The value of repeated lumbar puncture to test for xanthochromia, in patients with clinical suspicion of subarachnoid haemorrhage, with CT-negative and initial traumatic tap.

Objectives: For the diagnosis of subarachnoid haemorrhage (SAH), the presence of cerebrospinal fluid (CSF) xanthochromia is still considered the gold standard for patients with a thunderclap headache, in the absence of blood on brain CT scan. However, a traumatic lumbar puncture (LP) typically results in high concentrations of oxyhaemoglobin in CSF, impairing the detection of xanthochromia and preventing the reliable exclusion of SAH. In this context, the value of a repeat lumbar puncture has not yet been described.

Intraoperative neurophysiological monitoring in paediatric Chiari surgery-help or hindrance?

Introduction: The role of intraoperative neurophysiological monitoring (IONM) during surgery for Chiari I malformation has not been fully elucidated. Questions remain regarding its utility as an adjunct to foramen magnum decompression surgery, specifically, does IONM improve the safety profile of foramen magnum decompression surgery and can IONM parameters help in intraoperative surgical decision-making. This study aimed to describe a single institution experience of IOM during paediatric Chiari I surgery.

Effect of venous stenting on intracranial pressure in idiopathic intracranial hypertension.

Background: Idiopathic intracranial hypertension (IIH) is characterised by an increased intracranial pressure (ICP) in the absence of any central nervous system disease or structural abnormality and by normal CSF composition. Management becomes complicated once surgical intervention is required. Venous sinus stenosis has been suggested as a possible aetiology for IIH.

Proton beam therapy in the management of skull base chordomas: systematic review of indications, outcomes, and implications for neurosurgeons.

Background: Chordomas are rare tumours affecting the skull base. There is currently no clear consensus on the post-surgical radiation treatments that should be used after maximal tumour resection. However, high-dose proton beam therapy is an accepted option for post-operative radiotherapy to maximise local control, and in the UK, National Health Service approval for funding abroad is granted for specific patient criteria.

Improving neurosurgical communication and reducing risk and registrar burden using a novel online database referral platform.

Objectives: Documentation of urgent referrals to neurosurgical units and communication with referring hospitals is critical for effective handover and appropriate continuity of care within a tertiary service. Referrals to our neurosurgical unit were audited and we found that the majority of referrals were not documented and this led to more calls to the on-call neurosurgery registrar regarding old referrals. We implemented a new referral system in an attempt to improve documentation of referrals, communication with our referring hospitals and to professionalise the service we offer them.

Surgically managed idiopathic intracranial hypertension in adults: a single centre experience.

Introduction: Idiopathic intracranial hypertension (IIH) is a rare condition that is often managed conservatively. In patients with aggressive progression of the disease surgical options are considered. There are few data on the outcomes of these patients when surgically managed.

Evaluation of the impact of the Canadian subarachnoid haemorrhage clinical decision rules on British practice.

Introduction: Acute headache is among the commonest presenting complaints to emergency departments. While it is estimated that only 1-3% result from subarachnoid haemorrhage (SAH), because the disease carries such significant morbidity and mortality if missed, most clinicians have a low threshold for investigation. A recent prospective cohort study in Canada determined a number of high-risk clinical characteristics for SAH in patients with acute headache.