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Trauma is the leading cause of death and disability in those <45 years old. In more recent years, advances in different subspecialities led to the provision of better care and improved outcomes. Different techniques are described in this article: monitoring of intracranial pressure (ICP), evacuation of intracranial haematomas and external ventricular drainage to name a few. Finallly, trauma neurosurgery is emerging as a distinct subspecialty due to all the recent research advances explained in the article and an interdisciplinary working group between trauma neurosurgeons and clinicians from other disciplines is crucial to ensure high-quality care.

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An external ventricular drain (EVD) is a neurosurgical device used to treat hydrocephalus and relieve elevated intracranial pressure, most commonly when the normal flow of cerebrospinal fluid (CSF) inside the brain is obstructed. It is among the most common procedures performed by neurosurgeons, however it does carry a number of risks. A prospective multicentre cohort study of EVD insertions was conducted  by British Neurosurgical Trainee Research Collaborative to assess the incidence of infections infections. A total of 495 EVD catheters were inserted into 452 patients. In the assessed population, the incidence of EVD-associated infections was 9.3%.

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Saturday, 19 May 2018 07:03

WFNS Young Neurosurgeons Survey

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If you are a neurosurgery trainee or have been a consultant/attending for 10 years or less, the WFNS Young Neurosurgeons committee would like to hear from you. In order to best serve the needs of young neurosurgeons worldwide, we must first get to know them! This short survey is the first of many opportunities for the young neurosurgery community to voice their thoughts.

Participate in the Survey now

Dr. Angelos Kolias is Clinical Lecturer in Neurosurgery at the Cambridge Neuroscience Community. He is also a member of the WFNS Young Neurosurgeons Committee. His main interest is about neurotrauma, in particular with the mechanisms of action of interventions for traumatic brain injury (TBI).

In this video Dr Kolias presents the aim, the design and setting and the outcomes of the  RESCUEicp trial [Randomised Evaluation of Surgery with Craniectomy for Uncontrolled Elevation of Intra-Cranial Pressure], of which he was the research fellow.
The clinical question of this trial was to evaluated if decompressive craniectomy could result in more favourable mortality and neurological outcomes at 6 months, compared with barbiturate coma management. It resulted in a Class I evidence for using last-tier decompressive craniectomy (DC) as a life-saving intervention for refractory raised ICP following TBI. At 6 months DC  was associated with lower mortality but higher rate of vegetative state and lower and upper severe disability; the moderate disability and the good recovery rates were similar in comparison with the barbiturate coma management group.
In the second part of the video Dr Kolias presents the RESCUE-ASDH trial [Randomised Evaluation of Surgery with Craniectomy for patients Undergoing Evacuation of Acute SubDural Haematoma] of which the recruitment is still on-going. In this case the aim is to compare the neurological outcomes and the effectiveness of adult head-injury patients undergoing evacuation of acute subdural haematoma after a decompressive craniectomy versus craniotomy.

 

After the inspiration coming from the success of the West Midlands Research Collaborative (WMRC), a regional general surgical research collaborative established in 2008, the British Neurosurgical Trainee Research Collaborative (BNTRC) was founded in 2012. This initiative has also proven to be a scientific success, and has identified practices associated with improved outcome. The BNTRC has also provided an important platform for allowing high-quality research to be coordinated on a national level, and has given trainees the opportunity to be involved in the development and execution of research protocols - vital skills for the future generation of academic neurosurgeons.

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In this study, a retrospective single center one, Dr Al-Habib et al. analyzed the anatomic relationship between cervical pedicle screws, vertebral artery (VA), and related anatomic structures in the Saudi population. This work demonstrates important differences between various ethnic groups, which should be always considered. Moreover, assessment of VA entry at each level should be performed on an individual basis, as the characteristics of VA entry was found to vary in the same patient at different cervical levels.

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Thursday, 03 May 2018 18:04

Brainbook collaboration

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We are excited to announce our collaboration with Brainbook, an imaginative neurosurgical education platform based in London, UK. The team at Brainbook aim to provide a resource through which neurosurgery is made an accessible topic to the public, and also trainees of various levels can share ideas.

Visit the website

If you are a young neurosurgeon (i.e. in training or within 10 years after the end of residency), WFNS - Young Neurosurgeons Committee likes to hear from you!

This online survey aims to document, for the first time, the demographics and needs of Young Neurosurgeons worldwide but also their views on improving neurosurgical care for all those who need it.

The survey should not take you more than 10 minutes to complete.

Take part in this important initiative!

Participate in the Survey now

Sunday, 29 April 2018 20:44

www.neuroangio.com

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The purpose of Neuroangio.com is to provide an educational resource for vascular anatomy and pathology of the brain, spine and head & neck. The content is accessible to users at various levels of training, from junior registrars to consultants. Different sections are presented: anatomy, therapies, lectures and cases. The author, Maksim Shapiro, is a neurointerventional radiologist at the NYU Langone Medical Center in New York City.

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The superior approach for managing ruptured intracranial aneurysms (endovascular or clipping) has long been the subject of debate in the neurosurgical literature.

In 2012, the first results from The Barrow Ruptured Aneurysm Trial (BRAT) were published. This study was a single-centre randomized trial with 471 patients in which treatment with clipping was compared to treatment with coil embolization.

In January 2018, Dr Spetzler and his team published in Journal of Neurosurgery a scientific study, where only the outcomes from those patients with saccular aneurysms were considered. This cohort made up the majority of the original sample (362 out of 471). Authors concluded that there was no statistical difference between the two different types of treatment, showed by the modified Rankin Scale outcomes at 10 years follow-up. There was a significantly increased rate of retreatment required in the coiling group, as well as higher obliterations in the clipping arm.

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