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British Journal of Neurosurgery

Hiroyuki Masuda, Masaaki Nemoto, Naoyuki Harada, Yutaka Fuchinoue, Shinichi Okonogi, Yasuhiro Node, Shunpei Ando, Kosuke Kondo, Nobuo Sugo
PURPOSE: Central nervous system (CNS) tumour consistency is one of the factors determining the difficulty of surgery for such lesions. We measured the consistency of surgically excised CNS tumour specimens using a hardness meter. The purpose of this study was to identify imaging parameters that reflect tumour consistency by comparing preoperative imaging findings with CNS tumour consistency measurements. MATERIAL AND METHODS: Of 175 consecutive patients with CNS tumours who underwent surgery at our hospital between October 2012 and October 2018, 127 were included in this study (those whose specimens were difficult to measure were excluded)...
May 17, 2019: British Journal of Neurosurgery
Alexandros G Brotis, Jiannis Hajiioannou, Christos Tzerefos, Christos Korais, Efthymios Dardiotis, Kostas N Fountas, Kostantinos Paterakis
A 24-year-old man presented with bilateral Tapia's syndrome (TS) after a traumatic cervical spine injury, manifested by apraxia of the hypoglossal and recurrent laryngeal nerves. The initial presentation was a profound inability to maintain upper respiratory airway patency due to bilateral vocal cord paralysis, accompanied by impairment of swallowing and loss of speech. The diagnosis was based on clinical grounds and verified by endoscopic laryngoscopy. A C7 corpectomy was performed for stabilizing the cervical spine, while conservative treatment with steroids was reserved for the TS...
May 17, 2019: British Journal of Neurosurgery
Mehdi Nikoobakht, Hamidreza Shojaei, Peter C Gerszten, Seyedeh Fahimeh Shojaei, Reza Mollahoseini, Maziar Azar
BACKGROUND: Posterior fossa decompression both with and without duraplasty are accepted treatments for symptomatic adult patients with Chiari Malformations Type 1 (CM-1). There is still debate of the superiority of one technique over the other. The purpose of this study was to determine the clinical and craniometrical imaging outcomes of a series of patients who underwent posterior fossa decompression with duraplasty. MATERIALS AND METHODS: All adult patients with symptomatic CM-1 operated at a single institution with a minimum of 6 months follow-up were enrolled prospectively...
May 17, 2019: British Journal of Neurosurgery
Euidon Choi, Jong Young Lee, Hong Jun Jeon, Byung-Moon Cho, Dae Young Yoon
PURPOSE: To describe our experiences with a fully equipped high-end digital subtraction angiography (DSA) system within a hybrid operating room (OR). MATERIAL AND METHODS: A single-plane DSA system with 3-dimensional rotational angiography (3DRA), cone-beam computed tomography, and real-time navigation software was used in our hybrid OR. Between April 2014 and January 2018, 191 sessions of neurovascular procedures were performed in our hybrid OR. After the retrospective review of all cases, the procedures were categorised into five subcategorical procedures according to the dominance of surgical and/or endovascular procedures: intraoperative angiographic evaluation, combined endovascular and surgical procedure, complementary rescue procedure during intervention and surgery, surgical approach for interventional procedure, and frameless stereotaxic operation...
May 16, 2019: British Journal of Neurosurgery
Prajwal Ghimire, Jonathan Shapey, Istvan Bodi, Steve Connor, Nicholas Thomas, Konstantinos Barkas
We describe the case of a 65-year-old lady who presented with mutism and a right hemiparesis. Imaging showed a severe spontaneous tension pneumocephalus. The cause was diagnosed as Ecchordosis physaliphora (EP). EP is a rare cystic congenital hamartomatous benign notochordal tumor (BNCT) arising from an ectopic notochordal remnant. To the authors' knowledge, this is the first case of EP to be described in the literature which presented with a life-threatening but treatable condition of severe tension pneumocephalus...
May 11, 2019: British Journal of Neurosurgery
Muhammad Usman, Giles Critchley, Panayiotis Koumellis, Marius Poitelea
We present a rare case of an ICA aneurysm recurrence despite treatment with ICA balloon occlusion. There was evidence of ICA recanalization bypassing the balloons on a catheter angiogram follow-up 1 year post-procedure. Although initially stable in size, at 5 years after the original procedure, the aneurysm demonstrated evidence of enlargement and on angiography there was further enlargement of the recanalized ICA around the occluding balloons. We postulate that this has been caused by increasing antegrade flow through hypertrophied vasa vasorum in response to persistently increased demand for blood flow by the ipsilateral hemisphere; this indirectly may have also contributed to some extent to the aneurysm enlargement...
April 29, 2019: British Journal of Neurosurgery
C Burford, R Laxton, Z Sidhu, M Aizpurua, A King, I Bodi, K Ashkan, S Al-Sarraj
PURPOSE: The 2016 WHO tumour classification highlights the role of IDH1/2 gene mutation and 1p/19q co-deletion in classifying grade II/III gliomas. A recent cIMPACT-NOW update proposes the use of the term 'Not Elsewhere Classified' (NEC) for IDH-mutant, non co-deleted tumours. Here we show how the incorporation of ATRX immunohistochemistry can be used to better delineate the NEC group. METHODS: Clinical data was collected for 112 patients (59% male) treated at our unit...
April 24, 2019: British Journal of Neurosurgery
Andrew F Alalade, Sara Venturini, Neil Dorward, Nick Thomas
BACKGROUND: Endoscopic skull base surgery (ESBS) is a new subspecialty area that has become more popular over the past 20 years. It is fast evolving and the indications are getting increasingly diverse. The skill-sets also continue to significantly improve, hence, we, the authors aim to assess the current status of this unique sub-specialty within the United Kingdom. OBJECTIVE: Our objectives included identifying the proportion of neurosurgeons within the United Kingdom who utilize endoscopic skull base approaches, the background training involved and how much of the overall neurosurgical workload is constituted by endoscopic skull base neurosurgery...
April 24, 2019: British Journal of Neurosurgery
Guowen Qin, Peng Xu, Shengyong Lan, Yipu Mao, Yongta Huang, Jin Ye, Youming Liang
Angiosarcoma is an uncommon, aggressive endothelial-cell tumor that usually affects the skin, and involvement of the skull is rare. Here, we describe a case of skull angiosarcoma associated with a calcified chronic subdural hematoma (CSDH). HIGHLIGHTS A very rare case of skull angiosarcoma associated with a calcified chronic subdural hematoma is presented. An asymptomatic subdural hematoma with an atypical history and radiological features should prompt further investigation. Contrast MRI images should to be obtained early to differentiate a subdural hematoma from other pathologies...
April 24, 2019: British Journal of Neurosurgery
Mohammad Ghorbani, Maziar Azar, Karan Bavand, Hamidreza Shojaei, Reza Mollahoseini
INTRODUCTION: Hypersomnia is a condition in which a person has trouble staying awake during the day. There are several potential causes of it, including sleep apnea and sleep disorders. CASE PRESENTATION: A 43 year old male was referred to our practice with complaints of hypersomnia, snoring, slurred speech and sleep apnea for more diagnostic and therapeutic interventions. His brain MRI was significant for a vascular loop compression on medulla oblongata. The patient underwent microvascular decompression surgery subsequently and showed improvement in all of his symptoms...
April 24, 2019: British Journal of Neurosurgery
Jason Yuen, Wisam Selbi, Lucy Lee, Tim Germon
To our best knowledge, this is the first reported case of ossified ligamentum flavum in the lumbar spine in a Caucasian patient from the United Kingdom. It is an important risk factor to recognise during spinal operation as it can significantly increase its difficulty and the rate of complications.
April 23, 2019: British Journal of Neurosurgery
Andrew J Hall, Niamh S Toner, Pragnesh M Bhatt
PURPOSE: Neurosurgical patients are often complex and require high quality, attentive care in the immediate postoperative period. We identified a number of issues in our department pertaining to patient safety and the assessment and management of patients following handover of care to the neurosurgical ward, and intervened with an aim to provide safe, timely, patient-centred, and procedure-specific care in the postoperative period. METHOD: We reviewed the records of 50 patients between (Aug-Oct 2015) and analysed quality of postoperative assessment, prescriptions, and adherence to national standards of postoperative care...
April 22, 2019: British Journal of Neurosurgery
Onur Erdogan, Mustafa Sakar, Süheyla Bozkurt, Fatih Bayrakli
We report a 45 years old female patient with a left temporal grade II oligodendroglioma that recurred on the wall of the fourth ventricle at grade II oligodendroglioma.
April 22, 2019: British Journal of Neurosurgery
Caleb Rutledge, Soren Jonzzon, Ethan Andrew Winkler, Steven William Hetts, Adib Adnan Abla
A hyperplastic anterior choroidal artery is a vascular anomaly where the anterior choroidal artery supplies the posterior cerebral artery territory. We report a case of subarachnoid hemorrhage from a hyperplastic anterior choroidal artery with tandem fusiform aneurysms. The patient underwent a temporal craniotomy and transcortical transventricular transchoroidal-fissure approach for clip reconstruction. This case illustrates an unusual cerebrovascular pathology and approach to the ambient cistern.
April 22, 2019: British Journal of Neurosurgery
Zoe James, Paul A Leach, Caroline Hayhurst
INTRODUCTION: 30-day readmission rate is a widely adopted marker of quality and performance of acute care, but validity is not well demonstrated. Readmission data following cranial meningioma surgery is not well described and we sought to assess risk factors for readmission. SUBJECTS: All adult patients who underwent cranial meningioma resection from January 2015 to December 2017 in a single institution. METHODS: Using Welsh Clinical Portal electronic data to identify readmission within and beyond 30 days to both the index hospital and regional hospitals...
April 10, 2019: British Journal of Neurosurgery
James Booker, Saurabh Sinha, Kishor Choudhari, Jeremy Dawson, Rajiv Singh
INTRODUCTION: Several patients who suffer Mild Traumatic Brain Injury (mTBI) develop Persistent Post-Concussion Symptoms (PPCS) and long-term disability. Current prognostic models for mTBI have a large unexplained variance, which limits their use in a clinical setting. AIM: This study aimed to identify background demographics and mTBI details that are associated with PPCS and long-term disability. METHODS: Patients from the SHEFfield Brain Injury after Trauma (SHEFBIT) cohort with mTBI in the Emergency Department (ED) were analysed as part of the study...
April 9, 2019: British Journal of Neurosurgery
Nezih Oktar, Haluk M Ozer, Eren Demirtas
Intravascular papillary endothelial hyperplasia (Masson's vegetated hemangioendothelioma) is a rare condition affecting the neuroaxis. In the literature, only eight cases of this lesion involving the vertebral canal with spinal cord compression has been reported. We present a 37-year-old man with thoracic location mimicking schwannoma. Differential diagnosis, management, and review of literature are discussed in this short report.
April 9, 2019: British Journal of Neurosurgery
Viraat Harsh, Parijat Mishra, Preeti K Gond, Anil Kumar
Unbearable chronic neuropathic pain, which can often not be resolved by conservative pain management techniques, calls for peripheral nerve stimulation. The technique, based on the Gate control hypothesis, uses low intensity current to block depolarization and conduction of neuronal membrane. Conditions such as intractable migraine, occipital and trigeminal neuralgia, burn injury pain, transformed migraine, among others, which cause intense pain can be treated by PNS, especially when the pain is localised and can be traced back to a specific nerve...
April 7, 2019: British Journal of Neurosurgery
Kyosuke Matsunaga, Yujiro Tanaka, Daichi Kato, Takao Hashimoto, Michihiro Kohno
We report a 52-year-old man with progressive disturbance of visual acuity following a head injury. Magnetic resonance imaging (MRI) showed an aneurysm of the internal carotid artery. Digital subtraction angiography (DSA) 57 days after onset found that the aneurysm originated in the proximal ophthalmic artery. We treated the patient with an intravascular coil embolization, partially filling the aneurysm. Follow-up DSA indicated that the aneurysm did not recur.
March 20, 2019: British Journal of Neurosurgery
Kai Chen, Lijing Deng, Hualong She, Fang Hu, Tao Li
Charcot shoulder is occasionally seen with syringomyelia. To the best of our knowledge this is the first report of brachial plexus abnormalities detected by magnetic resonance(MR) neurography in these patients. MR neurography is useful to evaluate small nerves and their disorders, and may contribute to the early diagnosis and differential diagnoses of such patients.
March 20, 2019: British Journal of Neurosurgery
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