The evolution of an SBNS-accredited NANSIG simulated skills workshop for aspiring neurosurgical trainees: an analysis of qualitative and quantitative data.

Background: The Neurology and Neurosurgery Interest Group (NANSIG) neurosurgical skills workshop is novel in teaching neurosurgical skills solely to medical students and foundation trainees in the UK. The aim is to offer an affordable option for a high-fidelity simulation course enabling students to learn and practise specific neurosurgical skills in a safe, supervised environment.

Methods: A 10-delegate cohort was quantitatively assessed at the NANSIG neurosurgical skills workshop.

Trigeminal schwannoma presenting as a gelastic seizure: no laughing matter.

We present the case of a 66 year old gentleman with trigeminal schwannoma whose only presenting feature was a single gelastic seizure. This is the first case report of pathological laughter in trigeminal schwannoma in the absence of other trigeminal, brainstem, cerebellar or other cranial nerve dysfunction.

Launching an SBNS-accredited neurosurgical skills workshop for medical students and foundation trainees.

The Neurology and Neurosurgery Interest Group (NANSIG), the student arm of the Society of British Neurological Surgeons (SBNS), organised a neurosurgical skills workshop in January 2017 following evidence of high demand among medical students and foundation trainees. The workshop involved ten delegates and five neurosurgical trainees with one senior consultant. Modules covering head positioning, burr holes, ventricular access, and flaps were included.

Intra-operative combustion of Onyx embolic material.

We report a case of dangerous combustion of Tantalum/Onyx embolic agent when exposed to mono-polar diathermy during subsequent surgical resection of a partially embolised arteriovenous malformation. Surgeons should be aware that previous embolisation of a vascular malformation may make use of diathermy problematic if subsequent surgical management is required.

Supraorbital eyebrow minicraniotomy for anterior circulation aneurysms.

Background: We report our experience with the minimally invasive supraorbital approach to aneurysms of the ipsilateral anterior cerebral circulation.

Methods: A prospective review of all patients who underwent operations to clip aneurysms in Newcastle between 1993 and 2002.

Results: Fifty-six aneurysms were clipped via minicraniotomy in 47 patients.

Extradural spinal cord compression by rheumatoid nodule.

Rheumatoid disease is a systemic disorder affecting multiple organs. It is known to affect the nervous system in a variety of ways, but its presentation with spinal cord compression by a rheumatoid nodule is rare. We report two cases presenting with cord compression by a rheumatoid nodule who underwent surgical decompression with good recovery.

Neurosurgery in Victoria, Australia: training and practice compared with the United Kingdom.

In the UK there are currently great changes taking place in both higher surgical training and consultant practice. Australia inherited the British system, many aspects of which it retains, but has moved to a US type training programme. Recent experience of British and Australian neurosurgical practice allows useful comparisons to be made with possible benefit to both.

Anterior temporal abnormality in temporal lobe epilepsy: a quantitative MRI and histopathologic study.

Objective: To examine the nature and frequency of anterior temporal lobe (AT) abnormalities that occur in intractable temporal lobe epilepsy (TLE).

Methods: We reviewed the MR scans and clinical histories of 50 consecutive patients with intractable TLE. Histopathology was available in 42 surgically treated cases.

Transmural migration of an intracavernous carotid detachable balloon used to control surgically induced haemorrhage.

We report a case in which a balloon detached in the carotid siphon for control of iatrogenic bleeding migrated to the oesophagus. We discuss the pathophysiology.

A new instrument for improved accuracy of stereotactic depth electrode placement. Technical note.

A disadvantage of stereotactic placement of flexible depth electrodes is the risk of inaccurate positioning as a result of electrode movement when the introducer is withdrawn. A simple device that virtually eliminates this error is described.

A case of asymptomatic passage per-rectum of a fractured redundant peritoneal catheter from a ventriculo-peritoneal shunt.

Over 30 cases of perforation of the bowel have been described by intact peritoneal catheters of ventriculo-peritoneal and some lumbo-peritoneal shunts. Because of this risk it is advocated that redundant or free fractured or disconnected peritoneal catheters should if possible be removed from the abdomen; although we could find no reports of morbidity from such free fragments. We describe a case of extrusion per-rectum of a redundant fractured peritoneal catheter which it had not been possible to retrieve after a revision procedure.

Immunoreactivity, pharmacokinetics and bone marrow dosimetry of intrathecal radioimmunoconjugates.

Ten patients with neoplastic meningitis were treated with a variety of 131I-monoclonal antibody (MAb) conjugates, chosen to bind to their particular malignancy. Pharmacokinetic studies revealed that MAbs leave the ventricular compartment, enter the sub-arachnoid space and then pass into the blood. Once the MAbs enter the blood compartment, their clearance is determined by factors such as circulating anti-mouse Ig and circulating antigens.

New instrumentation for the assembly of shunt systems by a non-touch technique.

In modern neurosurgery there are many types of ventricular shunts, ventricular drains and access devices. These are composed of a variety of components which are best assembled and manipulated using a non-touch technique. A comprehensive and inexpensive set of instruments is described which is easy to sterilize and which will facilitate the easy manipulation and assembly of a wide range of these devices by a true non-touch technique.

Carcinomatous meningitis: antibody-guided therapy with I-131 HMFG1.

Seven patients with carcinomatous meningitis were administered intrathecal I-131 labelled monoclonal antibody HMFG1. Clinical responses were seen in two patients, with a long term survivor at 32 months. Aseptic meningitis occurred in 4/7 patients, but more serious toxicity was observed in the form of seizures (2/7 patients) and myelosuppression (3/7 patients).

Cysto-peritoneal shunt infection with Trichosporon beigelii.

Infection is a frequent problem affecting cysto-peritoneal shunts, the usual causative organisms being Staphylococcus epidermidis and Staphylococcus aureus. Fungi are rarely isolated from such infections. We present the first report, as far as the authors are aware, of a case of Trichosporon beigelii shunt infection that responded to shunt removal and antifungal therapy.

A new technique of brachytherapy for malignant gliomas with caesium-137: a new method utilizing a remote afterloading system.

Failure of conventional treatment to cure malignant gliomas has stimulated interest in various forms of brachytherapy. We describe a new method of using intracranial radiation utilizing a remotely-controlled afterloading system with a modified endotracheal tube as the applicator. The system used is the Selectron LDM/MDR (Nucleotron) which is a sophisticated machine widely available at radiotherapy centres and primarily used to treat gynaecological malignancies.