bluuebunny/crossref_metadata_2025_split huggingface dataset:
TP1-2 Treatment of dural and direct caroticocavernous fistulas via the transorbital approach
Authors: Ilyas M , Rennie A 
Published: February 2019

ObjectivesTo analyse the outcome of this novel approach in patients with Caroticocavernous fistulas (CCFs) and to compare it with the commonly used transvenous pathway.DesignRetrospective analysis of patients with CCFs treated using the transorbital approach.Subjects10 patients were identified following review of inpatient databases and collection of information for those treated offsite.MethodsAnalysis 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).ResultsNo 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.ConclusionsTransorbital 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

ObjectivesManaging 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.DesignSystematic review of this subject.Subjects260 paediatric patients within 12 studies were included within our criteria.MethodsA 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.ResultsNine 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.ConclusionsThe 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

ObjectivesAt 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.DesignProspective cohort.SubjectsPatients with aSAH who underwent over 24 hours of multi-modal PbtO2, temperature and intracranial pressure (ICP) monitoring via a Raumedic NEUROVENT-PTO probe.MethodsLongitudinal analysis of PbtO2 values, presented as mmHg (mean±SD).ResultsAnalysis 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).ConclusionsPbtO2 <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

ObjectivesPercutaneous 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.DesignRetrospective audit of prospectively collected data.SubjectsAll patients undergoing PBC at our centre.MethodsTheatre 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.ResultsTotal 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.ConclusionsPBC 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

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

ObjectivesLumbar 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.DesignSingle centre prospective observational study.SubjectsFifty-four patients (42F:12M, mean age 38±12 years) were included.MethodsPatients 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.ResultsThe 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).ConclusionsOur 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

ObjectivesIdiopathic 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.DesignSingle centre case series.SubjectsTwenty-four IIH patients underwent stent insertion on discovery of DVSS with medical management ongoing.MethodsClinical notes, radiographic reports and 24 hour ICP monitoring data before and after stent placement was collected.ResultsAfter 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).ConclusionsDVSS 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

ObjectivesTo study the presentation, management and outcomes of symptomatic intracranial arachnoid cysts.DesignRetrospective records review.SubjectsAll cases coded as intracranial cysts.MethodsPatients 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.ResultsMales 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).ConclusionsSymptomatic 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

ObjectivesA 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.DesignA 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).Subjects21 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.MethodsMedical records were retrospectively reviewed for demographics, interventions and clinical outcomes.ResultsMean 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.ConclusionsVP 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

ObjectivesExternal 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.DesignSurvey and experimental study.Subjects23 neurosurgical units surveyed. Porcine cadaver experimental model.MethodsSurvey 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.ResultsNationally, 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.ConclusionsAn 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

ObjectivesTo analyse the efficacy of epilepsy surgery in reducing the burden of seizures in a paediatric population – a single centre 10 year experience.DesignSingle centre retrospective review of medical records.Subjects74 consecutive paediatric patients who underwent epilepsy surgery between 2008–2017 by one neurosurgeon at a single centre.MethodsSeizure 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.ResultsThe 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.ConclusionsEpilepsy 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

ObjectivesThis 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.DesignA retrospective audit design was used.SubjectsWe 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.MethodsData 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.Results38 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.ConclusionsThere 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

ObjectivesThe 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.ResultsBy 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.ConclusionsThe 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

ObjectivesTo 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.DesignCross-sectional retrospective study of participants enrolled in the Non-motor Longitudinal International Study (NILS, UKCRN No: 10084) at King’s College Hospital, London.Subjects108 PwP with a PKG recording within 4 months of a NILS assessment were included in the analysis.MethodsPKG 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).ResultsUsing 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).ConclusionsIn 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.