Defining the typical characteristics of orthostatic headache in patients with spontaneous intracranial hypotension.

Background: Orthostatic headache (OH) is a common feature of various conditions, including spontaneous intracranial hypotension (SIH), but no precise definition currently exists outlining the typical OH characteristics. This ambiguity risks misdiagnosis with unnecessary investigations and delay in institution of treatment. The present study aimed to carry out structured phenotyping of OH in patients with SIH with the aim of outlining its typical characteristics.

Learning Curve of Endoscopic Lumbar Discectomy - A Systematic Review and Meta-Analysis of Individual Participant and Aggregated Data.

Study Design: A systematic review and meta-analysis of individual participant and aggregated data.

Objectives: To define the learning curves of endoscopic discectomies using unified statistical methodologies.

Methods: Searches returned 913 records, with 118 full-text articles screened.

Validation of a surgical simulator and establishment of quantitative performance thresholds-RealSpine simulation system for open lumbar decompressions.

Background Context: The majority of surgical training is conducted in real-world operations. High-fidelity surgical simulators may provide a safer environment for surgical training. However, the extent that it reflects real-world operations and surgical ability is often poorly characterized.

Early evaluation of a natural language processing tool to improve access to educational resources for surgical patients.

Purpose: Accessible patient information sources are vital in educating patients about the benefits and risks of spinal surgery, which is crucial for obtaining informed consent. We aim to assess the effectiveness of a natural language processing (NLP) pipeline in recognizing surgical procedures from clinic letters and linking this with educational resources.

Methods: Retrospective examination of letters from patients seeking surgery for degenerative spinal disease at a single neurosurgical center.

Mapping patient education encounters in elective surgery: a cohort study and cross-sectional survey.

Objective: Develop a process map of when patients learn about their proposed surgery and what resources patients use to educate themselves.

Design: A mixed methods design, combining semistructured stakeholder interviews, quantitative validation using electronic healthcare records (EHR) in a retrospective cohort and a cross-sectional patient survey.

Setting: A single surgical centre in the UK.

Distribution of case volumes in surgery: an analysis of the British Spine Registry.

Objectives: To characterize the distribution of case volumes within a surgical field.

Design: An analysis of British Spine Registry.

Setting: 295 centers in England that conducted at least one spinal operation either within the NHS or private settings between 1 May 2016 and 27 February 2021.

Spontaneous intracranial hypotension.

Spontaneous intracranial hypotension (SIH) is a highly disabling but treatable secondary cause of headache. Recent progress in neuroradiological techniques has catalysed understanding of its pathophysiological basis and clinical diagnosis, and facilitated the development of more effective investigation and treatment methods. A UK-based specialist interest group recently produced the first multidisciplinary consensus guideline for the diagnosis and treatment of SIH.

Multidisciplinary consensus guideline for the diagnosis and management of spontaneous intracranial hypotension.

Background: We aimed to create a multidisciplinary consensus clinical guideline for best practice in the diagnosis, investigation and management of spontaneous intracranial hypotension (SIH) due to cerebrospinal fluid leak based on current evidence and consensus from a multidisciplinary specialist interest group (SIG).

Methods: A 29-member SIG was established, with members from neurology, neuroradiology, anaesthetics, neurosurgery and patient representatives. The scope and purpose of the guideline were agreed by the SIG by consensus.

Survey of healthcare professionals' knowledge, attitudes and practices regarding spontaneous intracranial hypotension.

Objective: To assess the knowledge, attitudes and practices of healthcare professionals regarding the diagnosis and management of spontaneous intracranial hypotension (SIH).

Methods: We performed a cross-sectional, web-based survey of multiple healthcare professional groups in the UK from June to August 2021. There were 227 respondents to the survey, including 62 general practitioners, 39 emergency medicine physicians, 38 neurologists, 35 radiologists, 20 neurosurgeons, 18 anaesthetists and 15 headache nurse specialists.

Classical infratentorial superficial siderosis of the central nervous system: pathophysiology, clinical features and management.

The term superficial siderosis (SS) is derived from the Greek word 'sideros', meaning iron. It includes two subtypes, distinguished by their anatomical distribution, causes and clinical features: 'classical' infratentorial SS (iSS, which sometimes also affects supratentorial regions) and cortical SS (cSS, which affects only supratentorial regions). This paper considers iSS, a potentially disabling disorder usually associated with very slow persistent or intermittent subarachnoid bleeding from a dural defect, and characterised by progressive hearing and vestibular impairment, ataxia, myelopathy and cognitive dysfunction.

Targeted detection and repair of a spinal dural defect associated with successful biochemical resolution of subarachnoid bleeding in classical infratentorial superficial siderosis.

BACKGROUND AND IMPORTANCE  : Classical infratentorial superficial siderosis (iSS) is characterised by repeated insidious bleeding into the subarachnoid space, leading to haemosiderin deposition within the subpial layers of the brainstem, cerebellum and spinal cord, sometimes with supratentorial involvement. Although nearly always associated with a dural defect (usually from previous trauma or neurosurgery) there is little evidence to support definitive investigation and management strategies. Here, we present a novel investigation strategy to identify a dural defect and subsequent successful surgical repair with biochemical resolution of subarachnoid bleeding.

Iatrogenic dorsal spinal cord herniation and repair with clip-based expansile duraplasty: a case report.

Introduction: Myelopathy arising due to dorsal herniation of the spinal cord is a rare phenomenon, particularly so in the thoracic region. Where cases of thoracic dorsal cord herniation have been reported, the aetiology has typically been non-iatrogenic.

Case Presentation: We report the case of a paediatric oncology patient who presented with neurological deterioration secondary to thoracic dorsal spinal cord herniation, manifesting three months after laminectomy for biopsy of a spinal medulloblastoma lesion.

Neuropsychological and neuroimaging characteristics of classical superficial siderosis.

Objective: To define the neuropsychological and neuroimaging characteristics of classical infratentorial superficial siderosis (iSS), a rare but disabling disorder defined by hemosiderin deposition affecting the superficial layers of the cerebellum, brainstem and spinal cord, usually associated with a slowly progressive neurological syndrome of deafness, ataxia and myelopathy.

Methods: We present the detailed neuropsychological and neuroimaging findings in 16 patients with iSS (mean age 57 years; 6 female).

Results: Cognitive impairment was present in 8/16 (50%) of patients: executive dysfunction was the most prevalent (44%), followed by impairment of visual recognition memory (27%); other cognitive domains were largely spared.

A Novel Neurosurgery Referral Course: Feasibility, Validation, and Inferences for Patient Care.

Objective: The speciality of neurosurgery is under-represented in the majority of medical school curriculums, and those rotating within this specialty tend to be those with career aspirations within this field. Consequently, few emergency medicine trainees are exposed to this specialty. The aim of this educational project was to develop and validate a neurosurgery referral course for the target audience of emergency medics.

Extradural Compressive Spinal Cerebrospinal Fluid Leak in Ehlers-Danlos Syndrome.

Ehlers-Danlos syndrome can be associated with cerebrospinal fluid (CSF) disturbances including recurrent CSF leak and Chiari I malformations. Persistent pseudomeningoceles are known to be associated with raised intracranial pressure. We present an unusual case of a compressive epidural CSF collection occurring after a computed tomography-guided L5 nerve root block and describe an effective management strategy.

A Rare Case of Concurrent Herpes Simplex Encephalitis and Glioblastoma Multiforme.

Herpes encephalitis superimposed on an intracranial malignancy has previously been described mainly in the context of malignancy imitating infection or in the postoperative setting after neurosurgical intervention. We report a rare case of presentation of concurrent herpes encephalitis and glioblastoma. A 63-year-old man presented with status epilepticus and subsequent magnetic resonance imaging (MRI) brain showed a right temporal enhancing lesion with mass effect.

Spinal Cord Suspension Using Dentate Ligament Hitch Stitches: A Novel Technique for the Repair of Ventral Spinal Cord Herniation.

Background: Idiopathic spinal cord herniation is usually repaired by releasing the spinal cord and inserting a dural patch to close the herniated segment of dura. However, reherniation is a potential limitation of this standard technique.

Objective: To describe early results of a novel technique that utilizes the dentate ligament to hitch the spinal cord and prevent reherniation.

Outcome of adult patients with X-linked hypophosphatemia caused by PHEX gene mutations.

X-linked hypophosphatemia (XLH) is the most common monogenic disorder causing hypophosphatemia. This case-note review documents the clinical features and the complications of treatment in 59 adults (19 male, 40 female) with XLH. XLH is associated with a large number of private mutations; 37 different mutations in the PHEX gene were identified in this cohort, 14 of which have not been previously reported.

Paravertebral tumours of the cervicothoracic junction extending into the mediastinum: surgical strategies in a no man's land.

Purpose: Cervicothoracic paravertebral neoplasms extending into the mediastinum pose a surgical challenge due the complex regional anatomy, their biological nature, rarity and surgeon's unfamiliarity with the region. We aim to define a surgical access framework addressing the aforementioned complexities whilst achieving oncological clearance.

Methods: We carried out a retrospective review of 28 consecutive patients operated in two tertiary referral centres between 1998 and 2015.

Radiotherapy-related intracranial aneurysms: A role for conservative management.

Background: Radiotherapy-related intracranial aneurysms are a recognized but rare phenomenon and often present following rupture leading to subarachnoid hemorrhage. Treatment poses a particular dilemma and both endovascular, and surgical approaches have been used with varied success. We present the case of a radiotherapy-related aneurysm treated conservatively with a favorable outcome.

Syringomyelia secondary to "occult" dorsal arachnoid webs: Report of two cases with review of literature.

In a certain group of patients with syringomyelia, even with the advent of sophisticated magnetic resonance imaging (MRI), no associated abnormality or cerebrospinal fluid (CSF) block is easily identified. This type of syringomyelia is often termed idiopathic. Current literature has less than 10 reports of arachnoid webs to be the causative factor.

FANCD2 re-expression is associated with glioma grade and chemical inhibition of the Fanconi Anaemia pathway sensitises gliomas to chemotherapeutic agents.

Brain tumours kill more children and adults under 40 than any other cancer. Around half of primary brain tumours are glioblastoma multiforme (GBMs) where treatment remains a significant challenge, where survival rates have improved little over the last 40 years, thus highlighting an unmet need for the identification/development of novel therapeutic targets and agents to improve GBM treatment. Using archived and fresh glioma tissue, we show that in contrast to normal brain or benign schwannomas GBMs exhibit re-expression of FANCD2, a key protein of the Fanconi Anaemia (FA) DNA repair pathway, and possess an active FA pathway.

Neuroprotective effects of vitamin E in cold induced cerebral injury in guinea pigs.

Significant reduction in hemorrhage (10 v/s 13), necrosis (2 v/s 4), cavitations (7 v/s 13), neuronal degeneration, perivascular and parenchymal inflammatory infiltrate (7 v/s 11) were observed in Vitamin E treated cold induced head injury in guinea pigs, evaluated post injury using the modified Benderson's scale. The results suggest that Vitamin E is highly effective in promoting clinical and histopathological recovery in cold induced head injury in guinea pigs.