Outcomes following poor-grade aneurysmal subarachnoid haemorrhage: a prospective observational study.

Background: Up to 35% of aneurysmal subarachnoid haemorrhage (aSAH) cases may present as poor grade, defined as World Federation of Neurosurgical Societies (WFNS) grades IV and V. In this study, we evaluate functional outcomes and prognostic factors.

Methods: This prospective study included all patients referred to a national, centralized neurosurgical service with a diagnosis of poor-grade aSAH between 01/01/2016 and 31/12/2019.

Multidisciplinary Management of Lateral Skull Base Paragangliomas: A 20-Year Experience.

 Paragangliomas of the lateral skull base are rare, largely benign, neuroendocrine tumors. Little evidence exists to support clinicians in the management of these tumors. The present study evaluates considerations in the multidisciplinary workup and management of paragangliomas affecting the lateral skull base.

The weekend effect in aneurysmal subarachnoid haemorrhage: a single centre experience and review.

Clinical outcomes for patients admitted to hospital during weekend hours have been reported to be poorer than for those admitted during the week. Aneurysmal subarachnoid haemorrhage (aSAH) is a devastating form of haemorrhagic stroke, with a mortality rate greater than 30%. A number of studies have reported higher mortality for patients with aSAH who are admitted during weekend hours.

Timing of treatment of aneurysmal subarachnoid haemorrhage: are the goals set in international guidelines achievable?

Background And Aims: International guidelines emphasise the importance of securing ruptured cerebral aneurysms within 48-72 h of ictus. We assessed the timing of treatment of patients with aneurysmal subarachnoid haemorrhage (aSAH) referred to a national neurosurgical centre.

Materials And Methods: Analysis of a prospective database of patients with aSAH admitted between 1st of February 2016 and 29th of February 2020 was performed.

Management of Temporal Bone Malignancy in Ireland.

 Lateral temporal bone malignancy remains a challenging rare disease. We report 17 years of multidisciplinary care of these tumors with univariate and multivariate analyses of key prognostic indicators for consideration in contemporary oncological management.  This is a retrospective cohort study.

The role of a virtual telephone clinic in the follow-up management of lateral skull base tumours.

Objective: The purpose of this article was to determine the impact of employing a telephone clinic for follow-up of patients with stable lateral skull-base tumours.

Method: An analysis of 1515 patients in the national lateral skull-base service was performed, and 148 patients enrolled in the telephone clinic to date were identified. The length of time that patients waited for results of their follow-up scans and the travel distance saved by patients not having to attend the hospital for their results was determined.

Metastasis of papillary thyroid carcinoma to the thoracic spine.

Introduction: Papillary thyroid carcinoma (PTC) is the most common form of well-differentiated thyroid carcinoma. Despite its well-differentiated microscopic features, PTC may be minimally or overtly invasive. We present the case of a patient in whom thoracic spinal cord compression was the first presentation of metastatic PTC.

The shrinking vestibular schwannoma.

We present a case of spontaneous 79% regression in the size of a vestibular schwannoma (VS). A 41-year-old lady with a large (36 mm) vestibular schwannoma underwent serial follow-up MRI scans which demonstrated the shrinkage over 9 years; the highest relative spontaneous regression recorded in the literature for vestibular schwannoma of this size.

Signs and Symptoms of Acoustic Neuroma at Initial Presentation: An Exploratory Analysis.

Introduction The objective of this study was to describe the most common clinical features associated with an acoustic neuroma diagnosis and to identify those features associated with larger tumour size at initial diagnosis. Methods The clinical information of 945 consecutive patients diagnosed with acoustic neuroma at a single centre between 1992 and 2015 was analysed. Clinical features were examined and the relationship between these features and tumour size (>2.

The Impact of Primary Treatment Strategy on the Quality of Life in Patients with Vestibular Schwannoma.

Objective: To assess the quality of life (QoL) in a representative sample of patients with vestibular schwannoma and to ascertain the differences in outcomes associated with distinct management strategies.

Patients And Methods: Patients with vestibular schwannoma attending a tertiary referral center were asked to complete the Functional Assessment of Chronic Illness Therapy-Brain Questionnaire, which assesses QoL in 5 domains: physical, social, emotional and functional, and a brain cancer-specific domain. Results were analyzed in the overall cohort and in surgery, stereotactic radiosurgery, and conservative management subgroups.

Delayed recovery of adipsic diabetes insipidus (ADI) caused by elective clipping of anterior communicating artery and left middle cerebral artery aneurysms.

Adipsic diabetes insipidus (ADI) is an extremely rare complication following microsurgical clipping of anterior communicating artery aneurysm (ACoA) and left middle cerebral artery (MCA) aneurysm. It poses a significant challenge to manage due to an absent thirst response and the co-existence of cognitive impairment in our patient. Recovery from adipsic DI has hitherto been reported only once.

Brain Arteriovenous Malformation Recurrence-Recanalization or Rebirth?

Background: Bleeding secondary to recurrences of spontaneously obliterated arteriovenous malformations (AVMs) is an extremely rare occurrence.

Case Description: We report a 25-year-old man with cerebellar hemorrhage secondary to a recurrent AVM. His current admission with bleeding from a ruptured cerebellar AVM followed a previous presentation 15 years earlier with the similar clinical picture of AVM rupture within the same vascular territory.

Symptoms of gonadal dysfunction are more predictive of hypopituitarism than nonspecific symptoms in screening for pituitary dysfunction following moderate or severe traumatic brain injury.

Objective: The economic and logistic burden of screening for hypopituitarism following moderate/severe traumatic brain injury (TBI) is considerable. A key recommendation in published guidelines is to prioritize for screening those patients with symptoms suggestive of pituitary dysfunction. The purpose of this study was to evaluate the utility of targeted screening for hypopituitarism in long-term survivors after moderate/severe TBI using referrals on the basis of symptoms.

Stereotactic-Guided Evacuation of Spontaneous Supratentorial Intracerebral Hemorrhage: Systematic Review and Meta-Analysis.

Background: Spontaneous intracerebral hemorrhage (SICH) has a high morbidity and mortality and places a huge significant economic burden on health care and social services. The role of surgery is still controversial as evidenced by wide variation internationally in management of SICH. Traditional surgery for SICH involved open craniotomy with hematoma evacuation.

Foramen magnum decompression for Chiari I malformation: a procedure not to be underestimated.

Objective: Chiari I malformation may be treated with foramen magnum decompression (FMD). We aim to describe the symptoms with which patients initially present, and to determine the number and type of complications occurring after FMD for Chiari I malformation.

Methods: Retrospective review of medical records for patients who had FMD performed for Chiari I malformation between January 2009 and December 2011.

Acute glucocorticoid deficiency and diabetes insipidus are common after acute traumatic brain injury and predict mortality.

Context: Published data demonstrates that hypopituitarism is common after traumatic brain injury (TBI). Hormone deficiencies are transient in many, but the natural history of the acute changes after TBI has not been documented. In addition, it is not clear whether there are any early parameters that accurately predict the development of permanent hypopituitarism.

Loss-of-function mutations in SMARCE1 cause an inherited disorder of multiple spinal meningiomas.

One-third of all primary central nervous system tumors in adults are meningiomas. Rarely, meningiomas occur at multiple sites, usually occurring in individuals with type 2 neurofibromatosis (NF2). We sequenced the exomes of three unrelated individuals with familial multiple spinal meningiomas without NF2 mutations.

Invasive intracerebral fungal infection in a leukaemic patient.

Intracerebral abscesses secondary to Zygomycosis are potentially fatal. A 12-year-old girl with acute promyelocytic leukaemia was successfully treated for intracerebral abscess caused by Zygomycosis with complete surgical excision and combination antifungal therapy.

Idiopathic intracranial hypertension: lumboperitoneal shunts versus ventriculoperitoneal shunts--case series and literature review.

Objectives: Idiopathic intracranial hypertension (IIH) is an uncommon but important cause of headache that can lead to visual loss. This study was undertaken to review our experience in the treatment of IIH by neuronavigation-assisted ventriculoperitoneal (VP) shunts with programmable valves as compared to lumboperitoneal (LP) shunts.

Methods: A retrospective chart review was conducted on 25 patients treated for IIH between 2001 and 2009.

Acromegaly associated with gangliocytoma.

Background: Acromegaly secondary to growth hormone-releasing hormone (GHRH) excess is rare.

Aims/case Description: We report two patients with acromegaly who were diagnosed with sellar gangliocytomas that were immunopositive for GHRH. Tumour tissue persisted after debulking surgery and in the second case this was associated with persistent growth hormone hypersecretion, successfully suppressed by a somatostatin analogue.

Incidence and pathophysiology of severe hyponatraemia in neurosurgical patients.

Background: Hyponatraemia is a well-recognised complication of neurosurgical conditions, but the incidence and implications have not been well documented.

Objective: To define the incidence, pathophysiology and clinical implications of significant hyponatraemia in several neurosurgical conditions.

Methods: All patients admitted to the Irish National Neurosciences Centre at Beaumont Hospital, Dublin with traumatic brain injury, subarachnoid haemorrhage, intracranial neoplasm, pituitary disorders and spinal disorders who developed significant hyponatraemia (plasma sodium <130 mmol/l) from January 2002 to September 2003 were identified from computerised laboratory records.

Hypophysitis secondary to ruptured Rathke's cyst mimicking neurosarcoidosis.

Hypophysitis secondary to a ruptured Rathke's cyst is rare. We describe a 53-year-old female who presented with headache and subsequently developed aseptic meningitis and panhypopituitarism. MRI findings and concomitant cardiac arrhythmia and peripheral vasculitis led to a provisional diagnosis of neurosarcoidosis.