Examining Introduction of E-consent in the Neurosurgical Caseload: Understanding the Barriers to Implementation.

Objective: To evaluate current usage and barriers of electronic consent (e-consent) implementation in neurosurgical practice. E-consent forms provide an alternative method for conducting the informed consent (IC) procedure. IC requires an ability to understand, retain, weigh up, and communicate decisions regarding the proposed procedure.

The volume-outcome relationship for endoscopic transsphenoidal pituitary surgery for benign neoplasm: analysis of an administrative dataset for England.

Background: Setting minimum annual volume thresholds for pituitary surgery in England is seen as one way of improving outcomes for patients and service efficiency. However, there are few recent studies from the UK on whether a volume-outcome effect exists, particularly in the era of endoscopic surgery. Such data are needed to allow evidence-based decision making.

The use of augmented reality in transsphenoidal surgery: A systematic review.

Background: Augmented reality (AR) has become a promising tool in neurosurgery. It can minimise the anatomical challenges faced by conventional endoscopic or microscopic transsphenoidal reoperations and can assist in intraoperative guidance, preoperative planning, and surgical training.

Objectives: The aims of this systematic review are to describe, compare, and evaluate the use of AR in endoscopic and microscopic transsphenoidal surgery, incorporating the latest primary research.

The expression of neural cell adhesion molecule and the microenvironment of pituitary neuroendocrine tumours.

The neural cell adhesion molecule (NCAM) has previously been studied in pituitary neuroendocrine tumours (PitNETs), but its role in tumour biology and aggressiveness remains controversial, and its relationship with the tumour microenvironment remains unknown. We aimed to characterise NCAM expression in PitNETs, to correlate this with clinico-pathological features, and to assess the role of various microenvironment components on NCAM expression. NCAM and immune cells were investigated by immunohistochemistry in 16 human non-functioning-PitNETs (NF-PitNETs) and eight somatotrophinomas, including macrophages (CD68, CD163, HLA-DR), cytotoxic (CD8) and T helper (CD4) lymphocytes, regulatory T cells (FOXP3), B cells (CD20), and neutrophils (neutrophil elastase).

Temporal trends in craniopharyngioma management and long-term endocrine outcomes: A multicentre cross-sectional study.

Background: The optimal management of craniopharyngiomas remains controversial.

Objectives: To examine temporal trends in the management of craniopharyngioma with a focus on endocrine outcomes.

Methods: This was a cross-sectional, multicentre study.

The role of the tumour microenvironment in the angiogenesis of pituitary tumours.

Purpose: Angiogenesis has been studied in pituitary neuroendocrine tumours (PitNETs), but the role of the tumour microenvironment (TME) in regulating PitNET angiogenesis remains unknown. We aimed to characterise the role of TME components in determining the angiogenetic PitNET profile, focusing on immune cells and tumour-derived cytokines.

Methods: Immune cells were studied by immunohistochemistry in 24 human PitNETs (16 non-functioning-PitNETs (NF-PitNETs) and 8 somatotrophinomas): macrophages (CD68, CD163, HLA-DR), cytotoxic (CD8) and T helper (CD4) lymphocytes, regulatory T cells (FOXP3), B cells (CD20) and neutrophils (neutrophil elastase); endothelial cells were assessed with CD31.

Neurosurgery specialty training in the UK: What you need to know to be shortlisted for an interview.

Neurosurgery is one of the most competitive specialties in the UK. In 2019, securing an ST1 post in neurosurgery corresponds to competition ration of 6.54 whereas a CST1 post 2.

A Case Series of Patients with Isolated IgG4-related Hypophysitis Treated with Rituximab.

Context: The acute presentation of immunoglobulin G4 (IgG4)-related hypophysitis can be indistinguishable from other forms of acute hypophysitis, and histology remains the diagnostic gold standard. The high recurrence rate necessitates long-term immunosuppressive therapy. Rituximab (RTX) has been shown to be effective in systemic IgG4-related disease (IgG4-RD), but experience with isolated pituitary involvement remains limited.

The evolution of an SBNS-accredited NANSIG simulated skills workshop for aspiring neurosurgical trainees: an analysis of qualitative and quantitative data.

Background: The Neurology and Neurosurgery Interest Group (NANSIG) neurosurgical skills workshop is novel in teaching neurosurgical skills solely to medical students and foundation trainees in the UK. The aim is to offer an affordable option for a high-fidelity simulation course enabling students to learn and practise specific neurosurgical skills in a safe, supervised environment.

Methods: A 10-delegate cohort was quantitatively assessed at the NANSIG neurosurgical skills workshop.

Chemokines modulate the tumour microenvironment in pituitary neuroendocrine tumours.

Non-tumoural cells within the tumour microenvironment (TME) influence tumour proliferation, invasiveness and angiogenesis. Little is known about TME in pituitary neuroendocrine tumours (PitNETs). We aimed to characterise the role of TME in the aggressive behaviour of PitNETs, focusing on immune cells and cytokines.

Pituitary tumour fibroblast-derived cytokines influence tumour aggressiveness.

Tumour-associated fibroblasts (TAFs) are key elements of the tumour microenvironment, but their role in pituitary neuroendocrine tumours (PitNETs) has been little explored. We hypothesised that TAF-derived cytokines may play a role in tumour aggressiveness and that their release can be inhibited by somatostatin analogues. TAFs were isolated and cultured from 16 PitNETs (11 clinically non-functioning tumours and 5 somatotropinomas).

Clinical and biochemical characteristics of patients presenting with pituitary apoplexy.

Purpose: To review the clinical and biochemical characteristics and clinical outcome of patients presenting with pituitary apoplexy to a tertiary centre.

Methods: We retrospectively reviewed the clinical features, predisposing factors, biochemistry and clinical outcome of patients presenting with pituitary apoplexy to Imperial College Healthcare NHS Trust between 1991 to 2015.

Results: We identified 64 patients with pituitary apoplexy (more complete clinical records were available in 52 patients).

A patient with a germline mutation presenting with an isolated pituitary macroprolactinoma.

Unlabelled: Symptomatic pituitary adenomas occur with a prevalence of approximately 0.1% in the general population. It is estimated that 5% of pituitary adenomas occur in a familial setting, either in isolated or syndromic form.

Obesity and posterior spinal fat content: impact on complications in non-complex lumbar spine surgery.

Aim: Obesity is increasing in prevalence across the world with a potentially very significant impact in spine surgery. This study aimed to characterise this in the setting of neurosurgical spine practise at a single centre in UK. Uniquely, we assess the contribution of posterior spinal fat content to intraoperative complications.

Clinical outcomes in patients with nonfunctioning pituitary adenomas managed conservatively.

Context: The natural history and the optimum management of patients with nonfunctioning pituitary adenomas (NFPAs) are unclear.

Objective: Our objective was to characterize the natural history of patients with NFPAs managed conservatively.

Design And Patients: We conducted a retrospective analysis of patients presenting to a tertiary referral centre between 1986 and 2009.

SSTR3 is a putative target for the medical treatment of gonadotroph adenomas of the pituitary.

Gonadotroph pituitary adenomas (GPAs) often present as invasive macroadenomas not amenable to complete surgical resection. Radiotherapy is the only post-operative option for patients with large invasive or recurrent lesions. No medical treatment is available for these patients.

Tumour resection volumes and facial nerve outcomes for vestibular schwannomas.

The objective of this study is to correlate tumour volume relationship with surgical outcomes in subtotal resections and accepted nomenclature through a retrospective study at Charing Cross Hospital, London, a tertiary referral centre. The participants were 16 patients with vestibular schwannoma managed with subtotal resection between 2002 and 2011. The main outcome measures were surgical technique; tumour volume; recurrence and post-operative facial nerve function.

Characterization of SNARE proteins in human pituitary adenomas: targeted secretion inhibitors as a new strategy for the treatment of acromegaly?

Context: Targeted secretion inhibitors (TSIs), a new class of recombinant biotherapeutic proteins engineered from botulinum toxin, represent a novel approach for treating diseases with excess secretion. They inhibit hormone secretion from targeted cell types through cleavage of SNARE (soluble N-ethylmaleimide-sensitive factor-activating protein receptor) proteins. qGHRH-LH(N)/D is a TSI targeting pituitary somatotroph through binding to the GHRH-receptor and cleavage of the vesicle-associated membrane protein (VAMP) family of SNARE proteins.

Spinal extradural solitary fibrous tumor with retiform and papillary features.

We report a 66-year-old man with a spinal, extradural solitary fibrous tumor showing unique retiform and papillary architecture. The patient presented in May 2008 with worsening right-sided lower back pain and urinary frequency. Magnetic resonance imaging of the spine documented a heterogeneously enhancing dumbbell-shaped extradural lesion causing cord compression at T11/12 level.

Evaluation of corticospinal excitability in cervical myelopathy, before and after surgery, with transcranial magnetic stimulation: a pilot study.

Purpose: A pilot study to examine the impact of cervical myelopathy on corticospinal excitability, using transcranial magnetic stimulation, and to investigate whether motor evoked potential (MEP) and silent period (SP) recruitment curve (RC) parameters can detect changes in corticospinal function pre- and post-surgery.

Methods: We studied six cervical myelopathy patients undergoing surgery and six healthy controls. Clinical and functional scores and neurophysiological parameters were examined prior to and 3 months following the surgery.