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Objectives: Visual-field deficits following temporal lobe surgery have been reported in the literature. In this prospective study, the authors analyse their experience of visual-field deficits in 105 consecutive cases undergoing temporal-lobe surgery performed by a single surgeon, with particular consideration to the laterality of the deficit and its functional implications.Methods: 105 consecutive patients undergoing an anterior temporal lobe resection for epilepsy, between March 1998 and June 2004, were selected. The patient population had a mean age of 35 years (range 19-60 years); 53 had a left-sided resection and 52 a right-sided resection. 91 patients had mesial temporal sclerosis, three gangliogliomas, four dysembryoplastic neuroepithelial tumours (DNETs), two neurocytomas and two cavernomas, and in three cases the histology was inconclusive. Pre- and postoperative visual-field tests were obtained using the Humphrey Esterman binocular functional test for all cases. The test was set to stimulus white III, with a single intensity of 10 DB on the background of 31.5 ASB for all patients. A minimum follow-up period of 12 months postsurgery was employed. Postoperative MRI scans were carried out on all patients. 60 scans were randomly selected, and the extent of temporal lobe resection calculated manually for each.Results: Of the 105 cases, 16 patients had a visual-field deficit postoperatively which was not present preoperatively: 12 following a left and four following a right-sided resection. The OR for incurring a postoperative visual-field defect following left versus right-sided surgery was 3.51 (95% CI 1.05 to 11.73, p=0.04). In four patients, the deficit was severe enough to preclude them from driving in the UK (three left- and one right-sided resection). There was no association between the extent of tissue resection and the incidence of postoperative visual-field deficits.Conclusions: This study suggests left-/right-hemispherical asymmetry in the Geniculocalcarine tracts with field deficits being 3.5 times more likely following left-sided anterior temporal lobe resections compared with right-sided resections. This has significant implications on counselling patients for these procedures. MR tractography may provide an anatomical substrate for these clinical findings, perhaps revealing a more anterior course of the optic radiations within the temporal lobe in one hemisphere versus the other. [ABSTRACT FROM AUTHOR]

Background: Deep brain stimulation (DBS) is an emerging and effective therapy for Parkinson's disease (PD). However, little is known about its utilization, surgical populations, centers, coverages, regional balance, and influential factors., Materials and Methods: This large-scale multicenter cross-sectional study was conducted using a national census involving 74 Chinese centers. National DBS populations and centers for PD were investigated in 1997-2021, and regional sociodemographic features, surgical populations, related resources, and insurance policies in 2020 were explored., Results: Since the first DBS surgery in 1997, a total of 38 122 PD patients from 349 centers underwent DBS by 2021, which covered 1.118% (1.108-1.129) of patients and 0.954% (0.933-0.976) of centers. Significant upward trends in the annual surgical population and coverages were observed with rapid climbing rates, while the annual surgical centers and their coverage showed two growth peaks in 2002-2006 and 2010-2018, correlating with clinical approvals and new technologies. A total of 103 070 (51 165-154 975) PD patients [2.088% (1.351-2.825) coverage] and 603 (72-1134) centers [1.356% (1.126-1.586) coverage] are predicted to conduct DBS by 2030. The new remotely programmed DBS technology was recoded as the first application in 2015 and rapidly increased to 2771 (47.39%, 46.11-48.67) patients with 10 507 remote programming sessions annually in 2021. Provinces in the eastern and central regions had better economic status, more surgical patients, higher insurance affordability, and more related resources than those in the western and northeastern regions. Higher gross domestic product per capita ( β =5.041, 3.324-6.758 and β =0.008, 0.004-0.012; all P <0.001) and more functional neurosurgery doctors ( β =3.596, 0.353-6.839; P =0.031 and β =0.010, 0.002-0.017; P =0.013) positively influenced surgical populations and coverages, while higher insurance levels ( β =128.888, 64.702-193.075; P <0.001) positively influenced surgical coverages., Conclusion: Although surgical populations, centers, and coverages of DBS for PD have rapidly improved and are predicted to show future increases, this is still insufficient to cover potential eligible patients. Regionally imbalanced health coverage should be given attention to promote coordinated development., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Competing Interests: Authors’ disclosure of potential conflicts of interest The authors have nothing to disclose.

Epilepsy is defined as drug-resistant after failure of two adequate trials of appropriately chosen and administered antiepileptic drugs. Approximately 30% of patients with epilepsy have drug-resistant epilepsy. Reasons for treatment failure include failure to recognise epilepsy syndrome, poor drug compliance, and lifestyle factors. Patients with drug-resistant epilepsy should be encouraged to have early referral to a tertiary epilepsy centre for presurgical evaluation. Comprehensive neurophysiology, structural neuroimaging, neuropsychological, and psychiatric assessments are regarded as essential for determining suitability for epilepsy surgery. Epilepsy surgery, whether resection, disconnection, or neuromodulation, should be recommended only after multidisciplinary consensus agreement based on these assessments.

Human sparganosis is a foodborne zoonosis endemic in Asia. We report a series of 9 histologically confirmed human sparganosis cases in Hong Kong, China. All parasites were retrospectively identified as Spirometra erinaceieuropaei. Skin and soft tissue swelling was the most common symptom, followed by central nervous system lesions.

Objective: New information about antiepileptic drugs has arisen since the publication of the Hong Kong Epilepsy Guideline in 2009. This article set out to fill the knowledge gap between 2007 and 2016 on the use of antiepileptic drugs in Hong Kong., Participants: Between May 2014 and April 2016, four consensus meetings were held in Hong Kong, where a group comprising 15 professionals (neurologists, paediatricians, neurosurgeons, radiologists, and clinical psychologists) from both public and private sectors aimed to review the best available evidence and update all practising physicians on a range of clinical issues including drug-related matters. All participants were council members of The Hong Kong Epilepsy Society., Evidence: A literature review of the clinical use of antiepileptic drugs as monotherapy suggested Level A evidence for levetiracetam and Level B evidence for lacosamide. No change in the level of evidence was found for oxcarbazepine (Level A evidence) or pregabalin (undesignated), and no evidence was found for perampanel. A literature review on the clinical use of antiepileptic drugs as adjunctive therapy suggested Level A evidence for both lacosamide and perampanel. No change to the level of evidence was found for levetiracetam (Level A evidence), oxcarbazepine (Level A evidence), or pregabalin (Level A evidence). A literature search on the use of generic antiepileptic drugs suggested Level A evidence for the use of lamotrigine in generic substitution., Consensus Process: Three lead authors of the Subcommittee drafted the manuscript that consisted of two parts-part A: evidence on new antiepileptic drugs, and part B: generic drugs. The recommendations on monotherapy/adjunctive therapy were presented during the meetings. The pros and cons for our health care system of generic substitution were discussed. The recommendations represent the 'general consensus' of the participants in keeping with the evidence found in the literature., Conclusions: Recommendations for the use of levetiracetam, lacosamide, oxcarbazepine, pregabalin, and perampanel were made. The consensus statements may provide a reference to physicians in their daily practice. Controversy exists over the use of generic products among patients who are currently taking brand medications. In this regard, approvals from prescriber and patient are pivotal. Good communication between doctors and patients is essential, as well as enlisting the assistance of doctors, nurses, and pharmacists, therapeutic blood monitoring if available, and the option of brand antiepileptic drug as a self-financed item. The physical appearance of generic drugs should be considered as it may hamper drug compliance. Support from medical services is recommended. In the longer term, the benefit of flexibility and the options to have a balance between the generic and brand drug market may need to be addressed by institutions and regulatory bodies.

Objective: We assessed the effects of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) in patients with Parkinson disease at the 1-year and 2-year follow-up evaluations. Unified Parkinson's Disease Rating Scale (UPDRS) motor score at "off" medication ("on" DBS) and quality-of-life assessments (39-item Parkinson's Disease Questionnaire [PDQ-39]) were conducted. The percentage of awake "on" time and awake "off" time and levodopa requirement were also assessed., Methods: A 2-year prospective study was conducted of 25 consecutive patients from 3 DBS referral centers in Hong Kong. The patients were treated with bilateral stimulation of the STN. Assessments were performed at 1 year and 2 years after DBS and were compared with the baseline., Results: The 2-year outcome assessments were completed by 18 patients. The mean UPDRS motor score improvement was 57% in the first year and 45% in the second year. PDQ-39 showed significant improvement in quality of life for 2 consecutive years. The levodopa requirement decreased 63% in the first year and 55.9% in the second year. The awake "on" time was doubled in the first year and sustained in the second year. Awake "off" time was reduced from 28.1% to 5.9% in the first year and returned to 10.6% in the second year. Improvement of UPDRS motor score, reduction in awake "off" time, and decrease of daily levodopa dosage all were main factors correlated with the improvement in PDQ-39 summary index., Conclusions: The effects of STN DBS in patients with Parkinson disease in Hong Kong were satisfactory. The results showed that reduction in UPDRS motor score, awake "off"-time, and daily levodopa dosage were the major drivers of overall improvement in PDQ-39., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Even with the invention of locking plates, intra-articular fractures of distal radius with extreme comminution remain a challenge for orthopaedic surgeons. Osteochondral graft is a potential choice to reconstruct the articular defect. We report a patient who had a fracture of distal radius with costo-osteochondral graft for articular reconstruction which has not yet been described in the English literature. At nine-year follow-up, he was pain free and had full range of movement of the wrist. The authors suggest that costo-osteochondral graft could be an option with satisfactory result.

Object: Gamma Knife surgery (GKS) is gaining popularity in the treatment of patients with acromegaly after transsphenoidal tumor excision. In this paper, the authors examine the efficacy of GKS and predictors for biochemical remission., Methods: The authors retrospectively reviewed data spanning the period 1997–2008 in their hospital Gamma Knife statistics database. Forty patients with a mean age of 64 years (range 19–73 years) underwent GKS for acromegaly during that period. Transsphenoidal subtotal tumor excision had been performed prior to GKS in all these patients, except for 3 deemed to be at high surgical risk. All GKS treatment plans were formulated by the same team that performed the microsurgical procedures. Biochemical remission was defined as a growth hormone (GH) level <2 ng/ml and an insulin-like growth factor–I level that was considered normal with reference to the patient's age and sex. The mean follow-up period after radiosurgery was 73.8 months (range 12–132 months)., Results: Three patients died during the study period of causes unrelated to surgery or GKS. Twenty-nine patients (72.5%) underwent 1 radiosurgery session, and 11 patients (27.5%) required 2 radiosurgery sessions. Among the patients who underwent 1 radiosurgery session, excellent responses (76%–100% reductions in tumor size, GH level, and insulin-like growth factor–I level) were observed in 18 (62%; p < 0.0001), 20 (69%; p < 0.0001), and 5 patients (17%; p = 0.21), respectively. Tumors < 1 cm³ and those with no evidence of cavernous sinus extension were statistically significantly related to a good response in tumor size reduction (p = 0.029 and p = 0.0016, respectively). Subgroup analyses were performed in patients who attained biochemical remission in GH levels; the subgroups included patient sex, patient age, target volume, isodose volume, prescribed dose and isodose, pre-GKS GH level, and evidence of cavernous sinus extension. Only male sex was found to be a statistically significant predictor of good hormone regulation (p = 0.0124). The presence of a cavernous sinus extension was the statistically significant predictor of poor hormone control (p = 0.0011) in our study., Conclusions: Subtotal tumor excision followed by GKS was an effective treatment for acromegaly. Tumors < 1 cm³ and those with no evidence of cavernous sinus extension responded well to treatment. Male sex and absence of cavernous sinus involvement can be regarded as predictors of biochemical remission. (DOI: 10.3171/2010.7.GKS10

Objective: To study the association between upper gastrointestinal (GI) problems and inhalational ketamine abuse., Methods: This is a retrospective study of 64 ketamine abusers treated from 2001 to 2008. Variables studied included clinical presentations, findings of upper GI endoscopy, abstinence from ketamine and relief of epigastric pain., Results: The following patients with (i) a previous history of upper GI problem; (ii) a history of non-steroidal anti-inflammatory drug (NSAID), aspirin or other substance abuse; and (iii) a known history of Helicobacter pylori (H. pylori) infection were excluded. The study group thus consisted of 37 ketamine abusers, of whom 28 had upper GI symptoms. Overall 14 of these patients had an upper endoscopy performed. The endoscopic diagnoses were: 12 (85.7%) with gastritis, one (7.1%) with gastroduodenitis, and one (7.1%) normal finding. Test for H. pylori, infection was negative. Abstinence from ketamine was found to be associated significantly with relief of symptoms (P= 0.027). Logistic regression showed the odds ratio of symptomatic relief for abstinence versus continued use of ketamine is 12.5 (95% CI[1.20, 130.6], P= 0.035). In patients whom an upper GI endoscopy was performed, H. pylori negative gastritis was the commonest histopathological finding (78.6%). Despite the use of medications, symptoms are commonly not relieved and that is associated with the continued abuse of ketamine., Conclusion: Ketamine abusers frequently presented with upper GI symptoms, the commonest of which is epigastric pain (73% of abusers). Abstinence from ketamine abuse can lead to the relief of symptoms, which is an important message for ketamine abusers.

Magnetoencephalography is a newly developed technology used for diagnostic and brain mapping imaging during the presurgical evaluation of patients with medically intractable epilepsy. It provides comprehensive localisation of an epileptogenic focus using simultaneous recordings from the entire brain surface. Magnetoencephalography and electroencephalography are considered complementary and confirmatory to one another. We present a patient with magnetic resonance imaging-negative, non-lesional, neocortical epilepsy. Magnetoencephalography was used for re-evaluation of the epileptogenic zone and this enabled subsequent surgical removal of the epileptic focus. The role of magnetoencephalography in epilepsy surgery is discussed in this report.

A 38-year-old man had been tetraplegic and ventilator-dependent after sustaining a traumatic cervical spine fracture at the C1/C2 level in 1991, at the age of 22 years. He had been bedbound and mechanically ventilated since then. A multidisciplinary management team approached him in 2003 and helped him to become ambulatory and independent in his daily activities of living. We successfully implanted the diaphragm pacing stimulation system in this patient in 2004. Diaphragm pacing by phrenic nerve stimulation is well accepted in western countries, and has been in clinical application for children and adults for decades. Its use facilitates ambulation and improves the quality of life of tetraplegic individuals with chronic ventilatory failure.

This report is of a 36-year-old woman who initially presented with confusion and fever. Subsequent investigations showed tuberculous meningitis with acute hydrocephalus. Ventriculoperitoneal shunt was performed and anti-tuberculosis therapy was given. The patient was later noticed to have weakness of both lower limbs and urinary retention. Magnetic resonance imaging of the thoracic spine showed radiological features of tuberculous arachnoiditis with cord compression. Decompressive laminectomy was performed and high-dose systemic corticosteroid was given. A high level of awareness is required when diagnosing tuberculous arachnoiditis and the importance of high-dose corticosteroid in the treatment regimen is emphasised.

Subperiosteal abscess of orbit is an uncommon but serious complication of orbital infection. We report a case of a 78 year old gentleman who presented with bilateral periorbital oedema and proptosis. Computerised tomography of orbit revealed bilateral dilated superior ophthalmic veins. Bilateral carotid-cavernous fistula was initially suspected. Serial imaging showed an increasing bilateral subperiosteal lesion of the orbit. Fine needle aspiration confirmed subperiosteal abscess. A high level of awareness is necessary in diagnosing subperiosteal abscess., (Copyright 2001 Harcourt Publishers Ltd.)

Objective: To determine the ability of open reduction and plate fixation to restore articular congruity in the treatment of fractures of the distal radius with intraarticular comminution and displacement., Design: Prospectively followed series., Methods: Eighteen consecutive fractures of the distal radius with intraarticular comminution and displacement were treated with open reduction and combined volar and dorsal plate fixation in thirteen, dorsal plate fixation in four, and volar plate fixation in one case. Kirschner wires were added in thirteen fractures and cancellous bone graft was used in four fractures. Articular congruity after a mean follow-up of twenty-three months was assessed using anteroposterior and lateral radiographs., Results: Articular congruity without a two millimeter or more intraarticular stepoff was found at follow-up in fifteen of eighteen cases, without a two millimeter or more gap in nine cases and without a two millimeter or more stepoff or gap in only eight cases. One reason for not having obtained articular congruity in some of the fractures was insufficient intraoperative visualization of the joint surface. Three reduced fractures redisplaced. The reason for loss of intraarticular reduction was considered insufficient stabilization of the distal fragments. In two of the three cases, it was thought that insertion of bone graft would have prevented the loss of reduction., Conclusions: Articular incongruity after open reduction and plate fixation of comminuted fractures of the distal radius may occur more often than expected. The reduced fracture should be evaluated by intraoperative radiographs. If the reduced joint surface is not entirely visible on the radiographs because of implants or other reasons, oblique radiographs or fluoroscopy should be additionally used. Plate fixation alone does not always provide sufficient stability and cancellous bone graft should be added in cases of metaphyseal bone loss or for stabilization of multiple small articular fragments that cannot be fixed by screws or Kirschner wires.

The technical details of open reduction and internal fixation with double plating for a patient with comminuted intra-articular fractures of the distal radius were described. The vital steps included the exposure, initial dorsal reduction, ventral reduction and fixation, checking of reduction, return to dorsal surface with final reduction and X-ray check, and wound closure. Special attention and other technical tips were also highlighted, and hopefully will shorten the learning curve of others who would like to use this rather demanding technique for their patients.