bluuebunny/crossref_metadata_2025_split huggingface dataset:
P90 A systematic review of spinal cord serum and cerebrospinal fluid biomarkers for use in degenerative cervical myelopathy
Authors: Stewart M , Smith S , Davies B , Hutchinson P , Kotter M 
Published: February 2019

ObjectivesWhilst radiological evidence of compression is the hallmark of degenerative cervical myelopathy [DCM], it is unable to stage or prognosticate. Moreover, asymptomatic spinal cord compression is common and therefore new methods of assessing spinal cord function are required. We aimed to: 1) Evaluate the evidence-base for serum and CSF biomarkers of spinal cord damage in diagnosis, prognosis or predicting response to treatment in DCM 2) Identify serum and CSF biomarkers of spinal cord damage studied in other conditions, which may have relevance to DCM.DesignScoping review.SubjectsHuman only.MethodsA search of MEDLINE and EMBASE was performed. Studies involving DCM patients or biomarkers relevant to spinal cord pathobiology were included.Results852 results were screened, of which 83 were included. 9 studies explored 12 biomarkers in DCM. NFH (n=3), S100b and NSE (n=2) received most study. 74 studies explored a further 118 biomarkers in other conditions; S100b (n=13), NFH (n=11) and GFAP (n=10) received most study. Overall, 72 studies used targeted approaches, in which candidate biomarkers were chosen in advance. 11 used unbiased approaches, in which high throughput analyses identified candidate biomarkers during the study.ConclusionsThe evidence-base for use of biomarkers in DCM is limited. Whilst targeted approaches have identified a number of candidate spinal cord markers, few have shown clinical utility. There is a shift towards investigating panels of multiple markers and unbiased, high-throughput approaches.
P94 Ventricular subgaleal shunting is a safe and effective temporising measure for the treatment of neonatal post haemorrhagic hydrocephalus
Authors: Dawes WJ , James G , Aquilina K 
Published: February 2019

ObjectivesThe use of a temporising device to facilitate neonatal maturation prior to permanent ventricular peritoneal shunt (VPS) remains gold standard treatment for neonatal posthaemorrhagic hydrocephalus (PHH). The relative superiority of ventricular access device (VAD) or ventricular subgaleal shunt (VSG) remains contentious.DesignRetrospective case note review.Subjects49 neonates born between Sept 2012 to April 2018: (M:F 34:15); Average: gestation 26+3 (23 to 32+5); birth weight 870 g (±355 g); Papile grade 3:4 (ratio ≈ 1:2).MethodsComputer records from neonatal VSG at a single tertiary care children’s hospital reviewed.ResultsEarly complications associated with VSG seen in 13 cases (27%). Migration of shunt n=3, infection n=2, inadequate control of ventricular volume n=5, decompression haemorrhage n=2, wound leak n=1. All patients managed on NICU with an average inpatient stay of 5 days (range 2 to 15). 5 outcome groups defined: 1. Patient died (non neurological cause) (n=4) 2. VSGin situfor <1 year (n=7) 3. VSG and no VPS (n=6 16%) 4. VSG and VPS X1 never revised (n=17 45%) 5. VSG and VPS with revisions (n=15 39%) Rate of shunting in patients with VSG >1 year=84%. All patients that needed permanent VPS were operated within the first year. The average time elapsed prior to VPS was 86 days with over 80% of cases shunted within 100 days.ConclusionsVSG remains a safe method of temporary CSF drainage for the treatment of neonatal PHH with rates of shunting in line with the published literature.
P96 Screening for cerebrovascular pathology on the basis of positive family history in the paediatric population
Authors: Millward CP , Tonder LV , Foster M , Williams D , Griffiths M , Kneen R , Sinha A , Mallucci C 
Published: February 2019

ObjectivesNeurovascular disorders are uncommon, complex conditions in children. We reviewed the screening practice and outcome of children referred to the neurovascular service on the basis of positive family history.DesignRetrospective review of prospectively maintained database.SubjectsChildren referred to the neurovascular service on the basis of family history, for screening at our hospital.MethodsWe retrospectively examined our database between July 2008 and April 2018 for the reasons for referral, family history, investigations performed, and the outcome of the screening process.Results44 children were reviewed (23 male, median age 10). Thirty-one children had an MRI/MRA brain. One child subsequently had uncomplicated digital subtraction angiography. Thirty children were referred due to a family history of subarachnoid haemorrhage, of which 17 had a single first-degree relative, and two had two first-degree relatives. Nine children were referred with a family history of arteriovenous malformation, (2 were associated with hereditary haemorrhagic telangiectasia). Five children were discussed due to a family history of non-specific haemorrhagic stroke. Seven children had a history of headache, (4 were prescribed Pizotifen for migraine). No neurovascular pathology was detected following screening within our cohort.ConclusionsA consensus screening policy does not exist but is required both to guide clinical practice and to assuage parental or patient concerns. We will survey UK paediatric centres to commence this process.
P97 Utility of computer technology in management of non-syndromic craniosynostosis- is it cost effective?
Authors: Kaliaperumal C , Gallo P , Campbell D , Stewart K , Kandasamy J , Rose M 
Published: February 2019

ObjectivesTo discuss the utility of Computer technology for non-syndromic craniosynostosis (Metopic craniosynostosis) in the form of 3D printed models that could be utilised intraoperatively to aid fronto-orbital remodelling.DesignProspective study form 2015–2017.SubjectsPaediatric non-syndromic metopic craniosynostosis cohort.MethodsWe present a series of 7 patients with non-syndromic metopic craniosynostosis operated on by the craniofacial team Edinburgh over a three year period. The Edinburgh Craniofacial service is supported by the Managed Service Network (MSN) for Neurosurgery, Scotland as a part of nationally delivered Craniofacial service. We utilised 3D printing models of the orbital bar to plan a fronto-orbital advancement technique. The models were then subsequently sterilised and used intra operatively. 3D printer utility is available to us as a part of the NHS Lothian craniomaxillofacial and plastics surgery service.ResultsNo intra-operative or post operative complications were noted in our series. All patients undergo standardised pre and post operative 3D CT and photography follow up to objectively measure the outcome.ConclusionsThe utility of Computer technology is a useful and safe adjunct for non-syndromic craniosynostosis, particularly metopic craniosynostosis. A careful pre-operative planning and 3D printed model is helpful to achieve the desired bespoke surgical outcome and to reduce operative time. Post operative 3D CT and 3D photography were utilised to objectively measure the outcome. No extra costs were incurred to our service. We believe that this could be incorporated in preoperative planning as an essential tool.
P98 A decade of primary tumours of the spine in the paediatric population
Authors: Millward CP , Foster M , Tonder LV , Williams D , Pizer B , Pettorini B , Parks C , Mallucci C 
Published: February 2019

ObjectivesPrimary spinal tumours in children are rare and poorly understood; we review 10 years of surgical experience.DesignRetrospective review of prospectively maintained database.SubjectsChildren receiving surgical management of primary spinal tumours in a single, tertiary paediatric neurosurgery centre.MethodsOperations for primary spinal tumours were abstracted from our prospectively maintained surgical database and supplemented with data from case notes, operative records, and imaging studies.ResultsBetween 2008 and 2017, 37 procedures were performed on 29 patients (19 male; Median age 7.5 years, IQR 2–11.25). 28 had their primary procedure in our unit: 21 excisions, and 7 biopsies (of which 5 proceeded to further surgery). Tumours were classified as extradural (10), intradural extramedullary (3), intradural intramedullary (11) or bony (4). Tumours were found at the following levels: Cervical (8; 29%), Cervicothoracic (2; 7.1%), Thoracic (10; 36%), Thoracolumbar (3; 11%), Lumbar (2; 7.1%), Lumbosacral (2; 7.1%) and Sacral (1; 3.6%). Histology comprised: Pilocytic Astrocytoma (6), Other Astrocytoma (4), Schwannoma (3), Ewing Sarcoma (2), Langerhans cell histiocytosis (2), Lymphoma (2), Neurofibroma (2), and others (7) including one Myxopapillary Ependymoma.ConclusionsThe rarity and heterogeneity of paediatric spinal tumours makes treatment challenging. We propose a national online registry including a tissue bank, and invite collaboration with other units.
P104 One year failure rates for de novo ventriculo-peritonealshunts in under 3- month-old children
Authors: Bentley E , Ved R , Amato-Watkins A , Lang J , Zilani G , Bhatti I , Leach P 
Published: February 2019

ObjectivesHistorically VPS failure and infection rates are higher for neonates than for older children. We compared our one year VPS failure and infection rates in under 3-month-olds with those of older children.DesignA retrospective, single centre study comparing 1 year survival and infection rates of VPS in under 3-month-olds verses older children.Subjects58 children under 3 months of age underwent VPS insertion between January 2007 and December 2016.MethodsData was collected by three independent reviewers from electronic files and case notes. Data was analysed using descriptive statistics and one year shunt survival curves were produced.ResultsFor children under 3 months there was a 29.3% one-year shunt failure rate, of which 2 were shunt infections (3.4%). In patients greater than 3 months, the shunt malfunction rate was 23.4% and the infection rate was 4.3%. There were no shunt-related mortalities in either group.ConclusionsChildren under 3-months-old undergoing VPS insertion should not automatically expect an increased 1 year failure or infection rate compared with older children. Reasons for this may be increased sub-specialisation, improved neonatal care and use of antibiotic impregnated catheters.
P105 Shunt migration in ventriculoperitoneal shunting: a comprehensive review of literature
Authors: Srinivasan HL , Chatterjee S , Sharma A 
Published: February 2019

ObjectivesThe mechanical shunt complication- shunt migration is roughly noted in 1 in 1000 patients with shunt. Most of the literature on shunt migration is case reports. In this narrative review we analyze about presentation, complications and management options for each site of shunt migration.DesignNarrative review.SubjectsIn total 239 articles were reviewed in this narrative review which includes a total of 396 shunt migrations.MethodsLiterature search was performed using PubMed Central for all articles containing the term Ventriculoperitoneal shunt migration. All articles published through 2016 were included in this review.ResultsSites of migration were – perforation of the bowel in 139 patients; abdominal wall (57); scrotum (55); chest (32); intracranial (30); cardiac/intravascular (28); genitourinary (15); breast (13); subgaleal (12) and miscellaneous (15).ConclusionsMigration to bowel, heart, intracranial and subgaleal space are associated with 20% chance of shunt dysfunction Any extrusion (irrespective of the site) where the shunt catheter is exposed to the external environment is associated with around 50% chance of shunt infection.
P108 Acetazolamide for obstructive hydrocephalus in the pregnant female: a case report and literature review.
Authors: Strachan EL , Tsang K 
Published: February 2019

ObjectivesThis study presents a case report and literature review of acetazolamide use in the pregnant patient to further delineate its role and controversies in the treatment of symptomatic hydrocephalus. Here we present a case from our neurosurgical service which demonstrated safe use and efficacy of acetazolamide in refractory hydrocephalus secondary to a space-occupying lesion.DesignCase report and literature review.Subjects33-year-old, primigravid female treated at Charing Cross Hospital, London.MethodsAdaptation of the PRISMA guideline to facilitate an initial PubMed database search for all available full-text, peer-reviewed publications in English. Papers were screened for relevance to pregnant patients with hydrocephalus receiving acetazolamide therapy, as well as relevant papers describing related disorders of cerebrospinal fluid flow.ResultsThere exist no prospective, randomised-controlled trials for the use of acetazolamide to treat hydrocephalus in pregnancy. Retrospective data in patients with related conditions suggest no significant link between acetazolamide use and teratogenicity in humans.ConclusionsAcetazolamide can be a safe and efficacious therapy in the pregnant patient with refractory hydrocephalus as a bridge to delivery. We agree with the consensus and its appropriate use in the pregnant neurosurgical patient.
WM1-4 Decompressive craniectomy versus strokectomy for malignant middle cerebral artery (MCA) infarction
Authors: Moughal S , Boeris D , Hainsworth A , Pereira E , Shtaya A , Minhas P 
Published: February 2019

ObjectivesTo compare the outcomes of decompressive craniectomy (DC) with craniotomy and debulikng of stroke tissue (Strokectomy (SC)) for malignant MCA infarction at our centre.DesignRetrospective records review.SubjectsAll Patients with malignant MCA infraction that underwent DC and SC between Jan 2012 and Sep 2017.Methods20 patients had DC (11F/9M, mean age 44.7±1.8 y) and four patients had SC (1F/3M) 51.5±5.9 7 y). Outcomes were assessed by Modified Rankin Scale (mRS) scores before surgery and at latest follow up (3–6 months). mRS was dichotomised as good (0–3) and poor (4–6). Craniotomy size was measured by antero-posterior (AP) diameter and compared between the groups.Results18 patients (90%) of the DC group had mRS 4–6 before surgery versus 100% in the SC group. Post-surgery 15 patients (75%) of the DC group had poor outcome with 7 mortalities (35%) in comparison to one patient (25%) with poor outcome in the SC group and no mortalities. The average craniotomy size in DC was 120.1±4.1 mm versus 85.5±13.1 mm in the SC, p=0.003 students t test). Six patients of the DC group underwent cranioplasty where two developed post-operative seizures. There was no significant difference in age, sex and side of craniotomy (7 Left/13 Right in DC vs 2 Left/2 Right in SC).ConclusionsStrokectomy is comparable to decompressive craniectomy in outcomes without taking the extra risks and costs of cranioplasty. Further studies are required to promote this approach.
WP1-22 DuraGen™ as an encapsulating material for neural stem cell delivery
Authors: Finch L , Harris S , Adams C , Sen J , Tickle J , Tzerakis N , Chari DM 
Published: February 2019

ObjectivesAchieving neural regeneration after spinal cord injury (SCI) represents a significant challenge. Neural stem cell (NSC) therapy offers replacement of damaged cells and delivery of pro-regenerative factors, but >95% of cells die when transplanted to sites of neural injury. Biomaterial scaffolds provide cellular protective encapsulation to improve cell survival. However, current available scaffolds are overwhelmingly not approved for human use, presenting a major barrier to clinical translation. Surgical biomaterials offer the unique benefit of being FDA-approved for human implantation. Specifically, a neurosurgical grade material, DuraGen™, used predominantly for human duraplasty has many attractive features of an ideal biomaterial scaffold. Here, we have investigated the use of DuraGen™ as a 3D cell encapsulation device for potential use in combinatorial, regenerative therapies.MethodsPrimary NSCs were seeded into optimised sheets of DuraGen™. NSC growth and fate within DuraGen™ were assessed using 3D microscopic fluorescence imaging techniques.ResultsDuraGen™ supports the survival (ca 95% viability, 12 days) and 3D growth of NSCs. NSC phenotype, proliferative capacity and differentiation into astrocytes, neurons and oligodendrocytes were unaffected by DuraGen™.ConclusionsA ‘combinatorial therapy’, consisting of NSCs protected within a DuraGen™ matrix, offers a potential clinically translatable approach for neural cell therapy.
WP1-23 Vascular collagen 4A1 in subcortical white matter of older people and primates
Authors: Shtaya A , Yeo NE , Whittaker M , Pereira E , Bridges LR , Zamboni G , Esiri MM , Farris CW , Rosene DL , Hainsworth AH 
Published: February 2019

ObjectivesTo test whether collagen 4A1 in cerebral small arteries associated with age, hypertension or small vessel disease (SVD).DesignNeuropathology cohort study.SubjectsOlder people age >65 years with minimal Alzheimer’s Disease.MethodsWe examined subcortical white matter in archived brain tissue from older people (n=34, 15F/19M, median age 84, range 65–99 y) and from experimental non-human primates (NHP, Macaca mulatta) that were young adults (n=9, age 6.2–8.3 y) or older adults (n=8, age 17.0–22.7 y). Some of the primates (5 young, 3 older) were chronically hypertensive. Vascular collagen 4A1 immunohistochemical labelling was examined qualitatively and quantified as percent area fraction.ResultsCollagen 4A1 labelling was common in arterial myocytes and in the adventitial layer in human and primate brain arteries, as well as in basement membrane, which frequently exhibited replication. Among older people, collagen 4A1 associated with neuropathological SVD severity (sclerotic index; r=−0.461, p=0.0409, least squares) and with radiological SVD severity (leukoaraiosis; p=0.0455, 1-way ANOVA) but not with age or clinical history of hypertension. In NHP, age but not hypertension was significantly associated with collagen-4A1 labelling (p=0.0396, 0.232 respectively, 2-way ANOVA).ConclusionsIn this small cohort, vascular collagen 4A1 was related to SVD severity in older humans, in accord with genetic associations of COL4A1 with SVD phenotypes.
TM1-4 Verbal fluency test in patients with a newly diagnosed brain tumour
Authors: Zienius K , Brennan P , Grant R 
Published: February 2019

ObjectivesUtility of a simple 1 min cognitive screening tool, verbal fluency test, as a potential risk assessment tool for GPs for a suspected brain tumour.DesignCase-control study; patients with new diagnosis of brain tumour with a history of headache and patients referred for direct-access-CT for headache without a brain tumour.Subjects102 brain tumour patients: 34.3% HGG, meningioma 21.6%, cerebrals metastases 17.6%, LGG 11.8%, others (pituitary, schwannoma, haemangioblastoma) 11.8%, and CNS lymphoma 2.9%.MethodsGroup differences analysed with ANCOVA with age/gender as covariates.ResultsMean age was similar across both groups. There were more females in the control group. Tumour patients obtained significantly lower scores on fluency test measures. The largest effect size difference was observed for semantic total and phonemic total scores (Cohen’s d=−0.97 and −0.47, respectively. Brain tumour patients named on average 4.9 animals less (95% CI −6.32,–3.42) (p<0.001) than controls. On letter P task, there was a 2.2 word-mean difference (95% CI −3.6,–0.86)(p=0.001). Forty-eight (47.1%) tumour patients and 22 (23.4%) controls had subjective memory disturbance. Tumour patients performed equally on both fluency tasks regardless of memory complaints (p>0.5).ConclusionsSemantic test is more reliable to discriminate patients with a brain tumour. In contrasts to patients without a brain tumour, subjective memory impairment is not associated with a reduced performance on verbal fluency tasks.
WM1-5 Predictors of retreatment of anterior communicating artery aneurysms after endovascular embolisation
Authors: Borg A , Grover P , Schmitt A 
Published: February 2019

ObjectivesTo establish recurrence and retreatment rates of anterior communicating artery aneurysms (ACom) after endovascular embolization and the complication rate of retreatment. To establish predicting morphological characteristics that would favour surgery or endovascular coiling.DesignRetrospective review of all ACom aneurysms treated at a single neurological centre over a thirteen-year period.SubjectsPatients undergoing endovascular treatment of ACom aneurysms.MethodsAneurysm and patient characteristics were recorded for retreated patients. Analysis of retreatment predictors on imaging was made.ResultsBetween 2005 and 2018, 510 Acom aneurysms were treated, of which 456 presented with SAH and 54 were elective. Out of these, 36 underwent re-treatment. Out of the re-treated aneurysms 33 were identified from radiological follow up and three presented with a re-bleed. The complication rate from the second endovascular procedure was 5.6%. Four patients underwent surgical clipping after failed coiling. Retreatment was more likely in ruptured aneurysms. The dome shape, size (mm) and orientation, were recorded for both aneurysms requiring retreatment and aneurysms successfully excluded after the first procedure. Other parameters reported included time interval, coiling technique (balloon-assisted/stent-assisted).ConclusionsRecurrence of Acom aneurysms after coiling carries significant morbidity. Recognising predictors of recurrence would help identify those aneurysms that are better treated with surgery.
TM1-6 Intramedullary spinal cord tumours – a single centre 10 year retrospective review
Authors: Richards O , Goacher E , Derham C 
Published: February 2019

ObjectivesTo identify clinically relevant predictors of progression free survival by retrospectively analysing the anatomical location, pre- and post-operative function and histology in intramedullary spinal cord tumours from a single neurosurgical centre over 10 years.DesignRetrospective review.Methods49 patients were identified from a surgical database. Variables collected included pre-and post-operative Frankel Grade and Modified McCormick Scale assessments, tumour histology, extent of resection and length of follow up. Chi-Squared, Kaplan-Mier Survival and Mann-Whitney U-Tests were completed.ResultsThere was a statistically significant relationship between identification of the tumour plane and extent of resection (p<0.01), along with the extent of resection and recurrence (p<0.01). Compared to the other histological subtypes, ependymoma’s demonstrated a significantly greater extent of resection (p=0.02). There was a significant relationship between the grade of tumour and progression free survival (p<0.01). We did not find a significant relationship between pre- and post-operative neurological function and survival.ConclusionsTumour plane and the extent of tumour resection are significant determinants of progression free survival. Ependymoma, whilst being the commonest histology in our series were also the most resectable. Whilst complete resection reduces the rate of recurrence, tumour grade is the most important predictor of outcome.