Neurosurgical Implants Research Articles

Treatment of wound infections linked to neurosurgical implants.

As neurosurgery has advanced technologically, more and more neurosurgical implants are being employed on an aging patient population with several comorbidities. As a result, there is a steady increase in the frequency of infections linked to neurosurgical implants, which causes serious morbidity and mortality as well as abnormalities of the skull and inadequate brain protection. We discuss infections linked to internal and external ventricular and lumbar cerebrospinal fluid drainages, neurostimulators, craniotomies, and cranioplasty in this article. Biofilms, which are challenging to remove, are involved in all implant-associated illnesses. It takes a small quantity of microorganisms to create a biofilm on the implant surface. Skin flora bacteria are implicated in the majority of illnesses. Microorganisms that cause disruptions in wound healing make their way to the implant either during or right after surgery. In about two thirds of patients, implant-associated infections manifest early (within the first month after surgery), whereas the remaining infections present later as a result of low-grade infections or by direct extension from adjacent infections (per continuitatem) to the implants due to soft tissue damage. Except for ventriculo-atrial cerebrospinal fluid shunts, neurosurgical implants are rarely infected by the haematogenous route. This research examines established and clinically validated principles that are applicable to a range of surgical specialties using implants to treat biofilm-associated infections in orthopaedic and trauma cases. Nevertheless, there is little evidence and no evaluation in sizable patient populations to support the success of this extrapolation to neurosurgical patients. An optimal microbiological diagnostic, which includes sonicating removed implants and extending culture incubation times, is necessary for a positive result. Additionally, a strategy combining surgical and antibiotic therapy is needed. Surgical procedures involve a suitable debridement along with implant replacement or exchange, contingent on the biofilm's age and the state of the soft tissue. A protracted biofilm-active therapy is a component of antimicrobial treatment, usually lasting 4-12 weeks. This idea is appealing because it allows implants to be changed or kept in place for a single surgical procedure in a subset of patients. This not only enhances quality of life but also lowers morbidity because each additional neurosurgical procedure increases the risk of secondary complications like intracerebral bleeding or ischemia.

Approaches to ventriculoperitoneal shunt scalp erosion: countersinking into the calvarium. Illustrative case.

Ventriculoperitoneal shunting (VPS) is a standard procedure for the treatment of hydrocephalus, and the management of its complications is common in the practice of pediatric neurosurgery. Shunt exposure, though a rare complication, can occur because of thin, fragile skin, a young patient age, protuberant hardware, poor scalp perfusion, and a multitude of other patient factors. The authors report a complex case of VPS erosion through the scalp in a young female with Pfeiffer syndrome treated with external ventricular drainage, empirical antibiotics, and reinternalization with countersinking of replaced shunt hardware into the calvarium to prevent internal skin pressure points, reduce wound tension, and allow wound healing. Recessing the shunt hardware, or countersinking the implant, into the calvarium is a simple technique often used in functional neurosurgical implantation surgeries, providing a safe surgical strategy to optimize wound healing in select cases in which the skin flap is unfavorable.

Neurosurgical Implant Safety in 7T MRI: A Scoping Review.

The use of 7Tesla (T) magnetic resonance imaging (MRI) is expanding across neurosurgical and neurologic specialties. However, few neurosurgical-related implants have been tested for safety at 7T, limiting its use in patients with cranial fixation, shunt placements, and other implants. Implant safety can be determined via the American Society for Testing Materials International (ASTM) guidelines. To assess the current state of neurosurgical implant safety at 7T, a systematic search was performed using PubMed, MEDLINE, Web of Knowledge, and citation matching. Studies written in English that included at least one neurosurgical implant and at least one safety outcome were included. Data were extracted for implant studied, implant composition, deflection angle, torque, temperature change, and ASTM guidelines followed. PRISMA reporting guidelines for scoping reviews were followed. Overall, 18 studies consisting of 45 unique implants were included. Implants included cranial fixation devices, aneurysm clips, spinal rods, pedicle screws, ventriculoperitoneal (VP) shunts, deep brain stimulation devices, and electroencephalogram (EEG) caps and electrodes. Cranial fixation devices, deep brain stimulation devices, spinal rods, and pedicle screws are likely 7T MRI compatible based on outcomes reported. Aneurysm clips and EEG devices had variable safety outcomes. The VP shunts studied lost functionality after 7T MRI exposure. We identified several implants that are likely compatible with 7T MRI. Given the growth in 7T imaging and expansion of the technology, neurosurgical implants should be constructed with the aforementioned considerations. Caution must be taken with all implants, especially aneurysm clips, programmable VP shunts, and EEG recording devices. It is also noteworthy that several implant testing reports did not report following ASTM standards. This scoping review seeks to concisely summarize all neurosurgical-related implants that have been tested for safety in 7T MRI. EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 2.

Neurosurgical Team Acceptability of Brain–Computer Interfaces: A Two-Stage International Cross-Sectional Survey

Invasive brain-computer interfaces (BCIs) require neurosurgical implantation, which confers a range of risks. Despite this situation, no studies have assessed the acceptability of invasive BCIs among the neurosurgical team. This study aims to establish baseline knowledge of BCIs within the neurosurgical team and identify attitudes toward different applications of invasive BCI. A 2-stage cross-sectional international survey of the neurosurgical team (neurosurgeons, anesthetists, and operating room nurses) was conducted. Results from the first, qualitative, survey were used to guide the second-stage quantitative survey, which assessed acceptability of invasive BCI applications. Five-part Likert scales were used to collect quantitative data. Surveys were distributed internationally via social media and collaborators. A total of 108 qualitative responses were collected. Themes included the promise of BCIs positively affecting disease targets, concerns regarding stability, and an overall positive emotional reaction to BCI technology. The quantitative survey generated 538 responses from 32 countries. Baseline knowledge of BCI technology was poor, with 9% claiming to have a good or expert knowledge of BCIs. Acceptability of invasive BCI for rehabilitative purposes was >80%. Invasive BCI for augmentation in healthy populations divided opinion. The neurosurgical team's view of the acceptability of invasive BCI was divided across a range of indications. Some applications (e.g., stroke rehabilitation) were viewed as more appropriate than other applications (e.g., augmentation for military use). This range in views highlights the need for stakeholder consultation on acceptable use cases along with regulation and guidance to govern initial BCI implantations if patients are to realize the potential benefits.

A 1.66Gb/s and 5.8pJ/b Transcutaneous IR-UWB Telemetry System with Hybrid Impulse Modulation for Intracortical Brain-Computer Interfaces.

Intra-cortical extracellular neural sensing is being rapidly and widely applied in several clinical research and brain-computer interfaces (BCIs), as the number of sensing channels continues to double every 6 years. By distributing multiple high-density extracellular micro-electrode arrays (MEAs) in vivo across the brain, each with 1000's of sensing channels, neuroscientists have begun to map the correlation of neuronal activity across different brain regions, with single-neuron precision [1]. Since each neural sensing channel typically samples at 20 to 50kS/s with a > 10b ADC, multiple MEAs demand a data transfer rate up to Gb/s [2]. However, these BCIs are severely hindered in many clinical uses due to the lack of a high-data-rate and miniature-wireless-telemetry solution that can be implanted below the scalp, i.e., transcutaneously (Fig. 24.2.1). The area of the wireless telemetry module should be miniaturized to ~3cm <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sup> due to neurosurgical implantation constraints. A transmission range up to 10cm is highly desirable, in order to improve the reliability of the wireless link against e.g., antenna misalignment, etc. Finally, the power consumption of the wireless telemetry should be limited to ~10mW to minimize thermal flux from the module's surface area, avoiding excessive tissue heating. Most of the conventional transcutaneous wireless telemetry systems adopt inductive coupling, but the data-rate is limited to a few Mb/s. A near-infrared (NIR) optical transcutaneous TX using a vertical-cavity-surface-emitting laser (VCSEL) [2] demonstrated a data-rate up to 300Mb/s but suffers from a limited transmission range (4mm) and requires a sub-mm precise alignment between the implant TX and a wearable RX. Impulse-radio UWB (IR-UWB) is promising for the targeted requirements [3]–[5].

Environmental, Microbiological, and Immunological Features of Bacterial Biofilms Associated with Implanted Medical Devices.

The spread of biofilms on medical implants represents one of the principal triggers of persistent and chronic infections in clinical settings, and it has been the subject of many studies in the past few years, with most of them focused on prosthetic joint infections. We review here recent works on biofilm formation and microbial colonization on a large variety of indwelling devices, ranging from heart valves and pacemakers to urological and breast implants and from biliary stents and endoscopic tubes to contact lenses and neurosurgical implants. We focus on bacterial abundance and distribution across different devices and body sites and on the role of environmental features, such as the presence of fluid flow and properties of the implant surface, as well as on the interplay between bacterial colonization and the response of the human immune system.

Lead Migration in Neuromodulation

We describe a simple technique of securing surgically implanted leads for spinal cord (SCS), dorsal root ganglion (DRG) and occipital nerve stimulation (ONS), for both primary surgical implantation and correcting lead migration. This technique could also be adapted for securing percutaneously implanted leads. Thirty-nine patients underwent neurosurgical implantation of SCS, DRG, and ONS devices utilizing titanium mini-plates to obtain secure anchorage of leads to adjacent laminae close to their exit point from the epidural space, thereby minimizing the risk of further lead migration or electrode displacement. There were no cases of primary or recurrent lead migration in any patient undergoing lead placement using mini-plate anchorage. The technique appears to offer a reliable means of preventing post-operative lead migration in a variety of spinal and extra-cranial neuromodulation implants.

Dissection using pulsed radiofrequency energy device (PlasmaBlade) is safe and efficient in experimental revision neuromodulation implant surgery

Background The use of functional neurosurgical implants has increased over the past 10 years. PlasmaBlade is an innovative electrosurgical appliance harnessing pulsed radiofrequency (RF) energy. Our aim was to assess the risk of damage to neuromodulation hardware during PlasmaBlade dissection. Materials and methods A simulated setting with chicken breast threaded with different hardware and PlasmaBlade used in three configurations. . Post dissection, the wires were inspected naked eye and under an operating microscope. The induced current was assessed contemporaneously using an oscilloscope. Results Five surgeons tested the PlasmaBlade at different generator settings. Sixty dissections were undertaken. No structural damage or induced current was identified at CUT 3/4, COAG 5. At CUT 6, COAG 5 and during dissection in a perpendicular orientation with prolonged hardware contact, opacification of insulation material occurred in 15/20 dissections. There was no dissolution of insulation even at this setting. On deviation from Medtronic advice, hardware damaged occurred if one was reckless with the PlasmaBlade. Conclusion When using the recommended settings and operational technique, PlasmaBlade dissection did not cause any damage to implant wiring/tubing in this simulated setting. This report seeks to add to clinical data suggesting PlasmaBlade is safe for dissection around deep brain stimulator (DBS), vagal nerve stimulator (VNS), and spinal cord stimulator (SCS) hardware.

Neurosurgical implants and interactions of airport metal detectors: A review

Intracranial and spinal implants are increasingly prevalent around the world, placed for a wide range of neurosurgical conditions. Patients with these devices, like many individuals, may have travel plans involving passage through metal detectors and other security screening devise. However, there are virtually no studies in the currently literature evaluating the safety and interaction of neurosurgical implants with these machines. This review of manufacturer information and existing literature serves as a compilation of this information, and our pre-travel recommendations for affected patients.

Management of neurosurgical implant-associated infections.

With the technical developments in neurosurgery, increasing numbers of neurosurgical implants are used in an increasingly aged population of patients with several comorbidities. Consequently, the number of neurosurgical implant-associated infections is continuously raising, resulting in significant morbidity and mortality, including disfiguring skull deformities and lack of brain protection. In this article we review infections associated with craniotomy, cranioplasty, neurostimulators, internal cerebrospinal fluid shunts, and external ventricular and lumbar cerebrospinal fluid drainages. In all implant-associated infections biofilms are involved, which are difficult to eradicate. A low number of microorganisms is sufficient to form a biofilm on the implant surface. In most infections, microorganisms of the skin flora are involved. Microorganisms reach the implant during surgery or immediately thereafter as a result of wound healing disturbances. In about two thirds of patients, implant-associated infections manifest early (within the first month after surgery), whereas the remaining infections present later as a result of low-grade infections or by direct extension from adjacent infections (per continuitatem) to the implants due to soft tissue damage. Except for ventriculo-atrial cerebrospinal fluid shunts, neurosurgical implants are rarely infected by the haematogenous route. In this article we review established and clinically validated concepts for the management of biofilm-associated infections in orthopaedic and trauma surgery, which can be extrapolated to other surgical disciplines that use implants. However, the evidence for the success of this extrapolation to neurosurgical patients is sparse and has not been evaluated in large patient populations. For favourable outcome, an optimised microbiological diagnosis including sonication of removed implants and prolonged incubation of cultures is required. Furthermore, a combined surgical and antimicrobial management strategy is needed. Surgery includes an appropriate debridement with or without implant exchange or removal, depending on the age of the biofilm and the soft tissue condition. Antimicrobial treatment includes a prolonged biofilm-active therapy, typically for 4&ndash;12 weeks. This concept is attractive, because in selected patients, implants can be retained or exchanged in a one-stage surgical procedure, which improves not only quality of life, but also decreases morbidity because every additional neurosurgical intervention can lead to secondary complications, including intracerebral bleeding or ischemia.

Postoperative Imaging of Complications Following Cranial Implants

A wide range of neurosurgical implants, cranioplasty materials and catheters have been developed to treat a variety of intracranial disorders. Interpretation of postoperative imaging can be challenging and confounded by postoperative changes and implant-related complications. Review of recent literature suggested that there is a paucity of data on postoperative cranial implant-related complications.If not addressed appropriately in a timely manner, these complications may cause a delay in the patient’s treatment with subsequent prolongation of hospital stay. It is therefore paramount for clinicians and radiologists to be aware of the appearance of these implant-related complications on imaging during postoperative surveillance.

Stem cell therapy for Parkinson's disease: safety and modeling.

For decades, clinicians have developed medications and therapies to alleviate the symptoms of Parkinson’s disease, but no treatment currently can slow or even stop the progression of this localized neurodegeneration. Fortunately, sparked by the genetic revolution, stem cell reprogramming research and the advancing capabilities of personalization in medicine enable forward-thinking to unprecedented patient-specific modeling and cell therapies for Parkinson’s disease using induced pluripotent stem cells (iPSCs). In addition to modeling Parkinson’s disease more accurately than chemically-induced animal models, patient-specific stem cell lines can be created, elucidating the effects of genetic susceptibility and sub-populations’ differing responses to in vitro treatments. Sourcing cell therapy with iPSC lines provides ethical advantages because these stem cell lines do not require the sacrifice of human zygotes and genetically-specific drug trails can be tested in vitro without lasting damage to patients. In hopes of finally slowing the progression of Parkinson’s disease or re-establishing function, iPSC lines can ultimately be corrected with gene therapy and used as cell sources for neural transplantation for Parkinson’s disease. With relatively localized neural degeneration, similar to spinal column injury, Parkinson’s disease presents a better candidacy for cell therapy when compared to other diffuse degeneration found in Alzheimer’s or Huntington’s Disease. Neurosurgical implantation of pluripotent cells poses the risk of an innate immune response and tumorigenesis. Precautions, therefore, must be taken to ensure cell line quality before transplantation. While cell quality can be quantified using a number of assays, a yielding a high percentage of therapeutically relevant dopaminergic neurons, minimal de novo genetic mutations, and standard chromosomal structure is of the utmost importance. Current techniques focus on iPSCs because they can be matched with donors using human leukocyte antigens, thereby reducing the severity and risk of immune rejection. In August of 2018, researchers in Kyoto, Japan embarked on the first human clinical trial using iPSC cell therapy transplantation for patients with moderate Parkinson’s disease. Transplantation of many cell sources has already proven to reduce Parkinson’s disease symptoms in mouse and primate models. Here we discuss the history and implications for cell therapy for Parkinson’s disease, as well as the necessary safety standards needed for using iPSC transplantation to slow or halt the progression of Parkinson’s disease.

Evaluation of neurosurgical implant infection rates and associated pathogens: evidence from 1118 postoperative infections.

Various implanted materials are used in neurosurgery; however, there remains a lack of pooled data on infection rates (IRs) and infective bacteria over past decades. The goal of this study was to investigate implant infections in neurosurgical procedures in a longitudinal retrospective study and to evaluate the IRs of neurosurgically implanted materials and the distribution of pathogenic microorganisms. A systematic literature search was conducted using PubMed and Web of Science databases for the time period between 1968 and 2018. Neurosurgical implant infections were studied in 5 subgroups, including operations or diseases, implanted materials, bacteria, distribution by country, and time periods, which were obtained from the literature and statistically analyzed. In this meta-analysis, statistical heterogeneity across studies was tested by using p values and I2 values between studies of associated pathogens. Egger's test was used for assessing symmetries of funnel plots with Stata 11.0 software. Methodological quality was assessed to judge the risk of bias according to the Cochrane Handbook. A total of 22,971 patients from 227 articles satisfied the study's eligibility criteria. Of these, 1118 cases of infection were reported, and the overall IR was 4.87%. In this study, the neurosurgical procedures or disorders with the top 3 IRs included craniotomy (IR 6.58%), cranioplasty (IR 5.89%), and motor movement disorders (IR 5.43%). Among 13 implanted materials, the implants with the top 3 IRs included polypropylene-polyester, titanium, and polyetheretherketone (PEEK), which were 8.11%, 8.15%, and 7.31%, respectively. Furthermore, the main causative pathogen was Staphylococcus aureus and the countries with the top 3 IRs were Denmark (IR 11.90%), Korea (IR 10.98%), and Mexico (IR 9.26%). Except for the low IR from 1998 to 2007, the overall implant IR after neurosurgical procedures was on the rise. In this study, the main pathogen in neurosurgery was S. aureus, which can provide a certain reference for the clinic. In addition, the IRs of polypropylene-polyester, titanium, and PEEK were higher than other materials, which means that more attention should be paid to them. In short, the total IR was high in neurosurgical implants and should be taken seriously.

Care Bundle Approach to Minimizing Infection Rates after Neurosurgical Implants for Neuromodulation: A Single-Surgeon Experience

Implant-related infections carry a high morbidity. Infectious rates for neuromodulation implants range from 1% to 9% for deep brain stimulation (DBS), 0%to 10% for spinal cord stimulation (SCS) systems, and 3% to 15% for intrathecal (IT) pump systems. Meanwhile, studies of care bundles report infection rate reduction to 1.0% for SCS and 0.3% for cardiac implants. Herein, we evaluate the effectiveness of an infection prevention bundle (IPB) in minimizing infections after surgeries for neuromodulation implants. An IPB focused on preoperative checklists, screening questionnaires, methicillin-resistant and methicillin-sensitive Staphylococcus aureus decolonization, weight-based antibiotic prophylaxis, strict draping and surgical techniques, and wound care education was implemented in our functional neurosurgery division in April 2015. We retrospectively reviewed all surgeries for implantation or replacement of SCS, DBS, and IT pump system components from March 2013 to October 2017. The patients were divided into pre-IPB and post-IPB groups. All procedures were performed by a single surgeon. Each surgical site was considered a unique surgical case. Infection rates were calculated for pre-IPB and post-IPBgroups. A total of 688 patients underwent 1161 unique surgical procedures (222 DBS electrodes, 419 IPG, 203 SCS, 317 IT pumps) during the study period. There were 546 pre-IPB and 615 post-IPB surgical procedures. The pre-IPB infection rates were 0%, 1.3%, and 8.7% for SCS, DBS, and IT pumps, respectively. The post-IPB infection rates were 0%, 0.3%, and 1.8% for SCS, DBS, and IT pumps, respectively. Implementation of a standardized IPB approach reduced the number of infections for all neuromodulation implants studied. This approach can be adopted within any specialty to potentially decrease the incidence of implant-related infections.

The influence of deep cryogenic treatment and in-situ cryogenic micro turning of Ti-6Al-4V on cutting forces, surface integrity and chip morphology

The demand for sustainable manufacturing of axi-symmetric, micro turned titanium based neurosurgical implants are increasing. However, dry micro-turning of titanium alloy at higher cutting speeds, ...

Complication rates for preexisting baclofen pumps and ventricular shunts following scoliosis correction: a preliminary study.

OBJECTIVE Many patients undergoing spinal fusion for neuromuscular scoliosis have preexisting neurosurgical implants, including ventricular shunts (VSs) for hydrocephalus and baclofen pumps (BPs) for spastic cerebral palsy. Recent studies have discussed a possible increase in implant complication rates following spinal fusion, but published data are inconclusive. The authors therefore, sought to investigate: 1) the rate of implant complications following fusion, 2) possible causes of these complications, and 3) factors that place patients at higher risk for implant-related complications. METHODS Cases involving pediatric patients with a preexisting VS or BP who underwent spinal fusion for scoliosis correction between 2005 and 2016 at a single tertiary children's hospital were retrospectively analyzed. Patient demographics, implant characteristics, spinal fusion details, neurosurgical follow-up, and implant complications in the 180 days following fusion were recorded and analyzed. RESULTS Overall, 75 patients who underwent scoliosis correction had preexisting implants: 39 had BPs, 31 VSs, and 5 both. The patients' mean age at fusion was 13.49 ± 2.78 years (range 3.62-18.81 years), and the mean time from the most recent previous implant surgery to fusion was 5.70 ± 4.65 years (range 0.10-17.3 years). The mean preoperative and postoperative Cobb angles were 62.4° ± 18.9° degrees (range 20.9°-109.0°) and 23.5° ± 13.3° degrees (range 2.00°-67.3°), respectively. No VS complications were identified. Two patients with BPs were found to have complications (unintentional cutting of their BP catheter during posterior spinal fusion) within 180 days postfusion. There were no recorded neurosurgical implant infections, failures, fractures, or dislodgements. Although 10 patients required at least 1 surgical procedure for irrigation and debridement of the spine wound following fusion, there were no abdominal or cranial implant wound infections requiring revision, and no implants required removal. CONCLUSIONS The results of this study suggest that spinal fusion for scoliosis correction does not increase the rates of complications involving previously placed neurosurgical implants. A large-scale, prospective, multicenter study is needed to fully explore and confirm this finding.

Uma avaliação sobre a problemática dos clipes de aneurismas no Brasil

Este estudo utiliza a sistemática da utilização dos clipes de aneurisma para tecer considerações sobre a metodologia de fabricação, utilização e controle de próteses no Brasil. Inicialmente, abordamos alguns aspectos das normas internacionais que regem a fabricação de clipes de aneurisma, analisando algumas características físicas e mecânicas de 600 clipes nacionais, comparando a metodologia nacional de fabricação e fornecimento com as normas internacionais. Este trabalho leva às seguintes conclusões: 1) Não existe diferença significativa entre a qualidade dos dois fabricantes de clipes nacionais testados. 2) Embora os clipes importados tenham apresentado desempenho superior, alguns detalhes de fabricação podem tornar os nacionais tão bons quanto os importados. 3) Alguns aspectos da norma ISO 9713 podem ser revistos e aplicados nas normas nacionais de produção e fornecimento de clipes e implantes em geral. 4) Para benefício de todos, quais sejam, a comunidade neurocirúrgica, a indústria nacional, a ANVISA (Agência Nacional de Vigilância Sanitária) e os agentes normatizadores (ABNT – Agência Brasileira de Normas Técnicas), recomenda-se que as sociedades brasileiras da especialidade tomem assento e participe da formulação das normas de fabricação dos materiais utilizados em neurocirurgia.

S94 Update on technological advancements in invasive neurophysiological activity monitoring and deep-brain stimulation

Over the past decade technological advances have created entirely new opportunities for studying and understanding neural circuits and brain activities. Meanwhile the expansion of therapeutic scope of Deep Brain Stimulation has continuously happened together with the improvement in precision of stimulation and neurosurgical implantation techniques. The standard open-loop setup of high-frequency (HF) DBS utilizes permanent HF electrical pulse train, where electrical stimulation is administered continuously to the target areas irrespectively of the ongoing neural dynamics. Recent studies demonstrate that an adaptive, closed-loop DBS setup might be preferable over the open-loop setup. This presentation summarizes the technological advancements in closed-loop DBS system designs. We will discuss state-of-the-art implantable multielectrode technologies, requirements checklist for clinical practice, current issues, electronics designs as well as field potential and single unit activity based biomarkers with particular interest on Phase-amplitude coupling.

Anaesthetic considerations for patients with neurosurgical implants

### Key points Innovations in neurosurgical technology, neurosurgical techniques, approaches to surgical access, and interventional neuroradiology have revolutionized the treatment of many neurosurgical and neurological conditions, with many pathologies now amenable to surgical intervention; aggressive tumour resection in eloquent areas and on/adjacent to the motor strip, Parkinson's disease, epilepsy, benign intracranial hypertension, pituitary tumour, intracranial aneurysm surgery, and radiological intervention to name a few. Survival rates over 5 and 10 yr have improved and it follows that patients with residual tumour, cerebrospinal diversion devices (shunts), indwelling therapeutic implants (devices) and stents, and spinal metal work are more likely to present to their local hospital for non-neurosurgical procedures. Broadly speaking, patients with neurosurgical pathology requiring non-neurosurgical procedures can be considered in four main groups: An understanding and …

Optimisation of biomaterial surfaces for next generation neurosurgical implants

Optimisation of biomaterial surfaces for next generation neurosurgical implants