A Coexisting Adjacent Intradural and Extradural Spinal Cavernoma: A Rare Case.

A 34-year-old female patient, with no comorbidities, presented with complaints of upper back pain across the shoulders, with altered sensation on the left side from trunk to lower limb, which was associated with reduced motor function and an acute symptom of urinary retention. On examination, there was reduced power in the left lower limb, reduced anal tone, a positive Babinski sign bilaterally, and reduced sensation in the perianal region. Serial magnetic resonance imaging (MRI) scans were conducted, where initially an upper thoracic lesion suggestive of an intramedullary cavernoma was found, and nearly a decade later, an adjacent extradural lesion causing cord compression was found incidentally through a surgical procedure.

Reducing Surgical Site Infections in Neurosurgery During the Intra-operative Phase: An Audit of National Institute for Health and Care Excellence (NICE) Guideline Adherence at a Major Trauma Centre.

Surgical site infections (SSIs) pose significant risks to patient safety and healthcare systems globally despite preventive measures. This study audits compliance with the National Institute for Health and Care Excellence (NICE) guidelines for SSI prevention during the intra-operative phase in the Neurosurgery Department at Salford Royal National Health Service (NHS) Foundation Trust. Conducted in two audit cycles from October 2022 to October 2023, the study assessed adherence to 19 key parameters aimed at minimising SSIs.

Informed consent in neurosurgery - Evaluation of current practice and implementation of future strategies.

Background: In recent times, clinical negligence claims against National Health Service hospitals have doubled, with 8% of claims being made due to "failure to warn/informed consent." This study aimed to assess the current compliance of the neurosurgical division within a large tertiary neuroscience center with the national legal framework and professional guidelines around the issue of surgical consent and to develop strategies to improve the consent process.

Methods: Electronic patient records (EPR) were accessed to collect demographic data and information regarding the surgical procedures.

Clinicosocial determinants of hospital stay following cervical decompression: A public healthcare perspective and machine learning model.

Objective: Post-operative length of hospital stay (LOS) is a valuable measure for monitoring quality of care provision, patient recovery, and guiding hospital resource management. But the impact of patient ethnicity, socio-economic deprivation as measured by the indices of multiple deprivation (IMD), and pre-existing health conditions on LOS post-anterior cervical decompression and fusion (ACDF) is under-researched in public healthcare settings.

Methods: From 2013 to 2023, a retrospective study at a single center reviewed all ACDF procedures.

Natural language processing for the automated detection of intra-operative elements in lumbar spine surgery.

Background: The aim of this study was to develop natural language processing (NLP) algorithms to conduct automated identification of incidental durotomy, wound drains, and the use of sutures or skin clips for wound closure, in free text operative notes of patients following lumbar surgery.

Methods: A single-centre retrospective case series analysis was conducted between January 2015 and June 2022, analysing operative notes of patients aged >18 years who underwent a primary lumbar discectomy and/or decompression at any lumbar level. Extreme gradient-boosting NLP algorithms were developed and assessed on five performance metrics: accuracy, area under receiver-operating curve (AUC), positive predictive value (PPV), specificity, and Brier score.

Temporal trends in neurosurgical volume and length of stay in a public healthcare system: A decade in review with a focus on the COVID-19 pandemic.

Background: Over the past decade, neurosurgical interventions have experienced changes in operative frequency and postoperative length of stay (LOS), with the recent COVID-19 pandemic significantly impacting these metrics. Evaluating these trends in a tertiary National Health Service center provides insights into the impact of surgical practices and health policy on LOS and is essential for optimizing healthcare management decisions.

Methods: This was a single tertiary center retrospective case series analysis of neurosurgical procedures from 2012 to 2022.

Determining the risk of spinal pathology progression in neurofibromatosis type 1 patients - a national tertiary neurofibromatosis type 1 centre study.

Background: Neurofibromatosis type 1 (NF1) gives rise to a variety of spinal pathologies that include dural ectasia (DE), vertebral malalignments (VMA), spinal deformities (SD), syrinx, meningoceles, spinal nerve root tumours (SNRT), and spinal plexiform tumours (SPT). The relationship between these and the progression of these pathologies has not been explored before in detail and this paper aims to address this.

Methods: Data was retrospectively collected from adult NF1 multi-disciplinary team meetings from 2016 to 2022 involving a total of 593 patients with 20 distinct predictor variables.

Predicting neurosurgical referral outcomes in patients with chronic subdural hematomas using machine learning algorithms - A multi-center feasibility study.

Background: Chronic subdural hematoma (CSDH) incidence and referral rates to neurosurgery are increasing. Accurate and automated evidence-based referral decision-support tools that can triage referrals are required. Our objective was to explore the feasibility of machine learning (ML) algorithms in predicting the outcome of a CSDH referral made to neurosurgery and to examine their reliability on external validation.

A postoperative complication of lumbar discectomy: A discal/annular cyst.

Background: A postoperative discal/annular cyst following lumbar discectomy may reproduce the symptoms/signs of a recurrent lumbar disc herniation (i.e., back pain and radiculopathy).

Wrong site spine surgery in the U.K.: a review of current practice.

Wrong site spine surgery is a rare but serious complication. The scale of the problem in the U.K.

Development and Validation of the Chronic Subdural HematOma Referral oUtcome Prediction Using Statistics (CHORUS) Score: A Retrospective Study at a National Tertiary Center.

Background: Chronic subdural hematoma (CSDH) is a common neurosurgical condition with an increasing rate of patient referrals. CSDH referral decision-making is a subjective clinical process, and our aim was to develop a simple scoring system capable of acting as a decision support tool aiding referral triage.

Methods: A single tertiary center retrospective case series analysis of all CSDH patient referrals from 2015 to 2020 was conducted.

A Review of Spinal Lesions in Neurofibromatosis Type 1 in a Large Neurofibromatosis Type 1 Center.

Background: Spinal lesions are a known manifestation of neurofibromatosis type 1 (NF1). The aim of this retrospective review was to analyze and report the prevalence of spinal lesions on imaging in a large NF1 center.

Methods: The data were collected from a period of 62 months from a cohort of 514 patients.

Outcomes and efficiency of managing patients admitted for surgery for spinal metastases.

Background: This study evaluated the current pathways for dealing with patients admitted for surgery to address spinal metastases.

Methods: In this retrospective analysis (2016-2021), the following variables were studied admission, demographics, length of stay, critical care admission, hospital costs, primary cancer, and average survival.

Results: There were 306 patients admitted from 2016 to 2021; 66 were planned admissions, 203 were emergency admissions, and 37 were day case admission.

A case of a giant thoracic schwannoma.

Background: Giant solitary schwannomas are rare, benign, and typically slow-growing tumors reaching up to 20 cm in size.

Case Description: A 43-year-old male presented with shortness of breath and chest pain. The thoracic MRI showed a giant mass 15 cm in diameter filling the left chest cavity.

The Fate of Nonoperative Management in Patients with Lytic Spondylolisthesis.

Background:  There is a lack of consensus within the current literature about the role of nonoperative management in lytic spondylolisthesis. Our objective was to assess the fate that nonoperative management plays in patients diagnosed with lytic spondylolisthesis.

Methods:  Data were collected between May 2015 and February 2020 from 41 patients who were initially referred specifically for instrumented lumbar fixation but were instead planned for nonoperative management as they opted to avoid surgery.

Recommencement of anticoagulation/antiplatelet therapy following non-operative management of a Chronic Subdural Hematoma - Is there an optimal time frame?

Background: There is no consensus among clinicians regarding recommencement of antithrombotic agents following conservative management of a Chronic Subdural Hematoma (cSDH). Thus, the primary objective of this study was to determine the most commonly recommended interval and whether the data reveal a general consensus that should be adopted.

Methods: A retrospective analysis of Salford Royal Foundation Trust's Neurosurgical referral database for patients referred with a cSDH between March 2017 and March 2020 was carried out.

Neurosurgery activity levels in the United Kingdom and republic of Ireland during the first wave of the covid-19 pandemic - a retrospective cross-sectional cohort study.

The impact of Covid-19 on surgical patients worldwide has been substantial. In the United Kingdom (UK) and the Republic of Ireland (RoI), the first wave of the pandemic occurred in March 2020. The aims of this study were to: (1) evaluate the volume of neurosurgical operative activity levels, Covid-19 infection rate and mortality rate in April 2020 with a retrospective cross-sectional cohort study conducted across 16 UK and RoI neurosurgical centres, and (2) compare patient outcomes in a single institution in April-June 2020 with a comparative cohort in 2019.

Giant posterior mediastinal schwannoma requiring a thoracoabdominal approach for excision: Case report and literature review.

Background: A schwannoma is a tumor of the peripheral nerve sheath. They are the most common benign tumor; presenting at any age, and at any site of the body and also one of the most common posterior mediastinal tumors. Posterior mediastinal schwannoma is usually identified incidentally in chest radiographs and with follow-up imaging such as CT scan.

Considerations in revising occipitocervical fixation for dysphagia.

Background: Dysphagia after occipitocervical fixation (OCF) is a complex phenomenon and revision surgery in this context involves difficult decision-making. The pathogenesis is explored and surgical strategies discussed. A surgical strategy that has not been described before in the management of this condition, is discussed with two illustrative cases.

Circumferential intradural meningioma of the thoracic spine: Case report and literature review.

Background: Meningiomas are common intradural extramedullary spinal tumors with a predilection for the thoracic spine. They are mostly benign (90%), with only a few showing malignant potential. However, circumferential intradural meningiomas surrounding the spinal cord are exceptionally rare.

Spinal cord compression from hypertrophic nerve roots in chronic inflammatory demyelinating polyradiculoneuropathy - A case report.

Background: Spinal cord compression secondary to nerve root hypertrophy is often attributed to hereditary neuropathies. However, to avoid misdiagnosis, rare immune-mediated neuropathy such as chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) should not be overlooked. This report presents a case of multilevel nerve root hypertrophy leading to significant cord compression from CIDP.

The impact of COVID-19 on neurosurgical head trauma referrals and admission at a tertiary neurosurgical centre.

Background: COVID-19 has greatly impacted surgical specialities throughout the globe leading to a decrease in hospital admissions and referrals. Neurosurgery has seen a great decline in cases including head trauma leading to a negative impact on the development of neurosurgical trainees. The main objective of this study is to the identify changes in neurosurgical referrals, admissions and management during the COVID-19 pandemic.

Spinal cord herniation following multilevel anterior cervical discectomy and fusion: A case report and literature review.

Background: Anterior cervical discectomy and fusion (ACDF) is one of the most commonly performed spinal operations. Spinal cord herniation following these procedures is rare, more typically being described as occurring posteriorly rather than following anterior corpectomy and fusion (e.g.