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Spontaneous spinal epidural haematoma (SSEH) is a rare disease defined as blood accumulation within the vertebral epidural space without a cause identified, which can lead to severe neurological deficits. We aim to provide a comprehensive understanding of the prognostic factors affecting surgical outcomes in true SSEH and propose a critical time frame for operative management. A systematic literature search was performed and registered, using OVID Medline and EMBASE, in line with the PRISMA guidelines. Relevant demographic, clinical, surgical, and outcome data were extracted. The ASIA scale was uniformly used throughout our systematic review. Statistical analysis was performed via logistic regression. Of the 1179 articles examined, we included 181 studies involving 295 adult patients surgically treated for SSEH. SSEH were most commonly found in the cervicothoracic spine, with 2-4 spinal segments most commonly involved. Multivariable logistic regression model showed that the following factors were statistically significant in the post-operative outcome: operation type (P = 0.024), pre-operative neurologic status (P 0.001), use of warfarin (P = 0.039), and operative interval (P = 0.006). Our retrospective analysis confirms the reversibility of severe neurological deficits after surgical intervention, with a prognosis of post-operative outcomes determined by the use of warfarin, pre-operative ASIA grade, and above all surgical evacuation within 12 h.

This study aims to review therapeutic strategies in the management of craniospinal tumors in pregnant patients and the factors that may influence the management along with their influence on maternal and fetal outcomes.A retrospective single-center cohort study was performed at a tertiary neurosurgical referral center. Pregnant patients referred to the neuro-oncology multidisciplinary meeting (MDM) with craniospinal tumor were included. Ten-year patient data were collected from hospital records and neuro-oncology MDM outcomes. A systematic review was performed of the available literature as per PRISMA guidelines.Twenty-five patients were identified, with a mean age of 31 years. Of these patients, 88% (n = 22) had cranial lesions and 12% (n = 3) had spinal lesions. Most of the patients had World Health Organization grade I/II tumors. Of the patients, 44% underwent surgery when pregnant, whereas in 40%, this was deferred until after the due date. Of patients, 16% did not require surgical intervention and were followed up with serial imaging in the MDM. The left lateral/park bench position was the preferred position for the spinal and posterior fossa lesions. Systematic review and retrospective data led to proposal of treatment algorithms addressing the therapeutic strategy for management of craniospinal tumors during pregnancy. Factors that may influence maternal and fetal outcomes during management of these tumors were identified, including aggressiveness of the tumor and stage of pregnancy.Craniospinal tumors presenting in pregnancy are challenging. The surgical management needs to be tailored individually and as part of a multidisciplinary team approach. Factors influencing maternal and fetal outcomes are to be considered during management and patient counseling.

Infected cephalhaematomas are rare and can lead to complications such as sepsis, meningitis and osteomyelitis. We present an infected cephalhaematoma in a neonate with resultant underlying osteomyelitis and a review of the literature. Our patient presented 6 days following birth with a fever and a swelling consistent with cephalhaematoma. He was managed with intravenous antibiotics and early surgical intervention. Imaging demonstrated underlying osteomyelitis. The patient made a full recovery and was discharged home on completing his antibiotic course. On reviewing the literature, it is clear that early diagnosis and treatment with surgical intervention and antibiotic therapy are associated with improved outcome and can reduce the possibility of osteomyelitis developing.

Introduction and objectivesThe novel severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic has had drastic effects on global healthcare with the UK amongst the countries most severely impacted. The aim of this study was to examine how COVID-19 challenged the neurosurgical delivery of care in a busy tertiary unit serving a socio-economically diverse population.MethodsA prospective single-centre cohort study including all patients referred to the acute neurosurgical service or the subspecialty multidisciplinary teams (MDT) as well as all emergency and elective admissions during COVID-19 (18th March 2020–15th May 2020) compared to pre-COVID-19 (18th of January 2020–17th March 2020). Data on demographics, diagnosis, operation, and treatment recommendation/outcome were collected and analysed.ResultsOverall, there was a reduction in neurosurgical emergency referrals by 33.6% and operations by 55.6% during the course of COVID-19. There was a significant increase in the proportion of emergency operations performed during COVID-19 (75.2% of total,n=155) when compared to pre-COVID-19 (n= 198, 43.7% of total,p< 0.00001). In contrast to other published series, the 30-day perioperative mortality remained low (2.0%) with the majority of post-operative COVID-19-infected patients (n= 13) having underlying medical co-morbidities and/or suffering from post-operative complications.ConclusionThe capacity to safely treat patients requiring urgent or emergency neurosurgical care was maintained at all times. Strategies adopted to enable this included proactively approaching the referrers to maintain lines of communications, incorporating modern technology to run clinics and MDTs, restructuring patient pathways/facilities, and initiating the delivery of NHS care within private sector hospitals. Through this multi-modal approach we were able to minimize service disruptions, the complications, and mortality.

Objectives: The study aims to evaluate therapeutic strategies in the management of craniospinal tumours in pregnant patients and the factors that influence the management along with their influence on maternal & foetal outcomes. Materials and Methods:A retrospective single-centre cohort study was performed at a tertiary neurosurgical referral centre. Pregnant patients referred to neuro-oncology multidisciplinary meeting (MDM) with craniospinal tumour were included. Ten-year patient data were collected from hospital records and neuro-oncology MDM outcomes. A systematic review was performed on the available literature in PubMed as per PRISMA guidelines. Results:Thirty-three patients were identified with a mean age of 31 years. 91%(n=30) had cranial lesions and 9%(n=3) had spinal lesions. Most of the patients had WHO Grade I/II tumours. 33.3% underwent surgery when pregnant whilst in 24.2% this was deferred until after the due date. 27.2% patients did not require surgical intervention and were followed up with serial imaging in the MDM. Left Lateral/park bench position was the preferred position for the spinal and posterior fossa lesions. Systematic review identified 26 eligible articles. Treatment algorithms are proposed addressing the therapeutic strategy for management of cranio-spinal tumours during pregnancy and the challenges for maternal and foetal outcomes were tabulated. Conclusions:Craniospinal tumours presenting in pregnancy are challenging. The surgical management needs to be tailored individually and as part of a multidisciplinary team approach. Maternal and foetal outcomes are to be considered during patient counselling.

Transsulcal minimally invasive parafasicular (TsMIP) approaches to brain tumor resection use tubular retractors to minimize iatrogenic brain injury. Dynamic cortical and subcortical continuous neurophysiological mapping facilitates safer resection of motor-eloquent tumors.To describe a new technique to address the challenge of combining TsMIP with tubular retractors and dynamic subcortical mapping using a single electrified stimulating microdebrider instrument.We adapted the NICO Myriad microdebrider with continuous monopolar stimulation electrification using high-frequency stimulation with the train-of-5 technique. We performed continuous subcortical mapping using this device and compared it with standard dynamic monopolar subcortical mapping using a suction stimulation device. We found no significant difference in recorded stimulation response.Using a single operating instrument that provides synchronous tumor resection and monopolar subcortical mapping with the NICO Brainpath tubular retractor, we observed increased degrees of movement, faster surgical resection times with an enlarged working channel down the retractor, and improved safety because the stimulating probe sits 2 mm deep to the resection window.We show that the adapted device is reliable and provides similar stimulation response as conventional subcortical mapping. We advocate the use of our adapted microdebrider in TsMIP tubular retractor approaches.

Background: The novel severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic has had a drastic effect on global healthcare with the UK amongst the countries most severely impacted. The aim of this study was to examine how COVID-19 challenged the neurosurgical delivery of care in a busy tertiary unit serving a socio-economically diverse population. We also describe the strategies we adopted to meet these challenges. Methods: A prospective single centre cohort study including all patients referred to the acute neurosurgical service or the subspecialty multi-disciplinary teams (MDT) as well as all emergency and elective admissions during COVID-19 (18th March 2020-15th May 2020) compared to pre-COVID-19 (18th of January 2020-17th March 2020). Data on demographics, diagnosis, operation, and treatment recommendation/outcome were collected and analysed. Findings: Overall, there was a reduction in neurosurgical emergency referrals by 33·6% and operations by 55·6% during the course of COVID-19. There was a significant increase in the proportion of emergency operations performed during COVID-19 (75·2% of total, n=155) when compared to pre-COVID-19 (n=198, 43·7% of total, p

High-grade gliomas harboring H3 G34R/V mutations exclusively occur in the cerebral hemispheres of adolescents and young adults, suggesting a distinct neurodevelopmental origin. Combining multimodal bulk and single-cell genomics with unbiased genome-scale CRISPR/Cas9 approaches, we here describe a GABAergic interneuron progenitor lineage as the most likely context from which these H3 G34R/V mutations drive gliomagenesis, conferring unique and tumor-selective gene targets essential for glioma cell survival, as validated genetically and pharmacologically. Phenotypically, we demonstrate that while H3 G34R/V glioma cells harbor the neurotransmitter GABA, they are developmentally stalled, and do not induce the neuronal hyperexcitability described in other glioma subtypes. These findings offer a striking counter-example to the prevailing view of glioma origins in glial precursor cells, resulting in distinct cellular, microenvironmental, and therapeutic consequences.

INTRODUCTION: In patients presenting with obstructive hydrocephalus secondary to pineal region lesions, a combined endoscopic third ventriculostomy (ETV) and tumour biopsy is an increasingly common procedure. Performing it through a monoportal approach with a rigid scope is especially challenging given the anatomy of the third ventricle. Here we report our experience of the monoportal endoscopic combined approach made possible by splitting the choroid fissure (CF) and massa intermedia (MI). METHODS: A 13-year-old male was referred to our unit having presented with a 2-day history of headache, blurred vision, diplopia and vomiting. An MRI revealed a pineal region lesion causing obstructive hydrocephalus. RESULTS: An ETV was performed. Access to the pineal region was then gained by splitting of the CF and subsequent division of a small MI. A biopsy was taken and limited debulking performed (tumour was large and hard making complete resection difficult). Histopathology confirmed an immature teratoma. Post-operatively the patient made an excellent recovery. CONCLUSION: The endoscopic transchoroidal approach with splitting of the MI allows management of hydrocephalus and access to pineal tumours for biopsy/debulking via a single burr hole and using a solid scope. In the future complete resection of pineal lesions via this approach may become commonplace with improved instrumentation and equipment.

INTRODUCTION: The use of the endoscopic ultrasonic aspirator for the management of intraventricular tumours is still in its infancy. We share our early experience using the aspirator in the management of intraventricular, paraventricular and suprasellar tumours. SUBJECTS: 19 patients (10 males, 9 females) underwent 22 operations with the endoscopic ultrasonic aspirator. Ages ranged from 6 months to 86 years. Tumour types included: a choroid plexus papilloma (grade II), an infiltrative glioma (grade II), an intraventricular meningioma (grade I-II), a diffuse glioma (grade II-III), three craniopharyngiomas, an anaplastic ependymoma (grade III), two glioblastomas (grade IV), an immature teratoma, 2 gangliogliomas (grade I), a choroid plexus cyst, a central neurocytoma (grade II), a pineocytoma (grade I), a metastasis (lung primary), a subependymoma (grade I) and a pilocytic astrocytoma with pilomyxoid features (grade I). RESULTS: A monoportal approach guided by neuronavigation was used in all patients. Of the 22 procedures, 18 were carried out in patients with hydrocephalus. In 6 procedures a total or near-total resection was achieved. Tumour resection was limited by tumour location, size and consistency as well as instrumentation. CONCLUSION: The endoscopic ultrasonic aspirator is a powerful addition to our neuro-endoscopic armamentarium and with further development, endoscopic total resections may become more commonplace.

INTRODUCTION: Citation number can be considered a measure of a publication’s academic influence. Previous studies have suggested a citation number greater than 50 and a citation rate higher than 5 per year constitute a high impact in neurosurgery. We set out to determine and categorise the most highly influential papers related to the neurosurgical management of paediatric central nervous system (CNS) tumours between 2005-2010. METHODS: Child’s Nervous System, Journal of Neurosurgery: Pediatrics and Pediatric Neurosurgery were previously identified as publishing the most influential papers in paediatric neurosurgery. All papers published by these journals between 2005-2010 were collected from Web of Science. Papers describing surgical management of paediatric CNS neoplasms were identified and the 50 most cited were determined. RESULTS: Of the most highly cited papers, 54% were published in Child’s Nervous System, 26% in Journal of Neurosurgery: Pediatrics and 20% in Pediatric Neurosurgery. The citation number ranged from 27-93 (mean = 43) and citations rate (per year) ranged from 2.31-8.25. Of the top 50 papers, 24% had more than 50 citations and 8 of these had a citation rate greater than 5 per year. 72% of papers were experiential studies and 24% were review articles. 42% described surgical management of craniopharyngiomas and 10% related to management of posterior fossa tumours. There were no randomised controlled trials. CONCLUSION: Between 2005-2010, 8 papers related to surgical management of paediatric CNS tumours can be considered as having high impact in the literature. The majority of papers focused on surgical management of craniopharyngiomas.

BACKGROUND: 5-aminolevulinic acid (5-ALA, Gliolan) is widely used in adults for facilitating the resection of high-grade gliomas. However, its safety and efficacy in the paediatric population remains to be established. We present the UK’s first case series of 10 patients, undergoing 11 operations with 5-ALA. METHODS: 10 consecutive patients (aged 1.6-15 years) underwent pre-operative administration of 20mg/kg of 5-ALA. The tumours were visualised intra-operatively under violet-blue light and the presence and usefulness of fluorescence was assessed. RESULTS: Strong fluorescence was observed in two WHO grade III ependymomas and a GBM (IV). Moderate fluorescence was seen in one pilocytic astrocytoma (I) and a pilomxyoid astrocytoma (II). Weak fluorescence was observed in a diffuse astrocytoma (II). The tumours types which showed no fluorescence included: a pilocytic astrocytoma, a glioneuronal tumour (II) and an anaplastic medulloblastoma (IV). No significant adverse drug reactions were recorded in any of the patients. CONCLUSIONS: Our case series adds to the evidence base supporting the safety of 5-ALA in the paediatric population. However, the diverse range of responses to 5-ALA in these tumours highlights the need for further trials into its usefulness in specific tumour types.

The idiopathic Parkinson disease (IPD) is traditionally diagnosed by motor signs, but non-motor symptoms and signs are frequent and may help in the clinical diagnosis. PURPOSE: To evaluate the olfactory function in Brazilian healthy subjects, patients with early-onset PD (EOPD) and late-onset PD (LOPD) using the Sniffin' Sticks odor-identification test (SST). METHOD: We studied 70 patients with IPD (19 EOPD and 51 LOPD) and 70 controls matched for gender, age and years of schooling. Subjects with dementia and loss of smell for other reasons were excluded. RESULTS: The SST showed a significant difference (p

It ac-counts for approximately 3 to 5% of all cerebellopontine mass lesions. A variety of clinical syndromes have been re-lated due to pulsatile compression by the aberrant vessel: cerebellar dysfunction, hydrocephalus, ischemic stroke, transient or permanent motor deficits, central sleep ap-nea, trigeminal neuralgia, as well as brain stem compres-sion syndrome