Radiologic and Neurosurgical Diagnosis of Arterial Neurovascular Conflict on Magnetic Resonance Imaging for Trigeminal Neuralgia in Routine Clinical Practice.

Objective: The most common cause of trigeminal neuralgia is neurovascular conflict, particularly arterial compression of the trigeminal nerve (ACTN). It is possible to show this condition preoperatively on fine-cut constructive interference in steady state magnetic resonance imaging (MRI), supplemented by time-of-flight magnetic resonance angiography. We have noticed significant variability in the interpretation of these studies between radiologists and the treating neurosurgeon.

Automating Periodontal bone loss measurement via dental landmark localisation.

Purpose: Periodontitis is the sixth most prevalent disease worldwide and periodontal bone loss (PBL) detection is crucial for its early recognition and establishment of the correct diagnosis and prognosis. Current radiographic assessment by clinicians exhibits substantial interobserver variation. Computer-assisted radiographic assessment can calculate bone loss objectively and aid in early bone loss detection.

Congenital Appendiceal Diverticulum: An Incidental Finding During an Appendectomy.

Diverticula are small outpouchings that form at weak points in the wall of the digestive tract. They are commonly found in the colon, and while they can occur anywhere in the digestive tract, occurrence in the appendix is rare. Here, we report the case of a young woman presenting with complaints of right lower quadrant abdominal pain.

Intravenous milrinone for treatment of delayed cerebral ischaemia following subarachnoid haemorrhage: a pooled systematic review.

Small trials have demonstrated promising results utilising intravenous milrinone for the treatment of delayed cerebral ischaemia (DCI) after subarachnoid haemorrhage (SAH). Here we summarise and contextualise the literature and discuss the future directions of intravenous milrinone for DCI. A systematic, pooled analysis of literature was performed in accordance with the PRISMA statement.

Hyponatraemia and hypernatraemia: Disorders of Water Balance in Neurosurgery.

Disorders of tonicity, hyponatraemia and hypernatraemia, are common in neurosurgical patients. Tonicity is sensed by the circumventricular organs while the volume state is sensed by the kidney and peripheral baroreceptors; these two signals are integrated in the hypothalamus. Volume is maintained through the renin-angiotensin-aldosterone axis, while tonicity is defended by arginine vasopressin (antidiuretic hormone) and the thirst response.

Tension Pneumocephalus from Positive Pressure Ventilation Following Endoscopic Skull Base Surgery: Case Series and an Institutional Protocol for the Management of Postoperative Respiratory Distress.

Background: Tension pneumocephalus (TP) is a rare but feared complication of endoscopic endonasal skull base surgery. In contrast to simple pneumocephalus, which is common after endoscopic transnasal approaches and managed conservatively, TP represents a neurosurgical emergency and mandates urgent decompression.

Case Description: Here we present 2 cases of TP as a consequence of positive pressure ventilation following endoscopic endonasal skull base surgery.

Long-term follow-up for keystone design perforator island flap for closure of myelomeningocele.

Purpose: We have previously reported a small series on the closure of large myelomeningocele (MMC) defects with a keystone design perforator island flap (KDPIF) in a paediatric neurosurgical centre in Australia. We are now presenting an updated longer term follow-up of an expanded series demonstrating longer term durability of this vascularized flap for large myelomeningocele defects.

Methods: The prospective data from the Monash Neurosurgical Database were used to select all cases of MMC between December 2008 and September 2016.

Choice of valve type and poor ventricular catheter placement: Modifiable factors associated with ventriculoperitoneal shunt failure.

Ventriculoperitoneal (VP) shunt insertion is a common neurosurgical procedure, essentially unchanged in recent years, with high revision rates. We aimed to identify potentially modifiable associations with shunt failure. One hundred and forty patients who underwent insertion of a VP shunt from 2005-2009 were followed for 5-9years.

Subdural haematoma following infant spinal anaesthesia.

Introduction: Subdural haematoma (SDH) is rare following spinal anaesthesia and has not been reported previously in an infant. Non-accidental injury is the commonest cause of subdural haematoma in infants.

Methods: We describe two cases of SDH following spinal anaesthesia in infants.

Therapeutic potential of tranilast, an anti-allergy drug, in proliferative disorders.

Tranilast (N-[3,4-dimethoxycinnamoyl]-anthranilic acid; Rizaben®) is an anti-allergy drug approved for use in Japan and South Korea, also used against asthma, autoimmune diseases, and atopic and fibrotic pathologies. The antitumor potential of tranilast is attracting considerable interest. This review summarizes recent evidence concerning the effect of tranilast on different tumor types and discusses the drug's possible mode of action in this area.

Intravenous immunoglobulin for the treatment of Crohn's disease.

Crohn's disease (CD) is a debilitating condition which still requires improvement in its management. There is a need for alternatives to anti-tumour necrosis factor drugs which are costly and beneficial in less than 50% of patients. Intravenous immunoglobulin (IVIG) has been used in the management of aminosalicylate- and steroid-resistant CD for more than 20 years, although the published literature available is limited.

Therapeutic potential of the biscoclaurine alkaloid, cepharanthine, for a range of clinical conditions.

Cepharanthine (CEP) is a naturally occurring alkaloid extracted from the plant Stephania cepharantha Hayata. It has been widely used in Japan for more than 40 years to treat a wide variety of acute and chronic diseases. CEP inhibits tumor necrosis factor (TNF)-α-mediated NFκB stimulation, plasma membrane lipid peroxidation and platelet aggregation and suppresses cytokine production.

Keystone design perforator island flap for closure of myelomeningocele.

Object: We present a series of three infants who underwent keystone design perforator island flap (KDPIF) closure for myelomeningocele in a paediatric neurosurgical centre in Australia. This is the first recorded utilization of this flap for primary closure of myelomeningocele (MMC).

Methods: The prospective data from the Monash Neurosurgical Database were used to select all cases of MMC between December 2008 and September 2010.

Validation of blood testing for K-ras mutations in colorectal and pancreatic cancer.

K-ras mutation in a tumour is a powerful negative predictor for treatment success. Identifying tumour K-ras mutation is complex, and could be simplified by an appropriate blood test. Clinical studies were identified in which K-ras mutation status was assessed in both blood and tumour to ascertain whether blood K-ras mutation is predictive of tumour K-ras mutation.

Innovations in caring for a large burn in the Iraq war zone.

The authors report on a single case of a large, civilian burn cared for at a U.S. military hospital during Operation Iraqi Freedom.

Bilateral open thoracic cordotomy for refractory cancer pain: a neglected technique?

At least 10% of patients with cancer have pain that is refractory to systemic analgesics. For most of these patients, interventional techniques may be of benefit but are often not considered or are difficult to access. Of these techniques, spinal analgesia is most commonly used in Australia and the United Kingdom, and neurosurgical procedures, such as open cordotomy with sectioning of the spinothalamic tract, are rarely used.

Neurocysticercosis causing sudden death.

Neurocysticercosis causes significant morbidity due to neurologic manifestations including seizures. Sudden unexpected death in epilepsy (SUDEP) is responsible for mortality associated with seizure disorders. This case highlights death from neurocysticercosis and possible SUDEP in a nonendemic country.

Multiple spinal dural arteriovenous fistulae and deterioration post lumbar puncture.

We report a 73-year-old man presenting with bilateral leg numbness and weakness. Three spinal dural arteriovenous fistulae (SDAVF) were found after clinical deterioration post lumbar puncture (LP). This patient highlights the difficulties in the diagnosis and management of SDAVF, and the risks of LP.

Wound healing after craniotomy: a randomized trial comparing scalp clips to artery forceps for scalp hemostasis.

Object: In this prospective randomized clinical trial, investigators looked at wound healing after craniotomy. The hypothesis was that the self-closing plastic scalp clips used for hemostasis on the skin edge might lead to localized microscopic tissue damage and subsequent delayed wound healing.

Methods: The trial consisted of 2 arms in which different methods were used to secure scalp hemostasis: 1) the routinely used plastic clips (Scalpfix, Aesculap); and 2) the older method of artery forceps placed on the galea.

Massive Marjolin's ulcer in a burn graft site 46 years later.

Marjolin's ulcers, or malignancy originating from burn scars, have been recorded in the literature since the first century AD (Ozek et al. Marjolin's ulcers arising in burn scars. J Burn Care Rehabil 2001;22:384-9).

Efficacy of a pneumonia prevention protocol in the reduction of ventilator-associated pneumonia in trauma patients.

Background: We hypothesized that implementing evidence-based ventilator-associated pneumonia (VAP) prevention (VAPP) strategies would decrease the incidence of VAP, and that VAP affects patient outcomes.

Methods: A prospective study was performed with 331 consecutive ventilated trauma patients in a level one university teaching hospital. The VAPP protocol was modified to include elevation of the head of the bed more than 30 degrees , twice-daily chlorhexidine oral cleansing, a once-daily respiratory therapy-driven weaning attempt, and conversion from a nasogastric to an orogastric tube whenever possible.

Reduction in shunt infection using antibiotic impregnated CSF shunt catheters: an Australian prospective study.

Antibiotic impregnated shunt catheters have emerged as a promising tool against the continuing challenge of shunt infection. We present our prospective evaluation of the efficacy of antibiotic (rifampicin and clindamycin) impregnated cerebrospinal fluid (CSF) shunt catheters (AIC) in a mixed paediatric and adult Australian population. We have prospectively evaluated all the cerebrospinal fluid shunt procedures carried out in our institution over a 3-year period since July 2002, after the introduction of AIC in our practice.

Prospective analysis of nosocomial infection rates, antibiotic use, and patterns of resistance in a burn population.

Despite significant advances in burn care, infection remains a major cause of morbidity and mortality in burn patients. We sought to determine accurate infection rates, risk factors for infection, and the percentage of infections caused by resistant organisms. In addition, we attempted to identify interventions to decrease the use of antimicrobial drugs.