British Neurological Surgeons Research Articles

Proceedings of the 2024 Spring Meeting of the Society of British Neurological Surgeons

This meeting was hosted by the Royal Infirmary, Edinburgh 17th–19th April 2024 at The Edinburgh International Conference Centre, Edinburgh. The full abstracts of the platform presentations are followed by the titles of those submissions accepted as short orals and e-posters. The order of abstracts is that of presentation. Any papers in the programme that were not presented to the society at the meeting have not been published.

Equity, diversity and inclusion in neurosurgery: results of the SBNS engagement survey

INTRODUCTION Bullying, undermining and harassment (BUH) as well as discrimination have shown to be present throughout the National Health Service, especially in surgery. The Society of British Neurological Surgeons (SBNS) created its equity, diversity and inclusion (EDI) group to investigate the demographics of UK and Irish neurosurgeons, along with their experiences of BUH. METHODS A 31-item electronic survey was distributed through the national society email list for all neurosurgeons throughout the UK and Ireland in spring 2022. Descriptive statistics were used to present the results, along with 2x2 chi-squared contingency tables, with a p-value of <0.05 deemed statistically significant. RESULTS There were 175 respondents (approximately 18% of neurosurgeons in the UK and Ireland). Two-thirds (67%) were consultants and a quarter (23%) were women. Almost half (44%) were White British/Irish. A third (30%) went to university outside the UK/Ireland although most (82%) completed neurosurgical training in the UK or Ireland. Thirty-eight per cent said they did not have a primary caregiver or parental role. Two-thirds (65%) of respondents stated that they had been a victim of BUH, with 70% having witnessed BUH. Being female was the only demographic category with a significantly increased likelihood of experiencing BUH. A quarter (23%) of respondents felt uncomfortable about being open about themselves in the workplace and 39% had perceived a barrier to career progression due to a particular characteristic. CONCLUSIONS BUH and barriers to feeling comfortable in the workplace/career progression are problems in UK/Irish neurosurgery. Further work will be undertaken by the SBNS EDI working group to better understand the demographics of its community, to spread awareness of the issues, and to improve the experiences of neurosurgeons in the UK and Ireland.

Perioperative visual loss and consent for adult spine surgery: a national survey of the practice amongst spine surgeons and anaesthetists †

Background Perioperative Visual Loss (POVL) is a devastating complication for patients undergoing spine surgery. Consent process for POVL amongst spine surgeons and anaesthetist remains variable. The aim of this study is to evaluate their practice and views about it. Methods Two similar questionnaires were distributed to members of the Society of British Neurological Surgeons (SBNS), British Association of Spine Surgeons (BASS), and Neuroanaesthsia and Critical Care Society (NACCS). Results A total of 271 responses were received (SBNS/BASS n = 149, NACCS n = 122). Fewer surgeons considered POVL as a material risk for patients compared to the anaesthetists (57.7 versus 79.7%). Outpatient/pre-assessment clinics were considered as the optimal setting for discussing POVL by the majority of the clinicians (81.2 and 93.4%). POVL should be discussed by both specialists according to 75% of the anaesthetists. Estimated incidence of POVL was considered to be higher by the anaesthetists (0.03–0.2% by 63% of the anaesthetist versus 0.0001–0.004% by 57% of the surgeons). Twenty-three surgeons and 10 anaesthetists had a patient who suffered from POVL, which led to a change of practice in most of them. This questionnaire will lead to a change in practice/consent to 18.1% of the surgeons and 23.5% of the anaesthetists. Conclusions Most of the surgeons and anaesthetist feel that POVL is a material risk that ideally needs to be firstly discussed before the day of surgery, by both specialties. However, a significant number of clinicians have an opposite view. A national guidance from respective societies should encourage POVL to be discussed routinely.

Proceedings of the 2023 spring meeting of the Society of British Neurological Surgeons

This meeting was hosted by St George’s Hospital, London 13th–15th September 2023 at the Twickenham Conference and Events Centre, London. The full abstracts of the platform presentations are followed by the titles of those submissions accepted as short orals and e-posters. The order of abstracts is that of presentation. Any papers in the programme that were not presented to the society at the meeting have not been published.

Proceedings of the 2023 SPRING MEETING of the Society of British Neurological Surgeons

Proceedings of the 2023 SPRING MEETING of the Society of British Neurological Surgeons

Current landscape of academic neurosurgical training in the United Kingdom: analysis by the Society of British Neurological Surgeons

Objective Little is known about the impact of academic training on Neurosurgery in the United Kingdom (UK). The aim was to understand the early career clinical and research training journeys of potential future clinical academics, with a view to informing future policy and strategy to improve career development for academic neurosurgical trainees and consultants in the UK. Methods An online survey from the Society of British Neurological Surgeons (SBNS) academic committee was distributed to both the SBNS and British Neurosurgical Trainee Association (BNTA) mailing lists in early 2022. Neurosurgical trainees for any period between 2007 and 2022 or who had done any dedicated academic or clinical academic placement were encouraged to complete the survey. Results Sixty responses were received. Six (10%) were females and fifty-four (90%) were males. At the time of response, nine (15.0%) were clinical trainees, four (6.7%) were Academic Clinical Fellows (ACF), six (10.0%) were Academic Clinical Lecturers (ACL), four (6.7%) were post-CCT fellows, eight (13.3%) were NHS consultants, eight (13.3%) were academic consultants, eighteen (30.0%) were out of the programme (OOP) pursuing a PhD potentially returning to training, whilst three (5.0%) had left neurosurgery training entirely and no longer performing clinical neurosurgery. The mentorship was sought in most programmes, which tended to be informal. Self-reported success on a scale of 0 to 10 with 10 being the most successful, was greatest in the MD and the “Other research degree/fellowship group” which does not include a PhD. There was a significant positive association between completing a PhD and having an academic consultant appointment (Pearson Chi-Square = 5.33, p = 0.021). Conclusions This study provides a snapshot to better understand the opinions of academic training in neurosurgery within the UK. Establishing clear, modifiable, and achievable goals, as well as providing tools for research success, may contribute to the success of this nationwide academic training.

Proceedings of the 2022 Autumn Meeting of the Society of British Neurological Surgeons

Proceedings of the 2022 Autumn Meeting of the Society of British Neurological Surgeons

Early repeat resection for residual glioblastoma: decision-making among an international cohort of neurosurgeons.

The importance of extent of resection (EOR) in glioblastoma (GBM) has been thoroughly demonstrated. However, few studies have explored the practices and benefits of early repeat resection (ERR) when residual tumor deemed resectable is unintentionally left after an initial resection, and the survival benefit of ERR is still unknown. Herein, the authors aimed to internationally survey current practices regarding ERR and to analyze differences based on geographic location and practice setting. The authors distributed a survey to the American Association of Neurological Surgeons and Congress of Neurological Surgeons Tumor Section, Society of British Neurological Surgeons, European Association of Neurosurgical Society, and Latin American Federation of Neurosurgical Societies. Neurosurgeons responded to questions about their training, practice setting, and current ERR practices. They also reported the EOR threshold below which they would pursue ERR and their likelihood of performing ERR using a Likert scale of 1-5 (5 being the most likely) in two sets of 5 cases, the first set for a patient's initial hospitalization and the second for a referred patient who had undergone resection elsewhere. The resection likelihood index for each respondent was calculated as the mean Likert score across all cases. Overall, 180 neurosurgeons from 25 countries responded to the survey. Neurosurgeons performed ERRs very rarely in their practices (< 1% of all GBM cases), with an EOR threshold of 80.2% (75%-95%). When presented with 10 cases, the case context (initial hospitalization vs referred patient) did not significantly change the surgeon ERR likelihood, although ERR likelihood did vary significantly on the basis of tumor location (p < 0.0001). Latin American neurosurgeons were more likely to pursue ERR in the provided cases. Neurosurgeons were more likely to pursue ERR when the tumor was MGMT methylated versus unmethylated, with a resection likelihood index of 3.78 and 3.21, respectively (p = 0.004); however, there was no significant difference between IDH mutant and IDH wild-type tumors. Results of this survey reveal current practices regarding ERR, but they also demonstrate the variability in how neurosurgeons approach ERR. Standardized guidelines based on future studies incorporating tumor molecular characteristics are needed to guide neurosurgeons in their decision-making on this complicated issue.

A national survey on the management of foot drop secondary to lumbar degenerative disease in the United Kingdom

Purpose There is considerable variation in the management of foot drop secondary to lumbar degenerative disease (LDD) that occurs between centres and surgeons (spinal surgeons and neurosurgeons). The lack of standardised practice reflects the paucity in evidence base for management of this condition. In this survey, we aimed to assess current practice in the UK and identify the areas of variation. Methods A case-based survey was distributed to members of the Society of British Neurological Surgeons and British Association of Spine Surgeons through an online questionnaire. The survey consisted of 10 questions designed to determine the management of foot drop secondary to LDD. Results A total of 163 responses were collected among UK neurosurgeons and spinal surgeons with good geographical representation. 92% were Consultants. 86% of the respondents would offer surgery. The indication for offering surgery varied but 54% of respondents would offer surgery to patients who present with a painful foot drop. There was a huge variation in offering surgery dependent on the grade of weakness. The strongest prognostic indicator predicted was duration of weakness (92%). The timing of intervention was wide-ranging in the responses received. Almost all responded that they would be willing to participate in a prospective study in the future to determine best practice. Conclusions This survey highlights the significant variability in management of foot drop secondary to LDD amongst consultant surgeons within the UK. It is also suggestive of a weak evidence base and indicates an urgent need for a high quality national prospective study.

Foramen magnum decompression for Chiari malformation type I – UK surgical practice

Background: Symptomatic Chiari 1 malformation (CM1) is a common condition in Neurosurgery. Surgery involves hindbrain decompression and restoration of CSF flow through different surgical approaches. No Class 1 evidence exists to suggest the superiority of any of the surgical techniques. Aims: To investigate current surgical practice for symptomatic CM1 patients in the United Kingdom (UK) and determine the willingness to participate in a randomised controlled trial (RCT) comparing different surgical techniques. Methods: An electronic survey was sent to consultant members of the Society of British Neurological Surgeons and the British Chiari-Syringomyelia Group. The questions covered pre-operative and intra-operative management, presence of equipoise/uncertainty in optimal technique and willingness to participate in an RCT. Results: 98 responses were received. 67% operate on adults. 30% on adult and paediatric patients. There is variation in routine pre-operative use of: ICP monitoring (18%), flexion/extension x-rays (16%), venography (20%) and ophthalmology assessment (26%). 18% of neurosurgeons would not offer foramen magnum decompression when the presenting symptom is only refractory cough/sneeze headache. 15% routinely perform bony decompression alone in adults vs 8% in children. In 68% of adult cases, durotomy is performed routinely (46% of them leave the dura open, 54% perform a type of duroplasty) and 16% routinely resect the cerebellar tonsils. Only 17% leave the dura open in children. The most common indicators for durotomy are syringomyelia and intra-operative ultrasound findings. 61% believe there is equipoise/uncertainty in the optimal strategy for decompression and would be willing to participate in an RCT. Comments also mention the heterogeneity of CM1 and that treatment should be tailored to each patient. Conclusion: There is wide variation in pre- and intra-operative management of CM1 patients in the UK and the majority of neurosurgeons would be willing to participate in an RCT comparing bony decompression alone vs dural opening with/without duroplasty.

A proposed novel traumatic brain injury classification system – an overview and inter-rater reliability validation on behalf of the Society of British Neurological Surgeons

Introduction The measurement of traumatic brain injury (TBI) ‘severity’ has traditionally been based on the earliest Glasgow Coma Score (GCS) recorded, however, the underlying parenchymal pathology is highly heterogonous. This heterogeneity renders prediction of outcome on an individual patient level inaccurate and makes comparison between patients both in clinical practice and research difficult. The complexity of this heterogeneity has resulted in generic all encompassing ‘traumatic brain injury protocols’. Early management and studies of neuro-protectants are often done irrespective of TBI type, yet it may well be that a specific treatment may be beneficial in a subset of TBI pathologies. Methods A simple CT-based classification system rating the recognised types of blunt TBI (extradural, subdural, subarachnoid haemorrhage, contusions/intracerebral haematoma and diffuse axonal injury) as mild (1), moderate (2) or severe (3) is proposed. Hypoxic brain injury, a common secondary injury following TBI, is also included. Scores can be combined to reflect concomitant types of TBI and predominant location of injury is also recorded. To assess interrater reliability, 50 patient CT images were assessed by 5 independent clinicians of varying experience. Interrater reliability was calculated using overall agreement through Cronbach’s alpha including confidence intervals for intra-class coefficients. Results Interrater reliability scores showed strong agreement for same score and same injury for TBIs with blood on CT and Cronbach’s alpha co-efficient (range 0.87–0.93) demonstrated excellent correlation between raters. Cronbach’s alpha was not affected when individual raters were removed. Conclusions The proposed simple CT classification system has good inter-rater reliability and hence potentially could enable better individual prognostication and targeted treatments to be compared while also accounting for multiple intracranial injury types. Further studies are proposed and underway.

Hard collar immobilisation following elective surgery on the cervical spine: a cross-sectional survey of UK spinal surgeons

Introduction Although mostly used in the management of spinal trauma, hard collar immobilisation is also used as an adjunct to recovery after elective cervical spine surgery. Many surgeons believe that bracing reduces the risk of non-union and pain and provides a subjective sense of security for patients. There is little if any, evidence for this practice and immobilisation can be a direct cause of adverse events. The primary aim of this study was to provide an updated assessment of post-operative bracing practice in UK spinal surgeons, including the indications, rationale and perspectives on compliance and complications. Methods Neurosurgeons and spinal orthopaedic surgeons completed a web-based survey distributed by email to members of the Society of British Neurological Surgeons (SBNS) and the British Association of Spinal Surgeons (BASS). Professional information captured included level of experience and whether surgeons had a specialist interest in spinal surgery. Questions first focused on the frequency and duration of hard collar immobilisation for common decompressive procedures. Later questions captured surgeon rationale, perceptions of patient compliance, complications, and collar removal. Results A total of 86 surgeons completed the survey, of whom 83% were spinal specialists. In total, 33 (38%) surgeons recommend a hard collar following at least one of the elective procedures listed. Collars were most commonly recommended following cervical corpectomy (30%). The support of fusion and bone healing was the most common rationale (82%), with post-operative pain (45%) and limiting patient activity (39%) also considered. Most surgeons (69%) believed that their patients were compliant. All listed types of complications were reported, with impaired activities of daily living (41%) and impaired sleep (34%) the most frequently cited. Conclusions Current post-operative use of hard collars is much lower in the United Kingdom than previously reported in the United States. Surgeon decision-making is inconsistent and may benefit from greater standardisation. Future work is needed to help develop guidelines as a move away from arbitrary to evidence-based practice.

Cerebrospinal Fluid Diversion for Refractory Intracranial Hypertension: A United Kingdom and Ireland Survey on Practice Variation.

IntroductionDiversion 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.MethodsA 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.ResultsThirty-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.ConclusionThis 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.

Prof. Dr. Willian Harkness 1955-2021

We are deeply saddened by the passing of Dr. William Harkness. A gifted surgeon, a caring clinician, a visionary leader and devoted family man, William left an indelible impression on pediatric neurosurgery and the many people whose lives he touched. Dr. William was educated at Eton School and qualified in medicine in 1979, at the University of Birmingham. His neurosurgical training commenced at the Radcliffe Infirmary, Oxford and later continued in Birmingham. Upon completion of his specialist training in 1991, he was appointed as a consultant neurosurgeon at the National Hospital for Neurology and Neurosurgery, Queen Square and Great Ormond Street Hospital for Sick Children (GOSH), but it was the latter institution that became his professional home as he focused his career on pediatric neurosurgery, establishing a legendary partnership with Dr. Richard Hayward. Dr. William spent a year in North America undergoing training at UCLA, Seattle, Miami and Montreal. He enthusiastically embraced the multidisciplinary team approach, enabling him to establish a world-leading children’s epilepsy surgery service together with Helen Cross at GOSH. While this is where he had his greatest scientific impact, he was a consummate pediatric neurosurgeon who thought deeply and wrote on a wide range of conditions. William was known to be an exceptionally skillful surgeon, with many neurosurgical trainees citing him as the one of the leading technical neurosurgeons they had worked with. He served as clinical lead for pediatric neurosciences at GOSH and led the development of a national plan for epilepsy surgery services in Great Britain. Throughout his career William was an ardent advocate for pediatric neurosurgery, representing the specialty in many forums including the Society of British Neurological Surgeons. Dr. Willian was a participant in the first ever European Society for Pediatric Neurosurgery (ESPN) educational course, where he struck up a legendary friendship with the late Jim Goodrich, he went on to become one of the most sought-after lecturers worldwide, including many Latin American Courses of Pediatric Neurosurgery (LACPN). In ISPN, there are few who have contributed more to the society. Dr. William served as scientific chair, communications chair, treasurer and ultimately president, (2016-2017). Combining his organizational and technical skills, he worked with Jim Johnson to develop InterSurgeon, a web-based platform promoting international collaboration through linking neurosurgeons and related organisations across the world. Supported by among others, the ISPN, UAB and the G4Alliance, InterSurgeon has grown beyond neurosurgery and will be a lasting tribute to William’s vision and drive. Dr. William was also an integral member of the Global Neurosurgery Committee of the World Federation of Neurosurgical Societies (WFNS). He worked tirelessly to propel the field, and always made sure he was available to provide advice and assistance. During his time with the committee, he expanded the knowledge base on global neurosurgery, worked to align the multitude of projects in the field, and improved collaboration amongst neurosurgeons around the world. He married Philippa Lubomirski in 1982. She survives him as do their four children, Fran, Ed, Gabi and Letitia, their grandchildren, Arlo, Joanie, Betsy, Peggy and Ari, and his sister, Nicola. Above all else, we remember William’s devotion to his family most vividly. His beloved wife Philippa, who accompanied him on most of his travels. And his four children, Fran, Ed, Gabi and Letitia, their grandchildren, Arlo, Joanie, Betsy, Peggy and Ari, and his sister, Nicola. We extend our sincere condolences to his family and close friends

Hosting an Educational Careers Day Within the Virtual Paradigm: The Neurology and Neurosurgery Interest Group Experience.

Introduction: To explore our experience of hosting the 10th Annual Neurology and Neurosurgery Interest Group-Society of British Neurological Surgeons (NANSIG-SBNS) Neurosurgery Careers Day, held virtually for the first time.Methods: Reflective feedback and review of an international, virtual neurosurgery careers day. The authors reflect on the logistics of organizing the event, and the pre- and post-event feedback provided by delegates. Recommendations have been made on how to successfully host a virtual event. The key themes that permeated the event have been outlined and discussed in the context of the feedback received.Results: The event was attended by 231 delegates from 20 countries worldwide. Knowledge of neurosurgery as a career and the application process increased after attending the careers day (4.27/5 to 4.51/5, p=0.003 and 3.12/5 to 4.31/5, p<0.001 respectively). The key themes identified from the event include attendance, networking, and education. Qualitative feedback was positive and indicated a positive perception of the careers day.Conclusions: The future of educational events is unclear, and a hybrid approach is recommended to retain the benefits of the online space when in-person events eventually return.

Proceedings of the 2022 Spring Meeting of the Society of British Neurological Surgeons

Proceedings of the 2022 Spring Meeting of the Society of British Neurological Surgeons

Compliance With the Cauda Equina Pathway: Results of a Closed-Loop Audit.

IntroductionThe British Association of Spine Surgeons (BASS) and Society of British Neurological Surgeons (SBNS) recommend urgent MRI imaging and operative intervention in patients with suspected cauda equina syndrome (CES). Due to the lack of a 24-hour MRI service and the centralisation of neurosurgery to large tertiary centres, there is a need for an evidence-based protocol for the referral of patients presenting with back pain, with red flags to specialist tertiary neurosurgical centres.MethodsThe standard operating procedure (SOP) at our local hospital outlines steps in the assessment, triage and onward referral of patients presenting with symptoms of acute CES.A closed-loop audit cycle was performed; the first cycle was between September and December 2020 and the second was between January and April 2021. Recommendations made after the first cycle were actioned prior to re-audit.ResultsThere was 100% compliance regarding discussions with neurosurgery following MRI and appropriate management following neurosurgical advice. There was a 21.1% increase in appropriate discussions with neurosurgery by the emergency department (ED), increased accurate documentation of red flags (5% anal tone and 21% perianal sensation). There was a 53% decrease in senior ED doctor referral to neurosurgery, although 100% referrals were discussed with an ED senior prior to referral, and a 20% decrease in compliance regarding neurosurgery plan documentation.ConclusionWe were able to improve our compliance with several aspects of the SOP using simple measures. We could not improve one aspect of SOP, namely, a discussion with the specialist centre being performed by a senior doctor.Since CES requires timely management and early scanning, we recommend a robust protocol at the admitting hospital. This paper presents the protocol at our hospital and the rationale behind it. We discuss what affects our compliance with the SOP and how simple interventions have helped us improve.

Development of ‘Core Outcome Sets’ for meningioma in clinical studies: The COSMIC project

Abstract Aims To date, meningioma clinical trial activity has been limited, but a number of high-quality studies are underway, with more in development. There is heterogeneity in the outcomes reported in meningioma clinical trials. The COSMIC Project will develop two ‘Core Outcome Sets’ (COS) through comprehensive, transparent, consensus methodology; to ensure outcomes relevant to key stakeholders are reported within and across future meningioma clinical studies. The first will be for use in clinical effectiveness trials (COSMIC: Intervention), the second will be for use in clinical studies of incidental meningioma (COSMIC: Observation). Method Three systematic literature reviews will be performed to generate a long-list of outcomes potentially relevant to meningioma patients, healthcare professionals, researchers, and other stakeholder groups. The first systematic review will present the outcomes reported in published and ongoing meningioma clinical effectiveness trials. The second systematic review will present patient-reported outcomes (PRO) from the measurement tools utilised in meningioma PRO studies. The third systematic review will present the outcomes reported in published and ongoing clinical studies of untreated meningioma. Outcomes will be deduplicated, unique outcomes categorised according to the taxonomy presented by COMET, and the lists combined. The long-list of outcomes will be prioritised through two, 2-round, modified eDelphi surveys including meningioma patients, healthcare professionals, researchers, and other stakeholder groups. Undecided outcomes from both eDelphi surveys will be ratified at two, one-day consensus meeting, with representation from all key stakeholder groups. Results We have formed a study advisory group with international representation from key organisations. The project already has confirmed support from the International Consortium on Meningioma (ICOM), the European Association of Neuro-Oncology (EANO), the Response Assessment in Neuro-Oncology Patient-Reported Outcome group (RANO-PRO), the Society for Neuro-Oncology (SNO), British Neuro-Oncology Society (BNOS), Society of British Neurological Surgeons (SBNS), The Brain Tumour Charity (TBTC), and Brainstrust. Conclusion Standardising minimum outcome reporting in meningioma clinical effectiveness trials and meningioma clinical studies, through the development of these two COS will ensure outcomes reported are relevant to key stakeholder groups, including patients, whilst reducing research waste for a disease with increasing clinical trial activity. We seek to raise awareness of this project and invite participation from a wide range of stakeholders to ensure that the final COS reflects the opinion of the neuro-oncology community. Registration will take place via the study website www.thecosmicproject.org between June-August 2021.

Management of C2 odontoid peg fragility fractures – A UK survey of spinal surgeons

PurposePatients sustaining fragility fractures of the C2 odontoid peg have 30-day mortality rates as high as 10% rising up to 34.1% at 1 year. Substantial controversy exists regarding optimal management of these fractures and there is a lack of national guidance to inform best practice.The aim of this study was to determine current practice in the management of these fractures throughout the United Kingdom. MethodsA UK wide, cross sectional survey was conducted, asking 10 questions regarding the initial management, imaging and follow-up of an elderly patient with a type 2 fragility odontoid peg fracture. This was publicised through the British Orthopaedic Association website and sent to all members of the Society of British Neurological Surgeons (SBNS) via email. Results107 Responses were received. 56% from orthopaedic consultants, 29% from neurosurgical consultants and 15% from senior spine fellows.86% (92) of respondents choose treatment with a cervical orthosis, with 84% (77) of these opting for a semi rigid Aspen or Philadelphia collar compared to 16% (15) opting for a soft cervical collar. Three (3%) opted for operative intervention with a further three (3%) choosing Halo fixation. Nine respondents (8%) opted for no orthosis and treatment with analgesia alone.Length of immobilisation in cervical orthosis ranged from 6 to 12 weeks. Initial follow-up ranged from 1 week to 6 weeks, with 6% (6) discharged without follow up.There was also marked variation in the use of follow-up imaging with 17% (18) using plain radiographs, 62% (66) requesting lateral flexion / extension radiographs, 10% (11) using CT and 11% (12) not performing any imaging at final follow up.In 60% (64) of cases respondents did not change subsequent management as a result of imaging. ConclusionType-2 fragility peg fractures have high morbidity and mortality. There is marked variation in the treatment modalities used, follow-up regime and use of imaging throughout the UK.Given the rapidly increasing incidence of these injuries and the associated mortality this should be a high priority field for further research. Further large scale studies are urgently required to inform best practice and standardise management of these injuries.

Current state of social media utilization in neurosurgery amongst European Association of Neurosurgical Societies (EANS) member countries

BackgroundSocial Media (SoMe) is becoming increasingly used in the medical community, and its use has been related with academic productivity. However, utilization of SoMe in the European neurosurgical community has not been assessed systematically.MethodsAn online search was undertaken to discover SoMe accounts of (1) national and related neurosurgical societies listed on the EANS website, (2) neurosurgical journals present on EANS website, (3) neurosurgery centers within EANS member countries, as listed on their website. SoMe accounts of Facebook, Twitter, YouTube, and Instagram were searched for journals and societies, and Twitter, Instagram, and Facebook for neurosurgery departments. The number of likes/followers/subscribers was recorded.ResultsFive (31%) neurosurgery journals had a SoMe presence. The highest number of followers, likes, and tweets was found for JNNP, and Journal of Neurological Surgery Part B had the most subscribers and video views. SoMe usage was identified for 11 national (28.2%) and 2 multi-national neurosurgical societies. From these, the French Society of Neurosurgery had the largest number of Facebook followers (> 2800) and Likes (> 2700), the Society of British Neurological Surgeons had the largest number of Twitter followers (> 2850), whereas EANS overall had the most followers on Twitter > 5100 and Facebook > 5450. A total of 87 SoMe neurosurgery center accounts were found on either Facebook, Instagram or Twitter, for 64 of 1000 centers (6.4%) in 22 of 40 different countries (55%). Of these 67% (n = 43/64) arose from 6 countries (England, Germany, Italy, Romania, Turkey, Ukraine). There were more Facebook accounts (n = 42) than Instagram accounts (n = 23) or Twitter accounts (n = 22).ConclusionSoMe use amongst neurosurgical societies and departments in Europe is very limited. From our perspective, explanations are lacking for the correlated numbers to the market shares of SoMe in the respective countries. Further research, including a survey, to follow up on this important topic should be undertaken among EANS members.