In-House Intraoperative Monitoring in Neurosurgery in England - Benefits and Challenges.

Background: Intraoperative neurophysiological monitoring (IOM) is a valuable adjunct for neurosurgical operative techniques, and has been shown to improve clinical outcomes in cranial and spinal surgery. It is not necessarily provided by NHS hospitals so may be outsourced to private companies, which are expensive and at cost to the NHS trusts. We discuss the benefits and challenges of developing an in-house service.

Patient selection and outcome of deep brain stimulation for multiple sclerosis-associated tremor.

Introduction: Tremor is a disabling symptom of multiple sclerosis (MS), with limited treatment modalities. Thalamic ventral-intermediate-nucleus (VIM) deep brain stimulation (DBS) is a method of neuromodulation. We describe the long-term outcomes of our carefully selected patients who underwent VIM DBS for their MS-associated tremor.

Delayed presentation of bamboo foreign body in brainstem, with novel skull base foramen.

We describe the extremely unusual case of a childhood injury to the skull base presenting after many years, as a foreign body with chronic granulomatous infection of the brainstem, mimicking neoplasm. TB had an inconsequential penetrating injury to the left cheek, from a bamboo spike aged 15. After 4 years, he developed worsening left sided weakness, imaging at this time was normal.

Neurogenic Cough Associated with Hyperintensity in Dorsal Medulla: Case Report and Anatomical Discussion.

Background: The nucleus tractus solitarius and paratrigeminal nucleus, which are implicated in the processing of airway-derived sensory information, are found in the dorsal medulla. The mechanism and localization of higher-order processing of urge to cough is poorly understood, and much of the existing anatomical localization is limited to animal studies.

Case Description: A 44-year-old Caucasian lady underwent elective foramen magnum decompression for symptomatic Chiari I malformation; postoperatively she had resolution of Chiari symptoms but developed an intractable neurogenic cough.

Percutaneous retrogasserian glycerol rhizotomy for trigeminal neuralgia: an alternative technique.

One of the challenges faced by the modern-day NHS is workplace shortages, and experienced radiographers for intra-operative neurosurgical imaging is one such scenario. We describe our method for Percutaneous Retrogasserian Glycerol Rhizotomy (PRGR) using frameless neuronavigation which can be used effectively in such scenarios. Stealth neuronavigation is used for needle placement within the foramen ovale and injection of glycerol, under sedation.