonia were studied.MethodsFinger tapping was assessed while subjects wore electromagnetic sensors secured to index finger and thumb. Subjects were instructed to tap ‘as fast and as big as possible’ for 15 s, first with and then without activation of their geste. Precise position and orientation data, in six degrees of freedom, were recorded. Separable motor components were derived from a comparison of the x, y and z coordinates of each sensor. The product of amplitude and frequency, giving the sensor excursion per unit time, was used as a measure of average speed. A repeated measures ANOVA was conducted, with the factors CONDITION (with vs without geste), HAND (dominant vs non-dominant) and GROUP (organic vs functional).ResultsFor average speed, there was a significant effect of CONDITION—patients with both organic and functional dystonia performed better with geste (F1,24=13.5; p=0.001). There was no main effect of HAND or GROUP.ConclusionsGeste antagonistes enhance motor performance in organic and functional dystonia. These selective voluntary movements may have a general effect on the execution of motor plans in dystonia. Sample numbers were too small to allow meaningful analysis of GROUP effects.
P81 Intraoperative MEP recordings from a urethral sphincter electrode for spinal conus tumour surgery and its importance
Authors: Shaikh A , Hilaya LA , Wilma G , Forster A , Ross S 
Published: February 2019

ObjectivesTo emphasise the importance of motor evoked potential (MEP) recordings from a simple urethral sphincter electrode along with routine use of bulbocavernosus reflex recordings, anal sphincter and other lower limb muscle free running and stimulated EMG and MEP’s, and SEP techniques for sphincter preservation.DesignCase report.SubjectsPatients with conus or other spinal lesions at risk of postoperative sphincter disturbance.MethodsTranscranial ‘train of 5’ stimulation (5 pulses, interstimulus interval 4msec, 200 µsec pulse width) was applied, with recordings from the urethral sphincter (small electrode taped to Foley catheter to lie just inside the urethra, referred to nearby needle anteriorly in mons pubis) and anal sphincter (paired needle electrodes in both left and right sides of external sphincter).ResultsIntraoperative stimuli of structures during dissection at one point gave a motor response confined to the urethral sphincter suggesting that these fibres may have been considered non-functional and cut had these not been assessed separately. Urethral sphincter MEP’s during the dissection confirmed that these motor fibres remained in continuity throughout.. The patient was intact after tumour removal.ConclusionsThis is an avant-garde technique by which we managed to save the nerve supply to the urethral sphincter and eventually urinary continence which would have been compromised if separate urethral monitoring was not attempted along with usual intraoperative nerve monitoring. We believe its first in the UK.
P91 Post-operative pain in neurosurgery
Authors: Haigh PM , Al-Hatimi F , Stewart H , Rajagopal S , Khalifa S , Smart J 
Published: February 2019

ObjectivesAre the analgesic guidelines for those neurosurgical operations associated with major and complex major pain consistently followed? Is there a correlation between adherence and post-operative pain?DesignPatients undergoing spinal surgery and foramen magnum decompressions were visited on the first post-operative day (D1). They provided their pain score subjectively (0=nil; 10=worst ever experienced); objectively we recorded whether they could move in/out of bed without pain limitation.Subjectsn=57 consecutive patients undergoing elective major and complex major pain neurosurgery between April and June 2018 at the NHNN, Queen Square.MethodsA proforma was completed on D1. The patients consented to take part and answered three questions. We examined what (if any) analgesics they were admitted on, and what had been prescribed to cover the post-operative period. This was compared against the appropriate guideline for that category of operation.ResultsGuidelines were only followed in 16/57 (28.1%) cases; not followed in 41/57 (71.9%). On an unpaired T-test: 2-tailed P value=0.0195. Where guidelines were followed, the mean pain score reported was: 3.75 (SD 2.72) Where not followed, the mean pain score was 5.46 (SD 2.29). So with a 95% confidence interval −3.41 to −0.29, there is a significant difference between the pain in those prescribed according to the guidelines and those that were not.ConclusionsThe pain guidelines are not routinely followed. Most commonly this was due to no prescription for a non-steroidal anti-inflammatory agent. We suggest regular sessions of education of the guidelines. Cycle 2 closed the loop of the audit. We re-reviewed adherence and pain scores and found guidelines were followed in 34% of cases, which represented a 6% improvement. On a paired two-tailed P value=0.0794. The mean pain score where guidelines were followed=3.42 (SD1.62) against a mean=4.74 (SD 1.89) where guidelines were not followed.
P102 Shunting slit ventricles: a comparison of the parieto-occipital vs frontal approach
Authors: Craven CL , D’Antona L , Thompson S , Ramos J , Sennik S , Watkins LD , Toma AK 
Published: February 2019

ObjectivesSlit ventricles can be a challenging target during shunt catheter insertion. Traditionally, the frontal approach has been considered optimal. At this centre, routine use of electromagnetic (EM) stereotatic guidance (StealthTM, Medtronic) has enabled a parieto-occipital burr hole approach to the frontal horns. We compare shunt placement and revisions required for patients with slit ventricles who had shunts inserted via a parieto-occipital (P-O) approach vs. frontal shunt.DesignRetrospective cohort.SubjectsPatients with slit ventricles and a ventricular shunt inserted using EM guidance between 2012–2018.MethodsSlit ventricles were defined as <3 mm (widest). Outcome measures included placement accuary and survival using Kaplan-Meier curve.Results82 patients (77F:5M) aged 34.9±10.8 years (mean ±SD) had shunts inserted for IIH (n=63), chiari/syrinx (n=8), congenital hydrocephalus (n=10), pseudomeningocoele (n=1). 35 had primary P-O shunts and 46 had frontal shunts. Overall, 94% of cases had the catheter tip sitting in the frontal horn. The P-O approach was just as accurate as the frontal approach. Eight P-O shunts and 9 frontal shunts required revision over a 60 month periods. There was no significant different in shunt survival between the two approaches (p=0.99).ConclusionsEM guided placement has enabled the P-O approach to be as safe and with equivalent survival to frontal approach. The accuracy of shunt placement between the two approaches was equivocal.
P109 Experience of tunnelled vs. bolt EVDs on the intensive care unit
Authors: Asif H , Craven CL , Reddy U , Watkins LD , Toma AK 
Published: February 2019

ObjectivesThe placement of an external ventricular drain (EVD) is a common neurosurgical operation that carries great benefit in acute hydrocephalus but is not without risk. In our centre, bolt EVDs (B-EVD) are being placed in favour of tunnelled EVDs (T-EVD). The former has allowed for urgent CSF diversion in ITU. We compared EVD survival and complication rates between the two types of EVDs.DesignSingle centre prospective case-cohort.SubjectsTwenty-five patients with B-EVDs and thirty-four patients with T-EVDs.MethodsClinical notes and radiographic reports were collected before and after the placement of EVDs for patients in ITU between January 2017 and June 2018.ResultsFourteen of the 25 B-EVDs were placed on ITU, of which 2 were under stealth guidance. All 34 T-EVDs were placed in theatre. Mean time to CSF access after decision for diversion was 134 min in the B-EVD group and 227 min in the T-EVD group (p<0.05). Mean survival was 35 days for B-EVDs and 29 days for T-EVDs (p<0.05). Eight T-EVDs went onto be replaced as B-EVDs due to retraction or infection. Complications including infection, detachment or retraction were higher in the T-EVD group at 32% compared to 20% in the B-EVD group.ConclusionsBolt EVDs have a lower frequency of complications and higher survival compared to tunnelled EVDs. Since B-EVDs require fewer resources they can be placed faster and on ITU.
P111 Successful treatment of type 1 spinal dural arteriovenous fistula results in reduction of spinal cord volume
Authors: Visagan R , Norman I , Elhag A , Correia J , Walsh D 
Published: February 2019

ObjectivesTo examine the utility of standardised volumetric spinal cord measurement as an indicator of successful disconnection of a Type 1 spinal dural arteriovenous fistula.DesignRetrospective analysis at a tertiary neuroscience centre.SubjectsPatients with symptomatic Type 1 spinal dAVFs presenting to the senior author and neurovascular MDT (June 2009 – December 2017). Inclusion based on availability of appropriate cross-sectional imaging. DAVFs arising below T12 excluded: 18 patients with a total 19 dAVFs identified.MethodsType 1 fistulation demonstrated on TRICKS MR angiography and spinal catheter angiography. Sagittal volumes evaluated using Horos (Purview, Annapolis, USA) and wireframe models created. Measurement arbitrarily standardised at ±2 levels from the origin of the fistulous draining vein. Pre- and post-operative clinical outcomes assessed using the Aminoff-Logue Scale. Wilcoxon test employed for between-group comparisons and Spearman’s rank test for clinico-radiological correlation (Prism 7, GraphPad Software, Inc. California).ResultsCord volumes reduced by a mean of 0.854 cm3 (p=0.0181; 95% CI=−1.55,–0.16; SD=1.44). Volume change was not related to gait (r=0.037, p=0.8812, 95% CI=−0.44, 0.49) or micturition scores (r=−0.24, p=0.3165, 95% CI=−0.64, 0.25).ConclusionsSurgical disconnection of type 1 dAVF resulted in a reduction in spinal cord volume. This was not predictive of change in clinical indices in this small series but perhaps merits investigation of this as a surrogate marker in a larger series.
P118 A novel technique for repair of the vertebral artery during cranial surgery
Authors: Bonanos G , Prasad M , Mukerji N 
Published: February 2019

ObjectivesTo demonstrate a novel/alternative technique for repair of the vertebral artery intraoperatively.DesignLeft-sided retromastoid craniotomy in one patient.SubjectsA 61-year-old male patient with meningioma in the foramen magnum encasing the vertebral artery on the left side.MethodsStandard retrosigmoid craniotomy performed with preservation of transverse and sigmoid sinuses. The dura was opened and the cerebellum was retracted with CSF release. The tumour was debulked gradually. The attempt to peel the tumour from the vertebral artery resulted in arterial bleeding. The hole in the artery was sealed using an N-hydroxysuccinimide functionalised polyethylene glycol-coated collagen patch (Hemopatch®, Baxter Healthcare Ltd) as an onlay, applying pressure for 2 minutes. Another patch was applied for further support and the artery checked for haemostasis. The dura was closed with 3–0 vicryl and Hemopatch® onlay after further tumour debulking.ResultsHaemostasis of the vertebral artery was achieved at 140 mmHg SBP and a catheter angiogram found no dissection or false lumen. The patient did not suffer postoperative haemorrhage and after three months of inpatient rehabilitation was discharged with significantly improved cranial nerve function. There was no CSF leak.ConclusionsHaemostasis was successfully achieved in the vertebral artery with this novel technique. It can prove to be important in such scenarios where direct cross-clamping and arterial repair is technically challenging and can lead to brainstem ischemia.
WP1-1 Sphenopalatine ganglion stimulation for chronic cluster headache
Authors: Miller S , Lagrata S , Matharu M , Zrinzo L 
Published: February 2019

ObjectivesTo assess outcome of sphenopalatine ganglion stimulation (SPGS) in chronic cluster headache (CCH) in a UK centre.DesignUncontrolled open-label single centre prospective study.SubjectsNine patients with medically refractory CCH.MethodsParticipants underwent sphenopalatine ganglion stimulator implantation, ipsilateral to CCH symptoms via a gingival incision, with fluoroscopy guidance and dyna-CT confirmation of contact location adjacent to the Vidian canal in the pterygopalatine fossa. One month after surgery, the device was programmed. Patients were instructed to provide stimulation as early as possible after attack onset and at least twice daily. The primary outcome was change in headache frequency as well as adverse events.ResultsMean follow up was 14 months (SD 11.1, range: 3–31) with median reduction in headache frequency at last follow up of 73% (IQR: 67%–88%). At 3 months post op, 4/9 (45%) had at least 50% reduction in frequency of attacks; this increased to 8/9 patients (89%) at last follow up. Two patients became pain free (after 3 and 9 months). Preventative effects were seen in 7/9 and an acute effect in 2/9. One patient suffered numbness over the V2 distribution and did not respond to SPGS. The stimulator was removed 1 year later at the patient’s request. One wound infection settled with oral antibiotics.ConclusionsInitial data from the UK confirms the results from previous studies and compares well with the results of occipital nerve stimulation for CCH.
P15 Resuming antiplatelet and anticoagulant therapy following isolated traumatic brain injury in adults: a national survey and review of literature
Authors: Valenzuela T , Fellows D , Zaben M , Shastin D , Leach P 
Published: February 2019

ObjectivesAntithrombotics use in the elderly is widespread and is seen as a risk factor for intracranial complications following TBI. Antithrombotics are commonly discontinued on admission, with little guidance on when or how to restart them. This study aims to establish current national practices with restarting antithrombotic medications following TBI and review available evidence identifying areas for further research.DesignAn online survey and a literature review.SubjectsSBNS members.MethodsA SBNS Academic Committee approved survey with five TBI scenarios dealing with different antithrombotics. Respondents were asked to indicate when they would restart the medications for each scenario and what drives their decision.ResultsPreliminary results included responses from 22 consultants. The most common practice was to restart antithrombotics after two weeks; however, less than 50% agreed on each individual option. About 50% had the same approach to everything and 1/3 believed single antiplatelet can be resumed earlier than dual antiplatelets. Other deciding factors included size of intracranial bleed, patient’s neurological recovery, and follow up imaging. Some advocated involving the physicians. Final results following a repeat dissemination of the survey will be presented at the meeting.ConclusionsThere is obvious discrepancy in how the problem of restarting antithombotics following TBI is approached nationally. Further research is needed to help decision making with this everyday clinical problem.
Optical Radiomic Signatures Derived from Optical Coherence Tomography Images Improve Identification of Melanoma
Authors: Turani Zahra , Fatemizadeh Emad , Blumetti Tatiana , Daveluy Steven , Moraes Ana Flavia , Chen Wei , Mehregan Darius , Andersen Peter E. , Nasiriavanaki Mohammadreza 
Published: February 2019

Abstract

The current gold standard for clinical diagnosis of melanoma is excisional biopsy and histopathologic analysis. Approximately 15–30 benign lesions are biopsied to diagnose each melanoma. In addition, biopsies are invasive and result in pain, anxiety, scarring, and disfigurement of patients, which can add additional burden to the health care system. Among several imaging techniques developed to enhance melanoma diagnosis, optical coherence tomography (OCT), with its high-resolution and intermediate penetration depth, can potentially provide required diagnostic information noninvasively. Here, we present an image analysis algorithm, “optical properties extraction (OPE),” which improves the specificity and sensitivity of OCT by identifying unique optical radiomic signatures pertinent to melanoma detection. We evaluated the performance of the algorithm using several tissue-mimicking phantoms and then tested the OPE algorithm on 69 human subjects. Our data show that benign nevi and melanoma can be differentiated with 97% sensitivity and 98% specificity. These findings suggest that the adoption of OPE algorithm in the clinic can lead to improvements in melanoma diagnosis and patient experience.

Significance:
This study describes a noninvasive, safe, simple-to-implement, and accurate method for the detection and differentiation of malignant melanoma versus benign nevi.
Tissue 2-Hydroxyglutarate as a Biomarker for Isocitrate Dehydrogenase Mutations in Gliomas
Authors: Sim Hao-Wen , Nejad Romina , Zhang Wenjiang , Nassiri Farshad , Mason Warren , Aldape Kenneth D. , Zadeh Gelareh , Chen Eric X. 
Published: February 2019

Abstract

Purpose:
Isocitrate dehydrogenase (IDH) mutations are common in low-grade gliomas and the IDH mutation status is now integrated into the WHO classification of gliomas. IDH mutations lead to preferential accumulation of the R- relative to the S-enantiomer of 2-hydroxyglutarate (2-HG). We investigated the utility of tissue total 2-HG, R-2-HG, and the R-2-HG/S-2-HG ratio (rRS) as diagnostic and prognostic biomarkers for IDH mutations in gliomas.
Experimental Design: Glioma tissue and blood samples from 87 patients were analyzed with HPLC-MS/MS coupled with a CHIROBIOTIC column to quantify both enantiomers of 2-HG. ROC analysis was conducted to evaluate the sensitivity and specificity of 2-HG, R-2-HG, and rRS. The feasibility of real-time determination of IDH status was evaluated in 11 patients intraoperatively. The prognostic value of rRS was evaluated using the Kaplan–Meier method.

Results:
The rRS in glioma tissues clearly distinguished patients with IDH-mutant versus wild-type tumors (P &lt; 0.001). Sensitivity and specificity using an rRS cut-off value of 32.26 were 97% and 100%, respectively. None of total 2-HG, R-2-HG, or rRS was elevated in serum samples. Among patients with IDH-mutant tumors, tissue rRS stratifies overall survival. The duration of tissue analysis is approximately 60 minutes.

Conclusions:
Our study demonstrates that rRS is a reliable biomarker of IDH mutation status. This technique can be used to determine IDH mutation status intraoperatively, and to guide treatment decisions based on IDH mutation status in real time. Finally, rRS values may provide additional prognostic information and further validation is required.
MCL1 and DEDD Promote Urothelial Carcinoma Progression
Authors: Hong Andrew L. , Guerriero Jennifer L. , Doshi Mihir B. , Kynnap Bryan D. , Kim Won Jun , Schinzel Anna C. , Modiste Rebecca , Schlauch Amy J. , Adam Rosalyn M. , Kwiatkowski David J. , Beroukhim Rameen , Letai Anthony , Rosenberg Jonathan E. , Hahn William C. 
Published: February 2019

Abstract

Focal amplification of chromosome 1q23.3 in patients with advanced primary or relapsed urothelial carcinomas is associated with poor survival. We interrogated chromosome 1q23.3 and the nearby focal amplicon 1q21.3, as both are associated with increased lymph node disease in patients with urothelial carcinoma. Specifically, we assessed whether the oncogene MCL1 that resides in 1q21.3 and the genes that reside in the 1q23.3 amplicon were required for the proliferation or survival of urothelial carcinoma. We observed that suppressing MCL1 or the death effector domain–containing protein (DEDD) in the cells that harbor amplifications of 1q21.3 or 1q23.3, respectively, inhibited cell proliferation. We also found that overexpression of MCL1 or DEDD increased anchorage independence growth in vitro and increased experimental metastasis in vivo in the nonamplified urothelial carcinoma cell line, RT112. The expression of MCL1 confers resistance to a range of apoptosis inducers, while the expression of DEDD led to resistance to TNFα-induced apoptosis. These observations identify MCL1 and DEDD as genes that contribute to aggressive urothelial carcinoma.

Implications:
These studies identify MCL1 and DEDD as genes that contribute to aggressive urothelial carcinomas.