Peter C. Whitfield

Seven years of cranioplasty in a regional neurosurgical centre

Abstract Introduction. In recent years craniectomy has been widely used in the management of traumatic brain injury and ischaemic stroke. The objective of this study was to evaluate the indications, techniques and outcomes for patients undergoing cranioplasty over a recent 7-year period in a geographically distinct population. Materials and methods. An observational study was performed retrospectively, with review of case records from 2004 to 2011. Demographic, clinical and outcome data were collected, and complications were classified as major and minor. A multi-variant analysis was performed to identify patient and management factors that influenced outcome. Results. Data were collected on a total of 87 cranioplasty patients with a median age of 42 and a mean follow-up time of 3 years and 10 months. The main indications for craniectomy were trauma (46%), infection (19%) intracranial haemorrhage (15%), tumour (13%) and ischaemic stroke (6%). Eight percent of patients had a synchronous craniectomy and cranioplasty, 14% had cranioplasty within 3 months of craniectomy, 21% within 3–6 months, 35% within 6–12 months, 14% over 1 year and 8% over 2 years later. The most frequently implanted cranioplasty material was titanium (53%), followed by autologous bone (26%) and acrylic (15%). Administration of prophylactic antibiotics was recorded in 97% of cases. Major complications occurred in 20% of patients, including 2 deaths (2%), 5 extradural haemorrhages (6%) and 9 infections (10%). A further 10% of cases experienced minor or cosmetic complications. Conclusions. Cranioplasty is often considered as a low-risk procedure following craniectomy. In our cohort, a 20% risk of major complications, including death, was identified. These findings contribute to the literature, emphasising that cranioplasty is a high-risk procedure. Whilst compelling reasons may guide the undertaking of craniectomy, it is essential that consideration is given to the significant subsequent risks of cranioplasty.

Traumatic brain injury: review of current management strategies

Head injury is a common condition with a high morbidity and mortality. Serious intracranial haematomas require early recognition and evacuation to maximise chances of independent outcomes. Recent organisational changes have promoted the development of trauma units and major trauma centres where patients can go through triage and be managed in an appropriate environment, and the development of management pathways in intensive treatment units has resulted in improvements in the outcome of traumatic brain injuries. Evidence for the treatment of cerebral perfusion pressure, and management of hyperventilation, osmotherapy, tracheostomy, and leakage of cerebrospinal fluid (CSF) has accumulated during the last decade and is important in the management of patients in all clinical settings. Since head injury is commonly associated with maxillofacial injuries, this review will be relevant to all who deal with this aspect of trauma.

Simulation in neurosurgical training: a blueprint and national approach to implementation for initial years trainees.

Abstract Simulation has played an increasing role in surgical training in recent years, this follows from various reports such as the Chief Medical Officer annual report and Sir John Temple’s ‘Time for Training’ and also from other factors such as increasing focus on efficiency and transparency within the healthcare system. Evidence has shown that simulation can develop and improve technical, clinical, communication and management skills. With technological advances, the quality of simulation has also improved with more realistic models and environment. We have undertaken a review of recent drivers for simulation training in the UK, current techniques and have focused on the application of simulation training within the current UK Neurosurgical curriculum for newly appointed trainees.

The evolution of British neurosurgical selection and training over the past decade

Abstract Selection of junior doctors into the British neurosurgical training program and subsequent speciality training have undergone several key changes over the past decade. Shift patterns in the era of the European Working Time Directive (EWTD) have had a major impact on surgical training. We discuss the national selection process, formalization of surgical simulation training and the need to encompass generic professional capabilities within the neurosurgical curriculum in order to create the “well-rounded surgeon”. Future directions including hybrid cerebrovascular training, training in stereotactic radiosurgery, and dedicated training opportunities in spinal surgery.

Correlation Between Cost of Publication and Journal Impact. Comprehensive Cross-sectional Study of Exclusively Open-Access Surgical Journals

OBJECTIVES As open-access journals have become increasingly common, it has provided more options for researchers to publish their work and improved access of information to the public. However, some open-access journals charge the authors processing fee on submission. In certain cases, this can be rather expensive. This study is the first study to specifically assess the cost of publishing in exclusively open-access, peer-reviewed surgical journals, and their correlation with journal impact, in the form of 6 bibliometrics. DESIGN AND SETTING This is a cross-sectional study. A list of journals is compiled using the SCImago Journal & Country Rank and Directory of Open Access Journals. 6 indices are measured - impact factor, SCOPUS h-index, SCImago journal rank indicator (SJR), Eigenfactor, Article Influence Score and Google h5 index. The cost of publication (in USD

Increasing motivation and engagement in neurosurgery for medical students through practical simulation-based learning

) of a research article (maximum of 6 pages) is used as a baseline. RESULTS 89 research journals are included. The median cost of publication is USD

Giant vertebrobasilar aneurysm: a rare cause of central sleep apnoea

100 (range [0-2580]). 47% are free of charge. 13% can cost more than USD

A case of spontaneous haematoma from vertebral artery arterio-venous fistula in a patient with neurofibromatosis type 1

2000 per article. SJR and Google h5 index appear to be the only indices that correlate linearly with the cost (p = 0.015 and 0.041, respectively), although the correlations are weak. 3 indices, namely impact factor, SJR and Article Influence Score appear to have very strong correlations with each other (Pearson coefficient > 0.90). CONCLUSIONS From this study, the cost of publishing in open-access journals bears little correlation to their impact; this poses a dilemma for researchers without significant funding. Therefore, authors and funders must consider cautiously when submitting to these journals.

Early versus late readmission of subarachnoid haemorrhage patients into neurocritical care

Background Simulation-based learning (SBL) is an essential adjunct to modern surgical education. Our study aimed to evaluate the educational benefit and motivational impact of a pilot practical neurosurgical module. Materials and methods 38 clinical medical students from several EU Medical Schools attended an international surgical course focused on teaching and learning basic surgical skills. We designed a pilot neurosurgical workshop instructing students to insert an intracranial pressure bolt using an ex vivo pig model. Each delegate was assessed by two consultant neurosurgeons using a validated assessment tool. Structured questionnaires were distributed on completion of the module. Results Delegate performance increased (p < 0.001) with no difference in performance improvement across year of study (p = 0.676) or medical school (p = 0.647). All delegates perceived this workshop as a potential addition to their education (median 5/5, IQR = 0), and indicated that the course provided motivational value towards a neurosurgical career (median 4/5, IQR = 1), with no difference seen between year of study or medical school (p > 0.05). Conclusion Our pilot neurosurgical workshop demonstrated the educational value of practical SBL learning for motivating students towards a surgical career. Homogeneous views across year of study and medical school underline the value of developing a unified strategy to develop and standardise undergraduate surgical teaching with a practical focus.

Middle cranial fossa cystic schwannoma

Abstract We report a case of central sleep apnoea (CSA) due to a giant vertebrobasilar aneurysm with brainstem compression. A flow diverter stent was deployed with coil embolization of the right vertebral artery distal to the posterior inferior cerebellar artery (PICA) to occlude the aneurysm. The patient’s symptoms improved following therapy.