What’s new in the surgical management of traumatic brain injury?
Written by Giorgio Saraceno, MS
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.
Prospective, multicentre study of external ventricular drainage-related infections in the UK and Ireland
Written by Ismail Zaed
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%.
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
Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension
Written by Fabio PaioDr. 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.
The British Neurosurgical Trainee Research Collaborative: Five years on
Written by Ismail ZaedAfter 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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Quantitative assessment of vertebral artery anatomy in relation to cervical pedicles: surgical considerations based on regional differences.
Written by Edoardo Agosti, MSIn 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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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
Online Survey: needs of young neurosurgeons worldwide
Written by Dom Mahoney, MS
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
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.
Analysis of saccular aneurysms in the Barrow Ruptured Aneurysm Trial
Written by Ismail Zaed
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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Date: August 29 – September 2, 2018
Location: Prague, Czech Republic
This unique event is organized by the World Academy of Neurological Surgery, the
International Conference on Cerebrovascular Surgery and the International Meningioma Society, in partnership with many renowned institutions such as the WFNS and the EANS.
The week will start with the meeting of the World Academy of Neurological Surgery. On August 30th and September 1st there will be two main conferences focusing on cerebrovascular and meningioma, while on September 2nd the main topic will be skull base surgery. The week will finish with a two-day hands-on seminar on endoscopic neurosurgery organised by the WFNS Neurosurgical Anatomy Committee.
Management of Unruptured Intracranial Aneurysms and Cerebrovascular Malformations
Written by UpSurgeOn Team
Aneurysms are thought to arise from weak spots on a blood vessel wall, that leads to an outward bulging, likened to a bubble or balloon. They may be a result of a hereditary condition or an acquired disease. The securing of the aneurysm (which can be endovascular or open) may be undertaken prior to or after its rupture. Nowadays, it is still not entirely clear which is the best option of treatment for unruptured aneurysms. In this review, doctors Kelly D. Flemming and Giuseppe Lanzino elegantly discuss the best therapeutic approach to this kind of aneurysms.
Neurosurgery of Complex Vascular Lesions and Tumors
Written by Edoardo Agosti, MSAuthor:
S. Kobayashi
Editor:
Thieme
Publication date:
May 2005
Description:
Neurosurgery of Complex Vascular Lesions and Tumors includes two different parts, focusing first on cerebrovascular diseases and then brain tumors.
In this book, eminent neurosurgeons from around the world expose personal clinical cases met during their previous experience, discussing the difficulty of the case and techniques used to negotiate these.
A short and concise book useful for all neurosurgeons in order to acquire a greater ability to manage particularly complex clinical cases.
Treatment of Arteriovenous Malformation (AVM)
Written by UpSurgeOn TeamNeil Martin, MD, is famous for his contribution to the development of the arteriovenous malformation (AVM) grading system (Spetzler-Martin classification). He spent several decades as chair of the UCLA Department of Neurosurgery and co-director of the UCLA Stroke Center. Since 2016 he has been nominated responsible of the Geisinger Neuroscience Institute.
This lecture addresses the management of AVM, a cluster of abnormal blood vessels within the brain which is congenital but not necessary hereditary.
Dr. Martin exposes the clinical manifestations, the diagnostic processes and the grading systems of the AVM. In particular he focuses on the treatment choices which are represented by: microsurgical technique, embolization and radiotherapy.