British Neurological Surgeons Research Articles

Proceedings of the 2017 Autumn Meeting of the Society of British Neurological Surgeons

Proceedings of the 2017 Autumn Meeting of the Society of British Neurological Surgeons

The death of Sir Victor Horsley (1857–1916) and his burial in Amarah

ABSTRACTSir Victor Alexander Haden Horsley (1857–1916), the pioneering British neurological surgeon, passed away 100 years ago. He died young in his sixtieth year from the effects of heat stroke while serving as consulting military surgeon to the Mediterranean Expeditionary Force in Amarah, modern-day Iraq, and was buried in the now largely abandoned “Amara War Cemetery.” By the time of his death in 1916, Victor Horsley had established himself as one of the most eminent innovators of modern neurological surgery. His pioneering researches in cerebral physiology earned him an early reputation in the field, and his experiences with vivisection allowed him to confidently operate on the brain and spinal cord at a time when surgical intervention of the nervous system was fraught with uncertainty. Outside the operating theatre, Horsley was a proud advocate for a number of sometimes controversial sociopolitical issues; national temperance, women’s suffrage, and medical unionism particularly interested him. He brought the same courageousness to the British army during the First World War, and labored tirelessly under considerable hardships to improve the conditions for soldiers. Otherwise robust and healthy, it was only through great self-denial and overwork that Horsley suddenly succumbed to the burning heat of Mesopotamia. He died as he lived—a fearless and painstaking fighter for the common man. His was a most beautiful life of unselfish devotion to others.

Proceedings of the 2017 Spring Meeting of the Society of British Neurological Surgeons

Proceedings of the 2017 Spring Meeting of the Society of British Neurological Surgeons

National Survey of Neurosurgeons and Stroke Physicians on Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Infarction.

Several studies have evaluated the use of decompressive hemicraniectomy (DHC) in malignant middle cerebral artery infarction (MMCAI). In the United Kingdom, the National Institute for Health and Care Excellence (NICE) has set criteria for selection of patients for DHC in MMCAI. We set out to survey the attitudes and practice of neurosurgeons and stroke physicians within the United Kingdom towards DHC in MMCAI. An electronic survey of questions on management of MMCAI in various clinical scenarios was submitted to the academic committees of the Society of British Neurological Surgeons and the British Association of Stroke Physicians for approval before dissemination through the consultant members. Responses were collected over 2 months. A total of 78 responses, from 51 neurosurgeons and 27 stroke physicians, were included in final analysis. Atotal of 54% and 24% of all respondents would recommend DHC in patients aged 60-70 and 70-80 years, respectively; 60% would advocate surgery between 48 and 72 hours and 27% beyond 72 hours. A total of 36% indicated DHC with preoperative Glasgow Coma Scale 15/15. These findings do not conform to current NICE guidelines. Stroke physicians were statistically more likely to recommend DHC in patients older than 60 years (P= 0.032) and in those with dominant multiterritorial infarcts (P= 0.042) and accept a greater postoperative modified Rankin Scale (P= 0.034) compared with neurosurgeons. In view of evidence from recent trials and differences in NICE guidelines and current clinical practice within the United Kingdom, based on our survey results, it is important to reevaluate NICE guidelines.

SURG-02. UK LOW GRADE GLIOMA MANAGEMENT - A SURVEY OF NATIONAL PRACTICE

There remains a variation between clinical teams in their understanding and attitude regarding treatment options. We sought to obtain information about how LGG Neurosurgery & Oncology practice is shaped throughout the UK and how care is structured and delivered. Neurosurgical units in the UK were distributed a Society of British Neurological Surgeons approved questionnaire asking about LGG practices in their area. Paediatric hospitals were excluded. There was a 53.1% response rate. 41% of units see patients in specialised LGG clinics, 35% use neuro-oncology clinics, 24% review in general clinics. On average, 4 specialties will attend specialised clinics, 2 - neuro-oncology clinics, and only a neurosurgeon - general clinics. 76% of the units aim for primary resection where possible; only 12% will start by observing the tumour even if focal and deemed resectable. Units seeing patients in general clinics have more tendency to biopsy routinely at presentation (p=0.027). Most centres (88%) offer surgery via awake craniotomy – with a variety of testing methods used. A positive correlation between operative numbers and the ability to offer awake surgery was noted. Following surgery for LGG, 65% initially follow their patients with serial scans while the remainder may refer patients for consideration of adjuvant therapy. A large proportion of respondents confirmed that they provide specialist LGG services in established multidisciplinary environments. The majority of centres do recognise the value of upfront surgery with the aim of achieving significant bulk resection. The methodology surrounding awake craniotomy varies markedly across the UK centres. A unit-to-unit variation in the post-operative care of LGG patients was also noted, with disparity in which patients are referred for adjuvant therapy. This survey supports the establishment of a UK National LGG Working Group who can setup a regular National outcome audit & establish a National LGG Database.

Society of British Neurological Surgeons Autumn Conference

Society of British Neurological Surgeons Autumn Conference

Proceedings of the 2016 Autumn Meeting of the Society of British Neurological Surgeons

Proceedings of the 2016 Autumn Meeting of the Society of British Neurological Surgeons

Attitudes in 2013 to Monitoring Intracranial Pressure for Traumatic Intracerebral Haemorrhage.

Recent research has been equivocal regarding the usefulness of intracranial pressure (ICP) monitoring for traumatic intracerebral haemorrhage (ICH). We aimed to investigate attitudes of clinicians from as wide an international audience as possible. A SurveyMonkey® questionnaire was distributed to individuals, including members of the Society of British Neurological Surgeons, the European Brain Injury Consortium, the Euroacademia Multidisciplinaria Neurotraumatologica and the neurotrauma committee of the World Federation of Neurosurgical Societies. Ninety-eight participants from at least 25 different countries completed the survey (86 surgeons). ICP was routinely monitored by 76 % and would be monitored by 5 % more if they had equipment. ICP monitoring was valued (0 = not at all important, 10 = critically important) as 10 by 21 % (median = 8; Q1 = 7, Q3 = 9). Responders were aware of 16 trials that investigated the value of ICP monitoring in neurotrauma, including BEST TRIP (n = 35), Rescue ICP (n = 13) and DECRA (n = 8). Other results are discussed. Despite equivocation in the literature, we found that ICP monitoring continues to be routinely performed and is highly valued. Interestingly, only 36 % of responders were aware of the BEST TRIP trial, which found no difference in outcome between patients with a head injury managed with or without ICP monitoring.

Report from Society of British Neurological Surgeons autumn meeting

British Journal of Neuroscience NursingVol. 11, No. 5 BANN PagesReport from Society of British Neurological Surgeons autumn meetingRuth TroutRuth TroutSearch for more papers by this authorRuth TroutPublished Online:27 Oct 2015https://doi.org/10.12968/bjnn.2015.11.5.250AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article FiguresReferencesRelatedDetails 2 October 2015Volume 11Issue 5ISSN (print): 1747-0307ISSN (online): 2052-2800 Metrics History Published online 27 October 2015 Published in print 2 October 2015 Information© MA Healthcare LimitedPDF download

Cauda equina syndrome

There is no universally agreed definition of cauda equina syndrome (CES). Clinical signs of CES including direct rectal examination (DRE) do not reliably correlate with cauda equina (CE) compression on MRI. Clinical assessment only becomes reliable if there are symptoms/signs of late, often irreversible, CES. The only reliable way of including or excluding CES is to perform MRI on all patients with suspected CES. If the diagnosis is being considered, MRI should ideally be performed locally in the District General Hospitals within one hour of the question being raised irrespective of the hour or the day. Patients with symptoms and signs of CES and MRI confirmed CE compression should be referred to the local spinal service for emergency surgery. CES can be subdivided by the degree of neurological deficit (bilateral radiculopathy, incomplete CES or CES with retention of urine) and also by time to surgical treatment (12, 24, 48 or 72 hour). There is increasing understanding that damage to the cauda equina nerve roots occurs in a continuous and progressive fashion which implies that there are no safe time or deficit thresholds. Neurological deterioration can occur rapidly and is often associated with longterm poor outcomes. It is not possible to predict which patients with a large central disc prolapse compressing the CE nerve roots are going to deteriorate neurologically nor how rapidly. Consensus guidelines from the Society of British Neurological Surgeons and British Association of Spinal Surgeons recommend decompressive surgery as soon as practically possible which for many patients will be urgent/emergency surgery at any hour of the day or night.

Proceedings of the 2015 Autumn Meeting of the Society of British Neurological Surgeons

Proceedings of the 2015 Autumn Meeting of the Society of British Neurological Surgeons

Undergraduate teaching of neurosurgery – what is the current practice in the UK and is there a need for improvement?

There has been concern that the move towards generalism means that specialties, such as neurosurgery, are being pushed out of the undergraduate syllabus. Surveys were created, along with the Society of British Neurological Surgeons, and sent to medical school representatives (MSRs) and neurosurgery programme directors (NPDs) in the United Kingdom (UK). 60% of MSRs and 71% of NPDs responded. Neurosurgical topics were taught by a variety of specialties, and in one medical school, a MSR said that neurosurgery was not taught at all. 83% of MSRs and 80% of NPDs said that neurosurgeons should be more involved in undergraduate education, with 70% of NPDs saying that their unit would be willing to have increased involvement. All NPDs, but only 72% of MSRs, said that neurosurgery should be taught in medical school. Those MSRs who disagreed opined that it was a postgraduate subject, and could be difficult to engage all students. The majority of MSRs and NPDs thought that neurosurgery guidelines would be useful. The most popular forms of guidance were in the forms of curriculum/guidelines, website and powerpoint presentations. It is therefore recommended that neurosurgeons, under the umbrella of the Society of British Neurological Surgeons, create national guidelines for the teaching of undergraduate students; to aid their educational colleagues and ensure that accurate, standardised teaching occurs. Care must be taken not to be over-prescriptive in these endeavours.

Proceedings of the 2015 Spring Meeting of the Society of British Neurological Surgeons jointly with, as invited guests, the German Society of Neurosurgery (DGNC – Deutche Gessellschaft für Neurochirurgie)

Proceedings of the 2015 Spring Meeting of the Society of British Neurological Surgeons jointly with, as invited guests, the German Society of Neurosurgery (DGNC – Deutche Gessellschaft für Neurochirurgie)

Publication productivity of neurosurgeons in Great Britain and Ireland.

Bibliometrics are the methods used to quantitatively analyze scientific literature. In this study, bibliometrics were used to quantify the scientific output of neurosurgical departments throughout Great Britain and Ireland. A list of neurosurgical departments was obtained from the Society of British Neurological Surgeons website. Individual departments were contacted for an up-to-date list of consultant (attending) neurosurgeons practicing in these departments. Scopus was used to determine the h-index and m-quotient for each neurosurgeon. Indices were measured by surgeon and by departmental mean and total. Additional information was collected about the surgeon's sex, title, listed superspecialties, higher research degrees, and year of medical qualification. Data were analyzed for 315 neurosurgeons (25 female). The median h-index and m-quotient were 6.00 and 0.41, respectively. These were significantly higher for professors (h-index 21.50; m-quotient 0.71) and for those with an additional MD or PhD (11.0; 0.57). There was no significant difference in h-index, m-quotient, or higher research degrees between the sexes. However, none of the 16 British neurosurgery professors were female. Neurosurgeons who specialized in functional/epilepsy surgery ranked highest in terms of publication productivity. The 5 top-scoring departments were those in Addenbrooke's Hospital, Cambridge; St. George's Hospital, London; Great Ormond Street Hospital, London; National Hospital for Neurology and Neurosurgery, Queen Square, London; and John Radcliffe Hospital, Oxford. The h-index is a useful bibliometric marker, particularly when comparing between studies and individuals. The m-quotient reduces bias toward established researchers. British academic neurosurgeons face considerable challenges, and women remain underrepresented in both clinical and academic neurosurgery in Britain and Ireland.

Proceedings of the 2014 Autumn Meeting of the Society of British Neurological Surgeons

Proceedings of the 2014 Autumn Meeting of the Society of British Neurological Surgeons

Publication fate of abstracts presented at Society of British Neurological Surgeons meetings

Introduction. Society of British Neurological Surgeons (SBNS) meetings are important national events which allow for the presentation of current academic work. The publication rate of presented abstracts is considered a proxy marker of the scientific strength of a conference. We aimed to determine the publication fate of presented abstracts at SBNS meetings over a 5-year period. Methods. A retrospective review of SBNS conference proceedings between 2001 and 2005 was performed. To ascertain whether an abstract resulted in peer-reviewed publication, a range of databases (PubMed, Google Scholar, Medline and Ovid) were interrogated. s published in full were subsequently assessed for journal impact factor (IF), time of publication and number of citations received (per Google Scholar). Results. A total of 494 abstracts were presented. Of these, 181 abstracts were subsequently published in full, giving the conference a publication rate of 36.6%. The mean time to publication from presentation was 22 months (range 35 months pre-presentation to 133 months afterwards). The top three journals for publication were the British Journal of Neurosurgery (23.2%), Neurosurgery (7.7%) and Journal of Neurosurgery (7.7%). The IF of journal destinations ranged from no IF to 38.28 (median = 1.97). Number of citations ranged from 0 to 963 (median = 22). s with positive results were significantly more likely to be published in full compared to those with negative results (p = 0.0001). Conclusions. SBNS conferences have a respectable publication rate. Those abstracts that are published in full have gone on to gain a considerable number of citations reflecting their scientific relevance. However, studies presented at SBNS are susceptible to positive outcome bias.

Proceedings of the 2014 Spring Meeting of the Society of British Neurological Surgeons

24 months follow-up. Of these, 91 children (61%) were Engel class 1, 13 (9%) were Engel class II, 19 (12%) Engel class III and 25 (17%) Engel class IV. Children with tumour histology had the best outcome, with 73% achieving Engel I. Tumour predicted better outcome than hippocampal sclerosis (59%), dysplasias (44%) or cavernoma (33%). Post-op neuropsychology reports were available for 57 children. Of these, 46 (80%) had no new defi cit detectable following surgery. Conclusions. Th is is the largest series of TLR yet reported, and the implications will be discussed.

Attitudes to intracranial pressure monitoring of traumatic intracerebral haemorrhage

Introduction. Recent research has been equivocal regarding the usefulness of intracranial pressure (ICP) monitoring for traumatic intracerebral haemorrhage (ICH). We aimed to investigate attitudes of clinicians from as wide an international audience as possible. Materials and methods. A SurveyMonkey® questionnaire was distributed to individuals, including members of the Society of British Neurological Surgeons, the European Brain Injury Consortium, the neurotrauma committee of the Euroacademia Multidisciplinaria Neurotraumatologica and the World Federation of Neurosurgical Societies. Results. N = 98 completed the survey (surgeons n = 86) from at least 25 different countries. ICP was routinely monitored by 76% and would be monitored by 5% more if they had equipment. ICP monitoring was valued (0 = not at all important, 10 = critically important) as 10 by 21% (median = 8, Q1 = 7, Q3 = 9). Triggers to begin ICP monitoring included midline shift (n = 48), contusion (n = 47), ICH (n = 46), subdural haemorrhage (n = 42), Glasgow coma scale reduction of median 2 for eye, verbal or motor, and one reactive pupil (30%). Responders stated that intervention would begin for adults with an ICP median of 25 mmHg and for children 20 mmHg. Most favourable treatments of raised ICP included Mannitol and ventriculostomy, which were ranked as most favourable (out of 10) by n = 31 each. Responders claimed to be aware of 16 different trials that investigated the value of ICP monitoring in neurotrauma, including BEST TRIP (n = 35), Rescue ICP (n = 13) and DECRA (n = 8). Conclusion. ICP monitoring continues to be a highly valued and clinically desirable technique for managing traumatic ICH patients.

Proceedings of the 2013 Autumn meeting of the Society of British Neurological Surgeons

Proceedings of the 2013 Autumn meeting of the Society of British Neurological Surgeons

Proceedings of the 2013 Spring meeting of the Society of British Neurological Surgeons

Proceedings of the 2013 Spring meeting of the Society of British Neurological Surgeons