Recent Submissions

  • Cerebrospinal fluid shunting protocol for idiopathic intracranial hypertension for an improved revision rate.

    Galloway, Luke; Karia, Kishan; White, Anwen M; Byrne, Marian E; Sinclair, Alexandra J; Mollan, Susan P; Tsermoulas, Georgios; Galloway, Luke; White, Anwen M; Byrne, Marian E; et al. (American Association of Neurological Surgeons, 2021-10-08)
    Objective: Cerebrospinal fluid (CSF) shunting in idiopathic intracranial hypertension (IIH) is associated with high complication rates, primarily because of the technical challenges that are related to small ventricles and a large body habitus. In this study, the authors report the benefits of a standardized protocol for CSF shunting in patients with IIH as relates to shunt revisions. Methods: This was a retrospective study of consecutive patients with IIH who had undergone primary insertion of a CSF shunt between January 2014 and December 2020 at the authors' hospital. In July 2019, they implemented a surgical protocol for shunting in IIH. This protocol recommended IIH shunt insertion by neurosurgeons with expertise in CSF disorders, a frontal ventriculoperitoneal (VP) shunt with an adjustable gravitational valve and integrated intracranial pressure monitoring device, frameless stereotactic insertion of the ventricular catheter, and laparoscopic insertion of the peritoneal catheter. Thirty-day revision rates before and after implementation of the protocol were compared in order to assess the impact of standardizing shunting for IIH on shunt complications. Results: The 81 patients included in the study were predominantly female (93%), with a mean age of 31 years at primary surgery and mean body mass index (BMI) of 37 kg/m2. Forty-five patients underwent primary surgery prior to implementation of the protocol and 36 patients after. Overall, 12 (15%) of 81 patients needed CSF shunt revision in the first 30 days, 10 before and 2 after introduction of the protocol. This represented a significant reduction in the early revision rate from 22% to 6% after the protocol (p = 0.036). The most common cause of shunt revision for the whole cohort was migration or misplacement of the peritoneal catheter, occurring in 6 of the 12 patients. Patients with a higher BMI were significantly more likely to have a shunt revision within 30 days (p = 0.022). Conclusions: The Birmingham standardized IIH shunt protocol resulted in a significant reduction in revisions within 30 days of primary shunt surgery in patients with IIH. The authors recommend standardization for shunting in IIH as a method for improving surgical outcomes. They support the notion of subspecialization for IIH shunts, the use of a frontal VP shunt with sophisticated technology, and laparoscopic insertion of the peritoneal end.
  • Cerebrospinal fluid diversion for refractory intracranial hypertension: a United Kingdom and Ireland survey on practice v ariation.

    Chowdhury, Yasir A; Stevens, Andrew R; Soon, Wai C; Toman, Emma; Veenith, Tonny; Chelvarajah, Ramesh; Belli, Antonio; Davies, David; Stevens, Andrew R; Chelvarajah, Ramesh; et al. (Cureus, 2022-06-12)
    Introduction Diversion of cerebrospinal fluid (CSF) in a traumatic brain injury (TBI) is an established means for achieving control of intracranial pressure (ICP), aimed at improving intracranial homeostasis. The literature and anecdotal reports suggest a variation in practice between neurosurgical centres internationally, with current guidelines advocating ventricular drainage over lumbar drainage. We sought to establish the current neurosurgical practice in the United Kingdom regarding the methods of ICP control in TBI. Methods A 20-point survey was distributed electronically to British and Irish neurosurgeons after ratification by the Society of British Neurological Surgeons. Questions were directed at the clinician's opinion and experience of lumbar drain usage in patients with TBI: frequency, rationale, and experience of complications. Questions on lumbar drain usage in neurovascular patients were asked for practice comparison. Results Thirty-six responses from 21 neurosurgical centres were returned. Twenty-three per cent (23%) of responders reported using lumbar drains for refractory ICP in TBI patients: six units use lumbar drains and 15 do not. Three units showed partial usage, with mixed "yes/no" responses between consultants. Concerns of tonsillar herniation and familiarity with EVD were commonly given reasons against the usage of lumbar drains. Fifty-six per cent (56%) reported use in neurovascular patients. Conclusion This contemporary practice survey demonstrates mixed practice across the UK and within some centres. Responses and survey feedback demonstrate that the use of lumbar drains in TBI is a polarising topic. The variety of practice between and within neurosurgical units supports consideration of the prospective study of CSF diversion methods for control of refractory ICP in patients with TBI.
  • Case series of 100 supraorbital mini-craniotomies in patients with good grade aneurysmal subarachnoid haemorrhage at a single neurosurgical Centre.

    Thanabalasundaram, Gopiga; Soon, Wai Cheong; Ponnampalam, Athiththan; Brydon, Howard L; Soon, Wai Cheong; Neurology; Medical and Dental (Taylor & Francis, 2021-11-24)
    Background: Endovascular techniques are becoming more common for cerebral aneurysms, but not all patients are suitable and open surgery is necessary for some. The traditional pterional approach requires a large craniotomy and this carries some morbidity in itself. With the growing expectation for minimally invasive surgery, we present our experience in supraorbital mini-craniotomy for good grade aneurysmal subarachnoid haemorrhage. Methods: Data on good-grade subarachnoid haemorrhage patients having aneurysms clipped via this approach were collected prospectively. Aneurysms at all anterior circulation sites were included, with the exception of the pericallosal artery, which was not within reach. A long-term follow-up questionnaire was sent to patients who had a supraorbital approach to clip the aneurysm at more than 1 year from hospital discharge. Results: Our results demonstrate mortality of 1% and severe residual disability in 10% of patients. Approach-related complications were low and it was considered that the operating space was not restricted in any of our cases. Return to work was achieved in 70% of patients who were working at the time of their haemorrhage. Conclusions: Supraorbital micro-craniotomy is a safe approach for patients with proximal anterior circulation aneurysms, with low mortality and morbidity.
  • Hospitalisation for degenerative cervical myelopathy in England: insights from the National Health Service Hospital Episode Statistics 2012 to 2019.

    Goacher, Edward; Phillips, Richard; Mowforth, Oliver D; Yordanov, Stefan; Pereira, Erlick A C; Gardner, Adrian; Quraishi, Nasir A; Bateman, Antony H; Demetriades, Andreas K; Ivanov, Marcel; et al. (Springer, 2022-05-05)
    Purpose: Degenerative cervical myelopathy (DCM) is the most common cause of adult spinal cord dysfunction worldwide. However, the current incidence of DCM is poorly understood. The Hospital Episode Statistics (HES) database contains details of all secondary care admissions across NHS hospitals in England. This study aimed to use HES data to characterise surgical activity for DCM in England. Methods: The HES database was interrogated for all cases of DCM between 2012 and 2019. DCM cases were identified from 5 ICD-10 codes. Age-stratified values were collected for 'Finished Consultant Episodes' (FCEs), which correspond to a patient's hospital admission under a lead clinician. Data was analysed to explore current annual activity and longitudinal change. Results: 34,903 FCEs with one or more of the five ICD-10 codes were identified, of which 18,733 (53.6%) were of working age (18-64 years). Mean incidence of DCM was 7.44 per 100,000 (SD ± 0.32). Overall incidence of DCM rose from 6.94 per 100,000 in 2012-2013 to 7.54 per 100,000 in 2018-2019. The highest incidence was seen in 2016-2017 (7.94 per 100,000). The median male number of FCEs per year (2919, IQR: 228) was consistently higher than the median female number of FCEs per year (2216, IQR: 326). The rates of both emergency admissions and planned admissions are rising. Conclusions: The incidence of hospitalisation for DCM in England is rising. Health care policymakers and providers must recognise the increasing burden of DCM and act to address both early diagnoses and access to treatment in future service provision plans.
  • High risk factors for craniosynostosis during pregnancy: a case-control study.

    Plakas, Sotirios; Anagnostou, Evangelos; Plakas, Angelos Christos; Piagkou, Maria (Elsevier, 2022-03-19)
    Background: Craniosynostosis is a birth defect involving premature cranial sutures' fusion with an increasing prevalence and unknown underlying causes in nearly 80% of cases. The current study investigates a series of high-risk factors associated with a non-syndromic craniosynostosis. Methods: Ninety-seven (97) children were included in the retrospective case-control study, 62 controls and 35 with craniosynostosis. A questionnaire with 143 questions was used in face-to-face interviews. After univariate analyses, stepwise multivariate logistic regression analysis was implemented. Results: In craniosynostosis group, 3 out of 4 were male subjects and 2 out of 3 born with caesarian section. History for central nervous system abnormalities in their younger siblings, low birth weight, extended use of mobile phone from the parents and medications' use differed significantly between craniosynostosis and control group. After adjustment for all factors, only maternal medication use (aOR 6,1 [2.1 - 19], CI 95%) and oral progesterone intake (aOR 4 [1.2 - 14], CI 95%) were significantly associated with an increased risk in craniosynostosis group. Conclusion: The maternal medications' use and particular oral progesterone intake is associated with an increased risk for non-syndromic craniosynostosis. However, due to the study's limitations, further research is warranted.
  • Is image guidance essential for external ventricular drain insertion?

    Fisher, Benjamin; Soon, Wai Cheong; Ong, John; Chan, Tin; Chowdhury, Yasir; Hodson, James; White, Anwen; Soon, Wai Cheong; White, Anwen; Hodson, James; et al. (Elsevier, 2021-09-20)
    Background: This study aimed to compare the external ventricular drain (EVD) placement accuracy and complication rates, between neuronavigation-guided, ultrasound-guided, and freehand techniques in our single-center cohort, and through an additional meta-analysis of the currently available literature. Methods: A retrospective review of patients who underwent EVD insertion from January 2016 to April 2019 was conducted. Information regarding demographics, indication, Evans index, use of image guidance, accuracy of catheter tip placement, and procedural complications was extracted from electronic records and imaging systems. The accuracy of the EVD tip placement was classified according to the Kakarla grading system into optimal, or suboptimal based on its proximity to the Foramen of Monro and involvement of noneloquent/eloquent structures. Results: In total, 294 patients (median age of 54 years) underwent EVD insertion during the study period. A total of 183 catheters were placed freehand, 66 neuronavigation-guided, and 45 ultrasound-guided; the mean Evans ratios were 0.33, 0.29, and 0.31, respectively. Whilst there was a tendency for lower rates of suboptimal placement were guidance was used, with rates of 10.6% and 15.6% for neuronavigation- and ultrasound-guidance, respectively, compared to 20.8% in freehand placement, this did not reach statistical significance (P = 0.168). However, pooling this data with two additional studies on meta-analysis found a significant reduction in the risk of suboptimal placement for image-guided vs. freehand EVDs (odds ratio: 0.50, 95% CI: 0.32-0.77, P = 0.002). Surgeon seniority and other procedure-related factors had no significant impact on EVD placement accuracy or complications. Conclusions: Our results, pooled with those of previous studies, suggest image-guided EVD placement significantly reduced the rate of suboptimally placed EVDs. We conclude in appropriately selected cases that image-guided EVD insertions may improve accuracy of catheter placements and reduce associated complications of the procedure.
  • Haemorrhagic Tarlov cyst: a rare complication of anticoagulation therapy.

    Soon, W C; Sun, R; Czyz, M; Soon, Wai Cheong; Czyz, Marcin; Neurosurgery; Medical and Dental (Oxford University Press, 2021-08-13)
    No abstract available