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Scientific Articles

The technique of transcranial focused ultrasound has emerged as a potentially revolutionary tool in functional neurosurgery. This platform provides a method of ablating specific voxels of brain tissue without surgery. Ablative techniques suffer the disadvantage when compared to neuromodulatory interventions of being largely irreversible. However, as both our understanding of neurology and the technology we have access to improves, minimally invasive techniques such as focused ultrasound will undoubtedly become safer and evolve to play a significant role in the future of functional neurosurgery. In this review, the authors summarise the application of the technique to various common movement disorders.


Dejerine-Roussy syndrome (or thalamic pain syndrome) is a phenomenon experienced by some patients following thalamic stroke. Such lesions initially may cause hemibody numbness and/or paraesthesia contralateral to the affected hemisphere. This can progress into dysaesthesia and pain in the same distribution over the course of weeks or months. This pain is often refractory to standard treatments with analgesia such as opioids. This paper is a review of the application of DBS in patients with Dejerine-Roussy syndrome. The authors conclude that neuromodulation is a potentially viable management option in these patients when their pain is found to be refractory to other treatments. However, in order to achieve this, more research is required to elucidate potential anatomical targets, and a greater degree of homogeneity is required in the studied patient populations.


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Without sufficient cytoreduction, petroclival meningiomas often recur, whilst cases in which total resection has been achieved are frequently associated with significant morbidity. In this study, the authors investigated the long-term effects of gamma knife radiosurgery in controlling these tumours. The sample consisted of 89 patients, 58 of whom underwent gamma knife radiosurgery as a primary treatment, whilst the remaining 31 underwent irradiation as an adjuvant therapy to surgery. The authors found that gamma knife was associated with significant disease suppression and control of tumour volume in the majority of the sample, concluding that this platform is a valuable adjunct to the management of petroclival meningiomas. However, large-scale prospective studies are required to confirm these findings and motivate real change in practice.


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Arachnoid cysts are typically asymptomatic incidental findings, with an estimated prevalence of 2.3%. They are thought to arise from a congenital splitting of the arachnoid mater with CSF subsequently filling this space. Arachnoid cysts are most frequently found in the middle fossa, and may be stratified according to the Galassi classification. In this article, the authors present two cases of women presenting with dysphagia, dysarthria, and tongue weakness and atrophy. MRI confirmed the diagnosis of arachnoid cyst of the hypoglossal canal, and both patients underwent surgical resection. The lesion was approached via the ipsilateral occipital condyle - this is the first report of such an approach being used to access arachnoid cysts of the occipital condyle.



Monday, 23 October 2017 09:47

Spinal dural arteriovenous fistulas: a review

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Spinal dural AV fistulae are a complicated pathology to diagnose and treat. Less invasive imaging modalities are providing improved resolution for the detection of these lesions, however clinical presentations remain diverse.


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Due to the tortuous path described by the vessel, PICA aneurysms present a particular challenge. In this article the authors describe the clinical features and surgical techniques used in the management of 7 complex PICA aneurysms.




As is the case with many other tumours, the extent of resection of chordoma has been seen to correlate directly with prognosis. Surgical approach to these lesions is complicated due to their proximity to numerous critical neurovascular structures, however endonasal approaches are becoming more popular. Existing classification systems are based primarily on considering the requirements of open microsurgery. The authors of this article retrospectively reviewed 161 patients that underwent endonasal resection of chordomas at their unit, in order to develop a more endonasal-specific system of classification.

They describe a system of classifying endonasally approached chordomas based on their location. This system has the benefit of being more applicable to endonasal surgeries. Although the total and subtotal resection rates between tumours of the different classifications are described as ‘significant’, it is unclear whether this refers to statistical significance. The method will require further validation in larger studies before it can be fully adopted.






(DOI: 10.1007/s10143-015-0696-1)


Appropriate classification of thoracolumbar spinal injuries is crucial for appropriate management of patients and communication between healthcare professionals. The thoracolumbar injury and classification score (TLICS) was designed in 2005 to stratify spinal injuries based on their morphology, neurological sequelae and the integrity of the posterior ligamentous complex. Eleven years later, authors of the above article suggest a modified approach to TLICS, which they report shows greater correlation to outcomes in their series. Both are summarised below.






(DOI: 10.1177/0284185115580487)





Intramedullary spinal cord tumours have an estimated incidence of 1.1 cases in 100,000. Previously, the plane of dissection when surgically excising these lesions has been the key indicator for gauging extent of resection. Other articles have called into question the influence of histopathological characteristics on the definition of tumour boundary. The authors of this article report the results of a retrospective analysis determining the influence of tumour histology on resectability and neurological outcomes in cases of intramedullary spinal cord tumours. The 2016 WHO CNS classification emphasised the importance of genetic findings. This should be borne in mind when approaching results presented in articles in which this is not accounted for.

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Metastases make up the most significant group of tumours in the central nervous system in terms of incidence. Surgical resection of these lesions is often complicated by significant blood loss. Although allogenic blood product replacement is most frequently used to address this, the application of intraoperative cell salvage (IOCS) has been researched. Although the authors conclude that there is insufficient evidence to establish resolutely if IOCS is generally safe in cancer surgery, they did establish that the technique does not significantly increase the risk of tumour dissemination (a major concern in the use of IOCS). Critically, no studies on the use of IOCS in cases of spinal metastasis were included. However, the findings of the authors still provides valid justification for further investigation.

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