bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multiple risk exposures for reading achievement in childhood and adolescence
Authors: Taylor Catherine Louise , Zubrick Stephen R , Christensen Daniel 
Published: February 2019

BackgroundLiteracy is championed as a pathway out of poverty, yet it is vulnerable to the risk circumstances it seeks to mitigate. This study explored the developmental circumstances that gave rise to stark inequalities in reading achievement in Australian children across 6 years of school.MethodsWe used data fromGrowing up in Australia: the Longitudinal Study of Australian Children linked to Australia’s National Assessment Program-Literacy and Numeracy across school years 3, 5, 7 and 9. Latent class analysis and growth curve modelling (n=4983) were used to identify risk profiles for reading achievement for children (ages 8.2–15.2).ResultsFour distinct profiles were identified: developmentally enabled profile (62% of children); sociodemographic risk profile (25% of children); child development risk profile (11% of children); and sociodemographic and child development (double disadvantage) risk profile (2% of children). Children with a developmentally enabled profile achieved the expected rate of growth of 1.0 year per year of school across years 3, 5, 7 and 9. By comparison, children with sociodemographic and/or child development risk profiles started behind their developmentally enabled peers, and lost ground over time.DiscussionAcross 6 years of school, multiple risk-exposed children lagged behind low risk-exposed children in the order of years of lost gains in reading achievement. The results point to the complex contexts of educational disadvantage and the need for cross-cutting social, health and education policies and coordinated multiagency intervention efforts to break the cycle of educational disadvantage.
WP1-8 Radiographic markers of disturbances in CSF dynamics: correlating imaging with 24-hour ICP monitoring
Authors: Asif H , Craven C , Thorne L , Watkins L , Toma A 
Published: February 2019

ObjectivesDisorders with chronically elevated ICP have salient imaging findings associated with the sella turcica and optic nerves. We aim to quantify the degree of correlation between imaging features and ICP.DesignProspective case-cohort study.SubjectsOne-hundred and twenty-six patients (35M:91F) underwent ICPM with recent MR imaging.MethodsT1-saggital views for sella volume, optic nerve vertical tortuosity, then T2-axial views for optic nerve sheath distension were blindly reviewed against respective median ICP and pulse amplitudes (PA). Imaging was triple reviewed for discordant values.ResultsThe mean ICP of four sella morphologies (full/flat/concave/empty) were 1.2, 4.8, 8.4 and 16.7 mmHg respectively (p<0.01). AUROC for sella morphology predicting ICP was 0.81. This measurement was able to detect minimum ICP of 5.3 mmHg with 73.0% sensitivity and specificity, 73.0% PPV and 69.8% NPV. The mean PA values were 4.0, 5.2, 6.1 and 9.6 mmHg respectively (p<0.01). AUROC for sella morphology predicting PA was 0.78. This measurement was able to detect minimum PA of 5.47 mmHg with 76.3% sensitivity, 79.5% specificity, 63.5% PPV and 81.0% NPV. Mean PA values for vertical tortuosity (nil/uni/bi) were 5.2, 7.1 and 7.0 mmHg respectively (p<0.05). Mean ICP values for rail tracking (nil/uni/bi) were 4.5, 7.5 and 15.7 mmHg respectively (p<0.01). Mean PA values were 5.2, 5.8 and 8.0 mmHg respectively (p<0.0001).ConclusionsCombined radiological features of ICP are promising non-invasive markers for raised ICP.
P25 Hydrogel systems to enhance the delivery of cell therapy for traumatic spinal cord injury
Authors: Bartlett RD , Phillips JB , Choi D 
Published: February 2019

ObjectivesCell therapies are an emerging therapeutic approach for spinal cord injury. We assessed the survival and phenotype of olfactory ensheathing cells (OECs) in hydrogel delivery systems suitable for clinical use.DesignLaboratory study.MethodsCell survival in different formulations of collagen and fibrin hydrogels was assessed using Syto 9 and propidium iodide. The proportion of cells staining positive for a key repair marker (p75NTR) was also quantified using immunocytochemistry and fluorescence microscopy.ResultsThere were significant differences in OEC survival between the various collagen and fibrin hydrogel formulations tested (p<0.001 one-way ANOVA, n=17). 10% v/v fibrin conferred the best cell survival with 85% of OECs remaining alive. Incorporating OECs into collagen hydrogels promoted the highest proportion of p75NTR immunopositive cells (78%) and this was significantly higher than both fibrin hydrogels and traditional monolayer culture (53% and 20%, respectively, p<0.0001 one-way ANOVA, n=24).ConclusionsCollagen and fibrin hydrogels both have the potential to enhance the delivery, survival and retention of transplanted OECs for spinal cord repair. Both materials are clinically scalable, promote favourable OEC survival and have the potential to increase the proportion of cells expressing a key repair marker (p75NTR). Optimised hydrogel delivery systems may provide a valuable approach to improve the delivery of OECs for spinal cord repair in the future.
P26 Bridging the gap – benefits of neurosurgical tissue for pre-clinical research
Authors: Ahmed AI , Grundy PL , Vajramani G , Vargas-Caballero M , Willaime-Morawek S , Bulters DO 
Published: February 2019

ObjectivesThe use of primary human neural tissue for research provides an invaluable insight into human neural function that cannot be achieved in any other way. Despite this it is successfully collected and used in only a small minority of units. We have established a collaboration between Neurosurgical Unit and the University that allows us to study using human tissue resected during neurosurgery. Tissue is most commonly collected from oncological, epilepsy and vascular operations. Here we share our experiences of the practicalities and try to provide some insights for practicing neurosurgeons.SubjectsWe discuss the practical difficulties of the co-ordination of the clinical and academic teams, and challenge of optimization of the tissue for the research. We will present the mechanisms in place to optimize the study of human neural tissue. We will review the progression from resection of limited tissue to any neurosurgical procedure in which the normal brain is resected and tissue discarded. We discuss the different models that can be used and the application locally to glioma stem cells, pathways activated in TBI and the electrophysiology of the normal brain.ConclusionsWe will present examples of the value of human tissue studies, including electrophysiological differences between humans and rodent that could only be investigated through the use of live human tissue. We will also demonstrate how we have moved to streamline tissue collection and propose a move to establish a national framework.
P29 Dissection using pulsed radiofrequency energy device (PlasmaBlade) is safe round implanted neuromodulation hardwares
Authors: Paterson A , Kumaria A , Sitaraman M , Sabbubeh T , Ingale H , Basu S 
Published: February 2019

ObjectivesTo assess risk of damage to implanted neuromodulation hardware’s during dissection using the pulsed radiofrequency energy device (PlasmaBlade) in a simulated setting.DesignSimulated experiment.MethodsA simulated setting with fresh chicken breast threaded with different hardwires and PlasmaBlade in three configurations. Multiple substrates (wires), operators and observations were used representing typical hardware encountered in a functional neurosurgery service. Post dissection, the wires are inspected naked eye and under operating microscope. Induced current was assessed contemporaneously. A simple risk of physical and physiological damage is estimated.ResultsFive surgeons, of various grades, tested the PlasmaBlade at different CUT and COAG settings. Sixty dissections were undertaken. There was no structural damage and no induced current identified when PlasmaBlade was used at manufacturer recommended settings. At higher settings than would normally be used (CUT 6, COAG 5), there was opacification of insulation material of some wires (in 15 of 20 dissections; 75%), There was no dissolution of insulation even at this setting. Surgeons appreciated visibly lesser collateral damage to tissue and lesser smoke in the operative field using PlasmaBlade compared to conventional diathermy.ConclusionsWhen used at recommended settings, PlasmaBlade dissection did not cause any damage to implant wiring or tubing in this simulated setting. This report seeks to add to clinical data suggesting PlasmaBlade dissection is safe for dissection around DBS, SCS, VNS, ITB hardware.
P32 Targeting accuracy of the neuromate robot in DBS implantation for paediatric dystonia
Authors: Ellenbogen JR , Narbad V , Hasegawa H , Selway R 
Published: February 2019

ObjectivesTo quantify the accuracy of DBS electrode implantation for movement disorder in paediatric patients utilising the neuroinspire™ software and neuromate® robot.DesignRetrospective, single-centre, cohort study.SubjectsFifteen patients with dystonia (67% female; median age 11 years, range 8–18 years) underwent intervention since May 2017.MethodsDBS procedures were planned on the neuroinspire™ software and electrodes were implanted using the Renishaw neuromate® robot and Renishaw guide tubes and secured with a dog-bone plate under general anaesthetic. Post-operative CT imaging with the intra-operative O-arm was fused to pre-operative imaging. Planned entry and target coordinates were compared to actual entry and final target coordinates in order to obtain absolute and directional errors in x (medial-lateral), y (anterior-posterior) and z (dorsal-ventral) planes. Euclidean error was calculated for each electrode. Wilcoxon signed-rank test was used to analyse error.ResultsBilateral GPi were targeted and Medtronic DBS systems were implanted for each patient (n=30). Overall median Euclidean error for electrode implantation was 2.13 mm (range, 0.71–4.85; p<0.001). No discrepancy between left- and right-sided electrodes was seen (p=0.346). Absolute errors in x (med 1.25 mm, range 0.10–4.10), y (med 0.80 mm, range 0–2.70) and z (med 1.45 mm, range 0–3.90) planes were individually significant (p<0.001). On overall anterior displacement of leads was observed (med 0.55+0.85 mm, p=0.001) but there was no significant directional bias in x (p=0.219) or z (p=0.077) planes.ConclusionsWe observed an improvement in the discrepancy seen between planned and actual lead location compared to a previously reported series using the Leksell frame in a similar cohort. Addressing possible compounding factors such as drilling techniques and electrode fixation should increase accuracy further. The neuromate® Robot is a reliable and accurate alternative to the Leksell frame.
P36 A 1 and 5 year outcome analysis of epilepsy surgery in adults and children
Authors: Chadwick A , Josan V , Pringle C , Pope O 
Published: February 2019

ObjectivesTo evaluate the efficacy of epilepsy surgery at 1 year following surgery and to assess sustainability of seizure control at 5 years post-surgery. To find prognostic factors for good surgical outcomes.DesignRetrospective case notes analysis.Subjects82 consecutive patients operated on for epilepsy by a single surgeon between 2008–2013.MethodsPatients were identified in pre-existing hospital databases and included if 5 year follow-up was available. Their clinical records were accessed via the electronic patient records system at each site. The Engel Classification was used to grade seizure outcome at years 1 and 5 post-surgery. We classified Engel Class I and II as a good outcome and Engel class III and IV as a poor outcome. Case notes were also examined to find prognostic factors for a good long-term surgical outcome.Results86.4% of patients had a good outcome 1 year post-surgery and 77.9% had a good outcome at 5 years. The surgery site (temporal or otherwise) and the presence of a good outcome at year one were found to contribute significantly to odds of a good outcome at year 5. The ability to wean off medication is also commonly an important factor for patients and 24.4% of patients were AED free at 5 years.ConclusionsSurgery is an effective management option for intractable epilepsy in suitably selected patients with complete or near complete seizure cessation in about 80% of the patients and about a quarter of the patients no longer requiring AEDs.
P39 Sphenoid sinus mucosal thickening in pituitary apoplexy: a link to abnormal microbiota
Authors: Waqar M , Humphreys G , McCreary R , McBain A , Karabatsou K , Kearney T , Gnanalingham K 
Published: February 2019

ObjectivesSphenoid sinus mucosal thickening (SSMT) is described in small preliminary studies in the setting of pituitary apoplexy (PA). The aim of this study was to explore the possible association between PA and SSMT, and the microbial profile of SSMT.DesignSingle-centre case notes and tissue samples review (2007–2016).SubjectsPA group: radiological/histologically confirmed PA; control group: non-functioning pituitary adenomas (NFPAs).MethodsSSMT was measured on presenting MRI scans (pathological >1 mm). Forward stepwise logistic regression was used to identify factors associated with SSMT. Sphenoid sinus mucosal specimens were microbiologically profiled by PCR in a subset.ResultsImaging arm: 50 NFPA and 47 PA patients included. In multivariate analysis of both the PA and NFPA groups, the presence of PA was the only factor associated with SSMT (OR=0.043, 95% CI 0.012 to 0.16; p<0.001). In multivariate analysis of the PA group alone, a shorter time from symptom onset to presenting MRI scan (OR=0.12, 95% CI 0.026 to 0.54; p=0.006) and more severe grade of apoplexy (OR=7.29, 95% CI 1.10–48.40; p=0.04), were associated with SSMT. Microbiological arm: 5 PA and 5 NFPA patients included. PA patients harboured microbiota similar to that seen in sinusitis, unlike NFPA patients.ConclusionsSSMT is associated with PA, especially during the acute phase. SSMT is also associated with microbiota seen in sinusitis. Our results require further validation.
P41 Endoscopy in cerebellopontine angle lesions: feasibility and technical considerations
Authors: Oesman C , Alamri A , Khalil S , Wareing M , Saeed S , Bradford R , Paraskevopoulos D 
Published: February 2019

ObjectivesTo define selection criteria and describe technique nuances for the use of endoscopy in surgery for cerebello-pontine angle (CPA) lesions.DesignProspective observational study.SubjectsPatients undergoing CPA lesion resection were selected for endoscope-assisted and/or endoscope-guided lesion resection.MethodsCPA interventions without mass lesions were excluded. 10 CPA lesions were identified pre-operatively for intra-operative endoscopic use across two neurosurgical centres. We describe equipment and technique selection.Results10 cases were selected over a one year period. Histology revealed 3 vestibular schwannomas (VS) (30%), 1 cyst (10%), 3 epidermoids (30%), 3 meningiomata (30%). Three cases were planned and carried out fully endoscopically (including two VS and the cyst) based on patient factors and favourable anatomy. Four cases were carried out with endoscopic assistance. The endoscope was used in three cases for anatomical orientation ‘around the corner’ only. Techniques and equipment vary depending on surgical aims, surgical anatomy and working area. Tips and pitfalls are identified and described.ConclusionsEndoscopy can be applied safely in CPA pathologies, as an alternative to the operating microscope for highly selected cases, or as an adjunct for specific surgical steps, especially when microscope optics do not allow angled visualisation. It is particularly useful in identifying lesion residuum and ‘working around the corner’. High level training is required before applying endoscopy to the CPA.
P42 Predicting bleeding risk during meningioma surgery
Authors: Tsyben A , Surour M , Budohoski K , Kirollos R , Helmy A 
Published: February 2019

ObjectivesSurgical treatment of meningioma is frequently accompanied by significant intraoperative blood loss and the associated risks of blood transfusion. Surgical adjuncts such as pre-operative embolisation and the use of tranexamic acid have attendant risks. An ability to estimate blood loss can appropriately target these interventions.DesignRetrospective studySubjectsPatients following surgery for meningioma between 2015–2018MethodsIntraoperative blood loss, pre- to post-operative haemoglobin difference and blood transfusion were evaluated. Pre-operative imaging included size, shape and location of meningioma, involvement of sinuses and blood vessels, T1 and T2 weighted characteristics, restricted diffusion, peritumoral oedema, dural tail and hyperostosis. Multivariate analysis was used to determine the relationship between meningioma characteristics and blood loss.ResultsTumour diameter and venous sinus opening were significantly related to blood loss on multivariate analysis (p=0.004 and p=0.001 respectively). Furthermore, on univariate analysis additional factors included procedure duration (p<0.0001), pre-operative radiotherapy (p=0.042) and pre-operative platelet count (p=0.03).ConclusionsOnly size of tumour and opening venous sinuses was related to intraoperative bloods loss in this cohort of patients. Further research is required to define tumour characteristics that can be used to identify patients suitable for pre- and intra-operative adjunct therapies.
P44 Is restoration of pituitary function a realistic goal in endoscopic pituitary surgery?
Authors: Galloway L , Hayhurst C 
Published: February 2019

ObjectivesThe ability to restore pituitary function after endoscopic transsphenoidal surgery (ETSS) in pituitary tumours causing hypopituitarism remains unclear. This study analyses patients that required steroid replacement therapy prior to ETSS, and reviews endocrine function postoperatively.MethodsA prospectively held pituitary database was retrospectively analysed from May 2011 – July 2017 at a tertiary university hospital. Patients requiring steroids for hypopituitarism pre-operatively were included. Patient demographic data, tumour characteristics, and tumour hormonal profile were recorded.ResultsFrom a database of 156 patients, 28 (18%) were hypoadrenal pre-operatively and were included in the study. All patients underwent ETSS by a single neurosurgeon. The median age of patients was 56 years (range 17–81), whilst median follow-up was 48 months (range 6–78). 20 male patients and 8 female patients were included. All patients were established on steroid therapy preoperatively with either hydrocortisone (26 patients) or prednisolone (2 patients). 5 (18%) patients were able to stop steroid replacement postoperatively. The median time to cessation of steroid therapy was 4 months (range 2–16 months).ConclusionsRestoration of pituitary function following ETSS surgery was only successful in a small number of patients despite meticulous gland preservation. Our results suggest that restoration of function in all patients undergoing ETSS is an unrealistic goal and patients should be counselled accordingly.
P45 Gamma knife radiosurgery for the primary management of acromegaly
Authors: Sims-Williams H , Rajapaksa K , Sinha S , Radatz M , Walton L , Yianni J , Newell-Price J 
Published: February 2019

ObjectivesReport outcome and morbidity data for the treatment of acromegaly with primary stereotactic radiosurgery (STRS).DesignRetrospective.Subjects20 patients with acromegaly who underwent primary STRS at the National Centre for Radiosurgery, Sheffield (UK) between 1985 and 2015.MethodsReview of notes, database, laboratory results, patient questionnaire and death certification. Guideline-based control was defined as normal age-sex-adjusted IGF1 levels and either random GH <1 µg/L or GH <0.3 µg/L (OGTT) or mean Growth Hormone Day Curve (GHDC) <1 µg/L.ResultsControl at 20 years was 100% and 75% on and off medication respectively. Median time to control on medication was 3 years and 7.4 years off medication. Median marginal radiation dose was 27.5 Gray and median follow-up was 167 months. Seven patients died, median age 65 years. There were no STRS-related deaths. 53% of patients developed new hypopituitarism at median follow-up of 146 months. First onset of hypopituitarism occurred up to 20 years after treatment. No other complications were noted. Three patients underwent trans-sphenoidal surgery due to poor biochemical control at a mean of 35 months.ConclusionsMorbidity from STRS is low. There is significant latency to biochemical control and new onset hypopituitarism. While primary surgical intervention remains the gold standard in acromegaly, primary STRS results should inform discussions with patients considering non-surgical management.
P50 The role of care of the elderly in neurosurgery
Authors: Awan M , Bhagawati D 
Published: February 2019

ObjectivesAssess the volume of frailty in a neurosurgical centre and role of geriatric liaison.DesignRetrospective Review.SubjectsAll patients admitted to Charing Cross Hospital in Jan 2018.MethodsWe reviewed patient notes to assess frailty score using the Clinical Frailty Scale (Dalhousie University) and differences with emergency vs elective admissions and length of stay (LoS).ResultsMore than 50% of patients admitted to the unit were above 65 years old. 30% of all admissions met the criteria for mild to moderate frailty moreover 34% were classed as severely frail. These findings are comparable to acute medical wards. Two third of patients had an average LoS above 10 days, of these 50% were severely frail. Emergency admissions demonstrated a greater burden of frailty and expectedly LoS in severely frail patients was significantly higher 15 vs 40 days in elective and emergency admissions.ConclusionsNeurosurgery units would benefit from a geriatric liaison service given the burden of frailty is equivalent to medical wards in-order to improve patient care, experience, turnover and LoS.
P54 Formative test questions in neurology and neurosurgery
Authors: Tallantyre EC , Corns R , Smith PE , Thomson S 
Published: February 2019

ObjectivesTo provide a formative educational test of knowledge that allows clinicians to measure themselves against their peers.DesignAnnual Neurosurgery and Neurology knowledge tests, supported by the ABN & SBNS, have been available since 2014 (NSurg) and 2017 (Neurol). The NSurg test requires all candidates to participate over 3 days, answers are available after the test whereas the Neurol formative questions are available over 6 weeks, answers are available immediately.SubjectsThere have been 821 first attempts at the formative questions; NSurg; 44, 63,187,143,164 and Neurol; 74, 146. Candidates are mostly from UK (NSurg 92%, Neurol 69%) and mostly specialty trainees (NSurg 98%, Neurol 63%).MethodsThe formative questions are delivered through the ebrain virtual learning platform, statistics are generated automatically. Proposed questions are written by candidates as ‘payment’ for doing the formative test.ResultsMean Cronbach’s alpha was 87.3%. The mean score for the tests was 60.4% (Range 55.9%–77.9%). Feedback is voluntary: In 2018 17 feedback comments were received, 10 were unambiguously positive, 5 were mixed including criticism of one or more questions, 2 were judged to be neutral. Examples of feedback comments received this year included ‘Comprehensive exam that covers a wide range of topics’ and ‘This is of great value’.ConclusionsThis formative educational initiative has high internal consistency and solid feedback. Although set up differently, it is proving both valuable and popular in both specialties.