Awake craniotomy using stealth frameless stereotaxy without rigid skull fixation.

The authors describe a technique using the Medtronic Stealth spinal reference array allowing awake craniotomy to be performed without cranial fixation in the Mayfield pin head rest. A Medtronic spinal reference array (four-point H-shaped LED array) is fitted to a Yasargil footplate via a three-jointed swingarm. The Yasargil footplate is directly attached to the cranium after craniotomy and following stereotactic registration the patient is awakened.

Microvascular decompression for trigeminal neuralgia in the elderly: a review of the safety and efficacy.

Objective: To critically examine the efficacy and safety of microvascular decompression (MVD) for trigeminal neuralgia (TN) in elderly patients.

Methods: We performed a retrospective review of medical records, followed by prospective follow-up. The outcome data from 44 MVD operations for TN performed in 40 consecutive patients with a mean age of 65 years (range, 60-75 yr) in the period 1991 to 2001 were compared with those from 40 younger control subjects (mean age, 46 yr; range, 20-59 yr) operated on during the same period.

Acute cerebral tissue oxygenation changes following experimental subarachnoid hemorrhage.

Primary brain ischemia following subarachnoid hemorrhage is a major cause of morbidity and mortality. This study aims to determine whether changes in cerebral tissue oxygenation are related to cerebral blood flow changes in the acute phase following experimental subarachnoid hemorrhage. The endovascular puncture model was used to study subarachnoid hemorrhage in male Wistar rats with a tissue oxygenation probe and a laser Doppler probe placed contralateral to the side of hemorrhage.

High and low pressure states associated with posterior sacral meningocele.

We describe the rare cases of a 44-year-old woman and a 28-year-old woman each presenting with a large posterior sacrococcygeal mass and alternating symptoms of high and low intracranial pressure. The first patient underwent excision of her large sacral meningocele and simple ligation of the neck, resulting in resolution of all her associated symptoms. The second patient suffered traumatic rupture of the meningocele; she underwent excision of the redundant sac and repair of the dural defect using a musculofascial flap, also resulting in resolution of her symptoms.

Association between surgeon seniority and outcome in intracranial aneurysm surgery.

Specialist surgical registrars perform surgery as a requirement of their training, but the effect of the surgeon's level of training on outcome in intracranial aneurysm surgery is not known. This study addresses this question. A cohort of 278 consecutive patients who underwent a craniotomy to clip a recently ruptured intracranial aneurysm between January 1995 and December 1999 was assessed.

The use of hypothermia as a method of neuroprotection during neurosurgical procedures and after traumatic brain injury: a survey of clinical practice in Great Britain and Ireland.

Hypothermia has been employed as a method of neuroprotection for many decades. The evidence base for its use is limited, and the balance between benefit and risk is unclear. We felt that in light of this confusion it would be interesting to canvas the opinion of the members of The Neuroanaesthesia Society of Great Britain and Ireland.

Anaesthesia for awake craniotomy--evolution of a technique that facilitates awake neurological testing.

Background: There is an increasing trend towards performing craniotomy awake. The challenge for the anaesthetist is to provide adequate analgesia and sedation, haemodynamic stability, and a safe airway, with an awake, cooperative patient for neurological testing.

Methods: The records of all patients who had awake craniotomy at our institution were reviewed.

Neuropathological diagnostic accuracy.

This study investigated variations in neuropathological diagnosis when histopathological slides are evaluated with access to all information pertinent to a case, compared with evaluation of H & E stained slides with only limited clinical information. The aim of the study is to evaluate the role of 'local' factors in reaching a definitive, neuropathological diagnosis. Each of 227 cases was reviewed by the local neuropathologist at one of three European centres with access to all clinical, radiological and histopathological data.

The contribution of proton magnetic resonance spectroscopy (1HMRS) to clinical brain tumour diagnosis.

Proton magnetic resonance spectroscopy (1HMRS) provides biochemical information from tissue non-invasively, and has an evolving role in brain tumour diagnosis and management. We present 100 consecutive patients with brain tumours who had single voxel 1HMRS as part of their preoperative investigations. We report the histopathological findings and the diagnostic contribution of spectroscopy in an adjunctive role.

Subarachnoid haemorrhage: a clinical overview.

Subarachnoid haemorrhage affects up to 9,000 people a year in the UK (Lindsay and Bone 1997) and is a devastating condition. Although many patients make a good physical recovery, some are left with cognitive and perceptual deficits. Early rehabilitation and support is essential, and caring for these patients and their families is a major challenge for nurses.

Presentation of a choroid plexus papilloma mimicking an extradural haematoma after a head injury.

Introduction: Choroid plexus papillomas are rare, benign tumours of childhood. They usually present with subacute symptoms of raised intracranial pressure (ICP) commonly due to overproduction of CSF. Less common presentations include focal neurological deficits and epilepsy.

Magnetic resonance neurography studies of the median nerve before and after carpal tunnel decompression.

Object: Recently developed novel MR protocols called MR neurography, which feature conspicuity for nerve, have been shown to demonstrate signal change and altered median nerve configuration in patients with median nerve compression. The postoperative course following median nerve decompression can be problematic, with persistent symptoms and abnormal results on electrophysiological studies for some months, despite successful surgical decompression. The authors undertook a prospective study in patients with carpal tunnel syndrome, correlating the clinical, electrophysiological, and MR neurography findings before and 3 months after surgery.

A comparison of magnetic resonance imaging and neurophysiological studies in the assessment of cervical radiculopathy.

Neurophysiological studies (NPS) are often used by both neurosurgeons and neurologists to supplement neuroimaging findings in the diagnosis of cervical radiculopathy and in operative decision-making. The aim of this study was to assess whether nerve conduction and electromyographic studies added significant information to that obtained from high resolution MRI to warrant routine use. Over the 10-year period (1991-2001), we identified 48 patients who underwent both preoperative NPS and MRI for cervical radiculopathy.

Occludin expression in microvessels of neoplastic and non-neoplastic human brain.

The tight junction protein occludin 'glues' normal, adjacent brain microvessel endothelial cells together. Malignant brain tumours cause cerebral oedema because they have leaky endothelial tight junctions, which allow plasma fluid to enter the brain from the microvessel lumen. In order to identify molecular abnormalities in tumour endothelial tight junctions, we investigated occludin expression in microvessels from adult human non-neoplastic brain tissue using immunohistochemistry and immunoblotting.

Crisis in resources: a neurosurgical prospective.

In the light of the recent recommendations of the Society of British Neurological Surgeons on safe neurosurgery, we prospectively audited the work load, availability and efficiency in the use of neurosurgical resources in our department over a 1-month period. There were a total of 130 admissions--70 emergency and 60 elective cases. Twenty-three patients referred as emergencies were denied admission, directly or indirectly, because of shortage of beds.

Comparing the performance of mono- and biplane fluoroscopy systems in diagnostic and interventional neuroangiography using the dose-area product.

Biplane digital imaging systems are favoured in neurointerventional practice since they are believed to contribute to safer, quicker and more efficacious procedures. Our aim was to establish if such equipment exposes patients to the same level of ionising radiation as monoplane systems. We reviewed monoplane and biplane fluoroscopy screening times and dose-area products (DAP) for 267 diagnostic cerebral angiograms and 56 neurointerventional cases.

Gliomatosis cerebri: pitfalls in diagnosis.

We report two young patients with obscure presentations of gliomatosis cerebri. Initial CT scanning was inconclusive and in one case showed intraventricular haemorrhage, a feature not previously described. Magnetic resonance imaging was required to show the lesions with greater definition; however, in both cases, a biopsy was needed to confirm the diagnosis.

Emerging molecular mechanisms of brain tumour oedema.

A common property of brain tumours is their ability to cause oedema in the surrounding brain. Oedema forms as a result of a leaky blood-tumour barrier and persists when the brain fails to clear the excess fluid. It is a significant source of morbidity and mortality.

FLAIR imaging in the follow-up of low-grade gliomas: time to dispense with the dual-echo?

Fluid-attenuated inversion-recovery (FLAIR) imaging has established its utility in neuroimaging. We propose this imaging sequence as a replacement for proton density (PD) and T2-weighted spin-echo sequences in the follow-up of low-grade glioma. 26 MRI examinations of 18 patients with such tumours were reviewed by three neuroradiologists and a neurosurgeon.