Introduction
Early surgical series of shunt insertion for idiopathic normal-pressure hydrocephalus reported a low rate of short-term improvement with a relatively high rate of mortality and ...morbidity; subsequently shunt insertion was recommended for patients in whom there is favourable risk-to-benefit ratio.
Methods
Bibliographic search for studies that objectively assessed the outcome following shunt insertion in idiopathic normal-pressure hydrocephalus was done; the aim was to estimate the outcome of shunt insertion in terms of improvement rates and associated mortality and morbidity.
Results
A total of 64 studies of 3,063 patients were reviewed. Positive improvement following shunt insertion was reported in an average of 71 % of patients with an average 1 % mortality. Results from studies published in the last 5 years showed 82 % improvement following shunt insertion, mortality of 0.2 %, and combined common complications rate of 8.2 %.
Conclusion
When patients are properly selected, shunt insertion is a safe and effective management of idiopathic normal-pressure hydrocephalus with a prolonged positive outcome.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Background: IDH-wildtype glioblastoma is the most common malignant primary brain tumour in adults. As there is limited information on prognostic factors outside of clinical trials; thus, we conducted ...a retrospective study to characterise the glioblastoma population at our centre. Methods: Demographic, tumour molecular profiles, treatment, and survival data were collated for patients diagnosed with glioblastoma at our centre between July 2011 and December 2015. We used multivariate proportional hazard model associations with survival. Results: 490 patients were included; 60% had debulking surgery and 40% biopsy only. Subsequently, 56% had standard chemoradiotherapy, 25% had non-standard chemo/radio-therapy, and 19% had no further treatment. Overall survival was 9.2 months. In the multivariate analysis, longer survival was associated with debulking surgery vs. biopsy alone (14.9 vs. 8 months) (HR 0.54 95% CI 0.41−0.70), subsequent treatment after diagnosis (HR 0.12 0.08−0.16) (standard chemoradiotherapy 16.9 months vs. non-standard regimens 9.2 months vs. none 2.0 months), tumour MGMT promotor methylation (HR 0.71 0.58−0.87), and younger age (hazard ratio vs. age < 50: 1.70 1.26−2.30 for ages 50−59; 3.53 2.65−4.70 for ages 60−69; 4.82 3.54−6.56 for ages 70+). Conclusions: The median survival for patients with glioblastoma is less than a year. Younger age, debulking surgery, treatment with chemoradiotherapy, and MGMT promotor methylation are independently associated with longer survival.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Abstract
BACKGROUND:
The international guidelines for the diagnosis of normal pressure hydrocephalus (NPH) define ventricular enlargement as Evans' index greater than 0.3.
OBJECTIVE:
To establish ...whether there is a correlation between Evans' index and ventricular volume (VV) in NPH and whether choosing different planes for the measurements could produce significantly different results.
METHODS:
Pre–shunt insertion, thin-section CT scans of the brains of 10 patients with shunt-responsive NPH were reviewed retrospectively, measuring Evans' index, frontal horn index, VV, and total intracranial volume (ICV). The ventricular/intracranial volume index (VV/ICV) was calculated. Correlation between each of the linear indices and VV and VV/ICV was done.
RESULTS:
Significant differences were found in the index values calculated at different planes. The frontal horn index at a plane 16 mm parallel to the anterior commissure–posterior commissure (AC-PC) plane showed best correlation with VV and VV/ICV (r: 0.658 and 0.587, respectively). Evans' index, also obtained at a plane 16 mm parallel to the AC-PC plane, showed best correlation with VV and VV/ICV (r: 0.619 and 0.498, respectively).
CONCLUSION:
Evans' index value can vary significantly in a patient with NPH, depending on the level of the brain CT scan image at which the frontal horns and maximal inner skull diameters are measured. Evans' index is not an ideal method for estimating the VV in NPH patients. Volumetric measurements represent the logical accurate estimate of true ventricular size as well as the size of the other intracranial compartments.
Bibliometrics are the methods used to quantitatively analyze scientific literature. In this study, bibliometrics were used to quantify the scientific output of neurosurgical departments throughout ...Great Britain and Ireland.
A list of neurosurgical departments was obtained from the Society of British Neurological Surgeons website. Individual departments were contacted for an up-to-date list of consultant (attending) neurosurgeons practicing in these departments. Scopus was used to determine the h-index and m-quotient for each neurosurgeon. Indices were measured by surgeon and by departmental mean and total. Additional information was collected about the surgeon's sex, title, listed superspecialties, higher research degrees, and year of medical qualification.
Data were analyzed for 315 neurosurgeons (25 female). The median h-index and m-quotient were 6.00 and 0.41, respectively. These were significantly higher for professors (h-index 21.50; m-quotient 0.71) and for those with an additional MD or PhD (11.0; 0.57). There was no significant difference in h-index, m-quotient, or higher research degrees between the sexes. However, none of the 16 British neurosurgery professors were female. Neurosurgeons who specialized in functional/epilepsy surgery ranked highest in terms of publication productivity. The 5 top-scoring departments were those in Addenbrooke's Hospital, Cambridge; St. George's Hospital, London; Great Ormond Street Hospital, London; National Hospital for Neurology and Neurosurgery, Queen Square, London; and John Radcliffe Hospital, Oxford.
The h-index is a useful bibliometric marker, particularly when comparing between studies and individuals. The m-quotient reduces bias toward established researchers. British academic neurosurgeons face considerable challenges, and women remain underrepresented in both clinical and academic neurosurgery in Britain and Ireland.
Overdrainage is a common complication associated with shunt insertion in normal-pressure hydrocephalus (NPH) patients. Using adjustable valves with antigravity devices has been shown to reduce its ...incidence. The optimal starting setting of an adjustable shunt valve in NPH is debatable.
To audit our single-center practice of setting adjustable valves.
We performed a retrospective review of clinical records of all NPH patients treated in our unit between 2006 and 2009 by the insertion of shunts with a proGAV valve, recording demographic and clinical data, shunt complications, and revision rates. Radiological reports of postoperative follow-up computed tomography scans of the brain were reviewed for detected subdural hematomas.
A proGAV adjustable valve was inserted in 50 probable NPH patients between July 2006 and November 2009. Mean ± SD age was 76 ± 7 years. Mean follow-up was 15 months. The initial shunt setting was 6 ± 3 cm H2O, and the final setting was 4.9 ± 1.9 cm H2O. Nineteen patients required 24 readjustment procedures (readjustment rate, 38%; readjustment number, 0.48 times per patient). One patient (2%) developed delayed bilateral subdural hematoma after readjustment of his shunt valve setting as an outpatient.
Starting with a low opening pressure setting on a proGAV adjustable shunt valve does not increase the chances of overdrainage complications and reduces the need for repeated readjustments.
Object. Animal models provide a basis for clarifying the complex pathogenesis of delayed cerebral vasospasm (DCVS) and for screening of potential therapeutic approaches. Arbitrary use of experimental ...parameters in current models can lead to results of uncertain relevance. The aim of this work was to identify and analyze the most consistent and feasible models and their parameters for each animal.
Methods. An online search of the MEDLINE PubMed and EMBASE medical databases (1969 to week 21 of 2007) was performed using the key words "canine", "mice", "rabbit", "pig", "rat", "cat", and "primate" in combination with "subarachnoid hemorrhage", "model", and "vasospasm". Cross references of each model were checked. Analysis of identified publications was considered in accordance with predetermined eligibility criteria.
Results. 1254 abstracts were reviewed and 516 studies were included in the analysis. Then, 66 models in 7 animals were identified. Most often used blood amounts (ml) lead to degree (% vessel narrowing) and peak onset (day) of DCVS within animal models as follows: mice endovascular puncture (various, day 3, 20-62%); rat single injection (0.3 ml, day 2, 19-29%); rat double injection (2x0.3 ml, day 7, 28-47%); rabbit single injection (3 ml, day 3, 19-55%); rabbit double injection (not established, day 5, not established); dog double injection (2x4-5 ml, day 7, 45-66%); primate clot placement (5 ml, day 7, 32-52%).
Conclusions. Among the great number of experimental SAH methods and associated parameters only a fistful reliable and consistent models can be identified and recommended. Implementation of more standardized experimental techniques could increase the relevance of future experimental studies.
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DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract
BACKGROUND
Only a minority of intracranial aneurysms rupture to cause subarachnoid hemorrhage.
OBJECTIVE
To test the hypothesis that unruptured aneurysms have different characteristics and ...risk factor profiles compared to ruptured aneurysms.
METHODS
We recruited patients with unruptured aneurysms or aneurysmal subarachnoid hemorrhages at 22 UK hospitals between 2011 and 2014. Demographic, clinical, and imaging data were collected using standardized case report forms. We compared risk factors using multivariable logistic regression.
RESULTS
A total of 2334 patients (1729 with aneurysmal subarachnoid hemorrhage, 605 with unruptured aneurysms) were included (mean age 54.22 yr). In multivariable analyses, the following variables were independently associated with rupture status: black ethnicity (odds ratio OR 2.42; 95% confidence interval CI 1.29-4.56, compared to white) and aneurysm location (anterior cerebral artery/anterior communicating artery OR 3.21; 95% CI 2.34-4.40, posterior communicating artery OR 3.92; 95% CI 2.67-5.74, or posterior circulation OR 3.12; 95% CI 2.08-4.70, compared to middle cerebral artery). The following variables were inversely associated with rupture status: antihypertensive medication (OR 0.65; 95% CI 0.49-0.84), hypercholesterolemia (0.64 OR; 95% CI 0.48-0.85), aspirin use (OR 0.28; 95% CI 0.20-0.40), internal carotid artery location (OR 0.53; 95% CI 0.38-0.75), and aneurysm size (per mm increase; OR 0.76; 95% CI 0.69-0.84).
CONCLUSION
We show substantial differences in patient and aneurysm characteristics between ruptured and unruptured aneurysms. These findings support the hypothesis that different pathological mechanisms are involved in the formation of ruptured aneurysms and incidentally detected unruptured aneurysms. The potential protective effect of aspirin might justify randomized prevention trials in patients with unruptured aneurysms.
Purpose
Accurate glioma classification affects patient management and is challenging on non- or low-enhancing gliomas. This study investigated the clinical value of different chemical exchange ...saturation transfer (CEST) metrics for glioma classification and assessed the diagnostic effect of the presence of abundant fluid in glioma subpopulations.
Methods
Forty-five treatment-naïve glioma patients with known isocitrate dehydrogenase (IDH) mutation and 1p/19q codeletion status received CEST MRI (
B
1rms
= 2μT,
T
sat
= 3.5 s) at 3 T. Magnetization transfer ratio asymmetry and CEST metrics (amides: offset range 3–4 ppm, amines: 1.5–2.5 ppm, amide/amine ratio) were calculated with two models: ‘asymmetry-based’ (AB) and ‘fluid-suppressed’ (FS). The presence of T2/FLAIR mismatch was noted.
Results
IDH-wild type had higher amide/amine ratio than IDH-mutant_1p/19q
codel
(
p
< 0.022). Amide/amine ratio and amine levels differentiated IDH-wild type from IDH-mutant (
p
< 0.0045) and from IDH-mutant_1p/19q
ret
(
p
< 0.021). IDH-mutant_1p/19q
ret
had higher amides and amines than IDH-mutant_1p/19q
codel
(
p
< 0.035). IDH-mutant_1p/19q
ret
with AB/FS mismatch had higher amines than IDH-mutant_1p/19q
ret
without AB/FS mismatch ( < 0.016). In IDH-mutant_1p/19q
ret
, the presence of AB/FS mismatch was closely related to the presence of T2/FLAIR mismatch (
p
= 0.014).
Conclusions
CEST-derived biomarkers for amides, amines, and their ratio can help with histomolecular staging in gliomas without intense contrast enhancement. T2/FLAIR mismatch is reflected in the presence of AB/FS CEST mismatch. The AB/FS CEST mismatch identifies glioma subgroups that may have prognostic and clinical relevance.
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DOBA, EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, IZUM, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, SIK, UILJ, UKNU, UL, UM, UPUK, VKSCE, VSZLJ, ZAGLJ
Automatic segmentation of vestibular schwannomas (VS) from magnetic resonance imaging (MRI) could significantly improve clinical workflow and assist patient management. We have previously developed a ...novel artificial intelligence framework based on a 2.5D convolutional neural network achieving excellent results equivalent to those achieved by an independent human annotator. Here, we provide the first publicly-available annotated imaging dataset of VS by releasing the data and annotations used in our prior work. This collection contains a labelled dataset of 484 MR images collected on 242 consecutive patients with a VS undergoing Gamma Knife Stereotactic Radiosurgery at a single institution. Data includes all segmentations and contours used in treatment planning and details of the administered dose. Implementation of our automated segmentation algorithm uses MONAI, a freely-available open-source framework for deep learning in healthcare imaging. These data will facilitate the development and validation of automated segmentation frameworks for VS and may also be used to develop other multi-modal algorithmic models.
Free-hand insertion of an external ventricular drain (EVD) is a common emergency neurosurgical procedure, mostly performed for critically ill patients. Although EVD complications have been studied ...thoroughly, the accuracy of EVD positioning has been audited only occasionally.
Post-EVD insertion computed tomographic scans performed in our unit over a 2-year period were analyzed for EVD tip location and intracranial catheter length.
A total of 183 post-EVD insertion scans were reviewed. Of those, 73 EVD tips (39.9%) were in the ipsilateral frontal horn of the lateral ventricle (the desired target); of those, 18 (25%) required EVD revision/reinsertion. Of the others, 35 (19.1%) were in the third ventricle, 33 (18%) in the body of the lateral ventricle, 19 (10.4%) in the subarachnoid space, 5 (2.7%) in the contralateral frontal horn, and 18 (9.8%) within the brain parenchyma. When the EVD tip was outside the desired target, 44 of the patients (40%) required EVD revision/reinsertion procedure (P = 0.0383).
Free-hand insertion of an EVD is an inaccurate procedure, and further studies are required to assess the accuracy and feasibility of the routine use of neuronavigation, ultrasonography, or other guidance techniques and the possible implication of the decreasing revision rate, complications, and length of hospital stay.
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