The utility of plasma circulating cell-free messenger RNA as a biomarker of glioma: a pilot study.

Background: Research into the potential utility of plasma-derived circulating cell-free nucleic acids as non-invasive adjuncts to radiological imaging have been occasioned by the invasive nature of brain tumour biopsy. The objective of this study was to determine whether significant differences exist in the plasma transcriptomic profile of glioma patients relative to differences in their tumour characteristics, and also whether any observed differences were representative of synchronously obtained glioma samples and TCGA glioma-derived RNA.

Methods: Blood samples were collected from twenty glioma patients prior to tumour resection.

Plasma circulating cell free messenger RNA as a potential biomarker of melanoma.

Background: Blood borne cell free nucleic acids are increasingly emerging as significant non-invasive adjuncts to current methods of disease status evaluation in cancer patients. In this study, we sought to examine whether significant differences exist in the plasma transcriptomic profile of advanced melanoma patients with a high disease burden compared to patients with a low disease burden or therapeutic response.

Methods: Pathway focussed gene expression analysis was performed using cDNA derived from the plasma circulating cell free messenger ribonucleic acid (ccfmRNA) samples of twenty-two patients with advanced melanoma.

Biopsychosocial variations in quality of life outcome following microdiscectomy.

Background: Lumbar microdiscectomy is one of the most frequently performed neurosurgical procedures. In this review, we ask why patients' outcomes vary so widely even within the same unit, with the same surgeon performing the procedure and utilizing the technique?

Methods: In a cohort of 87 patients, we investigated how/whether multiple patient variables impacted outcomes following single-level lumbar microdiscectomy. We studied whether early surgical intervention improved the patients' quality of life (QOL) versus late intervention.

Octreotide use for rescue of vision in a pregnant patient with acromegaly.

Pregnancy in acromegaly is rare and generally safe, but tumour expansion may occur. Managing tumour expansion during pregnancy is complex, due to the potential complications of surgery and side effects of anti-tumoural medication. A 32-year-old woman was diagnosed with acromegaly at 11-week gestation.

Intra-operative imaging for spinal level localisation in lumbar surgery.

Retrospective review of the practice of 3 surgeons in a single centre during a 1-year period. We aimed to investigate our adherence to the Society of British Neurological Surgeons (SBNS) guidelines regarding intra-operative imaging during lumbar surgery and to determine if this has any impact on length of surgery or complications rates, in particular rates of wrong-level surgery. The SBNS recommends three x-rays for intra-operative spinal localisation - one prior to incision, the second after exposure of the laminae and before the commencement of decompression, and the third at the end of the operation to confirm the adequacy of decompression.

Spontaneous Fractures in the Setting of Extensive Craniocervical Pneumatization: Case Report and Literature Review.

Background: Cranial pneumatization in humans is normally confined to the paranasal sinuses and the petrous and mastoid parts of the temporal bones.

Case Description: We present a case of left-sided fractures of the occipital condyle and lateral mass of the atlas in the setting of extensive craniocervical pneumatization but in the absence of trauma, with a resulting unilateral hypoglossal nerve palsy.

Conclusions: We discussed the possible etiology of this rare disease, its management, and prognosis.

Hemilaminectomy for large spinal extradural meningeal cysts: A case report and review of surgical techniques.

Spinal extradural meningeal cysts (SEMC) are uncommon causes of back pain. The literature contains only case reports of this pathology, and treatment remains controversial due to its rarity. We present a case of SEMC and describe an approach via hemilaminectomy, with the choice of side guided by radiological imaging, followed by complete excision of the cyst and repair of the underlying dural defect.

Interdural Spinal Cyst: A Rare Clinical Entity.

Background: For more than 2 decades, dural spinal cysts have been broadly classified as extradural and intradural.

Case Description: A 40-year-old woman presented with radicular thoracic pain. Intraoperative findings showed the cyst to be present within the dura itself.

Extradural haematoma--to evacuate or not? Revisiting treatment guidelines.

Background: We describe three cases of extradural haematomas (EDHs) and their management, focusing on operative and non-operative treatment. We also review the available literature from the past three decades as well as the guidelines for the management of EDH. An algorithm is formulated based on different factors, including the clinical course of the patients and their CT findings.

Are we justified in doing blood tests 'routinely' for all neurosurgical patients?

To ensure continuing patient care in a cost effective and efficient manner and to determine the importance of routine pre-op bloods in patients undergoing spine surgery, a retrospective audit of 170 patients was carried out in the Neurosurgery Department at Cork University Hospital. There were 94 males and 76 females. No test had less than 87.

Brain dead or not? CT angiogram yielding false-negative result on brain death confirmation.

We describe a case of severe traumatic brain injury with multiple facial and skull fractures where CT angiogram (CTA) failed to yield a definite result of brain death as an ancillary test. A 28-year-old man was admitted following a road traffic accident with a Glasgow Coma Score (GCS) of 3/15 and fixed pupils. CT brain revealed uncal herniation and diffuse cerebral oedema with associated multiple facial and skull fractures.

Does surgical technique affect the incidence of spondylodiscitis post-lumbar microdiscectomy? A retrospective analysis of 3063 patients.

Study Design: Retrospective audit in a single center during a period of 7 years operated by 3 groups of surgeons after 3 different surgical techniques.

Objective: Our study aimed to determine whether surgical technique had any influence on the incidence of spondylodiscitis in patients undergoing lumbar microdiscectomy and to compare this with published rate of incidence of spondylodiscitis.

Summary Of Background Data: The incidence of spondylodiscitis post-lumbar microdiscectomy ranges from 0.

Dyskalaemia following diffuse axonal injury: case report and review of the literature.

Traumatic brain injury, and its management, commonly causes derangements in potassium balance. There are a number of recognised causative factors including head trauma, hypothermia and iatrogenic factors such as pharmacological agents and permissive cooling. We describe a case of a 19-year-old man with a severe traumatic brain injury.

A prospective randomised study to compare the utility and outcomes of subdural and subperiosteal drains for the treatment of chronic subdural haematoma.

Background: The usage of a drain following evacuation of a chronic subdural haematoma (CSDH) is known to reduce recurrence. In this study we aim to compare the clinical outcomes and recurrence rate of utilising two different types of drains (subperiosteal and subdural drain) following drainage of a CSDH.

Methods: Prospective randomised single-centre study analysing 50 patients who underwent CSDH treatment.

'Miracle baby': an outcome of multidisciplinary approach to neurotrauma in pregnancy.

Traumatic brain injury (TBI) warranting neurosurgical intervention in the pregnant population is a rarity. We describe a case of a 27-year-old woman who at 13 weeks of gestation presented with multiple traumas having been involved in a near fatal road traffic accident. Glasgow Coma Scale was 6/15.

Superior cerebellar aneurysm causing subarachnoid haemorrhage in a 17-year-old with alagille syndrome.

Alagille syndrome is a rare autosomal dominant condition characterised by mutation in Jagged1 gene. Intracranial aneurysms may be seen in this condition and may present as subarachnoid hemorrhage. We describe the first case of superior cerebellar aneurysm rupture causing WFNS grade 1 subarachnoid haemorrhage in a 17-year-old girl.

Proguanylin and prouroguanylin--assay evaluation and clinical analyte characterization.

Background: The biomarkers proguanylin and prouroguanylin are members of the natriuretic peptide family. The aim of this study was to evaluate two commercially available assays for proguanylin and prouroguanylin and to further characterize both analytes in terms of important clinical features.

Methods: We evaluated precision and linearity of the BioVendor human proguanylin and prouroguanylin ELISAs.

A neurosurgical presentation of patent foramen ovale with atrial septal aneurysm.

We describe a case of cerebral abscess in a 53-year-old lady with a background of congenital heart defect. She has an atrial septal defect with atrial septal aneurysm, which remained undiagnosed until this clinical presentation. She presented with a short history of right-sided hemiplaegia and neuroimaging revealed a heterogeneous lesion in the left frontoparietal region.

Sciatica as a presenting feature of thyroid follicular adenocarcinoma in a 79-year-old woman.

The authors describe an unusual case of metastatic thyroid follicular adenocarcinoma presenting with sciatica in a 79-year-old woman. The primary thyroid tumour was undiagnosed until this clinical presentation. The patient gave a short history of back pain and right-sided sciatica, which was progressive and nocturnal in nature.

Osteogenesis imperfecta presenting as aneurysmal subarachnoid haemorrhage in a 53-year-old man.

The authors describe a case of aneurysmal subarachnoid haemorrhage in a 53-year-old man with background of osteogenesis imperfecta (OI). CT brain revealed diffuse subarachnoid haemorrhage (SAH) and cerebral angiogram subsequently confirmed vertebral artery aneurysm rupture leading to SAH. To the authors knowledge this is the first case of vertebral artery aneurysmal SAH described in OI.

Prognostic value of established and novel biomarkers in patients with shortness of breath attending an emergency department.

Objectives: Acute dyspnea is a common cause for emergency department visits. The aim of this study was to evaluate the prognostic value of established and novel biomarkers in patients with acute dyspnea.

Design And Methods: We measured 10 biomarkers [B-type natriuretic peptide (BNP), midregional pro-A-type natriuretic peptide (MR-proANP), midregional-proadrenomedullin (MR-proADM), copeptin, C-terminal endothelin-1 precursor fragment (CT-proET-1), soluble ST2 (sST2), chromogranin A (CgA), adiponectin, proguanylin, and prouroguanylin] in 251 consecutive patients with acute dyspnea presenting to the emergency department of a tertiary care hospital.

Extraskeletal myxoid chondrosarcoma of the cerebellopontine angle presenting during pregnancy.

Extraskeletal myxoid chondrosarcoma (EMC) is a rare soft-tissue sarcoma, which usually occurs in the lower extremities. It is often associated with chromosomal translocations. The clinical, radiological and pathological findings in extraskeletal myxoid chondrosarcoma, with an origin in the cerebellopontine angle, are described along with the issues associated with management of this tumour presenting acutely in a 26-year-old woman who was 20 weeks pregnant.

Dural AVM supplied by the ophthalmic artery.

Dural arteriovenous malformations in the anterior cranial fossa are rare and are especially prone to haemorrhage. These lesions are usually treated by surgical excision. We report the embolization of an anterior cranial fossa DAVM using an endovascular approach via the ophthalmic artery.

Use of a simple intraoperative hydrostatic pressure test to assess the relationship between mobility of the ventricular stoma and success of third ventriculostomy.

Object: Neuroendoscopists often note pulsatility or flabbiness of the floor of the third ventricle during endoscopic third ventriculostomy (ETV) and believe that either is a good indication of the procedure's success. Note, however, that this belief has never been objectively measured or proven in a prospective study. The authors report on a simple test-the hydrostatic test-to assess the mobility of the floor of the third ventricle and confirm adequate ventricular flow.

Pseudoaneurysm of the occipital artery: an unusual cause of persisting headache after minor head injury.

Post-traumatic pseudoaneurysms of the extracranial arteries in the scalp are uncommon sequelae of head injury. We report on a patient who presented four weeks after a minor head injury with a tender, pulsating and enlarging mass in the course of the left occipital artery. There was associated headache radiating to the vertex.