bluuebunny/crossref_metadata_2025_split huggingface dataset:
P66 Should we be screening for depression and quality of life in all patients attending botulinum toxin injection clinics or just those with cervical dystonia?
Authors: Mozdiak R , Lally R , Osei-Poku F , Alty J 
Published: February 2019

ObjectivesCervical dystonia (CD) is known to be associated with depression and low quality of life (QoL) but we know little about these measures in non-CD patients attending botulinum toxin clinics. The objective was to evaluate the prevalence of depression and low QoL in both CD and nonCD patients.DesignCross-sectional pilot study.SubjectsConsecutive patients attending teaching hospital botulinum toxin clinic.MethodsPatients completed the Beck’s Depression Inventory (BDI) questionnaire and a Recovering Quality of Life (ReQoL) scale. BDI and ReQoL scores of ≥17 and≤24 indicated depression and impaired QoL respectively.Results48 patients (30 female; age 45–75 years) were evaluated; 33:15 CD:non-CD. The non-CD group comprised hemifacial spasm, upper limb dystonia/tremor, blepharospasm and Meige syndrome. 23% (11/48) of all patients had depression: 27% (9/33) of CD and 13% (2/15) of non-CD. Depression rates were more frequent amongst females and males (27%; 17%) (p=0.43). 34% of all patients had low QoL – 36% (12/33) and 27% (4/15) in the CD and non-CD groups respectively (p=0.51). Low QoL scores were more frequent in females (40%) than males (22%) but this difference was not significant (p=0.21).ConclusionsDepression and low quality of life were common in all patients in this pilot study. This suggests that screening of all patients attending botulinum toxin clinics, regardless of their diagnosis, may be clinically important. A larger study is required to validate these findings.
WP1-12 Reducing infection rates in an intrathecal baclofen service; closing the audit cycle
Authors: Donnelly A , Balaratnam M , Murphy M , Bahadur S , Padilla H , Keenan E , Farrell R , Stevenson V 
Published: February 2019

ObjectivesIntrathecal baclofen (ITB) is a recognised treatment strategy for the management of spasticity. We have 30 years of experience, and 160 patients currently receiving treatment.DesignAn audit (Jan 13 – Jul 15) demonstrated complication rates of 4.4% (infection) and 4.92% (catheter). After this we recommended 1 vancomycin wash of the pump pocket, 2 occlusive dressing of pressure sores, 3 timely MRSA pre-screening, and this was introduced June-August 2016. We present a re-audit of the service.SubjectsAll patients admitted for ITB pump surgery between June 2016 and June 2018.MethodsThe database of patients was used, from which the patient notes were reviewed with information relating to each surgical procedure recorded.ResultsThere were 92 surgical procedures and 78 patients (M 30, F 48). 12 patients had complications, requiring 18 surgical procedures. Out of 18 surgical procedures, 10 were catheter- and 7 pump-related). Our infection rate was lower at 1% of all surgeries (compared with 4.4%), or 0.6% of all ITB pump patients per year (compared with 3.4%), and our catheter complication rate was 6.25% of all patients per year. Our annual incidence rate of all complications was 5.6% in both groups.ConclusionsThe infection risk is lower and complication rate remains stable. We will discuss factors which may influence the risk of complication, and consider recommendations for the future.
WPI-13 Lack of association of cranial lacunae with intracranial hypertension in children with crouzon syndrome and apert syndrome: a 3D morphometric quantitative analysis
Authors: Mondal A , Rodriguez-Florez N , O’Hara JL , Ong J , Jeelani NuO , Dunaway DJ , James G 
Published: February 2019

ObjectivesCranial lacunae on CT is equivalent to the plain X-ray ‘copper beating’ seen in craniosynostosis. Copper beating has not been shown to correlate to intracranial hypertension (IH). However it is a purely quantitative assessment – can qualitative measurement of CT cranial lacunae more accurately predict IH in children with craniosynostosis?DesignRetrospective cohort study.Subjects18 consecutive children with Crouzon and 17 with Apert syndrome were identified.MethodsPatients were divided into IH and non-IH groups defined on an intention to treat basis. 3D software was used to analyse% of calvarial lacunae.ResultsMean age at CT scan was 380 days (range 6–1778). Of the 35 children, 21 required surgery for raised ICP (17 posterior vault expansion 2 ventriculo-peritoneal shunts (VPS), 1 spring-assisted cranioplasty and 1 fronto-orbital advancement) at mean age of 512 days (range 38–1710). Of the 21 children with raised ICP, 15 had lacunae with mean lacuna/calvarium percentage of 3% (0%–28%). Of the 14 non-raised ICP children, 8 had lacunae with mean lacuna/calvarium percentage of 2% (0%–8%). T-test demonstrated no significant difference between the 2 groups. For both groups, parietal bones were most likely to show lacunae (IH 14/21, non-IH 9/14), followed by occipital (IH 8/21, non-IH 3/14), followed by frontal (IH 6/21, non-IH 2/14).ConclusionsResults suggest that cranial lacunae, measured using quantitative 3D methods, do not predict IH, in agreement with evidence from qualitative plain skull radiograph studies.
P84 Cauda equina syndrome – an assessment of long-term outcomes following surgery
Authors: Hazelwood JE , Hoeritzauer I , Demetriades A 
Published: February 2019

ObjectivesData regarding long-term outcomes following surgery for cauda equina syndrome (CES) is scarce, especially concerning bowel and sexual function. This study aimed to assess long-term bladder, bowel, sexual and physical function in a CES cohort.DesignDescriptive.SubjectsA pre-existing ethically approved database was used to identify patients who had undergone surgery for CES between August 2013-November 2014.MethodsPatients were contacted over a one month period and completed validated questionnaires via telephone. These assessed bladder (Urinary Symptom Profile), bowel (Neurogenic Bowel Dysfunction Score), sexual (Arizona Sexual Experiences Scale) and physical function (SF-12). Patients were also asked which of their current symptoms they would most value treatment for and which NHS services they had accessed post-operatively.ResultsForty-six of 77 patients (response rate 72%, inclusion rate 59%) with a mean age of 45 years (21–83) and mean time since admission of 43 months (range 36–60) took part in the follow up study. The prevalence of bladder dysfunction was 76%, bowel dysfunction 41% with the majority (87%) reporting very minor symptoms, sexual dysfunction 39% and physical dysfunction 48%. Pain was the most deleterious current symptom in 57% but only 7% reported post-operative pain-management referral.ConclusionsThese findings confirm the high prevalence of long-term bladder, bowel, sexual and physical dysfunction in CES patients and provide useful data to guide the expectations of patients and clinicians.
P86 Surgical management of spinal cavernous malformations
Authors: Arora M , Sadek AR , Nader-Sepahi A 
Published: February 2019

ObjectivesEvaluation of the presentation, demographics, pathology and outcomes associated with the surgical management of spinal cavernous malformations [sCM].DesignA retrospective single-centre case series of surgically managed cavernous malformations over a 3 year period.SubjectsTen patients were identified to have a diagnosis of sCM.MethodsCases were identified from electronic and theatre records at a single centre. All patients underwent pre-operative assessment and radiographic evaluation.Results10 patients with a mean age of 52.6 years [SD ±14.1] and a male to female ratio of 1:1 with a mean follow-up of 14.1 months [SD ±7.9] were identified. Spinal CM spanned two vertebral levels in 9 out 10 cases with 3 cervical, 1 cervico-thoracic and 6 within the thoracic region. Duration of the symptoms prior to surgical intervention was 17 months [SD ±24], with three cases presenting with an acute [<2 week] history. Of those that underwent surgery [n=7] pain [85%, n=6], sensory/motor changes [85% n=6] and sphincteric disturbance [43%, n=3] were the commonest presenting signs and symptoms. Acute haemorrhage was a presenting factor in 3 cases. Post-operatively motor and sensory scores improved in 4 patients, 2 patients remained unchanged and 1 patient was worse. Recent haemorrhage was associated with increased likelihood in improvement in motor scores following resection.ConclusionsIn selected cases surgical management of sCM is associated with improvement in motor and sensory function postoperatively.
P92 What is a benign notochordal cell tumour?
Authors: Usher I , Choi D 
Published: February 2019

ObjectivesCharacteristics from a large systematic review.DesignThe first systematic review of benign notochordal cell tumours.SubjectsAll studies, in any language, published at any time, identified using specified search terms.MethodsPreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).ResultsSo-called benign notochordal cell tumours exhibited the following features: pain was the sole presenting symptom in 37/81 (45.7%) and neurological deficit in 36/81 (44.4%). Incidental discovery upon imaging was reported in 8/81 (9.9%). Radiologically, lesions were small, (≤30 millimetres at their maximum diameter) in 57/65 (87.7%), hypointense on T1 sequences and hyperintense on T2 sequences on magnetic resonance imaging (106/130; 81.5%), did not enhance following contrast administration (62/74; 83.8%) and were non-lytic (80/160; 50.0%). Histologically, these tumours lacked myxoid matrix (66/84; 78.6%) and nuclear atypia (100/112; 89.3%). In those managed conservatively, follow up was between 8.5 and 120 months. Most were stable at follow up (22/25; 88.0%), one lesion grew (4.0%), one patient died of an unrelated cause (4.0%) and outcome was not stated in one case (4.0%).ConclusionsBNCTs exhibit a spectrum of features, none of which are pathognomonic and diagnosis is subjective. The majority of reports describe small, non-progressive, non-lytic lesions that lack contrast enhancement, intercellular myxoid matrix and nuclear atypia. They are nevertheless difficult to distinguish from small chordomas.
WP1-14 A systematic review to evaluate different management strategies for incidental intracranial meningiomas
Authors: Mohan M , Islim A , Moon RDC , Srikandarajah N , Brodbelt AR , Mills SJ , Jenkinson MD 
Published: February 2019

ObjectivesEvaluate the outcomes of differing management strategies for incidental intracranial meningiomas.DesignSystematic review.SubjectsStudies with ≥10 patients≥16 years of age diagnosed radiologically with an incidental intracranial meningioma.MethodsPRISMA compliant methods were used to scan 6 databases up to September 2017. PROSPERO ID: CRD42017077928.ResultsTwenty retrospective studies (n=2130 patients) were included. Initial management strategies at diagnosis were: 27% (n=560) surgery, 22% (n=450) SRS and 51% (n=1040) active monitroing with a mean follow-up of 49.5 months (SD=29.3). 21% (n=220) of patients in the active monitoring cohort eventually had or were recommended an intervention due to: radiological progression (n=153), development of symptoms (n=66) and patient preference (n=1). Mean time-to-intervention was 24.8 months (SD=18.2). 94% (n=207) of interventions were within 5 years. The definition of ‘growth’ and the radiological surveillance regimens varied widely. Morbidity rates following surgery and SRS, accounting for cross over, were 15% and 22% respectively. Surgery revealed benign histology in 94% of the cases. Quality of life is improperly examined.ConclusionsThe management of patients with incidental intracranial meningiomas varies widely. Most patients who develop clinical or radiological progression will do so within 5 years of diagnosis. Intervention at diagnosis may result in unnecessary overtreatment. Prospective data is needed to develop a risk calculator for managing incidental meningioma.
P99 Neonatal subdural haematoma following forceps-assisted delivery: a systematic review of the literature
Authors: Zaben M , Manivannan S , Petralia T , Leach P 
Published: February 2019

ObjectivesSubdural haematoma (SDH) is a recognised complication of forceps-assisted delivery (FAD). There are no guidelines regarding its management. This study aims to provide a better insight into the management and outcomes of neonatal SDH post FAD.DesignRetrospective review of our neonatal database and systematic review of the literature.SubjectsNeonatal cases presented with SDH after FAD.MethodsRetrospective database search of cases managed in our unit between January 20 111 and January 2018. Systematic review of the literature was performed using PRISMA guidelines. Inclusion criteria: (i) neonates, (ii) forceps-assisted delivery, (iii) evidence of SDH on imaging, with or without other traumatic lesions.ResultsA literature search yielded 9 studies with 30 patients meeting our inclusion criteria, In addition three cases were identified from our institutional database. 42% (n=14) had their SDH managed surgically, with subsequent full neurological recovery in 57%. In comparison, 95% (n=18) of the conservatively managed patients made a full recovery. Hydrocephalus was present in 1 and 11 of the conservatively managed and surgically managed patients, respectively.ConclusionsConservative management can lead to a full neurological recovery in SDH following FAD in neonates. However, a significant number may still need neurosurgical intervention for the SDH or subsequent hydrocephalus, therefore we advocate early transfer to a specialist neuroscience centre.
P100 Removing the orbital bar in fronto-orbital advancement and reconstruction
Authors: Sheikh A , Schramm M , Carter P , Russell J , Liddington M , Chumas P 
Published: February 2019

ObjectivesTo describe our technique of using reverse frontal bone graft for FOAR for patients with metopic or coronal synostosis.DesignRetrospective analysis of digital records for operation notes and radiological images.SubjectsSince April 2014, 16 patients underwent FOAR without using orbital bar.MethodsWe plan a frontal bone graft using Marchac template and increase the angles on side by 1 cm. This graft is then reversed and supra orbital margins are drilled out. The orbital bar is then removed and drilled down to make bone dust which is then used to fill gaps on exposed dura. The reversed frontal graft is then placed in front and secured via absorbable sutures, plate and screws.ResultsAll 16 patients who underwent this technique have shown excellent cosmetic results with no complications or non healing. Removing orbital bar does not cause any cosmetic defect since orbital rims are drilled out in reverse frontal bone graft. The removed orbital bar provides an excellent source of bone dust to cover gaps on exposed dura.ConclusionsWe present our technique of FOAR without using orbital bar, which is drilled down to bone dust to fill gaps. This has shown excellent cosmetic results so far with no complications. This addresses the issue of temporal thinning.
P101 The leeds paediatric brain arteriovenous malformation (BAVM) outcomes
Authors: Kalra N , Solanki SP , Tyagi AK 
Published: February 2019

ObjectivesThe commonest cause of stroke in a paediatric population is a ruptured brain ateriovenous malformation (bAVM). We aim to assess the functional outcomes of patients who have undergone operative intervention at our unit for ruptured and non-ruptured bAVMs.DesignA single centre retrospective cohort analysis of paediatric bAVM patients.Subjects10 paediatric patients at time of surgery between January 2007 – December 2017 mean age at follow up 15.9 years, range 2–26 years, mean time to follow up 6.3 years, range 1.5–11.2 years.MethodsPatients with bAVMs were identified via the paediatric neurovascular database. They were contacted via telephone and the Paediatric Quality of Life (PedsQL) questionnaire administered via parent proxy if the patient was under 18, and by the patient if above 18. Functional outcomes were assessed using the PedsQL questionnaire score and converted in to a health-related quality of life (HRQOL) score.Results10 patients underwent resection of their bAVMS, 9 survived and 7 were contactable. The mean HRQOL score 88.9 points, range 65.2–100. Only one patient had a HRQOL score below the mean of a child with chronic disease.ConclusionsThe mean HRQOL outcome score of operated paediatric bAVM was similar to that of healthy children. Patients having bAVM surgery within our unit have had a good functional outcome. Although there are small numbers in this series, there is a low incidence of operated paediatric bAVMs. Our findings suggests that such operations should be undertaken in units with expertise.
WP1-15 Computer-assisted versus manual planning for stereotactic brain biopsy: retrospective comparative pilot study
Authors: Marcus HJ , Vakharia VN , Sparks R , Rodionov R , Kitchen N , McEvoy A , Miserocchi A , Thorne L , Ourselin S , Duncan JS 
Published: February 2019

ObjectivesStereotactic brain biopsy is among the most common neurosurgical procedures. Planning a safe surgical trajectory requires careful attention to a number of features including:traversing the skull perpendicularly;avoiding critical neurovascular structures; andminimising trajectory length.The aim of this study was to develop a platform, SurgiNav, for automated trajectory planning in stereotactic brain biopsy.MethodsA prospectively maintained database was searched between February and August 2017 to identify all adult patients that underwent stereotactic brain biopsy in whom post-operative imaging was available. In each case, the standard pre-operative T1-weighted gadolinium-enhanced MRI was used to generate models of the cortex and vasculature. A surgical trajectory was then generated using automated computer-assisted planning (CAP) and metrics compared to the trajectory of the implemented manual plan (MP) using the paired T-test.Results15 consecutive patients were identified; who had a diagnostic biopsy and there were no immediate complications. Feasible trajectories were generated using CAP in 12 patients, and in these the mean trajectory length using CAP was comparable to MP (31.7 mm vs. 37.1 mm; p=0.3), and mean angle was similarly perpendicular from orthogonal (9.3° vs. 15.3° p=0.1), but the risk-metric was significantly lower (0.16 vs. 0.48; p=0.03).ConclusionsComputer-assisted planning for stereotactic brain biopsy appears feasible in most cases and may be safer in selected cases.
P103 Chiari malformation type I: a review of literature to compare bony posterior fossa decompression with and without duraplasty
Authors: Tam KP , Foroughi M 
Published: February 2019

ObjectivesTwo main surgical approaches for symptomatic Chiari type I malformation (CM-I) patients are posterior fossa decompression (PFD) involving craniectomy alone, and posterior fossa decompression with duraplasty (PFDD). The aim of this review was to outline the indications, advantages and disadvantages of each surgical approach, with guidance regarding surgical decisions.MethodsWe reviewed pertinent articles. Data on the clinical improvement, radiological improvement, complications and reoperations were compared.ResultsSeventeen articles containing data on 3713 paediatric and adult participants met the inclusion criteria. PFDD was associated with more favourable clinical improvement in CM-I patients with syringomyelia (RR 1.59, 95% Cl, 1.09 to 2.31; p<0.05), but had a higher complication rate (RR 3.34, 95% Cl, 1.66 to 6.73; p<0.05) when compared with PFD. Regarding radiological improvement and reoperation rates, no significant differences were observed between the two surgical approaches.ConclusionsBoth PFD and PFDD are effective and safe surgical strategies for symptomatic CM-I associated with posterior fossa volume mismatch, in the absence of hydrocephalus and craniocervical region instability. Bony PFD has a lower complication rate and seems to be good option when carried out in those without major tonsillar impaction and in the absence of a syrinx. However, these patients should be adequately counseled regarding the requirement for possible further intra-dural decompression.
P112 Management and outcome of subarachnoid haemorrhage (SAH) in older people: a centre series
Authors: Boumrah T , Fahmy J , Trippier S , Hainsworth A , Madigan J , Pereira E , Minhas P , Shtaya A 
Published: February 2019

ObjectivesTo study the management and factors associated with outcomes in SAH in elderly over 80 years of age.DesignRetrospective records review.SubjectsAll Patients with SAH confirmed on head CT admitted Jan 2012-Dec 2017.MethodsWe admitted 1079 patients with SAH, 32 were aged ≥80 y (3%). We subdivided the patients into a poor outcome group (POG) (Modified Rankin Scale (mRS) 4–6), (n=24, 14F/10M, mean age 83.7±0.7 y) and good outcome group (GOG) (mRS 0–3) (n=8, 7F/1M, mean age 82.6±0.6 y). Spearman’s rank-order test evaluated correlation between outcome (mRS) and all other variables (WFNS grade, GCS, Motor score of GCS, age, sex, smoking, hypertension, intraventricular haemorrhage (IVH) and intracerebral haemorrhages (ICH)).Results9 patients (38%) of POG were WFNS grades IV – V versus 1 patient (13%) in GOG. More POG than GOG patients had IVH (83% vs 38%, rs=−0.44 p=0.011). 20% of POG had ICH vs none in GOG. GOG patients had better GCS (rs=−0.37, p=0.04), lower WFNS grade (rs=0.43, p=0.01) and did not need external ventricular drain (EVD) (rs=0.51, p=0.003). There was no significant correlation between outcome and sex, smoking, hypertension, size of aneurysm (4.9 mm ±1.0 in GOG vs 5.4 mm ±1.1 in POG, rs=−0.29, p=0.28), percentage receiving coiling or clipping, GCS motor score, procedure complications and general medical complications.Conclusions75% of patients’ aged ≥80 y with SAH had poor outcome. WFNS grade (I-III), higher GCS patients who did not need EVD had better outcome.
P115 Subarachnoid haemorrhage with negative initial vascular imaging: a single unit experience
Authors: Rasul F , Silva G , Fitzpatrick T , Derakshani S , Ghosh A , Vindlacheruvu R 
Published: February 2019

ObjectivesTo investigate the incidence of vascular abnormality and clinical outcomes in a group of patients presenting with spontaneous subarachnoid haemorrhage (SAH) and negative initial vascular investigation.DesignSingle centre prospective cohort study.SubjectsAll adult patients with SAH admitted to our unit over a 12 month period.MethodsProspective collection of data on secure electronic database. Information pertaining to gender, age, mode of initial and subsequent vascular investigations was acquired. Details regarding clinical outcomes at 30 days and complications were documented.Results118 consecutive patients with SAH were admitted to our unit over the 12 month study period. 37 patients had negative initial vascular imaging (37/118=31.4%). M:F=19:18, age range 26–76 years. 32 patients underwent a high quality CT angiogram as initial vascular investigation, 5 patients underwent catheter cerebral angiogram (DSA). The most common modality of further vascular imaging was DSA. 5 vascular abnormalities were detected on subsequent vascular imaging (5/37=13.5%). Hydrocephalus and vasospasm were the commonest complications. Clinical outcomes were very good; all patients had a GOS of 5 at 30 days.ConclusionsPatients with SAH and negative initial vascular investigation are an important subset of patients with SAH. There is no uniformity in the type of subsequent vascular investigations selected. Our experience is consistent with previously published studies.