Publication productivity of neurosurgeons in Great Britain and Ireland.

Object: Bibliometrics are the methods used to quantitatively analyze scientific literature. In this study, bibliometrics were used to quantify the scientific output of neurosurgical departments throughout Great Britain and Ireland.

Methods: A list of neurosurgical departments was obtained from the Society of British Neurological Surgeons website.

An investigation into the clinical impacts of lowering shunt opening pressure in idiopathic normal pressure hydrocephalus: A case series.

Introduction: Idiopathic normal pressure hydrocephalus (iNPH) is a shunt- reversible syndrome of the elderly. Shunt management is aimed at achieving a balance between clinical improvement and the complications associated with overdrainage. Although clinical improvement occurs at low pressure, these benefits may be negated by the increase in complication rates observed at lower pressures.

Systematic review of the outcome of shunt surgery in idiopathic normal-pressure hydrocephalus.

Introduction: Early surgical series of shunt insertion for idiopathic normal-pressure hydrocephalus reported a low rate of short-term improvement with a relatively high rate of mortality and morbidity; subsequently shunt insertion was recommended for patients in whom there is favourable risk-to-benefit ratio.

Methods: Bibliographic search for studies that objectively assessed the outcome following shunt insertion in idiopathic normal-pressure hydrocephalus was done; the aim was to estimate the outcome of shunt insertion in terms of improvement rates and associated mortality and morbidity.

Results: A total of 64 studies of 3,063 patients were reviewed.

An unusual anatomic and geographic location of primary germinoma of the fourth ventricle.

Intracranial germinoma is most commonly found in the pineal and suprasellar regions. The medulla oblongata and fourth ventricle are rare sites of primary germinoma, with only 12 previous patients reported, all from the Far East. To our knowledge, we report the first patient from Europe.

Early single centre experience of flow diverting stents for the treatment of cerebral aneurysms.

Introduction: The flow diverting stent (FDS) is a relatively new endovascular therapeutic tool specifically designed to reconstruct the parent artery and divert blood flow along the normal anatomical course and away from the aneurysm neck and dome.

Methods: Retrospective review of prospectively built clinical and imaging database of patients treated with FDS at the National Hospital for Neurology and Neurosurgery, Queen Square, London, UK was done.

Results: Between 18/03/2008 and 10/11/2011, 80 patients underwent 84 FDS insertion procedures for various indications.

Early years neurosurgical training in the era of the European Working Time Directive.

The past decade has seen significant changes to the face of neurosurgical training in the United Kingdom, driven in part by an increasing focus on patient safety and the introduction of Modernising Medical Careers and the European Working Time Directive (EWTD). Recent reforms to neurosurgical training over the past few years have resulted in creation of an 8-year 'run-through' training programme. In this programme, early years (ST1 and ST2) trainees often lack dedicated time for elective theatre lists and outpatient clinics.

Cerebral venous system and anatomical predisposition to high-altitude headache.

Objective: As inspired oxygen availability falls with ascent to altitude, some individuals develop high-altitude headache (HAH). We postulated that HAH results when hypoxia-associated increases in cerebral blood flow occur in the context of restricted venous drainage, and is worsened when cerebral compliance is reduced. We explored this hypothesis in 3 studies.

Conservative versus surgical management of idiopathic normal pressure hydrocephalus: a prospective double-blind randomized controlled trial: study protocol.

There is no level I evidence to indicate whether placement of a shunt is effective in the management of idiopathic normal pressure hydrocephalus (INPH), because no trial has as yet compared the placement of a shunt versus no shunt in a randomized controlled manner. We started recruiting patients into a prospective double-blind randomized controlled study aiming to provide class I evidence supporting or refuting the role of surgical management in INPH. Inclusion criterion was the diagnosis of probable INPH plus objective improvement of walking speed following 72 h of extended lumbar drainage.

Secondary normal pressure hydrocephalus in a patient with isolated frontal dilatation--an insight into pathophysiology?

Current theories of the pathophysiology of normal pressure hydrocephalus suggest the classical symptoms are a consequence of disruption of normal frontal function. We present the case of a 70-year-old patient with an isolated, frontal dilatation of his lateral ventricles in the presence of a complete triad as supportive of these theories.

The prognostic value of brain extracellular fluid nitric oxide metabolites after traumatic brain injury.

Background: Nitric oxide (NO) is a compound with both protective and damaging effects on neurons. Quantification of NO metabolites in humans is limited by sample contamination with blood. In vivo cerebral microdialysis may offer an alternative approach as sampling of extracellular fluid (ECF) adjacent to neurons becomes possible.

Cognitive, biochemical, and imaging profile of patients suffering from idiopathic normal pressure hydrocephalus.

Introduction: It has still not been clearly established whether the cognitive deficits of idiopathic normal pressure hydrocephalus (iNPH) are caused by a disturbance in cerebrospinal fluid (CSF) dynamics or an underlying metabolic disturbance.

Objective: To identify the possible associations between biochemical markers, the neuroimaging characteristics, and cognitive deficits of patients undergoing investigations for possible iNPH.

Methods: A CSF sample obtained during a lumbar puncture from 10 patients with iNPH was analyzed for several biochemical markers (lactate, 8-isoprostane, vascular endothelial growth factor [VEGF], neurofilament heavy protein, glial fibrillary acidic protein, amyloid beta 1-42, and total tau).

Natural history of idiopathic normal-pressure hydrocephalus.

Natural history of idiopathic normal-pressure hydrocephalus (INPH) is not clear. We performed a literature search for studies that looked into the outcome of unshunted INPH patients trying to answer the following questions: Do all INPH patients deteriorate without shunt? If yes, at what rate? Do some NPH patients improve without shunt? If yes, to what extent? Six studies objectively described the outcome of 102 INPH patients. Result shows that without surgery, most INPH patients had measurable deterioration as early as 3 months following initial assessment.

Use of cerebrospinal fluid amyloid-β and total tau protein to predict favorable surgical outcomes in patients with idiopathic normal pressure hydrocephalus.

Object: The prognostic value of CSF biomarkers in patients with idiopathic normal pressure hydrocephalus (iNPH) has not been adequately studied to date. The aim of this study was to identify CSF markers of favorable surgical outcome in patients with iNPH undergoing the insertion of a ventriculoperitoneal shunt.

Methods: Ventricular CSF was collected intraoperatively from 22 patients with iNPH and enzyme-linked immunosorbent assay was used to analyze the levels of amyloid-β 1-42 (Aβ(1-42)) and total tau protein.

Is there a difference in outcomes of patients with idiopathic intracranial hypertension with the choice of cerebrospinal fluid diversion site: a single centre experience.

Unlabelled: The visual and headache outcomes in patients with idiopathic intracranial hypertension (IIH) undergoing cerebrospinal fluid diversion with a lumboperitoneal (LPS) or ventriculoperitoneal shunting (VPS) have not been well reported. The aims of this study were to: (a) to assess outcomes of CSF diversion in IIH, (b) to understand influence of the type of shunt in outcomes, and (c) to understand factors predisposing in shunt failure.

Methods: The medical records of 34 patients who underwent cerebrospinal fluid diversion (CSFD) between 1996 and 2007 were retrieved and epidemiological and clinical data was collected.

Use of the proGAV shunt valve in normal-pressure hydrocephalus.

Background: Overdrainage is a common complication associated with shunt insertion in normal-pressure hydrocephalus (NPH) patients. Using adjustable valves with antigravity devices has been shown to reduce its incidence. The optimal starting setting of an adjustable shunt valve in NPH is debatable.

Evans' index revisited: the need for an alternative in normal pressure hydrocephalus.

Background: The international guidelines for the diagnosis of normal pressure hydrocephalus (NPH) define ventricular enlargement as Evans' index greater than 0.3.

Objective: To establish whether there is a correlation between Evans' index and ventricular volume (VV) in NPH and whether choosing different planes for the measurements could produce significantly different results.

Rostrocaudal dynamics of CSF biomarkers.

The rostrocaudal gradient (RCG) of markers present in cerebrospinal fluid (CSF) has not been studied adequately due to lack of appropriate control populations and ethical restrictions. The aim of this study is to understand the rostrocaudal gradient of CSF biomarkers. We contacted a study comparing CSF levels of seven biomarkers from cisternal (rostral) and lumbar (caudal) CSF obtained from patients with trigeminal neuralgia and tension-type headache.

Investigating shunt function using continuous intracranial pressure monitoring in adults: single center experience.

Object: Managing symptomatic ventriculoperitoneal shunts with no clear evidence of shunt malfunction either clinically or radiologically can be a difficult task. The aim of this study was to assess intracranial pressure (ICP) monitoring as a method of investigating shunt function.

Methods: The authors performed a retrospective analysis of 38 continuous ICP monitoring procedures done in patients with ventriculoperitoneal shunts and suspected shunt malfunction.

Working towards patient oriented outcome assessment in normal pressure hydrocephalus, what is the most important?

Objective: To date, there is no standard outcome assessment scale for shunt treatment in normal pressure hydrocephalus (NPH). In designing such scale, the relative weight of each of the common presentations of the condition from the patient's or his/her carer's point of view should be taken into consideration.

Methods: A questionnaire was sent to 24 patients treated for NPH and their family/carer, assessing the patient and carer categorization of the preoperative main complaint, the weight they give to each of the common presentations of NPH and their satisfaction with treatment.

Standard intracranial in vivo animal models of delayed cerebral vasospasm.

Object: Animal models provide a basis for clarifying the complex pathogenesis of delayed cerebral vasospasm (DCVS) and for screening of potential therapeutic approaches. Arbitrary use of experimental parameters in current models can lead to results of uncertain relevance. The aim of this work was to identify and analyze the most consistent and feasible models and their parameters for each animal.

Use of lumboperitoneal shunts with the Strata NSC valve: a single-center experience.

Object: The lumboperitoneal (LP) shunt with the adjustable PS Medical Strata NSC LP valve and small lumen peritoneal catheter was introduced in the authors' unit in 2007. The object of this study was to audit the unit's experience with this new shunt system.

Methods: The authors performed a retrospective review of the clinical records of patients who underwent Strata NSC LP shunt insertion.

Continuous intracranial pressure monitoring in pseudotumour cerebri: Single centre experience.

Objective: Investigating pseudotumour cerebri (PTC) patients who do not fulfil the diagnostic criteria, or those presenting post-shunt insertion with recurrent symptoms and signs, with no clear evidence of shunt malfunction, present a diagnostic challenge. PTC patients who underwent continuous intracranial pressure (ICP) monitoring in our unit were reviewed retrospectively.

Results: Twenty-six ICP monitoring procedures were done on 20 patients.

The Effect of Observation versus Microsurgical Excision on Quality of Life in Unilateral Vestibular Schwannoma: A Prospective Study.

With the emergence of three effective management options for vestibular schwannoma and the drastic reduction in mortality rate, the last two decades have seen increasing attention being paid to health-related quality of life. The vast majority of quality of life studies have been retrospective. We prospectively assessed quality of life of vestibular schwannoma patients before and after conservative or microsurgical management.