Neurosurgery Center Research Articles

Autologous fibrin glue for endoscopic skull base repair in patients with cerebrospinal fluid leakage

To analyze efficacy and safety of Vivostat autologous fibrin glue for endoscopic skull base repair in patients with nasal CSF leakage and to compare postoperative outcomes after defect closure by Vivostat fibrin glue and allogeneic fibrin glue. A retro- and prospective analysis included 56 patients with nasal CSF leakage who were treated at the Burdenko Neurosurgery Center between January 2021 and June 2022. Patients were divided into 2 groups: Vivostat fibrin glue (n=27, 48.2%) and allogeneic fibrin glue (n=29, 51.8%). Demographic and clinical perioperative data were analyzed. No early postoperative recurrence of CSF leakage was registered in both groups, whereas meningitis occurred in 2 cases in each group. Recurrent CSF leakage in delayed postoperative period occurred in 1 patient (3.4%) of the control group (p>0.05). Incidence of perioperative complications, subfebrile temperature in early postoperative period, surgery time and hospital-stay were similar. Vivostat autologous fibrin glue is a safe and effective method for fixing the grafts in endoscopic skull base repair. The advantages of this approach are easy application, elimination of the risk of allergic, immunological and infectious complications, as well as acceleration of tissue regeneration.

Laser fluorescence spectroscopy in surgical treatment of intramedullary tumors: experience of the Burdenko Neurosurgery Center

To analyze efficacy of fluorescence navigation technique and laser fluorescence spectroscopy in surgical treatment of various spinal cord tumors. There were more than 1000 patients with intramedullary spinal cord tumors between 2001 and 2022. Intraoperative fluorescence navigation with laser spectroscopy was used in 47 cases. All patients underwent examination before and after surgery. We analyzed somatic, neurological and functional status (McCormick scale). MRI of the spinal cord and intraoperative fluorescence spectroscopy (OPMI Pentero 900 microscope with a fluorescent module, Carl Zeiss, Germany) were performed. To induce visible fluorescence, we used 5-ALA-Alasens (NIOPIK, Russia). Laser spectroscopy was carried out on a LESA-01-BIOSPEC analyzer (Biospec JSC, Russia). Morphological analysis of intramedullary spinal cord tumors was carried out in the laboratory of neuromorphology of the Burdenko Neurosurgery Center. In our sample, fluorescence navigation and laser fluorescence spectroscopy were used only in surgical treatment of intramedullary tumors. Laser fluorescence spectroscopy was valuable to identify fragments of intramedullary ependymoma and astrocytoma in 86% of cases, visual fluorescence - only in 81% of cases. Advisability of this technique for low-grade astrocytomas is unclear and requires further study. Visual fluorescence combined with laser spectroscopy is a promising method for intraoperative imaging of tumor remnants. This approach can improve safety, quality and results of surgical treatment.

Construction of a predictive model based on MIV-SVR for prognosis and length of stay in patients with traumatic brain injury: Retrospective cohort study.

To investigate the mean impact value (MIV) method for discerning the most efficacious input variables for the machine learning (ML) model. Subsequently, various ML algorithms are harnessed to formulate a more accurate predictive model that can forecast both the prognosis and the length of hospital stay for patients suffering from traumatic brain injury (TBI). Retrospective cohort study. The study retrospectively accrued data from 1128 cases of patients who sought medical intervention at the Neurosurgery Center of the Second Affiliated Hospital of Anhui Medical University, within the timeframe spanning from May 2017 to May 2022. We performed a retrospective analysis of patient data obtained from the Neurosurgery Center of the Second Hospital of Anhui Medical University, covering the period from May 2017 to May 2022. Following meticulous data filtration and partitioning, 70% of the data were allocated for model training, while the remaining 30% served for model evaluation. During the construction phase of the ML models, a gamut of 11 independent variables-including, but not limited to, in-hospital complications and patient age-were utilized as input variables. Conversely, the length of stay (LOS) and the Glasgow Outcome Scale (GOS) scores were designated as output variables. The model architecture was initially refined through the MIV methodology to identify optimal input variables, whereupon five distinct predictive models were constructed, encompassing support vector regression (SVR), convolutional neural networks (CNN), backpropagation (BP) neural networks, artificial neural networks (ANN) and logistic regression (LR). Ultimately, SVR emerged as the most proficient predictive model and was further authenticated through an external dataset obtained from the First Hospital of Anhui Medical University. Upon incorporating the optimal input variables as ascertained through MIV, it was observed that the SVR model exhibited remarkable predictive prowess. Specifically, the Mean Absolute Percentage Error (MAPE) of the SVR model in predicting the GOS score in the test dataset is only 6.30%, and the MAPE in the external validation set is only 7.61%. In terms of predicting hospitalization time, the accuracy of the test and external validation sets were 9.28% and 7.91%, respectively. This error indicator is significantly lower than the error of other prediction models, thus proving the excellent efficacy and clinical reliability of the MIV-optimized SVR model. This study unequivocally substantiates that the incorporation of MIV for selecting optimal input variables can substantially augment the predictive accuracy of machine learning models. Among the models examined, the MIV-SVR model emerged as the most accurate and clinically applicable, thereby rendering it highly conducive for future clinical decision-making processes.

Evaluation of the Results of Differentiated Treatment of Traumatic Intracranial Hematomas in the Early Period of Traumatic Brain Injury

The purpose of this study was to study the results of the treatment of traumatic intracranial hematomas after the application of algorithms for complex diagnostics and differentiated tactics for the treatment of various types of traumatic hematomas. From 2014 to 2019, 635 patients with traumatic intracranial hematomas were examined and treated at the Republican Specialized Scientific and Practical Medical Center of Neurosurgery. In a hospital, questions of indications for surgical or conservative treatment required a unique approach based on the principles of urgency, complexity, and interconnection at all stages of treatment. The outcomes of treatment of traumatic intracranial hematomas, both surgical and conservative treatment, differ significantly not only in different periods and phases of the course of traumatic brain injury but also in the age, type of hematoma, its localization and prevalence. Application of algorithms of complex diagnostics and differentiated treatment.

Out-Patient Neurosurgery Telemedicine Clinics: A Model to Provide Healthcare And Prevent Cross-Infection

Objectives: To determine patient’s and health worker’s views of telemedicine on prevention of cross infection and delivery of health care in our centre. Methods: A prospective cross-sectional study conducted at our neurosurgery centre. Sample size was calculated, questionnaire designed and administered to consecutive patients or healthcare workers. Data was analysed using SPSS, IBM version 20.0. Results: We found 161 patients. 79.5% were males with a male to female ratio of 3.8:1. The mean age of the patients was 32±12 years. Majority of patients, 68.9% (111/161) lack awareness of virtual consultation. Most patients, 76.4% (123/161) showed interest in having virtual consultation to prevent COVID-19 infection. Most patients opined that, virtual consultation can be done in any day and at any time. There is statistically significant association between age (11-30year), male gender and short distance to the hospital (1-200KM), to interest in virtual consultation (p< 0.05). Patients living close to hospital have five times likelihood of accepting virtual consultation than those coming from far distance (odds ratio-5.7, CI-1.5-21.23, p-0.002). 84.6% of the health workers have prior knowledge of virtual consultation as a means of preventing COVID-19 infection. All age group, gender and non-emergency cases should be offered virtual consultation as suggested by the 100% of health workers. Conclusion: This single centre study shows paucity of knowledge of virtual consultation in our patients, though interested. In contrast, most health workers know about virtual consultation as a way of preventing COVID-19 infection, as such, virtual consultation should be introduced in our practice.

Radicality of lateral ventricular neoplasms removal and risk factors of postoperative hemorrhagic complications

Introduction. Lateral ventricular neoplasms (tumors, vascular neoplasms, cysts) are rare and according to different sources comprise between 0.64 and 3.5 % of all brain tumors. Due to relatively slow growth, tumors can reach significant size before patient develops neurological symptoms. Surgery is the main method of treatment of lateral ventricular neoplasms, and in many cases radical removal can be achieved. The main complications after surgery are hydrocephalus and hemorrhages. The later frequently lead to escalation of neurological symptoms and sometimes require repeat surgical intervention. The success of intraventricular surgery consists of reasonable radicality and absence of complications.Aims. To evaluate the radicality and safety of lateral ventricular tumor removal through traditional approaches–transcallosal and transcortical – using arterial spin labeling (ASL perfusion) and to analyze the risk of hemorrhagic complications in the early postoperative period in the context of tumor location and blood supply.Materials and methods. At the N.N. Burdenko National Medical Research Center of Neurosurgery between 2017 and 2019 48 patients with space‑occupying lesions of the lateral ventricles were examined and treated with surgery. All patients were examined using the same MRI protocol before and after surgery: Т1‑weighted, Т1‑weighed contrast‑enhanced, 3D SPGR, Т2‑weighted, Т2‑FLAIR, DWI, T2‑FLAIR CUBE, SWAN, ASL perfusion. In 28 (58 %) cases, transcortical approach was used (through the frontal lobe in 24 cases, through the upper temporal lobe in 2 cases, through the parietal lobe in 2 cases); transcallosal approach was used in 16 (33 %) cases; combination approach (for advanced tumors of the lateral ventricles) was used in 3 (6 %) cases; supracerebellar infratentorial approach was used in 1 (2 %) case. Radicality of lateral ventricular tumor removal and risk factors for postoperative hemorrhagic complications using different approaches were evaluated based on the following parameters: tumor volume and location, sex, blood flow characteristics, presence of hydrocephalus.Results. In the compared groups I and II, similar rates of radical tumor removal were observed: 63 % for transcortical approach and 71 % for transcallosal approach. Hematomas in the tumor bed were more frequently observed in patients operated through transcortical approach (64 % vs. 31 % in transcallosal) without statistical significance. Generally, there were no statistically significant differences between surgical treatment results in groups I and II (p >0.05); this conclusion was confirmed in pseudo‑randomized patient subgroups selected through propensity score matching. Analysis of the association between hematoma in the postoperative period and baseline blood flow level showed that in the group with such hematomas mean tumor blood flow prior to surgery was almost twice as high as in the group without hemorrhagic complications after resection (80.6 vs. 49.4 ml/100 g/min, respectively).The following postoperative parameters are statistically significant for development of hematoma in the tumor bed: presence of hydrocephalus, Evans index in the early postoperative period.Conclusions. Correct and adequate choice of surgical approach considering anatomical location and advancement of the tumor, presence of hydrocephalus and surgeon’s preferences ensures high radicality of removal. Factors affecting the risk of hemorrhagic complications in the early postoperative period should be taken into account: sex, presence of hydrocephalus, neoplasm location and blood flow level.

Surgical treatment of adenoid cystic carcinomas of sinonasal localization

Background. Tumors of the sinonasal region represent a large group of both benign and malignant formations affecting the nasal cavity, paranasal sinuses, structures of the anterior and middle cranial pits of the base of the skull.Aim. Evaluation of the results of surgical treatment of patients with adenoid cystic carcinomas of sinonasal localization treated in the period from 2007 to 2021.Material and methods. The present study is a retrospective analysis of the results of surgical treatment of patients with adenoid cystic cancer of the base of the skull operated at the N.N. Burdenko National Medical Research Center of Neurosurgery in the period from 2007 to 2021.Results. The radicality of tumor removal was assessed based on an MRI analysis performed no earlier than 3 months after surgery. Total (95–100 %) tumor removal was achieved in 8 (25 %), subtotal (80–95 %) in 15 (46.9 %), partial (50–80 %) in 5 (15.6 %) patients; extended biopsy was performed in 4 (12.5 %) cases. At the same time, total and subtotal removal was more often achieved with open surgery, which was due to the topographic and anatomical features of the location of tumors.Discussion. In this paper, we present an analysis of the results of treatment of 32 patients with adenocystic cancer of sinonasal localization.The main method of treatment is an integrated approach – radical surgical resection of the tumor together with adjuvant radiation therapy. Surgical treatment is aimed at the maximum possible resection of pathological tissues to prevent recurrence of the disease.One of the most common approaches is transfacial with or without bifrontal craniotomy, which includes craniofacial resection.Conclusion. Adenoid cystic carcinoma is an aggressive malignant tumor that requires a comprehensive approach to treatment. Important factors that positively affect the results of treatment are the conduct of chemoradiation treatment and the age of patients, as well as the initial stage of the disease at which treatment was initiated, which necessitates strengthening dispensary monitoring and raising awareness of the population about the possibility of developing such diseases for timely access to a doctor.

Volumetric Growth and Growth Curve Analysis of Residual Intracranial Meningioma.

After meningioma surgery, approximately 1 in 3 patients will have residual tumor that requires ongoing imaging surveillance. The precise volumetric growth rates of these tumors are unknown. To identify the volumetric growth rates of residual meningioma, growth trajectory, and factors associated with progression. Patients with residual meningioma identified at a tertiary neurosurgery center between 2004 and 2020 were retrospectively reviewed. Tumor volume was measured using manual segmentation, after surgery and at every follow-up MRI scan. Growth rates were ascertained using a linear mixed-effects model and nonlinear regression analysis of growth trajectories. Progression was defined according to the Response Assessment in Neuro-Oncology (RANO) criteria (40% volume increase). There were 236 patients with residual meningioma. One hundred and thirty-two patients (56.0%) progressed according to the RANO criteria, with 86 patients being conservatively managed (65.2%) after progression. Thirteen patients (5.5%) developed clinical progression. Over a median follow-up of 5.3 years (interquartile range, 3.5-8.6 years), the absolute growth rate was 0.11 cm 3 per year and the relative growth rate 4.3% per year. Factors associated with residual meningioma progression in multivariable Cox regression analysis were skull base location (hazard ratio [HR] 1.60, 95% CI 1.02-2.50) and increasing Ki-67 index (HR 3.43, 95% CI 1.19-9.90). Most meningioma exhibited exponential and logistic growth patterns (median R 2 value 0.84, 95% CI 0.60-0.90). Absolute and relative growth rates of residual meningioma are low, but most meet the RANO criteria for progression. Location and Ki-67 index can be used to stratify adjuvant treatment and surveillance paradigms.

Commentary: Exploring the Pathogenesis of Atlanto-Occipital Instability in Chiari Malformation With Type II Basilar Invagination: A Systematic Morphological Study.

*Department of Neurosurgery, Lilavati Hospital and Research Center, Bandra, Mumbai, India; ‡Department of Neurosurgery, R.N Cooper Hospital and Medical College, Mumbai, India; §Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, India Correspondence: Atul Goel, MCh, Department of Neurosurgery, Lilavati Hospital and Research Center, Bandra, Mumbai400050, India. Email: [email protected]

Prevalence of dysphagia following posterior fossa tumour resection in children: the Alder Hey experience.

Surgery for posterior fossa tumours (PFTs) in children is associated with bulbar palsy and swallowing difficulties although this risk is not well defined in the literature and issues contributing to dysphagia following surgery are not fully understood. This study aims to study the eating, drinking and swallowing function of children following PFT resection in a specialist paediatric neurosurgery centre. This included the frequency and duration of dysphagia, the risk of aspiration and the link between tumour type and dysphagia. This is a retrospective review of children undergoing surgery for PFT between 2014 and 2019. Information was obtained from the patients' hospital and speech and language therapy (SLT) notes, oncology database and clinical letters. The International Dysphagia Diet Standardisation Initiative (IDDSI) Framework was used to describe food and fluid modifications. Seventy children had surgery to resect a posterior fossa tumour at Alder Hey from 2014 to 2019. Thirty-one children were included in the study following referral to SLT. Videofluoroscopy (VF) was undertaken at our institution in 68% (21/31) of cases. Fifty-two percent (11/21) of children aspirated or were considered at risk, and 55% (6/11) of those who aspirated showed silent aspiration. After 3months, 43% (13/30) still required modified food and/or fluid textures, with this proportion reducing as time progressed. By tumour type, VF was performed in 5/7 medulloblastoma patients with 3/5 showing aspiration and 3/3 silently aspirating; in 8/9 patients with ependymoma with 4/8 patients aspirating with 2/4 showing silent aspiration; and 6/12 glioma patients with 4/6 aspirating with 1/4 showing silent aspiration. Swallowing difficulties, including silent aspiration, are an important complication of PFT resection. A proportion of children will need ongoing food and/or fluid modification. Further study into dysphagia following PFT resection is indicated.

A Machine Learning-Based Approach to Predict Prognosis and Length of Hospital Stay in Adults and Children With Traumatic Brain Injury: Retrospective Cohort Study

The treatment and care of adults and children with traumatic brain injury (TBI) constitute an intractable global health problem. Predicting the prognosis and length of hospital stay of patients with TBI may improve therapeutic effects and significantly reduce societal health care burden. Applying novel machine learning methods to the field of TBI may be valuable for determining the prognosis and cost-effectiveness of clinical treatment. We aimed to combine multiple machine learning approaches to build hybrid models for predicting the prognosis and length of hospital stay for adults and children with TBI. We collected relevant clinical information from patients treated at the Neurosurgery Center of the Second Affiliated Hospital of Anhui Medical University between May 2017 and May 2022, of which 80% was used for training the model and 20% for testing via screening and data splitting. We trained and tested the machine learning models using 5 cross-validations to avoid overfitting. In the machine learning models, 11 types of independent variables were used as input variables and Glasgow Outcome Scale score, used to evaluate patients' prognosis, and patient length of stay were used as output variables. Once the models were trained, we obtained and compared the errors of each machine learning model from 5 rounds of cross-validation to select the best predictive model. The model was then externally tested using clinical data of patients treated at the First Affiliated Hospital of Anhui Medical University from June 2021 to February 2022. The final convolutional neural network-support vector machine (CNN-SVM) model predicted Glasgow Outcome Scale score with an accuracy of 93% and 93.69% in the test and external validation sets, respectively, and an area under the curve of 94.68% and 94.32% in the test and external validation sets, respectively. The mean absolute percentage error of the final built convolutional neural network-support vector regression (CNN-SVR) model predicting inpatient time in the test set and external validation set was 10.72% and 10.44%, respectively. The coefficient of determination (R2) was 0.93 and 0.92 in the test set and external validation set, respectively. Compared with back-propagation neural network, CNN, and SVM models built separately, our hybrid model was identified to be optimal and had high confidence. This study demonstrates the clinical utility of 2 hybrid models built by combining multiple machine learning approaches to accurately predict the prognosis and length of stay in hospital for adults and children with TBI. Application of these models may reduce the burden on physicians when assessing TBI and assist clinicians in the medical decision-making process.

Letter: Global Neurosurgery: The Pakistani Perspective.

Letter: Global Neurosurgery: The Pakistani Perspective.

Ventriculo-Peritoneal Shunt Infection: Three Years Experience in Combined Military Hospital, Dhaka

Introduction: Treatment of Hydrocephalus by placement of Ventriculo-peritoneal (V-P) Shunt is a common neurosurgical practice. But presence of shunt predisposes to increased infection. Objective: To focus on aetiological factors for developing shunt infection. Methods: This prospective observational study was carried out at Neurosurgery Center, Combined Military Hospital, Dhaka during the period of June 2015 to May 2018. A total of 33 patients were included in the study, all of them underwent CSF shunt surgery at this centre. They were followed up for one month after surgery. Age, sex and socioeconomic condition of the patients, types (obstructive or communicating) of hydrocephalus (HCP), aetiology of HCP, duration of surgery, shunt type used and routine or emergency surgery were the factors that were analysed for possible association with infection. Results: Eight (24.2%) patients developed shunt infection, among whom infants and male were predominate. Low socio-economic group, prolonged operation time and emergency surgery were found to have association with increased rate of infection. Conclusion: V-P shunt insertions had unacceptably high infection rate despite the presence of a protocol for the procedure. A protocol should be developed for strict compliance and where possible, alternative procedure Endoscopic Third Ventricullostomy (ETV) or External Ventricular Drain (EVD) should be employed to minimize shunt infection. JAFMC Bangladesh. Vol 18, No 1 (June) 2022: 16-18

PO042 / #960 CASE REPORT OF 21 Y/O. PATIENT WITH 9 YEARS OF DBS IN DYSTONIA HISTORY AND SOCIOECONOMIC OUTCOME: E-POSTER VIEWING

Subject was diagnosed General dystonia, and undergone GPi DBS surgery in Tyumen Federal Center of Neurosurgery, Russia. Examined through 9 (2013-2021) years after surgery. The long follow-up period and geographic difference between his city Krasnodar and Tyumen (2835) km. made it impractical to perform consistent in-person evaluations every 3 month as we planned. Social media allowed doctors to contact patient and to achieve a high responder rate.

Commentary: Endoscope-Assisted Microsurgical Resection of a Large Petroclival Meningioma Using a Retrosigmoid Approach: 2-Dimensional Operative Video.

*Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; ‡National Center for Neurological Disorders; §Shanghai Key laboratory of Brain Function and Restoration and Neural Regeneration; ‖Neurosugical Institute of Fudan University, Shanghai, China; ¶Shanghai Clinical Medical Center of Neurosurgery, Shanghai, China Correspondence: Feng Xu, MD, Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, No. 12 Wulumuqi Middle Rd, Shanghai, China. Email: [email protected]

Endoscopic transnasal surgery in optic pathway gliomas located in the chiasma-hypothalamic region: case series of ten patients in a single-center experience and endoscopic literature review.

Optic pathway gliomas (OPGs) constitute approximately 3-5% of childhood intracranial tumors. In this study, the authors presented their experience of using the endoscopic endonasal approach to treat patients with OPG located in the chiasma-hypothalamic region and aimed to use the infrachiasmatic corridor in the endoscopic endonasal approach as an alternative to the transcranial approach in the surgical necessity of OPGs. We retrospectively analyzed the data of ten patients diagnosed with OPG histopathologically among 3757 cases who underwent endoscopic endonasal surgery between August 1997 and March 2021 at Kocaeli University Faculty of Medicine Pituitary Research Center and Department of Neurosurgery. Mean follow-up period 48.5months. During the postoperative follow-up period, 3 of these 10 patients underwent reoperation due to tumor recurrence. Combined (endoscopic endonasal approach + transcranial approach) approach was applied to 2 patients in the same session. Surgical and clinical outcomes were evaluated in detail. Ten patients with a mean patient age of 20.6 ± 11.4 were included in this study. The most common complaint was visual impairment. After surgery, improvement in visual impairment was observed in five patients. No increase in postoperative visual impairment was observed in any of the patients. Postoperative panhypopituitarism was not observed in any of the patients. STR resection was performed in 5 patients and NTR resection in 5 patients. No additional treatment was required during follow-up in 4 of 5 patients who underwent NTR. A total of 6 patients received postoperative radiotherapy treatment. In gliomas located in the chiasma-hypothalamic region, appropriate patient selection and endoscopic endonasal surgical treatment may contribute to the elimination of symptoms due to the mass effect of the tumor. It may also contribute to keeping the disease under control with targeted adjuvant therapies by clarifying the pathological diagnosis of the lesion.

Deep brain stimulation for Parkinson's disease in practice: results of the survey by the Italian Neurosurgery Society.

Deep brain stimulation (DBS) is a safe and effective treatment for patients with advanced Parkinson's disease (PD) and many neurosurgical centers in Italy have a DBS program. Considering the prevalence of PD and criteria for DBS implantation, about 3200-10,350 PD patients may benefit from DBS in Italy. The global management of patients underwent DBS is complex and it can be supposed that many differences exist between centers in clinical practice. The Italian Neurosurgery Society (SINch) designed this survey to investigate the state of the art of DBS for PD in Italy. A 26-item closed-ended question survey was designed and sanded by email at all Italian Neurosurgery centers. The main topic investigated was DBS teams, anatomical target selection, surgical procedure, neuroimaging, intraoperative target localization, DBS device and patients' follow-up. A total of 23 neurosurgery centers completed the survey. There are mainly low-to medium-volume centers (<20 annual DBS procedures) with dedicated DBS teams. The principal anatomical target used is subthalamic nucleus (STN) and, relative to the surgical technique, it emerges that in Italy DBS are bilaterally implanted in a single-step session with awake anesthesia and with frame-based technique. Final leads positioning is defined by microelectrode recordings (MER) and microstimulation (MS), with limited role of intraoperative neuroimaging (MRI and O-Arm). The stimulation is started at 15 or 30 days from procedure. Many centers of neurosurgery in Italy have a well-established DBS program for patients with advanced PD and some practical differences in technique between centers exist. Further investigation is needed to investigate specific criteria for selecting one technique over another.

Abusive Head Trauma in Infants During the COVID-19 Pandemic in the Paris Metropolitan Area

The COVID-19 pandemic and the containment and mitigation measures taken were feared to be associated with increased child abuse. To investigate the trend of abusive head trauma (AHT) incidence and severity in infants during the COVID-19 pandemic. In a time-series analysis of a longitudinal, population-based, cohort study, all consecutive cases of AHT in infants younger than 12 months old referred between January 2017 and December 2021 to Necker Hospital for Sick Children, the single regional pediatric neurosurgery center for the Paris metropolitan area, were included. AHT was defined as 1 or more subdural hemorrhage and a positive multidisciplinary evaluation after a social, clinical, biological, and radiological workup. Data were analyzed from January to March 2022. The primary outcome was the monthly incidence of AHT, which was analyzed using Poisson regression modeling. Secondary outcomes included mortality and severe morbidity and were studied with logistic and linear regressions. The monthly incidence of neurosurgical interventions for hydrocephalus was used as a control series. Among the 99 included infants with AHT (median [IQR] age, 4 [3-6] months; 64 boys [65%]), 86 of 99 (87%) had bridging vein thrombosis, 74 of 99 (75%) had retinal hemorrhages, 23 of 72 (32%) had fractures, 26 of 99 (26%) had status epilepticus, 20 of 99 (20%) had skin injuries, 53 of 99 (54%) underwent neurosurgical interventions, and 13 of 99 (13%) died. Compared with the prepandemic period (2017-2019), AHT incidence was stable in 2020 (adjusted incidence rate ratio, 1.02; 95% CI, 0.59-1.77) and then significantly increased in 2021 (adjusted incidence rate ratio, 1.92; 95% CI, 1.23-2.99). The severity of AHT worsened in 2021 in terms of mortality (odds ratio 9.39; 95% CI, 1.88-47.00). Other secondary outcomes and the control series were not significantly modified. In this cohort study, a marked increase in AHT incidence and severity occurred during the COVID-19 pandemic in the Paris metropolitan area. These results suggest the need for clinical awareness and preventive actions.

558 An Evaluation of Surgical Input and Management of Head Injury in a New Acute Hospital in South Wales: Does It Need to Be a Headache?

Abstract Aim The Grange University Hospital is a new major acute hospital in South Wales. Similarly, to other hospitals without neurosurgery, patients presenting to A&amp;E with head injury (HI) that do not require transfer to a neurosurgery centre are admitted under general surgery. This audit aimed to: Method Patients admitted via A&amp;E with the diagnosis code “Head Injury” (N=119) identified between November 28th-April 28th, 2021 (6 months). Paediatric (Aged 0–18) patients (N=25) were excluded as identified admitting team as per protocol is paediatrics. Relevant data extracted using Clinical Workstation. Results N =94 patients. Of these, 12 were discussed with neurosurgery and 1 patient transferred to a tertiary centre. 44% were referred to a surgical speciality other than general surgery for assessment. Despite this, of those 41, 61% (25) were admitted under general surgery (Average length of stay 2.5 days). Only 8 admitted patients necessitated plans beyond neuro observations. 28% of patients admitted under general surgery required medical assessment (4 falls assessments, 3 COTE referrals and subsequent takeovers). 0 patients had any general surgical pathology. Conclusions

Analysis of the management of ventriculitis cases at a UK neurosurgery centre

SummaryBackgroundVentriculitis is an infection of the ventricular system of the central nervous system associated with neurosurgery and/or indwelling medical devices mainly caused by coagulase-negative staphylococci and increasingly by Gram-negative bacilli and other Gram-positive bacteria. The Infectious Diseases Society of America (IDSA) and the neurosurgery department University Hospital Coventry and Warwickshire (UHCW) have treatment guidelines for ventriculitis which recommend antimicrobials and device removal.MethodsData on ventriculitis cases, their management and outcomes were collected from electronic laboratory and hospital records as well as patients' paper records from 2009 to 2019. Cases included patients with CSF shunts or external ventricular drainage. The management of the cases was then compared to both Infectious Diseases Society of America (IDSA) and UHCW guidelines. The data collected included the causative organisms and the use of inappropriate antimicrobials. The cost of inappropriate antimicrobials was calculated.Results99 patients with microbiologically confirmed ventriculitis were identified. Some cases had multiple devices and the total number of devices was 105.98% of cases had medical device removal as part of their care. Only 50% and 56% of cases had antimicrobial treatment which was compliant with local (UHCW) and IDSA guidelines, respectively. The most frequently inappropriate antimicrobials used were meropenem and linezolid, at an estimated cost of £201,172 over 10 years. The most frequently isolated organisms were coagulase negative staphylococci. Mortality rate was estimated at 14% of cases.ConclusionsWe report the first analysis of the management of ventriculitis cases at UHCW over a 10-year period and demonstrate the importance of antimicrobial stewardship. We also report the local epidemiology of causes of ventriculitis at UHCW which will guide the empirical treatment of ventriculitis at UHCW.