المؤلفون: Craven, Claudia, Jankovic, Ivana, Dyson, Edward, Boyd, Stewart G, D'Arco, Felice, Cheung, Moira Shang-Mei, Thompson, Dominic

مصطلحات موضوعية: Neurology, Neurosurgery, Paediatrics, Physiology

الوصف: Peer reviewed: True ; INTRODUCTION: Foramen magnum stenosis in achondroplasia carries a risk of sudden death. A proportion of these patients benefit from foramen magnum decompression (FMD). The Achondroplasia Foramen Magnum Score (AFMS) was developed to stratify those most at risk. We hypothesise that this score may be reflected in neurophysiological findings. METHODS: Patients with achondroplasia who had undergone FMD (n=20) were retrospectively grouped into AFMS 2, 3 and 4. Amplitude from tibialis anterior (TA) and the percentage change in somatosensory evoked potential (SSEP) latency after FMD were reported. RESULTS: Baseline motor evoked potential amplitudes for patients with AFMS=4 were significantly lower left (p=0.0017 and p=0.02 for right and left TA, respectively) compared with AFMS grades 2 and 3. Median reduction (% change) in SSEP latency (ms) after surgery was not significantly different in any of the patients. CONCLUSIONS: This short report cross-references AFMS to intraoperative neuromonitoring. Baseline amplitudes were noticeably lower in the most severe AFMS group. This observation supports the notion that AFMS can help risk stratify patients and aid in surgical selection.

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العلاقة: https://www.repository.cam.ac.uk/handle/1810/369129Test

الإتاحة: https://www.repository.cam.ac.uk/handle/1810/369129Test

المؤلفون: Craven, Claudia L, Gissen, Paul, Bower, Rebecca, Lee, Laura, Aquilina, Kristian, Thompson, Dominic NP

المصدر: Journal of Neurosurgery: Pediatrics , 29 (1) pp. 115-121. (2022)

مصطلحات موضوعية: Cerliponase alfa, intracerebroventricular, drug delivery, neurosurgery, neuronal ceroid lipofuscinosis, ventricular access devices, punctures, complications, surgical technique

الوصف: OBJECTIVE: Late infantile neuronal ceroid lipofuscinosis type 2 (CLN2) is a rare autosomal recessive disease caused by tripeptidyl peptidase 1 enzyme deficiency. At the authors' center, the medication cerliponase alfa is administered every 2 weeks via the intracerebroventricular (ICV) route. This requires the placement of a ventricular access device (VAD) or reservoir and frequent percutaneous punctures of this device over the child's lifetime. In this study, the authors audited the longevity and survival of these VADs and examined the causes of device failure. METHODS: A single-center survival analysis of VAD insertions and revisions (January 2014 through June 2020) was conducted. All children received cerliponase alfa infusions through a VAD. Patient characteristics and complications were determined from a prospectively maintained surgical database and patient records. For the VAD survival analysis, the defined endpoint was when the device was removed or changed. Reservoir survival was assessed using Kaplan-Meier curves and the log-rank (Cox-Mantel) test. RESULTS: A total of 17 patients had VADs inserted for drug delivery; median (range) age at first surgery was 4 years 4 months (1 year 8 months to 15 years). Twenty-six VAD operations (17 primary insertions and 9 revisions) were required among these 17 patients. Twelve VAD operations had an associated complication, including CSF infection (n = 6) with Propionibacterium and Staphylococcus species being the most prevalent organisms, significant surgical site swelling preventing infusion (n = 3), leakage/wound breakdown (n = 2), and catheter obstruction (n = 1). There were no complications or deaths associated with VAD insertion. The median (interquartile range) number of punctures was 59.5 (7.5-82.0) for unrevised VADs (n = 17) versus 2 (6-87.5) for revised VADs (n = 9) (p = 0.70). The median survival was 301 days for revisional reservoirs (n = 9) versus 2317 days for primary inserted reservoirs (n = 17) (p = 0.019). CONCLUSIONS: In the context of the current ...

وصف الملف: text

العلاقة: https://discovery.ucl.ac.uk/id/eprint/10145763/2/Gissen_Battens%20manuscript.pdfTest; https://discovery.ucl.ac.uk/id/eprint/10145763Test/

الإتاحة: https://discovery.ucl.ac.uk/id/eprint/10145763/2/Gissen_Battens%20manuscript.pdfTest
https://discovery.ucl.ac.uk/id/eprint/10145763Test/

المؤلفون: Chau, Charlene YC, Craven, Claudia L, Rubiano, Andres M, Adams, Hadie, Tülü, Selma, Czosnyka, Marek, Servadei, Franco, Ercole, Ari, Hutchinson, Peter J, Kolias, Angelos G

مصطلحات موضوعية: EVD, ICP, TBI, intracranial pressure, neurosurgery, neurotrauma, ventriculostomy

الوصف: External ventricular drains (EVDs) are commonly used in neurosurgery in different conditions but frequently in the management of traumatic brain injury (TBI) to monitor and/or control intracranial pressure (ICP) by diverting cerebrospinal fluid (CSF). Their clinical effectiveness, when used as a therapeutic ICP-lowering procedure in contemporary practice, remains unclear. No consensus has been reached regarding the drainage strategy and optimal timing of insertion. We review the literature on EVDs in the setting of TBI, discussing its clinical indications, surgical technique, complications, clinical outcomes, and economic considerations.

وصف الملف: Electronic; application/pdf

العلاقة: https://www.repository.cam.ac.uk/handle/1810/296746Test

الإتاحة: https://doi.org/10.17863/CAM.43789Test
https://www.repository.cam.ac.uk/handle/1810/296746Test

المؤلفون: Fernández-Méndez, Rocío, Richards, Hugh K, Seeley, Helen M, Pickard, John D, Joannides, Alexis J, UKSR collaborators, Allcutt, David, Arnold, Fiona, Ashpole, Richard, Ballantyne, Eric, Bleil, Cristina, Brydon, Howard, Bulters, Diederik, Byrne, Marian, Cadoux-Hudson, Tom, Cairns, Claire, Cameron, Kerry, Cartmill, Maria, Chandler, Christopher, Choksey, Munchi S, Collins, Sally-Ann, Colthrust, Kimona, Craven, Claudia, Crimmins, Darach, Critchley, Giles, Crocker, Matthew, Cudlip, Simon, Czosnyka, Marek, Czosnyka, Zofia, D’Antona, Linda, Dewhurst, Emma, Dunn, Laurence, Edwards, Richard, Evans, Fiona, Fernandes, Helen, Fieldsend, Amy, Flint, Graham, Garnett, Matthew, Golash, Aprajay, Goodden, John, Gourley, Lois, Hallet, Jennifer, Hardy, Jan, Hennigan, Dawn, Herbert, Katie, Hinde, Liz, Holliman, Damian, Hutchinson, Peter, Jenkinson, Michael, Kamaly, Ian, Kandasamy, Jothy, Keong, Nicole, Kewin, Sara, King, Andrew, Kolias, Angelos, Kvedaras, Sarah, Lalou, Afroditi, Leach, Paul, MacArthur, Donald, Mallucci, Conor, Martin, John, Mathew, Bruce, McConnell, Roy, McMahon, Catherine, McMullan, John, Moran, Emma, Mukerji, Nitin, Nabbanja, Eva, O'Kane, Roddy, O’Connor, Jody, O’Reilly, Gerry, Papadopoulos, Marios, Pople, Ian, Rajaraman, Chittoor, Ramirez, Roberto, Ramos, Joana, Ross, Sheila, Ross, Nicholas, Santarius, Thomas, Saxena, Amar, Shanmuganathan, Mano, Sinha, Saurabh, Solanki, Guirish, Strachan, Roger, Thompson, Dominic, Thompson, Simon, Thorne, John, Thorne, Lewis, Thurlby, Kim, Tisdall, Martin, Tizzard, Simon, Todd, Lorraine, Toma, Ahmed, Turner, Carole, Ushewokunze, Shungu, Vindlacheruvu, Raghu, Wadley, John, Watkins, Laurence, Whitfield, Peter, Wilson, Mark, Zebian, Bassel

مصطلحات موضوعية: Neurosurgery

الوصف: Objectives To determine current epidemiology and clinical characteristics of cerebrospinal fluid (CSF) shunt surgery, including revisions. Methods A retrospective, multicentre, registry-based study was conducted based on 10 years’ data from the UK Shunt Registry, including primary and revision shunting procedures reported between 2004 and 2013. Incidence rates of primary shunts, descriptive statistics and shunt revision rates were calculated stratified by age group, geographical region and year of operation. Results 41 036 procedures in 26 545 patients were submitted during the study period, including 3002 infants, 4389 children and 18 668 adults. Procedures included 20 947 (51.0%) primary shunt insertions in 20 947 patients, and 20 089 (49.0%) revision procedures. Incidence rates of primary shunt insertions for infants, children and adults were 39.5, 2.4 and 3.5 shunts per 100 000 person-years, respectively. These varied by geographical subregion and year of operation. The most common underlying diagnoses were perinatal intraventricular haemorrhage (35.3%) and malformations (33.9%) in infants, tumours (40.5%) and malformations (16.3%) in children, and tumours (24.6%), post-haemorrhagic hydrocephalus (16.2%) and idiopathic normal pressure hydrocephalus (14.2%) in adults. Ninety-day revision rates were 21.9%, 18.6% and 12.8% among infants, children and adults, respectively, while first-year revision rates were 31.0%, 25.2% and 17.4%. The main reasons for revision were underdrainage and infection, but overdrainage and mechanical failure continue to pose problems. Conclusions Our report informs patients, carers, clinicians, providers and commissioners of healthcare, researchers and industry of the current epidemiology of shunting for CSF disorders, including the potential risks of complications and frequency of revision.

وصف الملف: text/html

العلاقة: http://jnnp.bmj.com/cgi/content/short/90/7/747Test; http://dx.doi.org/10.1136/jnnp-2018-319927Test

الإتاحة: https://doi.org/10.1136/jnnp-2018-319927Test
http://jnnp.bmj.com/cgi/content/short/90/7/747Test

المؤلفون: Pradini-Santos, Laura¹ (AUTHOR), Craven, Claudia L.¹ (AUTHOR) claudia.craven@gmail.com, Watkins, Laurence D.¹ (AUTHOR), Toma, Ahmed K.¹ (AUTHOR)

المصدر: World Neurosurgery. Apr2020, Vol. 136, p83-89. 7p.

مصطلحات موضوعية: *CATHETERS, *LITERATURE reviews, *ARRHYTHMIA, *TRICUSPID valve, *HEART atrium, *TRICUSPID valve insufficiency, *TRICUSPID valve diseases

مستخلص: Given recent positive safety evidence, ventriculoatrial (VA) shunt placement may increase in popularity once more. We describe a rare case of Tricuspid regurgitation due to VA shunt catheter tip traversing the valve. A woman aged 42 years with a preexisting VA shunt was referred to this center with 3 months of orthostatic headache, nausea, and palpitations that occurred while sleeping on her right side. An echocardiogram demonstrates a VA shunt catheter in the right atrium during cardiac diastole, which traversed the tricuspid annular plane during cardiac systole. The echocardiogram revealed mild to moderate tricuspid regurgitation. She had no clinical evidence of cardiac failure or arrhythmia and had normal electrocardiogram findings. The catheter tip appeared to be adhered to the underside of the leaflets or to the chordae tendineae. Pulling the catheter tip back could therefore cause irreversible damage to the tricuspid valve. For this reason, the catheter was not removed, and the patient was referred for close follow-up with cardiologists. A literature review was performed to determine where this rare complication fits into the spectrum of VA shunt distal catheter complications, and what techniques can be done to avoid similar occurrences. This report reiterates the importance of ensuring the tip is carefully placed within the atrium, under fluoroscopic guidance. Although rare, the described complication is difficult to manage once it has occurred. [ABSTRACT FROM AUTHOR]

المؤلفون: Craven, Claudia¹ claudia.craven@gmail.com, Baudracco, Irene¹ irene.baudracco@gmail.com, Zetterberg, Henrik henrik.zetterberg@clinchem.gu.se, Lunn, Michael michael.lunn@uclh.nhs.uk, Chapman, Miles² miles.chapman@uclh.nhs.uk, Lakdawala, Neghat² neghat.lakdawala@uclh.nhs.uk, Watkins, Laurence¹ laurence.watkins@uclh.nhs.uk, Toma, Ahmed¹ ahmed.toma@uclh.nhs.uk

المصدر: Acta Neurochirurgica. Dec2017, Vol. 159 Issue 12, p2293-2300. 8p.

مصطلحات موضوعية: *HYDROCEPHALUS, *BRAIN diseases, *DANDY-Walker syndrome, *CEREBROSPINAL fluid, *NEUROSURGERY, *PROGNOSIS

مستخلص: Background: Idiopathic normal pressure hydrocephalus (INPH) has no reliable biomarker to assist in the selection of patients who could benefit from ventriculo-peritoneal (VP) shunt insertion. The neurodegenerative markers T-tau and Aβ1-42 have been found to successfully differentiate between Alzheimer's disease (AD) and INPH and therefore are candidate biomarkers for prognosis and shunt response in INPH. The aim of this study was to test the predictive value of cerebrospinal fluid (CSF) T-tau and Aβ1-42 for shunt responsiveness. In particular, we pay attention to the subset of INPH patients with raised T-tau, who are often expected to be poor surgical candidates. Methods: Single-centre retrospective analysis of probable INPH patients with CSF samples collected from 2006 to 2016. Index test: CSF levels of T-tau and Aβ1-42. Reference standard: postoperative outcome. ROC analysis assessed the predictive value. Results: A total of 144 CSF samples from INPH patients were analysed. Lumbar T-tau was a good predictor of post-operative mobility (AUROC 0.80). The majority of patients with a co-existing neurodegenerative disease responded well, including those with high T-tau levels. Conclusion: INPH patients tended to exhibit low levels of CSF T-tau, and this can be a good predictor outcome. However levels are highly variable between individuals. Raised T-tau and being shunt-responsive are not mutually exclusive, and such patients ought not necessarily be excluded from having a VP shunt. A combined panel of markers may be a more specific method for aiding selection of patients for VP shunt insertion. This is the most comprehensive presentation of CSF samples from INPH patients to date, thus providing further reference values to the current literature. [ABSTRACT FROM AUTHOR]

المؤلفون: Craven, Claudia^1,2 (AUTHOR) claudia.craven@gmail.com, Baxter, David^2,3 (AUTHOR), Cooke, Martyn² (AUTHOR), Carline, Lydia^2,4 (AUTHOR), Alberti, Samuel J. M. M.² (AUTHOR), Beard, Jonathan² (AUTHOR), Murphy, Mary² (AUTHOR)

المصدر: British Journal of Neurosurgery. Dec2014, Vol. 28 Issue 6, p707-712. 6p.

مصطلحات موضوعية: *NEUROSURGEONS, *CRANIOTOMY, *SKULL surgery, *NEUROSURGERY, *TRAINING

الشركة/الكيان: ROYAL College of Surgeons of England

مستخلص: Introduction. The Modelled Anatomical Replica for Training Young Neurosurgeons (MARTYN) is a novel simulation model developed by the Royal College of Surgeons England (RCSEng). This study describes the development of the model and aims to determine its feasibility as a potential future training tool. Methods and materials. Traditional model-making methods were used to develop a prototype. Initial procedural trials tested the feasibility of the model. Eighteen participants, grouped by experience (nine novices, four intermediates and five experienced), completed two tasks: a craniotomy and a burr hole followed by insertion of an external ventricular drain (EVD). Subjective data on confidence, usefulness, realism and preference to other training modalities were collected via a standardised questionnaire and a 5-point Likert scale. Results. Preliminary trials of the model prototype demonstrated feasibility. The novice group had the greatest self-reported benefit from MARTYN training, with significant increases in self-rated confidence in both the craniotomy ( p < 0.01) and EVD insertion ( p < 0.05) procedures. MARTYN was reported to having good visual and tactile realism overall with the bone component being considered highly realistic. The model was reported to be a useful training tool. When asked to rank preferred training modalities, operative experience was chosen first with cadaveric training and MARTYN consistently scoring a second choice. Conclusions. MARTYN was developed with the intention to fill the current niche for an inexpensive synthetic model head. This study shows that the use of MARTYN for training is both feasible and realistic. We demonstrate a preliminary face and construct validity of the model in this pilot study. With the reduction in working hours, we believe this model will be a suitable supplement to the current ST 1-3 level cadaveric training and will have a positive impact on patient safety. [ABSTRACT FROM AUTHOR]

المؤلفون: Chau, Charlene Y. C.¹ (AUTHOR), Craven, Claudia L.² (AUTHOR), Rubiano, Andres M.^3,4 (AUTHOR), Adams, Hadie¹ (AUTHOR), Tülü, Selma^1,5 (AUTHOR), Czosnyka, Marek¹ (AUTHOR), Servadei, Franco⁶ (AUTHOR), Ercole, Ari⁷ (AUTHOR), Hutchinson, Peter J.^1,4 (AUTHOR), Kolias, Angelos G.^1,4 (AUTHOR) angeloskolias@gmail.com

المصدر: Journal of Clinical Medicine. Sep2019, Vol. 8 Issue 9, p1422. 1p.

مصطلحات موضوعية: *BRAIN injuries, *DRAINAGE, *INTRACRANIAL pressure, *CLINICAL indications, *CEREBROSPINAL fluid

مستخلص: External ventricular drains (EVDs) are commonly used in neurosurgery in different conditions but frequently in the management of traumatic brain injury (TBI) to monitor and/or control intracranial pressure (ICP) by diverting cerebrospinal fluid (CSF). Their clinical effectiveness, when used as a therapeutic ICP-lowering procedure in contemporary practice, remains unclear. No consensus has been reached regarding the drainage strategy and optimal timing of insertion. We review the literature on EVDs in the setting of TBI, discussing its clinical indications, surgical technique, complications, clinical outcomes, and economic considerations. [ABSTRACT FROM AUTHOR]

المؤلفون: Chau, Charlene YC, Craven, Claudia L, Rubiano, Andres M, Adams, Hadie, Tülü, Selma, Czosnyka, Marek, Servadei, Franco, Ercole, Ari, Hutchinson, Peter J, Kolias, Angelos G

مصطلحات موضوعية: neurotrauma, TBI, intracranial pressure, ICP, neurosurgery, ventriculostomy, EVD, nervous system diseases, 3. Good health

الوصف: External ventricular drains (EVDs) are commonly used in neurosurgery in different conditions but frequently in the management of traumatic brain injury (TBI) to monitor and/or control intracranial pressure (ICP) by diverting cerebrospinal fluid (CSF). Their clinical effectiveness, when used as a therapeutic ICP-lowering procedure in contemporary practice, remains unclear. No consensus has been reached regarding the drainage strategy and optimal timing of insertion. We review the literature on EVDs in the setting of TBI, discussing its clinical indications, surgical technique, complications, clinical outcomes, and economic considerations.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::c62f394c3ca15d849036b31558369e22Test