Pub Date : 2024-10-01Epub Date: 2022-06-22DOI: 10.1080/02688697.2022.2090504
Yusuf Çağdaş Kumbul, Nazan Okur, Erdoğan Okur, Vural Akın, Kemal Ertilav, Ali Serdar Oğuzoğlu, Veysel Atilla Ayyıldız
Transoral penetrating foreign body injury of the neck involving the cervical spine is a rare condition. We present an injury caused by transoral penetration of a broken piece of a wooden plank into the neck with injury to the upper cervical spine in a 31-year-old male patient. The foreign body was removed transorally with the patient making a full recovery under close observation and was discharged and followed up with no complications. This paper highlights the types of neck injuries, the key points to be considered in zone III neck injury in light of existing literature and a discussion on the management of these patients.
涉及颈椎的颈部经口穿透性异物伤是一种罕见病。我们介绍了一名 31 岁男性患者因木板碎片经口穿入颈部导致上颈椎损伤的病例。经口取出异物后,患者在严密观察下完全康复,出院后随访未发现并发症。本文重点介绍了颈部损伤的类型、根据现有文献对 III 区颈部损伤应考虑的要点以及对这些患者的处理方法进行了讨论。
{"title":"Transoral penetrating upper cervical injury: a case report.","authors":"Yusuf Çağdaş Kumbul, Nazan Okur, Erdoğan Okur, Vural Akın, Kemal Ertilav, Ali Serdar Oğuzoğlu, Veysel Atilla Ayyıldız","doi":"10.1080/02688697.2022.2090504","DOIUrl":"10.1080/02688697.2022.2090504","url":null,"abstract":"<p><p>Transoral penetrating foreign body injury of the neck involving the cervical spine is a rare condition. We present an injury caused by transoral penetration of a broken piece of a wooden plank into the neck with injury to the upper cervical spine in a 31-year-old male patient. The foreign body was removed transorally with the patient making a full recovery under close observation and was discharged and followed up with no complications. This paper highlights the types of neck injuries, the key points to be considered in zone III neck injury in light of existing literature and a discussion on the management of these patients.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40165130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2022-06-16DOI: 10.1080/02688697.2022.2086966
Leandro Infantini Dini, Simone Afonso Dini, Wanderson Willian Dos Santos Dias, Michel Martins Guarenti, Eduardo Madruga Lombardo, Rogério Miranda Pagnoncelli, Gustavo Rassier Isolan
Surgery to expose the anterior occiptocervical junction (OCJ) is exacting, and optimal approaches are debatable. The close proximity of vital structures and difficult surgical access present a unique challenge to treat lesions in this area. Routine access to the upper anterior cervical spine remains limited. The authors present a modified retropharyngeal approach and instrumentation in order to resect an exceptionally rare atypical rhabdoid teratoid tumor involving the craniovertebral junction. The technical aspects of this approach in anatomical perspectives are discussed in this article.
{"title":"Anatomical aspects and technical note of a modified retropharyngeal approach and reconstruction of the anterior occipitocervical junction.","authors":"Leandro Infantini Dini, Simone Afonso Dini, Wanderson Willian Dos Santos Dias, Michel Martins Guarenti, Eduardo Madruga Lombardo, Rogério Miranda Pagnoncelli, Gustavo Rassier Isolan","doi":"10.1080/02688697.2022.2086966","DOIUrl":"10.1080/02688697.2022.2086966","url":null,"abstract":"<p><p>Surgery to expose the anterior occiptocervical junction (OCJ) is exacting, and optimal approaches are debatable. The close proximity of vital structures and difficult surgical access present a unique challenge to treat lesions in this area. Routine access to the upper anterior cervical spine remains limited. The authors present a modified retropharyngeal approach and instrumentation in order to resect an exceptionally rare atypical rhabdoid teratoid tumor involving the craniovertebral junction. The technical aspects of this approach in anatomical perspectives are discussed in this article.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44963046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2024-08-20DOI: 10.1080/02688697.2024.2392440
Ashwin Kumaria, B J Sudhir, Nitin Mukerji
{"title":"Travelling to other neurosurgical centres: experiencing global neurosurgery.","authors":"Ashwin Kumaria, B J Sudhir, Nitin Mukerji","doi":"10.1080/02688697.2024.2392440","DOIUrl":"10.1080/02688697.2024.2392440","url":null,"abstract":"","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142003646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2022-12-20DOI: 10.1080/02688697.2022.2152429
Richard D C Moon, Neil U Barua
Purpose: This study aimed to describe our institutional use of a commercially available mixed reality viewer within a multi-disciplinary planning workflow for awake craniotomy surgery and to report an assessment of its usability.
Materials and methods: Three Tesla MRI scans, including 32-direction diffusion tensor sequences, were reconstructed with BrainLab Elements auto-segmentation software. Magic Leap mixed reality viewer headsets were registered to a shared virtual viewing space to display image reconstructions. System Usability Scale was used to assess the usability of the mixed reality system.
Results: The awake craniotomy planning workflow utilises the mixed reality viewer to facilitate a stepwise discussion through four progressive anatomical layers; the skin, cerebral cortex, subcortical white matter tracts and tumour with surrounding vasculature. At each stage relevant members of the multi-disciplinary team review key operative considerations, including patient positioning, cortical and subcortical speech mapping protocols and surgical approaches to the tumour.The mixed reality system was used for multi-disciplinary awake craniotomy planning in 10 consecutive procedures over a 5-month period. Ten participants (2 Anaesthetists, 5 Neurosurgical trainees, 2 Speech therapists, 1 Neuropsychologist) completed System Usability Scale assessments, reporting a mean score of 71.5. Feedback highlighted the benefit of being able to rehearse important steps in the procedure, including patient positioning and anaesthetic access and visualising the testing protocol for cortical and subcortical speech mapping.
Conclusions: This study supports the use of mixed reality for multidisciplinary planning for awake craniotomy surgery, with an acceptable degree of usability of the interface. We highlight the need to consider the requirements of non-technical, non-neurosurgical team members when involving mixed reality activities.
{"title":"Usability of mixed reality in awake craniotomy planning.","authors":"Richard D C Moon, Neil U Barua","doi":"10.1080/02688697.2022.2152429","DOIUrl":"10.1080/02688697.2022.2152429","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to describe our institutional use of a commercially available mixed reality viewer within a multi-disciplinary planning workflow for awake craniotomy surgery and to report an assessment of its usability.</p><p><strong>Materials and methods: </strong>Three Tesla MRI scans, including 32-direction diffusion tensor sequences, were reconstructed with BrainLab Elements auto-segmentation software. Magic Leap mixed reality viewer headsets were registered to a shared virtual viewing space to display image reconstructions. System Usability Scale was used to assess the usability of the mixed reality system.</p><p><strong>Results: </strong>The awake craniotomy planning workflow utilises the mixed reality viewer to facilitate a stepwise discussion through four progressive anatomical layers; the skin, cerebral cortex, subcortical white matter tracts and tumour with surrounding vasculature. At each stage relevant members of the multi-disciplinary team review key operative considerations, including patient positioning, cortical and subcortical speech mapping protocols and surgical approaches to the tumour.The mixed reality system was used for multi-disciplinary awake craniotomy planning in 10 consecutive procedures over a 5-month period. Ten participants (2 Anaesthetists, 5 Neurosurgical trainees, 2 Speech therapists, 1 Neuropsychologist) completed System Usability Scale assessments, reporting a mean score of 71.5. Feedback highlighted the benefit of being able to rehearse important steps in the procedure, including patient positioning and anaesthetic access and visualising the testing protocol for cortical and subcortical speech mapping.</p><p><strong>Conclusions: </strong>This study supports the use of mixed reality for multidisciplinary planning for awake craniotomy surgery, with an acceptable degree of usability of the interface. We highlight the need to consider the requirements of non-technical, non-neurosurgical team members when involving mixed reality activities.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10751941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2021-12-21DOI: 10.1080/02688697.2021.2016624
Andreas Wetzel-Yalelis, Cihat Karadag, Lan Li, Bernd Turowski, Richard Bostelmann, Yousef Abusabha, Björn B Hofmann, Konstantinos Gousias, Rachit Agrawal, Matthias König, Marga Kaiser, Hendrik-Jan Mijderwijk, Athanasios K Petridis
Background and objectives: Although the formation and rupture risk of an anterior communicating artery (ACoA) aneurysm has been the subject of many studies, no previous study has primarily searched for the relationship of the parent and daughter vessels and the impact of their size/diameter ratio on the potential rupture risk of an AcoA aneurysm. The objective of this study is to explore this link and to further analyse the surrounding vasculature of the anterior communicating artery aneurysm.
Materials and methods: We conducted a retrospective analysis of 434 patients: 284 patients with an ACoA aneurysm (121 unruptured and 162 ruptured) and 150 control patients without an ΑCoA aneurysm. Radiological angiography investigations were used to assess the diameter ratios of the parent vessels in addition to ACoA aneurysm morphology parameters.
Results: When comparing the ruptured to the unruptured cases, we observed no significant difference in the parent or daughter vessel diameter ratios. Younger patient age (OR 0.96, p = 0.00) and a higher aneurysm size ratio (OR 1.10, p = 0.02) were of prognostic importance concerning the rupture risk of the aneurysm. The A1 diameter ratio and the A2 diameter were not statistically significant (OR 1.00, p = 0.99, and OR 3.38, p = 0.25 respectively).
Conclusions: In our study, we focused on asymmetry in the parent and daughter vessels as well as traditional ACoA aneurysm morphological characteristics. We were able to label younger patient age and a greater size ratio as independent prognostic factors for ACoA aneurysm rupture. We were unable to label parent and daughter vessel asymmetry as prognostic factors. To validate our findings, parent and daughter vessel asymmetry should be subjected to future prospective studies.
{"title":"The rupture of an anterior communicating artery aneurysm does not associate with an asymmetry in the A1 or A2 arteries: a retrospective study of radiological features.","authors":"Andreas Wetzel-Yalelis, Cihat Karadag, Lan Li, Bernd Turowski, Richard Bostelmann, Yousef Abusabha, Björn B Hofmann, Konstantinos Gousias, Rachit Agrawal, Matthias König, Marga Kaiser, Hendrik-Jan Mijderwijk, Athanasios K Petridis","doi":"10.1080/02688697.2021.2016624","DOIUrl":"10.1080/02688697.2021.2016624","url":null,"abstract":"<p><strong>Background and objectives: </strong>Although the formation and rupture risk of an anterior communicating artery (ACoA) aneurysm has been the subject of many studies, no previous study has primarily searched for the relationship of the parent and daughter vessels and the impact of their size/diameter ratio on the potential rupture risk of an AcoA aneurysm. The objective of this study is to explore this link and to further analyse the surrounding vasculature of the anterior communicating artery aneurysm.</p><p><strong>Materials and methods: </strong>We conducted a retrospective analysis of 434 patients: 284 patients with an ACoA aneurysm (121 unruptured and 162 ruptured) and 150 control patients without an ΑCoA aneurysm. Radiological angiography investigations were used to assess the diameter ratios of the parent vessels in addition to ACoA aneurysm morphology parameters.</p><p><strong>Results: </strong>When comparing the ruptured to the unruptured cases, we observed no significant difference in the parent or daughter vessel diameter ratios. Younger patient age (OR 0.96, <i>p</i> = 0.00) and a higher aneurysm size ratio (OR 1.10, <i>p</i> = 0.02) were of prognostic importance concerning the rupture risk of the aneurysm. The A1 diameter ratio and the A2 diameter were not statistically significant (OR 1.00, <i>p</i> = 0.99, and OR 3.38, <i>p</i> = 0.25 respectively).</p><p><strong>Conclusions: </strong>In our study, we focused on asymmetry in the parent and daughter vessels as well as traditional ACoA aneurysm morphological characteristics. We were able to label younger patient age and a greater size ratio as independent prognostic factors for ACoA aneurysm rupture. We were unable to label parent and daughter vessel asymmetry as prognostic factors. To validate our findings, parent and daughter vessel asymmetry should be subjected to future prospective studies.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39745727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2022-01-01DOI: 10.1080/02688697.2021.2019193
Aditaya Kumar, Phil Copley, Aimun Jamjoom, Khaled Badran, Christopher Barrett
Background: There is no literature specifically addressing the morbidity of out of hours surgery for Cauda Equina Syndrome (CES). Our paper rectifies this omission. This will assist the surgeon with real-time decision making with regards to timing of intervention in this rare but potentially disabling disease.
Methods: A retrospective case series analysis. Individual cases were identified using local electronic theatre management systems in the four neurosurgical centres in Scotland in 2017. "Out of hours" surgery was defined as starting outside the times 0900-1700 Monday to Friday.
Results: 86 patients underwent out of hours surgery for CES in Scotland in 2017. One patient sustained a nerve root injury without new deficit, giving an overall risk of 1.2%. Four patients had the intra-operative complication of CSF leak, giving an overall risk of 4.7%. Five patients underwent early revision surgery, equivalent to a re-operation risk of 5.8%.
Conclusions: The morbidity of out of hours surgery for CES is comparable to that of elective microdiscectomy. Operating out of hours for CES does not appear to have an increased risk of complications. Since increased surgical risk is not borne out by our study, this should not be used as a justification to delay operative treatment.
{"title":"The morbidity of out-of-hours surgery for Cauda Equina Syndrome.","authors":"Aditaya Kumar, Phil Copley, Aimun Jamjoom, Khaled Badran, Christopher Barrett","doi":"10.1080/02688697.2021.2019193","DOIUrl":"10.1080/02688697.2021.2019193","url":null,"abstract":"<p><strong>Background: </strong>There is no literature specifically addressing the morbidity of out of hours surgery for Cauda Equina Syndrome (CES). Our paper rectifies this omission. This will assist the surgeon with real-time decision making with regards to timing of intervention in this rare but potentially disabling disease.</p><p><strong>Methods: </strong>A retrospective case series analysis. Individual cases were identified using local electronic theatre management systems in the four neurosurgical centres in Scotland in 2017. \"Out of hours\" surgery was defined as starting outside the times 0900-1700 Monday to Friday.</p><p><strong>Results: </strong>86 patients underwent out of hours surgery for CES in Scotland in 2017. One patient sustained a nerve root injury without new deficit, giving an overall risk of 1.2%. Four patients had the intra-operative complication of CSF leak, giving an overall risk of 4.7%. Five patients underwent early revision surgery, equivalent to a re-operation risk of 5.8%.</p><p><strong>Conclusions: </strong>The morbidity of out of hours surgery for CES is comparable to that of elective microdiscectomy. Operating out of hours for CES does not appear to have an increased risk of complications. Since increased surgical risk is not borne out by our study, this should not be used as a justification to delay operative treatment.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39780072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We herein report the effectiveness of contralateral osteotomy of the pedicle and posterolateral elements for en bloc resection (COPPER) of paraspinal and spinal tumours. This surgical method allows for complete resection of the localized tumour in the lateral posterior lesion without removing the entire vertebral body, as in total en bloc spondylectomy. Complete resection of paraspinal and spinal tumours is challenging for spinal surgeons because of anatomical complexities. Although the COPPER method has been introduced as a less invasive surgical procedure for wide resection of spinal tumours, no studies have reported the usefulness of this technique. We identified three patients with paraspinal or spinal tumours who underwent wide resection using the COPPER method and reviewed their clinical, radiological, and pathological outcomes. In all cases, we resected the spinal and paraspinal tumours extending to the anterior column and extravertebral component using the modified COPPER method. All patients underwent en bloc resection with a negative margin. We report three cases of spinal and paraspinal tumours extending to the anterior column and extravertebral component.
{"title":"Application of contralateral osteotomy for the en bloc resection of paraspinal and spinal tumours: a report of three cases.","authors":"Yu Toda, Tadatsugu Morimoto, Yoshihiro Matsumoto, Nokitaka Setsu, Tomohito Yoshihara, Shinichi Aishima, Yoshinao Oda, Yasuharu Nakashima, Masaaki Mawatari","doi":"10.1080/02688697.2022.2076809","DOIUrl":"10.1080/02688697.2022.2076809","url":null,"abstract":"<p><p>We herein report the effectiveness of contralateral osteotomy of the pedicle and posterolateral elements for en bloc resection (COPPER) of paraspinal and spinal tumours. This surgical method allows for complete resection of the localized tumour in the lateral posterior lesion without removing the entire vertebral body, as in total en bloc spondylectomy. Complete resection of paraspinal and spinal tumours is challenging for spinal surgeons because of anatomical complexities. Although the COPPER method has been introduced as a less invasive surgical procedure for wide resection of spinal tumours, no studies have reported the usefulness of this technique. We identified three patients with paraspinal or spinal tumours who underwent wide resection using the COPPER method and reviewed their clinical, radiological, and pathological outcomes. In all cases, we resected the spinal and paraspinal tumours extending to the anterior column and extravertebral component using the modified COPPER method. All patients underwent en bloc resection with a negative margin. We report three cases of spinal and paraspinal tumours extending to the anterior column and extravertebral component.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44790010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2022-01-18DOI: 10.1080/02688697.2021.2024144
Mohammad Ashraf, Mohamed Abdelsadg, Athanasios Grivas
Objective: This study aims to assess the relationship between the molecular characteristics of glioblastoma multiforme (GBM) and the subventricular zone (SVZ).
Material and methods: Eligible patients had their data anonymously collected from an institutional database, including age, sex, preoperative performance status, the extent of tumour resection, anatomical location, IDH mutation and MGMT methylation status. An Institutional picture archiving and communications system was used for volumetric and morphometric analysis. All measurements were made on T1-weighted magnetic resonance images with gadolinium contrast enhancement. IDH wild-type and mutant GBMs were stratified by MGMT methylation status. The relationship between tumour volume, distance from the tumour's enhancing edge and the tumour's geometric centre to the SVZ and their molecular characteristics were assessed.
Results: Fifty IDH wild-type GBMs were studied. Twenty-three were MGMT methylated, Twenty-seven were unmethylated. IDH wild-type MGMT methylated GBMs were significantly associated with a tumour's enhancing boundary being contiguous to the SVZ (P < 0.001). Ninety percent of tumours contiguous to the SVZ were wild-type methylated (n = 18) and 10% were unmethylated (n = 2). Mean GBM geometric centre distance to SVZ was significantly less for methylated wild-type GBMs compared to unmethylated (P = 0.025) and median GBM distance from the tumour's edge of enhancement to the SVZ was significantly shorter in methylated tumours compared to unmethylated (P < 0.001). Mean and median distances to SVZ from the edge of enhancement was 3.8 millimetres (mm) and 0 mm, respectively, for wild-type methylated GBMs, while for unmethylated wild-types, 14.6 mm, and 12.5 mm. There was no anatomical localisation of IDH wild-type GBMs by MGMT methylation status to a cerebral hemisphere or lobe.
Conclusion: IDH wild-type GBMs contiguous to the SVZ are highly likely to be MGMT methylated. Replication by further studies is required to affirm our results and conclusion.
{"title":"Relationship between molecular characteristics of glioblastoma multiforme and the subventricular zone.","authors":"Mohammad Ashraf, Mohamed Abdelsadg, Athanasios Grivas","doi":"10.1080/02688697.2021.2024144","DOIUrl":"10.1080/02688697.2021.2024144","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to assess the relationship between the molecular characteristics of glioblastoma multiforme (GBM) and the subventricular zone (SVZ).</p><p><strong>Material and methods: </strong>Eligible patients had their data anonymously collected from an institutional database, including age, sex, preoperative performance status, the extent of tumour resection, anatomical location, <i>IDH</i> mutation and <i>MGMT</i> methylation status. An Institutional picture archiving and communications system was used for volumetric and morphometric analysis. All measurements were made on T1-weighted magnetic resonance images with gadolinium contrast enhancement. <i>IDH</i> wild-type and mutant GBMs were stratified by <i>MGMT</i> methylation status. The relationship between tumour volume, distance from the tumour's enhancing edge and the tumour's geometric centre to the SVZ and their molecular characteristics were assessed.</p><p><strong>Results: </strong>Fifty <i>IDH</i> wild-type GBMs were studied. Twenty-three were <i>MGMT</i> methylated, Twenty-seven were unmethylated. <i>IDH</i> wild-type <i>MGMT</i> methylated GBMs were significantly associated with a tumour's enhancing boundary being contiguous to the SVZ (<i>P</i> < 0.001). Ninety percent of tumours contiguous to the SVZ were wild-type methylated (<i>n</i> = 18) and 10% were unmethylated (<i>n</i> = 2). Mean GBM geometric centre distance to SVZ was significantly less for methylated wild-type GBMs compared to unmethylated (<i>P</i> = 0.025) and median GBM distance from the tumour's edge of enhancement to the SVZ was significantly shorter in methylated tumours compared to unmethylated (<i>P</i> < 0.001). Mean and median distances to SVZ from the edge of enhancement was 3.8 millimetres (mm) and 0 mm, respectively, for wild-type methylated GBMs, while for unmethylated wild-types, 14.6 mm, and 12.5 mm. There was no anatomical localisation of <i>IDH</i> wild-type GBMs by <i>MGMT</i> methylation status to a cerebral hemisphere or lobe.</p><p><strong>Conclusion: </strong><i>IDH</i> wild-type GBMs contiguous to the SVZ are highly likely to be <i>MGMT</i> methylated. Replication by further studies is required to affirm our results and conclusion.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39917859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2022-05-17DOI: 10.1080/02688697.2022.2077306
Nicola Montemurro, Paolo Perrini, Michael T Lawton
Aneurysms of the basilar trunk represent an exceptional challenge to the neurosurgeon, due to high mortality and surgical morbidity. We present a 69-year-old man with a giant dolichoectatic thrombotic basilar trunk aneurysm (BTA), who underwent right orbitozygomatic craniotomy, posterior cerebral artery (PCA) to right middle cerebral artery (MCA) bypass and trapping of the BTA. Unfortunately, patient died after surgery due to multiple foci of intraparenchymal haemorrhage and thrombosis of a short segment proximal to aneurysm trapped and his body was donated to the hospital, giving us the unique opportunity to compare intraoperative details with anatomical dissection findings, according to our previously published cadaveric neurosurgical research. The great and unique opportunity of this reported case, to learn by watching and watching again what has been done during surgery, to observe small vessels and brainstem perforators and to look at stiches of the bypass, SVG and the position of the clips, permits to refine the theoretical and practical skills for the treatment of complex aneurysms such as that one reported.
{"title":"Unsuccessful bypass and trapping of a giant dolichoectatic thrombotic basilar trunk aneurysm. What went wrong?","authors":"Nicola Montemurro, Paolo Perrini, Michael T Lawton","doi":"10.1080/02688697.2022.2077306","DOIUrl":"10.1080/02688697.2022.2077306","url":null,"abstract":"<p><p>Aneurysms of the basilar trunk represent an exceptional challenge to the neurosurgeon, due to high mortality and surgical morbidity. We present a 69-year-old man with a giant dolichoectatic thrombotic basilar trunk aneurysm (BTA), who underwent right orbitozygomatic craniotomy, posterior cerebral artery (PCA) to right middle cerebral artery (MCA) bypass and trapping of the BTA. Unfortunately, patient died after surgery due to multiple foci of intraparenchymal haemorrhage and thrombosis of a short segment proximal to aneurysm trapped and his body was donated to the hospital, giving us the unique opportunity to compare intraoperative details with anatomical dissection findings, according to our previously published cadaveric neurosurgical research. The great and unique opportunity of this reported case, to learn by watching and watching again what has been done during surgery, to observe small vessels and brainstem perforators and to look at stiches of the bypass, SVG and the position of the clips, permits to refine the theoretical and practical skills for the treatment of complex aneurysms such as that one reported.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44884572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01Epub Date: 2021-12-20DOI: 10.1080/02688697.2021.2016620
Timothy D Shaw, Tanya Curran, Stephen Cooke, Ronan McMullan, Michael Hunter
Background: Optimal management of intracranial infections relies on microbiological diagnosis and antimicrobial choice, but conventional culture-based testing is limited by pathogen viability and pre-sampling antimicrobial exposure. Broad-range 16S rRNA gene sequencing has been reported in the management of culture-negative infections but its utility in intracranial infection is not well-described. We studied the efficacy of 16S rRNA gene sequencing to inform microbiological diagnosis and antimicrobial choice in intracranial infections.
Methods: This was a retrospective study of all intraoperative neurosurgical specimens sent for 16S rRNA gene sequencing over an 8-year period at a regional neurosurgical centre in the UK. Specimen selection was performed using multidisciplinary approach, combining neurosurgical and infection specialist discussion.
Results: Twenty-five intraoperative specimens taken during neurosurgery from 24 patients were included in the study period. The most common reason for referral was pre-sampling antimicrobial exposure (68%). Bacterial rDNA was detected in 60% of specimens. 16S rRNA gene sequencing contributed to microbiological diagnosis in 15 patients and informed antimicrobial management in 10 of 24 patients with intracranial infection. These included targeted antibiotics after detection of a clinically-significant pathogen that had not been identified through other microbiological testing (3 cases), detection of commensal organisms in neurosurgical infection which justified continued broad cover (2 cases) and negative results from intracranial lesions with low clinical suspicion of bacterial infection which justified avoidance or cessation of antibiotics (5 cases).
Conclusion: Overall, 16S rRNA gene sequencing represented an incremental improvement in diagnostic testing and was most appropriately used to complement, rather than replace, conventional culture-based testing for intracranial infection.
{"title":"The utility of 16S rRNA gene sequencing on intraoperative specimens from intracranial infections: an 8-year study in a regional UK neurosurgical unit.","authors":"Timothy D Shaw, Tanya Curran, Stephen Cooke, Ronan McMullan, Michael Hunter","doi":"10.1080/02688697.2021.2016620","DOIUrl":"10.1080/02688697.2021.2016620","url":null,"abstract":"<p><strong>Background: </strong>Optimal management of intracranial infections relies on microbiological diagnosis and antimicrobial choice, but conventional culture-based testing is limited by pathogen viability and pre-sampling antimicrobial exposure. Broad-range 16S rRNA gene sequencing has been reported in the management of culture-negative infections but its utility in intracranial infection is not well-described. We studied the efficacy of 16S rRNA gene sequencing to inform microbiological diagnosis and antimicrobial choice in intracranial infections.</p><p><strong>Methods: </strong>This was a retrospective study of all intraoperative neurosurgical specimens sent for 16S rRNA gene sequencing over an 8-year period at a regional neurosurgical centre in the UK. Specimen selection was performed using multidisciplinary approach, combining neurosurgical and infection specialist discussion.</p><p><strong>Results: </strong>Twenty-five intraoperative specimens taken during neurosurgery from 24 patients were included in the study period. The most common reason for referral was pre-sampling antimicrobial exposure (68%). Bacterial rDNA was detected in 60% of specimens. 16S rRNA gene sequencing contributed to microbiological diagnosis in 15 patients and informed antimicrobial management in 10 of 24 patients with intracranial infection. These included targeted antibiotics after detection of a clinically-significant pathogen that had not been identified through other microbiological testing (3 cases), detection of commensal organisms in neurosurgical infection which justified continued broad cover (2 cases) and negative results from intracranial lesions with low clinical suspicion of bacterial infection which justified avoidance or cessation of antibiotics (5 cases).</p><p><strong>Conclusion: </strong>Overall, 16S rRNA gene sequencing represented an incremental improvement in diagnostic testing and was most appropriately used to complement, rather than replace, conventional culture-based testing for intracranial infection.</p>","PeriodicalId":9261,"journal":{"name":"British Journal of Neurosurgery","volume":null,"pages":null},"PeriodicalIF":1.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11418903/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39742042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}