25 results found
Dixon L, Lim A, Grech-Sollars M, et al., 2022, Intraoperative ultrasound in brain tumor surgery: A review and implementation guide, Neurosurgical Review, Vol: 45, Pages: 1-13, ISSN: 0344-5607
Accurate and reliable intraoperative neuronavigation is crucial for achieving maximal safe resection of brain tumors. Intraoperative MRI (iMRI) has received significant attention as the next step in improving navigation. However, the immense cost and logistical challenge of iMRI precludes implementation in most centers worldwide. In comparison, intraoperative ultrasound (ioUS) is an affordable tool, easily incorporated into existing theatre infrastructure, and operative workflow. Historically, ultrasound has been perceived as difficult to learn and standardize, with poor, artifact-prone image quality. However, ioUS has dramatically evolved over the last decade, with vast improvements in image quality and well-integrated navigation tools. Advanced techniques, such as contrast-enhanced ultrasound (CEUS), have also matured and moved from the research field into actual clinical use. In this review, we provide a comprehensive and pragmatic guide to ioUS. A suggested protocol to facilitate learning ioUS and improve standardization is provided, and an outline of common artifacts and methods to minimize them given. The review also includes an update of advanced techniques and how they can be incorporated into clinical practice.
Marcus AP, Marcus HJ, Camp SJ, et al., 2020, Improved Prediction of Surgical Resectability in Patients with Glioblastoma using an Artificial Neural Network, SCIENTIFIC REPORTS, Vol: 10, ISSN: 2045-2322
Irvine S, Awan M, Chharawala F, et al., 2020, Factors affecting patient flow in a neurosurgery department, The Annals of The Royal College of Surgeons of England, Vol: 102, Pages: 18-24, ISSN: 0035-8843
<jats:sec><jats:title>Introduction</jats:title><jats:p> Patient flow is the process by which movement of patients and clinical productivity is achieved. The objectives of this study were to implement and evaluate the NHS Improvement SAFER patient flow bundle, evaluate the impact of the Red2Green initiative, and assess the impact of frailty on patient flow. </jats:p></jats:sec><jats:sec><jats:title>Materials and methods</jats:title><jats:p> All patients admitted to a neurosurgery unit from 1 September to 30 November 2017 were included. Using guidance set out by NHS, data were prospectively collected from daily ward lists and patient notes, including demographics, admission and discharge details, length of stay, anticipated discharge date, red days with reasons and frailty (Rockwood Clinical Frailty Scale). NHS reference costs were used for cost analyses. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> A total of 420 patients (55% elective) were included, totalling 3909 bed days. All patients received daily senior reviews before midday, and anticipated discharge dates were set at daily multidisciplinary team meetings. Ten per cent of patients were discharged before midday. There were 21% (837) red days, significantly more (76%) for emergency patients (639 vs 198 elective; P < 0.001); 63% red days were attributed to awaiting a bed in a local hospital; 25% (106) patients were classed as frail (50 elective), which was associated with a significantly longer length of stay (17.3 vs 6; P < 0.01), and more red days (615 vs 222; p<0.01). Considering excess bed charges and lost revenue (with penalties), red days cost over £1 million per year. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> SAFER has identified areas for improvement in patient flow, with obvious cost impli
Grech-Sollars M, Ordidge KL, Vaqas B, et al., 2019, Imaging and tissue biomarkers of choline metabolism in diffuse adult glioma; 18F-fluoromethylcholine PET/CT, magnetic resonance spectroscopy, and choline kinase α, Cancers, Vol: 11, Pages: 1-15, ISSN: 2072-6694
The cellular and molecular basis of choline uptake on PET imaging and MRS-visible choline containing compounds is not well understood. Choline kinase alpha (ChoKa) is an enzyme that phosphorylates choline, an essential step in membrane synthesis. We investigate choline metabolism through 18F-fluoromethylcholine (18F-FMC) PET, MRS and tissue ChoKa in human glioma. 14 patients with suspected diffuse glioma underwent multimodal 3T MRI and dynamic 18FFMC PET/CT prior to surgery. Co-registered PET and MRI data were used to target biopsies to regions of high and low choline signal, and immunohistochemistry for ChoKa expression was performed. 18F-FMC/PET differentiated WHO grade IV from grade II and III tumours, whereas MRS differentiated grade III/IV from grade II tumours. Tumoural 18F-FMC/PET uptake was higher than in normal-appearing white matter across all grades and markedly elevated within regions of contrast enhancement. 18F-FMC/PET correlated weakly with MRS Cho ratios. ChoKa expression on IHC was negative or weak in all but one GBM sample, and did not correlate with tumour grade or imaging choline markers. MRS and 18F-FMC/PET provide complimentary information on glioma choline metabolism. Tracer uptake is, however, potentially confounded by blood-brain barrier permeability. ChoKa overexpression does not appear to be a common feature in diffuse glioma.
Steele L, Raza MH, Perry R, et al., 2019, Subarachnoid haemorrhage due to intracranial vertebral artery dissection presenting with atypical cauda equina syndrome features: case report, BMC Neurology, Vol: 19, ISSN: 1471-2377
BACKGROUND: Failing to recognise the signs and symptoms of subarachnoid haemorrhage (SAH) causes diagnostic delay and may result in poorer outcomes. We report a rare case of SAH secondary to a vertebral artery dissection (VAD) that initially presented with cauda equina-like features, followed by symptoms more typical of SAH. CASE PRESENTATION: A 55-year-old man developed severe lower back pain after sudden movement. Over the next 5 days he developed paraesthesiaes in the feet, progressing to the torso gradually, and reported constipation and reduced sensation when passing urine. On day six he developed left facial palsy, and later gradual-onset headache and intermittent confusion. Magnetic resonance imaging of the brain showed diffuse subarachnoid FLAIR hyperintensity, concerning for blood, including a focus of cortical/subcortical high signal in the left superior parietal lobule, which was confirmed by computed tomography. Digital subtraction angiography demonstrated a left VAD with a fusiform aneurysm. CONCLUSION: We present a very rare case of intracranial VAD with SAH initially presenting with spinal symptoms. The majority of subsequent clinical features were consistent with a parietal focus of cortical subarachnoid blood, as observed on neuroimaging.
Pakzad-Shahabi L, Soni S, Le Calvez K, et al., 2019, Response rates to Quality of Life questionnaires over time (why we need the CaPaBLE study)
Marcus A, Marcus HJ, Camp SJ, et al., 2019, IMPROVED PREDICTION OF SURGICAL RESECTABILITY IN PATIENTS WITH GLIOBLASTOMA MULTIFORME USING AN ARTIFICIAL NEURAL NETWORK, Joint Autumn Meeting of the Society-of-British-Neurological-Surgeons (SBNS)/Association-of-British-Neurologists (ABN), Publisher: BMJ PUBLISHING GROUP, Pages: E9-E9, ISSN: 0022-3050
Irvine S, Chharawala F, Lawrance N, et al., 2019, FP1-4 Factors affecting patient flow in a neurosurgery department, Journal of Neurology, Neurosurgery & Psychiatry, Vol: 90, Pages: e22.4-e23, ISSN: 0022-3050
<jats:sec><jats:title>Objectives</jats:title><jats:p>The objectives of this study were to audit the NHS Improvement SAFER patient flow bundle, evaluate the impact of the Red2Green initiative, and assess the impact of frailty on patient flow.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>A prospective review over a 3 month period.</jats:p></jats:sec><jats:sec><jats:title>Subjects</jats:title><jats:p>All patients admitted to a Neurosurgery Unit from 01/09/2017 to 30/11/2017 were included.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Data were prospectively collected from daily ward lists and patient notes, including demographics, admission/discharge details, length of stay (LOS), expected discharge date, red days with reasons, and frailty (Rockwood Clinical Frailty Scale). NHS Improvement Reference Costs were used for cost analyses.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>420 patients (55% elective) were included, total 3909 bed days. All patients received a daily senior review before midday, and EDDs were set at daily MDT meetings. 10% patients were discharged before midday. There were 21% (837) red days, significantly more (76%) for emergency patients (639 vs 198 elective; p<0.001). 63% red days were attributed to awaiting a bed in a local hospital. 25% (106) patients were classed as frail (50 elective), which was associated with a significantly longer LOS (17.3 vs 6; p<0.01), and more red days (615 vs 222; p<0.01). Considering bed costs and lost revenue (with penalties), red days cost is estimated at over £1M per year.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>SAFER has identified areas for improvement in patient flow, with obv
Camp SJ, Apostolopoulos V, Raptopoulos V, et al., 2017, Objective image analysis of real-time three-dimensional intraoperative ultrasound for intrinsic brain tumour surgery, JOURNAL OF THERAPEUTIC ULTRASOUND, Vol: 5, Pages: 1-8, ISSN: 2050-5736
Marcus HJ, Williams S, Hughes-Hallett A, et al., 2017, Predicting surgical outcome in patients with glioblastoma multiforme using pre-operative magnetic resonance imaging: development and preliminary validation of a grading system., Neurosurgical Review, Vol: 40, Pages: 621-631, ISSN: 1437-2320
The lack of a simple, objective and reproducible system to describe glioblastoma multiforme (GBM) represents a major limitation in comparative effectiveness research. The objectives of this study were therefore to develop such a grading system and to validate it on patients who underwent surgical resection. A systematic review of the literature was performed to identify features on pre-operative magnetic resonance imaging (MRI) that predict the surgical outcome of patients with GBM. In all, the five most important features of GBM on pre-operative MRI were as follows: periventricular or deep location, corpus callosum or bilateral location, eloquent location, size and associated oedema. These were then used to develop a grading system. To validate this grading system, a retrospective cohort study of all adult patients with supratentorial GBM who underwent surgical resection between the 1 January 2014 and the 31 June 2015 was performed. There was a substantial agreement between the two neurosurgeons grading GBM (Cohen's κ was 0.625; standard error 0.066). High-complexity lesions were significantly less likely to result in complete resection of contrast-enhancing tumour than low-complexity lesions (50.0 versus 3.4%; p = 0.0007). The proposed grading system may allow for the standardised communication of anatomical features of GBM identified on pre-operative MRI.
Sinha P, Jane Camp S, Akram H, et al., 2017, Superficial siderosis following trauma to the cervical spine: Case series and review of literature, International Journal of Case Reports and Images, Vol: 8, Pages: 11-11, ISSN: 0976-3198
Bal J, Camp SJ, Nandi D, 2016, The use of ultrasound in intracranial tumor surgery, ACTA NEUROCHIRURGICA, Vol: 158, Pages: 1179-1185, ISSN: 0001-6268
Camp S, Birch R, 2015, Peripheral Nerve Injury, Challenging Concepts in Neurosurgery Cases with Expert Commentary, Publisher: OUP Oxford, ISBN: 9780191017797
Part of the Challenging Concepts in series, this book is a case-based guide to challenging clinical scenarios in neurosurgery covering the major sub-speciality areas of oncology, vascular neurosurgery, brain and spine trauma, paediatrics, ...
Zadeh G, Salehi F, An S, et al., 2012, Diagnostic implications of histological analysis of neurosurgical aspirate in addition to routine resections., Neuropathology, Vol: 32, Pages: 44-50
Many neurosurgical centers use surgical aspirators to remove brain tumor tissue. The resulting aspirate consists of fragmented viable tumor, normal or tumor-infiltrated brain tissue as well as necrotic tissue, depending on the type of tumor. Typically, such fragmented aspirate material is collected but discarded and not included when making the histopathological diagnosis. Whereas the general suitability of surgical aspirate for histological diagnosis and immunohistochemical staining has been reported previously, we have systematically investigated whether the collection and histological examination of surgical aspirate has an impact on diagnosis, in particular on the tumor grading, by providing additional features. Surgical and aspirate specimens from 85 consecutive neurosurgical procedures were collected and routinely processed. Sixty-five of the 85 specimens were intrinsic brain tumors and the remainder consisted of metastatic tumors, meningiomas, schwannomas and lymphomas. Important diagnostic features seen in surgical aspirate were microvascular proliferation (n = 3), more representative necrosis (n = 2), and gemistocytic component (n = 2). In one case, microvasular proliferations were seen in the aspirate only, leading to a change of diagnosis. Collection of surgical aspirate also generates additional archival material which can be microdissected and used for tissue microarrays or for molecular studies.
Camp S, 2012, Neurosurgery, The Hands-on Guide to Surgical Training, Publisher: John Wiley & Sons, ISBN: 9780470672617
The Hands-on Guide to Surgical Training is the ultimate, practical guide for medical students and junior doctors thinking about taking the plunge into surgery, and also for surgical trainees already in training.
Camp SJ, Apostolopoulos V, Mehta A, et al., 2011, REALTIME INTRAOPERATIVE THREE DIMENSIONAL ULTRASOUND IN BIOPSY/RESECTION OF INTRINSIC BRAIN LESIONS, Conference of the British-Neuro-Oncology-Society (BNOS), Publisher: OXFORD UNIV PRESS INC, Pages: 2-2, ISSN: 1522-8517
Camp SJ, Birch R, 2011, Injuries to the spinal accessory nerve A LESSON TO SURGEONS, JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, Vol: 93B, Pages: 62-67, ISSN: 0301-620X
Camp SJ, Carlstedt T, Casey ATH, 2010, The lateral approach to intraspinal reimplantation of the brachial plexus, The Journal of Bone and Joint Surgery. British volume, Vol: 92-B, Pages: 975-979, ISSN: 0301-620X
<jats:p> Intraspinal re-implantation after traumatic avulsion of the brachial plexus is a relatively new technique. Three different approaches to the spinal cord have been described to date, namely the posterior scapular, anterolateral interscalenic multilevel oblique corpectomy and the pure lateral. We describe an anatomical study of the pure lateral approach, based on our clinical experience and studies on cadavers. </jats:p>
Camp SJ, Allen D, 2008, Co-contraction of swallowing musculature and trapezius following basal skull fracture, Injury Extra, Vol: 39, Pages: 95-97, ISSN: 1572-3461
CAMP SJ, MILANI R, SINISI M, 2008, INTRACTABLE NEUROSTENALGIA OF THE ULNAR NERVE ABOLISHED BY NEUROLYSIS 18 YEARS AFTER INJURY, Journal of Hand Surgery (European Volume), Vol: 33, Pages: 45-46, ISSN: 1753-1934
<jats:p> A 39 year-old farmer sustained a closed rupture of the left brachial artery, which was successfully managed by emergency vein graft repair of the artery. Adjacent nerve trunks were seen to be intact, but stretched. Burning pain in the distribution of the ulnar nerve started at day seven postoperatively, and worsened over the ensuing years. There was no response to membrane stabilising drugs, amitryptiline, nor to regional sympatholytic or local anaesthetic blocks. Neurolysis of the ulnar nerve, which was densely adherent to the dilated vein graft, abolished his pain. </jats:p>
Camp SJ, Stevenson VL, Thompson AJ, et al., 2005, A longitudinal study of cognition in primary progressive multiple sclerosis, Brain, Vol: 128, Pages: 2891-2898, ISSN: 0006-8950
Camp SJ, Thompson AJ, Langdon DW, 2001, A new test of memory for multiple sclerosis I: Format development and stimuli design, Multiple Sclerosis, Vol: 7, Pages: 255-262, ISSN: 1352-4585
Camp SJ, Stevenson VL, Thompson AJ, et al., 1999, Cognitive function in primary progressive and transitional progressive multiple sclerosis: A controlled study with MRI correlates, Brain, Vol: 122, Pages: 1341-1348, ISSN: 0006-8950
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