المؤلفون: Woodfield, Julie, Hoeritzauer, Ingrid, Jamjoom, Aimun A.B., Jung, Josephine, Lammy, Simon, Pronin, Savva, Hannan, Cathal J., Watts, Anna, Hughes, Laura, Moon, Richard D.C., Darwish, Stacey, Roy, Holly, Copley, Phillip C., Poon, Michael T.C., Thorpe, Paul, Srikandarajah, Nisaharan, Grahovac, Gordan, Demetriades, Andreas K., Eames, Niall, Sell, Philip J., Statham, Patrick F. X., UCES Collaborators, ., British Neurosurgical Trainee Research Collaborative, .

الوصف: Background: Cauda equina syndrome (CES) results from nerve root compression in the lumbosacral spine, usually due to a prolapsed intervertebral disc. Evidence for management of CES is limited by its infrequent occurrence and lack of standardised clinical definitions and outcome measures. Methods: This is a prospective multi-centre observational cohort study of adults with CES in the UK. We assessed presentation, investigation, management, and all Core Outcome Set domains up to one year post-operatively using clinician and participant reporting. Univariable and multivariable associations with the Oswestry Disability Index (ODI) and urinary outcomes were investigated. Findings: In 621 participants with CES, catheterisation for urinary retention was required pre-operatively in 31% (191/615). At discharge, only 13% (78/616) required a catheter. Median time to surgery from symptom onset was 3 days (IQR:1–8) with 32% (175/545) undergoing surgery within 48 h. Earlier surgery was associated with catheterisation (OR:2.2, 95%CI:1.5–3.3) but not with admission ODI or radiological compression. In multivariable analyses catheter requirement at discharge was associated with pre-operative catheterisation (OR:10.6, 95%CI:5.8–20.4) and one-year ODI was associated with presentation ODI (r = 0.3, 95%CI:0.2–0.4), but neither outcome was associated with time to surgery or radiological compression. Additional healthcare services were required by 65% (320/490) during one year follow up. Interpretation: Post-operative functional improvement occurred even in those presenting with urinary retention. There was no association between outcomes and time to surgery in this observational study. Significant healthcare needs remained post-operatively. Funding: DCN Endowment Fund funded study administration. Castor EDC provided database use. No other study funding was received.

وصف الملف: text

العلاقة: https://eprints.gla.ac.uk/286067/1/286067.pdfTest; Woodfield, J. et al. (2023) Presentation, management, and outcomes of cauda equina syndrome up to one year after surgery, using clinician and participant reporting: a multi-centre prospective cohort study. Lancet Regional Health - Europe , 24, 100545. (doi:10.1016/j.lanepe.2022.100545 ) (PMID:36426378) (PMCID:PMC9678980)

الإتاحة: https://doi.org/10.1016/j.lanepe.2022.100545Test
https://eprints.gla.ac.uk/286067Test/
https://eprints.gla.ac.uk/286067/1/286067.pdfTest

المؤلفون: Hughes, Mark Antony, Ho, Jen Wae, Keenlyside, Andrew, Sieradzki, Jake, Statham, Patrick F. X.

المساهمون: Wellcome Institutional Translational Partnership award

المصدر: British Journal of Neurosurgery ; page 1-5 ; ISSN 0268-8697 1360-046X

الإتاحة: https://doi.org/10.1080/02688697.2021.2014782Test

المؤلفون: Hoeritzauer, Ingrid, Paterson, Mhairi, Jamjoom, Aimun, Srikandarajah, Nisaharan, Soleiman, Hamzah, Poon, Michael Tin Chung, Copley, Phillip C., Graves, Catriona, MacKay, Sinead, Duong, Charis, Leung, Andraay H.C., Eames, Niall, Statham, Patrick F. X., Darwish, Stacey, Sell, Philip J., Thorpe, Paul, Shekhar, Himanshu, Roy, Holly, Woodfield, Julie, British Neurosurgical Trainee Research Collaborative

الوصف: Aims: Patients with cauda equina syndrome (CES) require emergency imaging and surgical decompression. The severity and type of symptoms may influence the timing of imaging and surgery, and help predict the patient’s prognosis. Categories of CES attempt to group patients for management and prognostication purposes. We aimed in this study to assess the inter-rater reliability of dividing patients with CES into categories to assess whether they can be reliably applied in clinical practice and in research. Methods: A literature review was undertaken to identify published descriptions of categories of CES. A total of 100 real anonymized clinical vignettes of patients diagnosed with CES from the Understanding Cauda Equina Syndrome (UCES) study were reviewed by consultant spinal surgeons, neurosurgical registrars, and medical students. All were provided with published category definitions and asked to decide whether each patient had ‘suspected CES’; ‘early CES’; ‘incomplete CES’; or ‘CES with urinary retention’. Inter-rater agreement was assessed for all categories, for all raters, and for each group of raters using Fleiss’s kappa. Results: Each of the 100 participants were rated by four medical students, five neurosurgical registrars, and four consultant spinal surgeons. No groups achieved reasonable inter-rater agreement for any of the categories. CES with retention versus all other categories had the highest inter-rater agreement (kappa 0.34 (95% confidence interval 0.27 to 0.31); minimal agreement). There was no improvement in inter-rater agreement with clinical experience. Across all categories, registrars agreed with each other most often (kappa 0.41), followed by medical students (kappa 0.39). Consultant spinal surgeons had the lowest inter-rater agreement (kappa 0.17). Conclusion: Inter-rater agreement for categorizing CES is low among clinicians who regularly manage these patients. CES categories should be used with caution in clinical practice and research studies, as groups may be heterogenous and not ...

العلاقة: Hoeritzauer, I. et al. (2023) Cauda equina syndrome: poor inter-rater agreement for diagnostic categories. Bone and Joint Journal , 105-B(9), pp. 1007-1012. (doi:10.1302/0301-620x.105b9.bjj-2022-1343.r1 ) (PMID:37652459)

الإتاحة: https://doi.org/10.1302/0301-620x.105b9.bjj-2022-1343.r1Test
https://eprints.gla.ac.uk/308992Test/

المؤلفون: Woodfield, Julie, Hoeritzauer, Ingrid, Jamjoom, Aimun A B, Pronin, Savva, Srikandarajah, Nisaharan, Poon, Michael, Roy, Holly, Demetriades, Andreas K, Sell, Philip, Eames, Niall, Statham, Patrick F X, British Neurosurgical Trainee Research Collaborative (BNTRC), Edlman, Ellie, Ma, Ruichong, Scott, Kenneth

مصطلحات موضوعية: Protocol

الوصف: Introduction Cauda equina syndrome (CES) is a potentially devastating condition caused by compression of the cauda equina nerve roots. This can result in bowel, bladder and sexual dysfunction plus lower limb weakness, numbness and pain. CES occurs infrequently, but has serious potential morbidity and medicolegal consequences. This study aims to identify and describe the presentation and management of patients with CES in the UK. Methods and analysis Understanding Cauda Equina Syndrome (UCES) is a prospective and collaborative multicentre cohort study of adult patients with confirmed CES managed at specialist spinal centres in the UK. Participants will be identified using neurosurgical and orthopaedic trainee networks to screen referrals to spinal centres. Details of presentation, investigations, management and service usage will be recorded. Both patient-reported and clinician-reported outcome measures will be assessed for 1 year after surgery. This will establish the incidence of CES, current investigation and management practices, and adherence to national standards of care. Outcomes will be stratified by clinical presentation and patient management. Accurate and up to date information about the presentation, management and outcome of patients with CES will inform standards of service design and delivery for this important but infrequent condition. Ethics and dissemination UCES received a favourable ethical opinion from the South East Scotland Research Ethics Committee 02 (Reference: 18/SS/0047; IRAS ID: 233515). All spinal centres managing patients with CES in the UK will be encouraged to participate in UCES. Study results will be published in medical journals and shared with local participating sites. Trial registration number ISRCTN16828522 ; Pre-results.

وصف الملف: text/html

العلاقة: http://bmjopen.bmj.com/cgi/content/short/8/12/e025230Test; http://dx.doi.org/10.1136/bmjopen-2018-025230Test

الإتاحة: https://doi.org/10.1136/bmjopen-2018-025230Test
http://bmjopen.bmj.com/cgi/content/short/8/12/e025230Test

المؤلفون: Fouyas, Ioannis P, Sandercock, Peter A G, Statham, Patrick F X, Nikolaidis, Ioannis

المصدر: BMJ: British Medical Journal, 2010 Jul . 341(7765), 200-202.

الوصول الحر: https://www.jstor.org/stable/20734902Test

المؤلفون: Fouyas, Ioannis P, Sandercock, Peter A G, Statham, Patrick F X, Nikolaidis, Ioannis

مصطلحات موضوعية: PRACTICE

وصف الملف: text/html

العلاقة: http://www.bmj.com/cgi/content/short/341/jul13_2/c3108Test; http://dx.doi.org/10.1136/bmj.c3108Test

الإتاحة: https://doi.org/10.1136/bmj.c3108Test
http://www.bmj.com/cgi/content/short/341/jul13_2/c3108Test

المؤلفون: Raghu, Ashley L. B., Flower, Hannah D., Statham, Patrick F. X., Brennan, Paul M., Hughes, Mark A.

المصدر: Journal of Neurological Surgery Part B: Skull Base ; volume 81, issue 05, page 579-584 ; ISSN 2193-6331 2193-634X

الوصف: Introduction As they grow, pituitary adenoma can remodel the sella turcica and alter anatomical relationships with adjacent structures. The intercarotid distance (ICD) at the level of the sella is a measure of sella width. The purpose of this study was to (1) assess how ICD changes after transsphenoidal surgery and (2) explore whether the extent of ICD change is associated with tumor recurrence. Methods A retrospective analysis of preoperative and postoperative coronal magnetic resonance imaging (MRI) scans was carried out by two independent assessors on patients who underwent transsphenoidal surgery for nonfunctioning pituitary macroadenomas. Preoperative tumor volume and any change in ICD following surgery were recorded and compared between groups. Logistic regression models of recurrence were generated. Results In 36 of 42 patients, ICD fell after surgery (mean = 1.8 mm) and six cases were static. At time of follow-up (mean = 77 months), 25 had not required further intervention and 17 had undergone second surgery or radiosurgery. In patients in whom no further intervention has yet been necessary, the postoperative reduction in ICD was significantly smaller than in those who required repeat intervention (1.1 vs. 2.7 mm respectively, p < 0.01). ICD decrease was weakly correlated with tumor volume (r = 0.35). ICD decrease was a significant predictor of recurrence (odds ratio [OR] = 3.15; 95% confidence interval [CI]: 1.44–6.87), largely independent of tumor volume. Conclusion For most patients, ICD falls following surgical excision of a nonfunctioning pituitary macroadenoma. A greater reduction in ICD postsurgery appears to predict recurrence. Change in ICD shows promise as a radiographic tool for prognosticating clinical course after surgery.

الإتاحة: https://doi.org/10.1055/s-0039-1693700Test

المؤلفون: Woodfield, Julie, Hoeritzauer, Ingrid, Jamjoom, Aimun A B, Pronin, Savva, Srikandarajah, Nisaharan, Poon, Michael, Roy, Holly, Demetriades, Andreas K, Sell, Philip, Eames, Niall, Statham, Patrick F X

المصدر: Woodfield, J, Hoeritzauer, I, Jamjoom, A A B, Pronin, S, Srikandarajah, N, Poon, M, Roy, H, Demetriades, A K, Sell, P & Eames, N & Statham, P F X 2018, ' Understanding cauda equina syndrome : protocol for a UK multicentre prospective observational cohort study ', BMJ Open, vol. 8, no. 12, e025230 . https://doi.org/10.1136/bmjopen-2018-025230Test
BMJ Open

مصطلحات موضوعية: spinal surgery, Adolescent, Incidence, Standard of Care, Cauda Equina Syndrome, outcomes, Neurosurgical Procedures, United Kingdom, Treatment Outcome, Outcome Assessment, Health Care, Protocol, cohort study, Humans, Surgery, Interdisciplinary Communication, Orthopedic Procedures, Guideline Adherence, Prospective Studies, Child

الوصف: INTRODUCTION: Cauda equina syndrome (CES) is a potentially devastating condition caused by compression of the cauda equina nerve roots. This can result in bowel, bladder and sexual dysfunction plus lower limb weakness, numbness and pain. CES occurs infrequently, but has serious potential morbidity and medicolegal consequences. This study aims to identify and describe the presentation and management of patients with CES in the UK.METHODS AND ANALYSIS: Understanding Cauda Equina Syndrome (UCES) is a prospective and collaborative multicentre cohort study of adult patients with confirmed CES managed at specialist spinal centres in the UK. Participants will be identified using neurosurgical and orthopaedic trainee networks to screen referrals to spinal centres. Details of presentation, investigations, management and service usage will be recorded. Both patient-reported and clinician-reported outcome measures will be assessed for 1 year after surgery. This will establish the incidence of CES, current investigation and management practices, and adherence to national standards of care. Outcomes will be stratified by clinical presentation and patient management. Accurate and up to date information about the presentation, management and outcome of patients with CES will inform standards of service design and delivery for this important but infrequent condition.ETHICS AND DISSEMINATION: UCES received a favourable ethical opinion from the South East Scotland Research Ethics Committee 02 (Reference: 18/SS/0047; IRAS ID: 233515). All spinal centres managing patients with CES in the UK will be encouraged to participate in UCES. Study results will be published in medical journals and shared with local participating sites.TRIAL REGISTRATION NUMBER: ISRCTN16828522; Pre-results.

وصف الملف: application/pdf

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=pmid_dedup__::2e092b54e9980b0ef473bc69942d25bfTest
https://hdl.handle.net/20.500.11820/c12c5683-31b4-4ca2-b231-69efe784aaa2Test

المؤلفون: Raghu, Ashley L. B., Flower, Hannah D., Statham, Patrick F. X., Brennan, Paul M., Hughes, Mark A.

المصدر: Journal of Neurological Surgery. Part B. Skull Base; 2020, Vol. 81 Issue 5, p579-584, 6p

مصطلحات موضوعية: ADENOMATOUS polyps, SURGICAL excision, MAGNETIC resonance imaging, SURGERY, LOGISTIC regression analysis, ODDS ratio, SPHENOID sinus

مستخلص: Introduction  As they grow, pituitary adenoma can remodel the sella turcica and alter anatomical relationships with adjacent structures. The intercarotid distance (ICD) at the level of the sella is a measure of sella width. The purpose of this study was to (1) assess how ICD changes after transsphenoidal surgery and (2) explore whether the extent of ICD change is associated with tumor recurrence. Methods  A retrospective analysis of preoperative and postoperative coronal magnetic resonance imaging (MRI) scans was carried out by two independent assessors on patients who underwent transsphenoidal surgery for nonfunctioning pituitary macroadenomas. Preoperative tumor volume and any change in ICD following surgery were recorded and compared between groups. Logistic regression models of recurrence were generated. Results  In 36 of 42 patients, ICD fell after surgery (mean = 1.8 mm) and six cases were static. At time of follow-up (mean = 77 months), 25 had not required further intervention and 17 had undergone second surgery or radiosurgery. In patients in whom no further intervention has yet been necessary, the postoperative reduction in ICD was significantly smaller than in those who required repeat intervention (1.1 vs. 2.7 mm respectively, p  < 0.01). ICD decrease was weakly correlated with tumor volume (r  = 0.35). ICD decrease was a significant predictor of recurrence (odds ratio [OR] = 3.15; 95% confidence interval [CI]: 1.44–6.87), largely independent of tumor volume. Conclusion  For most patients, ICD falls following surgical excision of a nonfunctioning pituitary macroadenoma. A greater reduction in ICD postsurgery appears to predict recurrence. Change in ICD shows promise as a radiographic tool for prognosticating clinical course after surgery. [ABSTRACT FROM AUTHOR]

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المؤلفون: Fouyas, Ioannis P., Statham, Patrick F. X., Sandercock, Peter A. G.

المصدر: Spine ; volume 27, issue 7, page 736-747 ; ISSN 0362-2436

الإتاحة: https://doi.org/10.1097/00007632-200204010-00011Test
https://journals.lww.com/00007632-200204010-00011Test