1
|
Ashraf M, Sajjad F, Hussain SS, Cheema HA, Ali S, Umar H, Gillespie CS, Faiz U, Shahid A, Akmal M, Ashraf N. Long-term outcome of microvascular decompression for typical trigeminal neuralgia with autologous muscle: an analysis of 1025 patients from a developing country. J Neurosurg 2024:1-11. [PMID: 38608302 DOI: 10.3171/2023.9.jns231473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/28/2023] [Indexed: 04/14/2024]
Abstract
OBJECTIVE The objective was to evaluate the long-term outcome of microvascular decompression (MVD) utilizing autologous muscle for trigeminal neuralgia (TGN). METHODS A retrospective review was performed of all first-time MVD patients for typical classic TGN without prior surgical intervention who were treated between 2000 and 2019 at a tertiary supraregional neurosurgery practice. Demographic characteristics, surgical findings, operative results, complications, and recurrence rates at 1 year, 5 years, and last follow-up were collected. Pain outcome was assessed using the Barrow Neurological Institute (BNI) pain score. The chi-square test with continuity correction was used to compare categorical variables, and Kaplan-Meier curves and Cox regression were used to identify factors associated with recurrence. RESULTS In total, 1025 patients were studied with a median (interquartile range [IQR]) (range) follow-up of 8 (5-13) (3-20) years. In the immediate postoperative period, 889 patients (86.7%) had complete pain relief and 106 (10.3%) had partial pain relief; neither group required medication, and 30 patients (2.9%) had no relief. One hundred forty-one recurrences (13.8%) occurred over a median (IQR) of 3 (2-6) years after surgery. The proportion of patients without recurrence was 97% at 1 year, 90% at 5 years, 85% at 10 years, 82% at 15 years, and 81% at 20 years. There was no significant difference in the probability of recurrence between patients with complete (114/907 [12.6%] recurrences) or partial (19/106 [17.9%] recurrences) postoperative pain relief (p = 0.124, log-rank test). Patients with venous compression (n = 322) had a significantly higher rate of MVD failure (n = 16 [5%]) compared to those with arterial compression (14/703 [2%]) (p = 0.015, chi-square test). In the Cox proportional hazards model, venous compression and lack of immediate postoperative pain relief had hazard ratios of 1.62 (95% CI 1.16-2.27) and 2.65 (95% CI 1.45-4.82) for recurrence, respectively. One hundred twenty-four (12.1%) complications were documented, including facial numbness (44 [4.3%]), facial nerve palsy (37 [3.6%]), CSF leak (13 [1.3%]), and diplopia (5 [0.5%]), which resolved in all patients. CONCLUSIONS MVD with autologous muscle provides long-lasting pain relief in TGN patients with vascular compression with minimum morbidity and is a viable alternative to synthetic materials.
Collapse
Affiliation(s)
- Mohammad Ashraf
- 1Wolfson School of Medicine, University of Glasgow & Queen Elizabeth University Hospital, Glasgow, United Kingdom
- 2Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan
- 3Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Fauzia Sajjad
- 2Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan
- 3Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
- 4Department of Neurosurgery, Services Institute of Medical Sciences, Lahore, Pakistan
- 7Department of Neurosurgery, Khawaja Safdar Medical College, Sialkot, Pakistan
| | - Syed Shahzad Hussain
- 2Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan
- 3Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Huzaifa Ahmad Cheema
- 5Department of Neurosurgery, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Sundus Ali
- 5Department of Neurosurgery, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Hira Umar
- 4Department of Neurosurgery, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Conor S Gillespie
- 6Department of Clinical Neurosciences, University of Cambridge, United Kingdom; and
| | - Umar Faiz
- 7Department of Neurosurgery, Khawaja Safdar Medical College, Sialkot, Pakistan
| | - Abia Shahid
- 5Department of Neurosurgery, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Muhammad Akmal
- 2Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan
- 3Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | - Naveed Ashraf
- 2Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan
- 3Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| |
Collapse
|
2
|
Ali AMS, Mustafa MA, Ali OME, Gillespie CS, Richardson GM, Clark S, Wilby MJ, Millward CP, Srikandarajah N. Patient-reported outcomes in Primary Spinal Intradural Tumours: a systematic review. Spinal Cord 2024:10.1038/s41393-024-00987-6. [PMID: 38589551 DOI: 10.1038/s41393-024-00987-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/10/2024]
Abstract
STUDY DESIGN Systematic review. OBJECTIVES Primary Spinal Intradural Tumours (PSITs) are rare pathologies that can significantly impact quality of life. This study aimed to review patient reported outcomes (PROs) in PSITs. METHODS A systematic search of Pubmed and Embase was performed to identify studies measuring PROs in adults with PSITs. PRO results were categorised as relating to Global, Physical, Social, or Mental health. Outcomes were summarised descriptively. RESULTS Following review of 2382 records, 11 studies were eligible for inclusion (737 patients). All studies assessed surgically treated patients. Schwannoma was the commonest pathology (n = 190). 7 studies measured PROs before and after surgery, the remainder assessed only post-operatively. For eight studies, PROs were obtained within 12 months of treatment. 21 PRO measurement tools were used across included studies, of which Euro-Qol-5D (n = 8) and the pain visual/numerical analogue scale (n = 5) were utilised most frequently. Although overall QoL is lower than healthy controls in PSITs, improvements following surgery were found in Extramedullary tumours (EMT) in overall physical, social, and mental health. Similar improvements were not significant across studies of Intramedullary tumours (IMT). Overall QoL and symptom burden was higher in IMT patients than in brain tumour patients. No studies evaluated the effect of chemotherapy or radiotherapy. CONCLUSION Patients with PSITs suffer impaired PROs before and after surgery. This is particularly true for IMTs. PRO reporting in PSITs is hindered by a heterogeneity of reporting and varied measurement tools. This calls for the establishment of a standard set of PROs as well as the use of registries.
Collapse
Affiliation(s)
- Ahmad M S Ali
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK.
| | | | - Omar M E Ali
- Royal Victoria Infirmary, Newcastle upon-Tyne, UK
| | - Conor S Gillespie
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Simon Clark
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Martin J Wilby
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Christopher P Millward
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular, & Integrative Biology, University of Liverpool, Liverpool, UK
| | | |
Collapse
|
3
|
Brannigan JFM, Gillespie CS, Adegboyega G, Watson M, Lee KS, Mazzoleni A, Goacher E, Mantle O, Omar V, Gamage G, Yanez Touzet A, Mowforth O, Thomas W, Uprichard J, Hutchinson PJ, Stubbs DJ, Davies BM. Impact of antithrombotic agents on outcomes in patients requiring surgery for chronic subdural haematoma: a systematic review and meta-analysis. Br J Neurosurg 2024:1-8. [PMID: 38584489 DOI: 10.1080/02688697.2024.2333399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/12/2024] [Indexed: 04/09/2024]
Abstract
A chronic subdural haematoma (CSDH) is a collection of aged blood between the dura and the brain, typically treated with surgical evacuation. Many patients with CSDH have comorbidities requiring the use of antithrombotic medications. The optimal management of these medications in the context of CSDH remains unknown, as the risk of recurrence must be carefully weighed against the risk of vaso-occlusive events. To better understand these risks and inform the development of clinical practice guidelines, we conducted a systematic review and meta-analysis. A systematic review was conducted in accordance with the PRISMA guidelines, searching Medline and Embase databases. The study was registered with PROSPERO (CRD42023397061). A total of 44 studies were included, encompassing 1 prospective cohort study and 43 retrospective cohort studies. Pooled odds ratios (ORs) were calculated for CSDH recurrence and vaso-occlusive events in patients taking anticoagulant or antiplatelet medications compared to patients not receiving antithrombotic therapy. GRADE was used to assess the quality of evidence. In patients on anticoagulant therapy at CSDH diagnosis, the pooled OR for CSDH recurrence was 1.41 (95% CI 1.11 to 1.79; I2 = 28%). For patients on antiplatelet therapy, the pooled OR was 1.31 (95% CI 1.08 to 1.58; I2 = 32%). Patients taking antithrombotic medications had a significantly higher risk of vaso-occlusive events, with a pooled OR of 3.74 (95% CI 2.12 to 6.60; I2 = 0%). There was insufficient evidence to assess the impact of time to recommence antithrombotic medication on CSDH outcomes. We found that baseline antithrombotic use is associated with the risk of CSDH recurrence and vaso-occlusive events following surgical evacuation. The evidence base is of low quality, and decisions regarding antithrombotic therapy should be individualised for each patient. Further high-quality, prospective studies or registry-based designs are needed to better inform clinical decision-making and establish evidence-based guidelines.
Collapse
Affiliation(s)
- Jamie F M Brannigan
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Conor S Gillespie
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Gideon Adegboyega
- Addenbrookes Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Matthew Watson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | | | - Adele Mazzoleni
- Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - Edward Goacher
- Sheffield University Teaching Hospitals NHS Trust, Sheffield, UK
| | | | - Vian Omar
- University of Buckingham Medical School, Buckingham, UK
| | - Githmi Gamage
- Royal College of Surgeons of Ireland, Dublin, Republic of Ireland
| | - Alvaro Yanez Touzet
- School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Oliver Mowforth
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Will Thomas
- Department of Haematology, Cambridge University Hospitals NHS Foundation trust, Cambridge, UK
| | - James Uprichard
- Department of Haematology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Peter J Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Daniel J Stubbs
- Department of Haematology, St George's University Hospitals NHS Foundation Trust, London, UK
- Division of Anaesthesia, University of Cambridge Addenbrooke's Hospital Cambridge, Cambridge, UK
| | - Benjamin M Davies
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| |
Collapse
|
4
|
Richardson GE, Clynch AL, Mustafa MA, Gillespie CS, Chawira A, Walkden J, Brodbelt AR, Chavredakis E, McMahon CJ, Mills SJ, Islim AI, Mallucci CL, Jenkinson MD. Tectal Plate Glioma: A Clinical and Radiologic Analysis of Progression and Management in Adults. World Neurosurg 2024; 184:e266-e273. [PMID: 38286323 DOI: 10.1016/j.wneu.2024.01.107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 01/19/2024] [Indexed: 01/31/2024]
Abstract
BACKGROUND Tectal plate gliomas (TPGs) are a heterogeneous group of uncommon brain tumors. TPGs are considered indolent and are usually managed conservatively but they have the potential to transform into higher-grade tumors. The aims of this study were to investigate the natural history of adult TPG, treatment outcomes, and overall survival. METHODS A retrospective cohort analysis was performed of adult patients with TPG between 1993 and 2021. Baseline clinical, radiologic, and management characteristics were collected. The primary outcome was tumor progression, defined as increasing size on radiologic assessment or new gadolinium contrast enhancement. Secondary outcomes included management and mortality. RESULTS Thirty-nine patients were included, of whom 23 (52.2%) were men. Median age at diagnosis was 35 years (interquartile range, 27-53). Radiologic tumor progression was observed in 8 patients (20.5%). The 10-year progression-free survival was 72.6% (95% confidence interval [CI], 0.58-0.91). The 10-year overall survival was 86.5% (95% confidence interval, 0.75-1.0). Cerebrospinal fluid diversion procedures were used in 62% of the cohort (n = 24). Seventeen patients (43.6%) underwent at least 1 endoscopic third ventriculostomy, whereas only 6 patients (15.4%) underwent at least 1 ventriculoperitoneal shunt. CONCLUSIONS TPG has an overall favorable clinical prognosis, although progression occurs in 1 in 5 patients. Showing accurate factors by which patients with TPG may be risk stratified should be a key area of further research. A follow-up duration of 10 years would be a reasonable window based on the radiologic progression rates in this study; however, larger cohort studies are needed to answer both questions definitively.
Collapse
Affiliation(s)
- George E Richardson
- Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.
| | - Abigail L Clynch
- Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom
| | - Mohammad A Mustafa
- Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom
| | - Conor S Gillespie
- Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Athan Chawira
- Department of Neurosurgery, Alder Hey Hospital, Liverpool, United Kingdom
| | - James Walkden
- Department of Neurosurgery, Alder Hey Hospital, Liverpool, United Kingdom
| | - Andrew R Brodbelt
- Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Emmanuel Chavredakis
- Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Catherine J McMahon
- Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Samantha J Mills
- Department of Neuro-Radiology, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Abdurrahman I Islim
- Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom
| | - Conor L Mallucci
- Department of Neurosurgery, Alder Hey Hospital, Liverpool, United Kingdom
| | - Michael D Jenkinson
- Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom
| |
Collapse
|
5
|
Henney AE, Gillespie CS, Alam U, Hydes TJ, Boyland E, Cuthbertson DJ. Ultra-processed food and non-communicable diseases in the United Kingdom: A narrative review and thematic synthesis of literature. Obes Rev 2024; 25:e13682. [PMID: 38204299 DOI: 10.1111/obr.13682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/27/2023] [Accepted: 11/13/2023] [Indexed: 01/12/2024]
Abstract
The social and economic constructs of the United Kingdom (UK) provide a fertile food environment for the dramatic expansion in the ultra-processed food (UPF) market, driving increased UPF consumption. This has coincided with the significant increase in the incidence and prevalence of non-communicable diseases (NCDs) such as obesity, type 2 diabetes, cardiovascular disease, and cancer, with an inherent impact on morbidity and mortality. Our review aims to assess the current epidemiological and public health trends in the United Kingdom, specifically examining consumption of UPFs and subsequent development of NCDs, summarizing existing meta-analytical and experimental approaches. First, we address important socioeconomic and psychosocial domains that may contribute to increased availability and consumption of UPF. Additionally, we explore the putative mechanistic basis for the association between UPFs and NCDs: partly attributable to their energy density, the macro- and micronutrient composition (including high refined carbohydrate, saturated, and trans fats composition, in addition to low fiber and protein content), and artificially engineered additives and other compounds that adversely affect health in inadequately researched pathophysiological pathways. This review highlights the importance of promoting minimally processed diets to both clinical and political decision makers.
Collapse
Affiliation(s)
- Alex E Henney
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism and Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Conor S Gillespie
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Uazman Alam
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism and Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Theresa J Hydes
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism and Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
- Department of Gastroenterology and Hepatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Emma Boyland
- Department of Psychology, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Daniel J Cuthbertson
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism and Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
| |
Collapse
|
6
|
Ekert JO, Sabsevitz DS, Martin Del Campo I, Goyal A, Gillespie CS, Middlebrooks EH, Chaichana KL, Lee KS, Sanchez-Garavito JE, Quiñones-Hinojosa A. Awake brain mapping paradigms for nondominant hemisphere gliomas. Neurosurg Focus 2024; 56:E7. [PMID: 38301243 DOI: 10.3171/2023.11.focus23610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/28/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Traditionally, resection of nondominant hemisphere brain tumors was performed under general anesthesia. An improved understanding of right-lateralized neural networks has led to a paradigm shift in recent decades, where the right or nondominant hemisphere is no longer perceived as "functionally silent." There is an increasing interest in awake brain mapping for nondominant hemisphere resections. The objective of this study was to perform a comprehensive review of the existing brain mapping paradigms for patients with nondominant hemisphere gliomas undergoing awake craniotomies. METHODS In accordance with PRISMA guidelines, systematic searches of the Medline, Embase, and American Psychological Association PsycInfo databases were undertaken from database inception to July 1, 2023. Studies providing a description of the intraoperative mapping paradigm used to assess cognition during an awake craniotomy for resection of a nondominant hemisphere glioma were included. RESULTS The search yielded 1084 potentially eligible articles. Thirty-nine unique studies reporting on 788 patients were included in the systematic review. The most frequently tested cognitive domains in patients with nondominant hemisphere tumors were spatial attention/neglect (17/39 studies, 43.6%), speech-motor/language (17/39 studies, 43.6%), and social cognition (9/39 studies, 23.1%). Within the frontal lobe, the highest number of positive mapping sites was identified for speech-motor/language, spatial attention/neglect, dual tasking assessing motor and language function, working memory, and social cognition. Within the parietal lobe, eloquence was most frequently found upon testing spatial attention/neglect, speech-motor/language, and calculation. Within the temporal lobe, the assessment of spatial attention/neglect yielded the highest number of positive mapping sites. CONCLUSIONS Cognitive testing in the nondominant hemisphere is predominantly focused on evaluating two domains: spatial attention/neglect and the motor aspects of speech/language. Multidisciplinary teams involved in awake brain mapping should consider testing an extended range of functions to minimize the risk of postoperative deficits and provide valuable information about anatomo-functional organization of cognitive networks.
Collapse
Affiliation(s)
- Justyna O Ekert
- 1Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, United Kingdom
- 2Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida
| | - David S Sabsevitz
- 3Department of Psychiatry & Neurosurgery, Mayo Clinic, Jacksonville, Florida
| | - Isabel Martin Del Campo
- 2Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida
- 4Faculty of Health Sciences, Anáhuac University, Mexico City, Mexico
| | - Anshit Goyal
- 2Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida
| | - Conor S Gillespie
- 5Department of Clinical Neurosciences, University of Cambridge, United Kingdom
| | - Erik H Middlebrooks
- 2Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida
- 6Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | | | - Keng Siang Lee
- 7Department of Neurosurgery, King's College Hospital, London, United Kingdom; and
- 8Department of Basic and Clinical Neurosciences, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology, and Neuroscience, King's College, London, United Kingdom
| | - Jesus E Sanchez-Garavito
- 2Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida
- 3Department of Psychiatry & Neurosurgery, Mayo Clinic, Jacksonville, Florida
| | | |
Collapse
|
7
|
Bakhsh A, Gillespie CS, Richardson GE, Mustafa MA, Millward CP, Mirza N, Jenkinson MD. Evaluation of systemic inflammation in seizure phenotypes following meningioma resection. J Clin Neurosci 2024; 120:82-86. [PMID: 38219304 DOI: 10.1016/j.jocn.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/28/2023] [Accepted: 01/04/2024] [Indexed: 01/16/2024]
Abstract
PURPOSE To investigate the association between perioperative peripheral blood inflammatory markers and seizures in patients who have undergone meningioma resection. MATERIALS AND METHODS A single neurosurgery tertiary centre blood bank database was screened to extract pre-operative and post-operative white cell count (WCC), neutrophils, lymphocytes, monocytes, platelets and neutrophil-lymphocyte ratio (NLR) and derived NLR (dNLR). All patients who underwent resection of meningioma from 2012 to 2020 were eligible. Patients were excluded if they had an inflammatory condition, peri-operative infection, medical illness or operative complication. RESULTS 30 patients suffered pre-operative seizures only, 16 experienced de novo post-operative seizures within 1 year and 42 patients did not experience seizures throughout their treatment timeline. Patients with post-operative de novo seizures had a significantly higher WCC when compared those who never had a seizure (7.1 vs. 4.8x109/L, p =.048, 95 % 1.96 to 5.60). However, this difference of WCC was poorly predictive of de novo seizures at one year (AUC 0.61). dNLR was significantly higher in patients with continued post-operative seizures than in patients in which seizures were terminated with tumour resection (1.2 vs. 0.1, p =.035, 95 % 1.47 to 2.29). dNLR was predictive of seizures at one year with an 87.5 % sensitivity and 82.1 % specificity. CONCLUSIONS There is a significantly higher post-operative systemic white cell count response in patients who suffered de novo seizures after meningioma resection. Peripheral blood markers have the potential to predict seizures in patients with meningioma.
Collapse
Affiliation(s)
- Ali Bakhsh
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.
| | - Conor S Gillespie
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - George E Richardson
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Mohammed A Mustafa
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Christopher P Millward
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Nasir Mirza
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Michael D Jenkinson
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| |
Collapse
|
8
|
Henney AE, Gillespie CS, Alam U, Hydes TJ, Mackay CE, Cuthbertson DJ. High intake of ultra-processed food is associated with dementia in adults: a systematic review and meta-analysis of observational studies. J Neurol 2024; 271:198-210. [PMID: 37831127 PMCID: PMC10770002 DOI: 10.1007/s00415-023-12033-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/26/2023] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND AND AIMS Poor cardiometabolic health is associated with dementia. Considering previous meta-analyses have confirmed associations between ultra-processed foods (UPFs) and cardiometabolic disease, we were interested in the contribution of UPF consumption to the risk of developing dementia. METHODS We performed a systematic review and meta-analysis of all records registered on Ovid Medline and Web of Science from inception until December 2022 [PROSPERO (CRD42023388363)]. Studies that assessed UPF consumption in adults, determined according to NOVA, and that reported dementia (Alzheimer's disease, vascular dementia and mild cognitive impairment) determined by clearly stated diagnostic criteria (including formal assessment of dementia or use of diagnostic codes) were included. The association between UPF consumption and dementia was assessed using random-effects meta-analysis, controlling for confounding variables. Study quality was assessed using the Newcastle Ottawa Scale and evidence credibility evaluated using the NutriGrade system. RESULTS Seven thousand ten records were screened, and 122 records underwent full text review. From these, 10 observational (8 longitudinal) studies, analysing 867,316 individuals, were included. Included studies adjusted for age, socioeconomic status and co-morbidity, alongside other confounders. High (vs. low) intake of UPF was associated with increased risk of dementia (pooled relative risk 1.44 (95% confidence interval 1.09-1.90) (p = 0.02)) (I2 = 97.0%), although moderate (vs. low) intake of UPF was not (1.12 (0.96-1.31) (0.13)) (85.0%). Funnel plots demonstrate low risk of publication bias. CONCLUSION High UPF consumption is associated with dementia. Public health measures to reduce overconsumption of UPFs are imperative to reduce the burden of dementia.
Collapse
Affiliation(s)
- Alex E Henney
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK.
- Metabolism and Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK.
- Aintree University Hospital, Liverpool, UK.
| | - Conor S Gillespie
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Uazman Alam
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism and Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
| | - Theresa J Hydes
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism and Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
- Department of Gastroenterology and Hepatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Clare E Mackay
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Daniel J Cuthbertson
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool, UK
- Metabolism and Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Merseyside, UK
| |
Collapse
|
9
|
Gillespie CS, Hall BJ, George AM, Hennigan D, Sneade C, Cawker S, Silva AHD, Vloeberghs M, Aquilina K, Pettorini B. Selective dorsal rhizotomy in non-ambulant children with cerebral palsy: a multi-center prospective study. Childs Nerv Syst 2024; 40:171-180. [PMID: 37439914 PMCID: PMC10761507 DOI: 10.1007/s00381-023-06062-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 07/05/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE Assess the effects of selective dorsal rhizotomy (SDR) on motor function and quality of life in children with a Gross Motor Function Classification System (GMFCS) level of IV or V (non-ambulatory). METHODS This is a prospective, observational study in three tertiary neurosurgery units in England, UK, performing SDR on children aged 3-18 with spastic diplegic cerebral palsy, and a GMFCS level of IV or V, between 2012 and 2019. The primary outcome measure was the change in the 66-item Gross Motor Function Measure (GMFM-66) from baseline to 24 months after SDR, using a linear mixed effects model. Secondary outcomes included spasticity, bladder function, quality of life, and pain scores. RESULTS Between 2012 and 2019, 144 children who satisfied these inclusion criteria underwent SDR. The mean age was 8.2 years. Fifty-two percent were female. Mean GMFM-66 score was available in 77 patients (53.5%) and in 39 patients (27.1%) at 24 months after SDR. The mean increase between baseline and 24 months post-SDR was 2.4 units (95% CI 1.7-3.1, p < 0.001, annual change 1.2 units). Of the 67 patients with a GMFM-66 measurement available, a documented increase in gross motor function was seen in 77.6% (n = 52). Of 101 patients with spasticity data available, mean Ashworth scale decreased after surgery (2.74 to 0.30). Of patients' pain scores, 60.7% (n = 34) improved, and 96.4% (n = 56) of patients' pain scores remained the same or improved. Bladder function improved in 30.9% of patients. CONCLUSIONS SDR improved gross motor function and reduced pain in most patients at 24 months after surgery, although the improvement is less pronounced than in children with GMFCS levels II and III. SDR should be considered in non-ambulant patients.
Collapse
Affiliation(s)
- Conor S Gillespie
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Trust, Liverpool, UK.
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
- Department of Neurology, Alder Hey Children's Hospital NHS Trust, Liverpool, UK.
| | - Benjamin J Hall
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Trust, Liverpool, UK
| | - Alan M George
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Trust, Liverpool, UK
| | - Dawn Hennigan
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Trust, Liverpool, UK
| | - Christine Sneade
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Trust, Liverpool, UK
| | - Stephanie Cawker
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Adikarige Haritha Dulanka Silva
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Michael Vloeberghs
- Department of Neurosurgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kristian Aquilina
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Benedetta Pettorini
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Trust, Liverpool, UK
| |
Collapse
|
10
|
Ashraf M, Chaudhary A, Ismahel H, Gillespie CS. Letter to the Editor Regarding "Systematic Review of Research, Mentorship, and Career Resources for Medical Students Pursuing Neurosurgical Training". World Neurosurg 2023; 180:262-263. [PMID: 38115391 DOI: 10.1016/j.wneu.2023.08.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Mohammad Ashraf
- Glasgow Neuro Society, Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom; Queen Elizabeth University Hospital, Glasgow, United Kingdom.
| | - Attika Chaudhary
- Glasgow Neuro Society, Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Hassan Ismahel
- Glasgow Neuro Society, Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Conor S Gillespie
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, England, United Kingodm; Past Chair, Neurology and Neurosurgery Interest Group, United Kingdom
| |
Collapse
|
11
|
Gillespie CS, Mustafa MA, Richardson GE, Alam AM, Lee KS, Hughes DM, Escriu C, Zakaria R. Genomic Alterations and the Incidence of Brain Metastases in Advanced and Metastatic NSCLC: A Systematic Review and Meta-Analysis. J Thorac Oncol 2023; 18:1703-1713. [PMID: 37392903 DOI: 10.1016/j.jtho.2023.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/14/2023] [Accepted: 06/18/2023] [Indexed: 07/03/2023]
Abstract
INTRODUCTION Brain metastases (BMs) in patients with advanced and metastatic NSCLC are linked to poor prognosis. Identifying genomic alterations associated with BM development could influence screening and determine targeted treatment. We aimed to establish prevalence and incidence in these groups, stratified by genomic alterations. METHODS A systematic review and meta-analysis compliant with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were conducted (PROSPERO identification CRD42022315915). Articles published in MEDLINE, EMBASE, and Cochrane Library between January 2000 and May 2022 were included. Prevalence at diagnosis and incidence of new BM per year were obtained, including patients with EGFR, ALK, KRAS, and other alterations. Pooled incidence rates were calculated using random effects models. RESULTS A total of 64 unique articles were included (24,784 patients with NSCLC with prevalence data from 45 studies and 9058 patients with NSCLC having incidence data from 40 studies). Pooled BM prevalence at diagnosis was 28.6% (45 studies, 95% confidence interval [CI]: 26.1-31.0), and highest in patients that are ALK-positive (34.9%) or with RET-translocations (32.2%). With a median follow-up of 24 months, the per-year incidence of new BM was 0.13 in the wild-type group (14 studies, 95% CI: 0.11-0.16). Incidence was 0.16 in the EGFR group (16 studies, 95% CI: 0.11-0.21), 0.17 in the ALK group (five studies, 95% CI: 0.10-0.27), 0.10 in the KRAS group (four studies, 95% CI: 0.06-0.17), 0.13 in the ROS1 group (three studies, 95% CI: 0.06-0.28), and 0.12 in the RET group (two studies, 95% CI: 0.08-0.17). CONCLUSIONS Comprehensive meta-analysis indicates a higher prevalence and incidence of BM in patients with certain targetable genomic alterations. This supports brain imaging at staging and follow-up, and the need for targeted therapies with brain penetrance.
Collapse
Affiliation(s)
- Conor S Gillespie
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Mohammad A Mustafa
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - George E Richardson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Ali M Alam
- Institute of Infection, Veterinary, and Ecological Science, University of Liverpool, Liverpool, United Kingdom
| | - Keng Siang Lee
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom; Department of Basic and Clinical Neurosciences, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - David M Hughes
- Department of Health Data Science, University of Liverpool, Liverpool, United Kingdom
| | - Carles Escriu
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom; Department of Medical Oncology, Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Rasheed Zakaria
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom; Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom.
| |
Collapse
|
12
|
Goyal K, Sunny JT, Gillespie CS, Wilby M, Clark SR, Kaiser R, Fehlings MG, Srikandarajah N. A Systematic Review and Meta-Analysis of Vertebral Artery Injury After Cervical Spine Trauma. Global Spine J 2023:21925682231209631. [PMID: 37924280 DOI: 10.1177/21925682231209631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2023] Open
Abstract
STUDY DESIGN Systematic Review and Meta-Analysis. OBJECTIVE Identify the incidence, mechanism of injury, investigations, management, and outcomes of Vertebral Artery Injury (VAI) after cervical spine trauma. METHODS A systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines (PROSPERO-ID CRD42021295265). Three databases were searched (PubMed, SCOPUS, Google Scholar, CINAHL PLUS). Incidence of VAI, investigations to diagnose (Computed Tomography Angiography, Digital Subtraction Angiography, Magnetic Resonance Angiography), stroke incidence, and management paradigms (conservative, antiplatelets, anticoagulants, surgical, endovascular treatment) were delineated. Incidence was calculated using pooled proportions random effects meta-analysis. RESULTS A total of 44 studies were included (1777 patients). 20-studies (n = 503) included data on trauma type; 75.5% (n = 380) suffered blunt trauma and 24.5% (n = 123) penetrating. The overall incidence of VAI was .95% (95% CI 0.65-1.29). From the 16 studies which reported data on outcomes, 8.87% (95% CI 5.34- 12.99) of patients with VAI had a posterior stroke. Of the 33 studies with investigation data, 91.7% (2929/3629) underwent diagnostic CTA; 7.5% (242/3629) underwent MRA and 3.0% (98/3629) underwent DSA. Management data from 20 papers (n = 475) showed 17.9% (n = 85) undergoing conservative therapy, anticoagulation in 14.1% (n = 67), antiplatelets in 16.4% (n = 78), combined therapy in 25.5% (n = 121) and the rest (n = 124) managed using surgical and endovascular treatments. CONCLUSION VAI in cervical spine trauma has an approximate posterior circulation stroke risk of 9%. Optimal management paradigms for the prevention and management of VAI are yet to be standardized and require further research.
Collapse
Affiliation(s)
- Kartik Goyal
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Northern General Hospital, Sheffield Teaching Hospital Trusts, Sheffield, UK
| | - Jesvin T Sunny
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Cambridge University Hospital NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Conor S Gillespie
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Martin Wilby
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Simon R Clark
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Radek Kaiser
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital, Prague, Czech Republic
| | - Michael G Fehlings
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Nisaharan Srikandarajah
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, Liverpool, UK
| |
Collapse
|
13
|
Clynch AL, Norrington M, Mustafa MA, Richardson GE, Doherty JA, Humphries TJ, Gillespie CS, Keshwara SM, McMahon CJ, Islim AI, Jenkinson MD, Millward CP, Brodbelt AR. Correction to: Cranial meningioma with bone involvement: surgical strategies and clinical considerations. Acta Neurochir (Wien) 2023; 165:2923. [PMID: 37477713 PMCID: PMC10541489 DOI: 10.1007/s00701-023-05710-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Affiliation(s)
- Abigail L Clynch
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK.
| | - Max Norrington
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool, L9 7LJ, UK
| | - Mohammad A Mustafa
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - George E Richardson
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - John A Doherty
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool, L9 7LJ, UK
| | - Thomas J Humphries
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool, L9 7LJ, UK
| | - Conor S Gillespie
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - Sumirat M Keshwara
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - Catherine J McMahon
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool, L9 7LJ, UK
| | - Abdurrahman I Islim
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool, L9 7LJ, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - Michael D Jenkinson
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool, L9 7LJ, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - Christopher P Millward
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool, L9 7LJ, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - Andrew R Brodbelt
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool, L9 7LJ, UK
| |
Collapse
|
14
|
Lee KS, Siow I, Zhang JJ, Syn NL, Gillespie CS, Yuen LZ, Anil G, Yang C, Chan BP, Sharma VK, Teoh HL, Mingxue J, Teo KSH, Myint MZ, Bhogal P, Meyer L, Schob S, Sia CH, Mpotsaris A, Maus V, Andersson T, Arnberg F, Gontu VK, Lee TH, Tan BYQ, Yeo LL. Bridging thrombolysis improves survival rates at 90 days compared with direct mechanical thrombectomy alone in acute ischemic stroke due to basilar artery occlusion: a systematic review and meta-analysis of 1096 patients. J Neurointerv Surg 2023; 15:1039-1045. [PMID: 36175014 DOI: 10.1136/jnis-2022-019510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/13/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Mechanical thrombectomy (MT) is an effective treatment for patients with acute ischemic stroke (AIS) from basilar artery occlusion (BAO). OBJECTIVE To compare the clinical outcomes of MT, with and without bridging intravenous thrombolysis (IVT), in acute BAO through a systematic review and meta-analysis of the current literature. METHODS Systematic searches of Medline, EMBASE, and Cochrane Central were undertaken on August 1, 2022. Good functional outcome defined as 90-day modified Rankin Scale score 0-2 was the primary outcome measure. Secondary outcome measures were 90-day mortality, successful post-thrombectomy recanalization (modified Thrombolysis in Cerebral Infarction score ≥2b), symptomatic intracranial hemorrhage (sICH), and subarachnoid hemorrhage (SAH). RESULTS Three studies reporting 1096 patients with BAO AIS were included in the meta-analysis. No significant differences in good functional outcome were detected between the two groups (RR=1.28 (95% CI 0.86 to 1.92); p=0.117). However, specifically patients with large artery atherosclerosis (LAA) benefited from bridging IVT (OR=2.52 (95% CI 1.51 to 4.22); p<0.001) with better functional outcomes. There was a significantly lower 90-day mortality rate for patients who underwent bridging IVT compared with MT alone (RR=0.70 (95% CI 0.62 to 0.80); p=0.008). No significant differences were detected in rates of post-treatment recanalization (RR=1.01 (95% CI 0.35 to 2.91); p=0.954), sICH (RR=0.96 (95% CI 0.66 to 1.42); p=0.724), and SAH (RR=0.93 (95% CI 0.31 to 2.83); p=0.563). CONCLUSIONS In patients with AIS due to BAO, bridging IVT was associated with lower mortality rates at 90 days, compared with direct MT. There were no improved functional outcomes or increased sICH or SAH between both arms, However, patients with LAA benefited from bridging IVT, with better functional outcomes.
Collapse
Affiliation(s)
- Keng Siang Lee
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Isabel Siow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - John Jy Zhang
- Department of Neurosurgery, National Neuroscience Institute, Singapore
| | - Nicholas L Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Conor S Gillespie
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Linus Zh Yuen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gopinathan Anil
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Divison of Interventional Radiology, Department of Diagnostic Imaging, National University Health System, Singapore
| | - Cunli Yang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Divison of Interventional Radiology, Department of Diagnostic Imaging, National University Health System, Singapore
| | - Bernard Pl Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Vijay Kumar Sharma
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Hock-Luen Teoh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Jing Mingxue
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Kevin Soon Hwee Teo
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - May Zin Myint
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Pervinder Bhogal
- Department of Interventional Neuroradiology, St. Bartholomew's and The Royal London Hospital, London, UK
| | - Lukas Meyer
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Schob
- Department of Neuroradiology, Clinic and Policlinic of Radiology, University Hospital Halle/Saale, Halle, Germany
| | - Ching-Hui Sia
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Anastasios Mpotsaris
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Volker Maus
- Department of Diagnostic and Interventional Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Tommy Andersson
- Department of Neuroradiology; Department of Clinical Neuroscience, Karolinska University Hospital; Karolinska Institutet, Stockholm, Sweden
- Department of Medical Imaging, AZ Groeninge, Kortrijk, Belgium
| | - Fabian Arnberg
- Department of Neuroradiology; Department of Clinical Neuroscience, Karolinska University Hospital; Karolinska Institutet, Stockholm, Sweden
| | - Vamsi Krishna Gontu
- Department of Neuroradiology; Department of Clinical Neuroscience, Karolinska University Hospital; Karolinska Institutet, Stockholm, Sweden
| | - Tsong-Hai Lee
- Department of Neruology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Benjamin Y Q Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Leonard Ll Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| |
Collapse
|
15
|
Sajjad F, Baloch MF, Ashraf M, Gillespie CS, Umar H, Zafar A, Zulfiqar J, Ullah I, Ali S, Ashraf N. Focal dystonia and ataxic hemiparesis as the initial presentation of a thalamic tuberculoma: A diagnostic challenge in an immunocompetent pediatric patient. Surg Neurol Int 2023; 14:350. [PMID: 37810325 PMCID: PMC10559370 DOI: 10.25259/sni_581_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Background Central nervous system (CNS) tuberculomas are rare and account for approximately 1% of all tuberculosis (TB) cases. These intracranial lesions are more commonly observed in immunocompromised individuals, often as part of disseminated miliary TB or after latent infection reactivation. This case report presents the occurrence of a thalamic tuberculoma in an immunocompetent girl. Case Description An 11-year-old girl presented with a 3-month history of progressive right-sided ataxic hemiparesis, hand dystonia/thalamic hand, and headache. There was only a mildly elevated erythrocyte sedimentation rate (25 mm/h.), and her remaining biochemistry and vitals were unremarkable. Magnetic resonance imaging (MRI) brain revealed an ill-defined intra-axial heterogeneous lobulated lesion with crenated margins involving the thalamus and the posterior limb of the internal capsule with significant vasogenic edema. Given the clinical picture, the working diagnosis was a high-grade brain tumor. Due to the absence of a viable operative corridor for a meaningful resection and the diagnostic uncertainty, a stereotactic biopsy was performed, and histopathological analysis confirmed the presence of granulomas consistent with TB. A human immunodeficiency virus test (negative) and interferon-gamma release assay (positive) were then obtained. The patient was commenced on a regimen of anti-TB drugs with a tapering steroid dose. At 8 months, her most recent MRI showed a significant reduction in the size of her tuberculoma, and there is a complete resolution of her hand dystonia and hemiparesis to allow for independence in her activities of daily living. Conclusion This report emphasizes the importance of considering causes other than degenerative, vascular, or neoplasms in patients with hemiparesis with dystonia. CNS tuberculomas can present as such without prior history or specific clinical symptoms of TB, making them a diagnostic challenge. In cases with such uncertainty regarding the nature of an intracranial lesion and the role of resection, a stereotactic biopsy is invaluable.
Collapse
Affiliation(s)
- Fauzia Sajjad
- Department of Neurosurgery, Services Institute of Medical Sciences, Lahore, Pakistan
- Department of Neurosurgery, Allama Iqbal Medical College, Jinnah Hospital, Lahore, Pakistan
| | | | - Mohammad Ashraf
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
| | - Conor S. Gillespie
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Hira Umar
- Department of Neurosurgery, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Ammara Zafar
- Department of Neurosurgery, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Javaria Zulfiqar
- Department of Neurosurgery, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Imdad Ullah
- Department of Neurosurgery, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Sundus Ali
- Department of Neurosurgery, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | | |
Collapse
|
16
|
Clynch A, Richardson GE, Mustafa MA, Gillespie CS, Rathi N, Bakhsh A, Zakaria R, Islim AI, Millward CP, Jenkinson MD. Beyond the WHO classification of meningioma: using molecular diagnostics to guide management. Adv Clin Neurosci Rehabil 2023; 22:WVJZ9783. [PMID: 37860270 PMCID: PMC7615222 DOI: 10.47795/wvjz9783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Meningioma are the most common primary brain tumour. Classically, meningioma are phenotypically grouped using the World Health Organisation (WHO) classification system. However, it is now understood that the WHO approach overfits tumours into three grades, resulting in similarly graded tumours displaying phenotypically distinct behaviour. There is a growing body of research investigating the molecular biology of these tumours, including genomic, transcriptomic, metabolomic, proteomic, and methylomic profiling. Such advancements in molecular profiling of meningioma are providing greater accuracy in prognostication of tumours. Furthermore, a clearer understanding of tumour molecular biology highlights potential targets for pharmacotherapies. Currently, the routine application of in-depth tumour molecular analysis is limited, however as it becomes more widely available it will likely result in improved patient care. This review seeks to explore the important developments in meningioma molecular biology, discussed in the context of their clinical importance.
Collapse
|
17
|
Suppree JS, Patel A, Keshwara SM, Krishna ST, Gillespie CS, Richardson GE, Mustafa MA, Hart S, Islim AI, Jenkinson MD, Millward CP. Assessing the reporting quality of adult neuro-oncology protocols, abstracts, and trials: Adherence to the SPIRIT and CONSORT statements. Neurooncol Pract 2023; 10:391-401. [PMID: 37457230 PMCID: PMC10346400 DOI: 10.1093/nop/npad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Background Comprehensive and transparent reporting of clinical trial activity is important. The Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013 and Consolidated Standards of Reporting Trials (CONSORT) 2010 statements define the items to be reported in clinical trial protocols and randomized controlled trials, respectively. The aim of this methodological review was to assess the reporting quality of adult neuro-oncology trial protocols and trial result articles. Methods Adult primary and secondary brain tumor phase 3 trial protocols and result articles published after the introduction of the SPIRIT 2013 statement, were identified through searches of 4 electronic bibliographic databases. Following extraction of baseline demographic data, the reporting quality of independently included trial protocols and result articles was assessed against the SPIRIT and CONSORT statements respectively. The CONSORT-A checklist, an extension of the CONSORT 2010 statement, was used to specifically assess the abstract accompanying the trial results article. Percentage adherence (standard deviation [SD]) was calculated for each article. Results Seven trial protocols, and 36 trial result articles were included. Mean adherence of trial protocols to the SPIRIT statement was 79.4% (SD: 0.11). Mean adherence of trial abstracts to CONSORT-A was 75.3% (SD: 0.12) and trial result articles to CONSORT was 74.5% (SD: 0.10). Conclusion The reporting quality of adult neuro-oncology trial protocols and trial result articles requires improvement to ensure comprehensive and transparent communication of planned neuro-oncology clinical trials and results within the literature. Raising awareness by clinical triallists and implementing mandatory evidence of proof of adherence by journals should improve reporting quality.
Collapse
Affiliation(s)
- Joshua S Suppree
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Avni Patel
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Sumirat M Keshwara
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Conor S Gillespie
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - George E Richardson
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Mohammad A Mustafa
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Sophia Hart
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Abdurrahman I Islim
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Christopher P Millward
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| |
Collapse
|
18
|
Mustafa MA, Richardson GE, Gillespie CS, Clynch AL, Keshwara SM, Gupta S, George AM, Islim AI, Brodbelt AR, Duncan C, McMahon CJ, Sinha A, Jenkinson MD, Millward CP. Health-related quality of life following cranioplasty - a systematic review. Br J Neurosurg 2023:1-11. [PMID: 37265087 DOI: 10.1080/02688697.2023.2202244] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Cranioplasty is a neurosurgical procedure that repairs a defect in the skull Coupled with the underlying pathology cranioplasty associated morbidity can have a large impact on patient quality of life, which is often poorly explored. The objective of this systematic review was to identify patient-reported outcomes evaluating health-related quality of life following cranioplasty. The review protocol was registered on PROSPERO (CRD42021251543) and a systematic review was conducted in accordance with the PRISMA statement. PubMed, Embase, CINAHL Plus, and the Cochrane databases were searched from inception to 1 May 2022. All studies reporting HRQoL following cranioplasty were included. Reporting was assessed using the ISOQOL checklist and risk of bias was assessed using the Newcastle-Ottawa Scale or the Johanna-Briggs Institute Scale, as appropriate. A total of 25 studies were included of which 20 were cross-sectional and 2 longitudinal. Most studies utilized study specific questionnaires and Likert scales to assess HRQoL. The studies found a significant improvement in physical functioning, social functioning, cosmetic outcome, and overall HRQoL following cranioplasty. Further longitudinal studies utilising validated measurement tools are required to better understand the effect of cranioplasty at a patient level.
Collapse
Affiliation(s)
| | - George E Richardson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Conor S Gillespie
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Abigail L Clynch
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Sumirat M Keshwara
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Shubhi Gupta
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Alan M George
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Abdurrahman I Islim
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Andrew R Brodbelt
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Christian Duncan
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Catherine J McMahon
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Ajay Sinha
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Christopher P Millward
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| |
Collapse
|
19
|
Gillespie CS, Fung KW, Alam AM, Yanez Touzet A, Dhesi J, Edlmann E, Coles J, Menon DK, Hutchinson PJ, Stubbs DJ, Davies BM. How does research activity align with research need in chronic subdural haematoma: a gap analysis of systematic reviews with end-user selected knowledge gaps. Acta Neurochir (Wien) 2023:10.1007/s00701-023-05618-2. [PMID: 37249690 DOI: 10.1007/s00701-023-05618-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/30/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Chronic subdural haematoma (CSDH) is increasingly common. Although treatment is triaged and provided by neurosurgery, the role of non-operative care, alongside observed peri-operative morbidity and patient complexity, suggests that optimum care requires a multi-disciplinary approach. A UK consortium (Improving Care in Elderly Neurosurgery Initiative [ICENI]) has been formed to develop the first comprehensive clinical practice guideline. This starts by identifying critical questions to ask of the literature. The aim of this review was to consider whether existing systematic reviews had suitably addressed these questions. METHODS Critical research questions to inform CSDH care were identified using multi-stakeholder workshops, including patient and public representation. A CSDH umbrella review of full-text systematic reviews and meta-analysis was conducted in accordance with the PRISMA statement (CRD42022328562). Four databases were searched from inception up to 30 April 2022. Review quality was assessed using AMSTAR-2 criteria, mapped to critical research questions. RESULTS Forty-four critical research questions were identified, across 12 themes. Seventy-three articles were included in the umbrella review, comprising 206,369 patients. Most reviews (86.3%, n=63) assessed complications and recurrence after surgery. ICENI themes were not addressed in current literature, and duplication of reviews was common (54.8%, n=40). AMSTAR-2 confidence rating was high in 7 (9.6%) reviews, moderate in 8 (11.0%), low in 10 (13.7%) and critically low in 48 (65.8%). CONCLUSIONS The ICENI themes have yet to be examined in existing secondary CSDH literature, and a series of new reviews is now required to address these questions for a clinical practice guideline. There is a need to broaden and redirect research efforts to meet the organisation of services and clinical needs of individual patients.
Collapse
Affiliation(s)
- Conor S Gillespie
- Department of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, CB2 0SZ, Cambridge, UK.
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK.
| | - Kwan Wai Fung
- Department of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, CB2 0SZ, Cambridge, UK
| | - Ali M Alam
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Alvaro Yanez Touzet
- Department of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, CB2 0SZ, Cambridge, UK
- School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jugdeep Dhesi
- Department of Ageing and Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ellie Edlmann
- Department of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, CB2 0SZ, Cambridge, UK
| | - Jonathan Coles
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - David K Menon
- Department of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, CB2 0SZ, Cambridge, UK
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Peter J Hutchinson
- Department of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, CB2 0SZ, Cambridge, UK
| | - Daniel J Stubbs
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Benjamin M Davies
- Department of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, CB2 0SZ, Cambridge, UK
| |
Collapse
|
20
|
Lee KS, Gillespie CS, Chari A, Momin S, Turner C, Jenkinson MD, Brownstone R. Current landscape of academic neurosurgical training in the United Kingdom: analysis by the Society of British Neurological Surgeons. Br J Neurosurg 2023:1-7. [PMID: 37199545 DOI: 10.1080/02688697.2023.2213329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Little is known about the impact of academic training on Neurosurgery in the United Kingdom (UK). The aim was to understand the early career clinical and research training journeys of potential future clinical academics, with a view to informing future policy and strategy to improve career development for academic neurosurgical trainees and consultants in the UK. METHODS An online survey from the Society of British Neurological Surgeons (SBNS) academic committee was distributed to both the SBNS and British Neurosurgical Trainee Association (BNTA) mailing lists in early 2022. Neurosurgical trainees for any period between 2007 and 2022 or who had done any dedicated academic or clinical academic placement were encouraged to complete the survey. RESULTS Sixty responses were received. Six (10%) were females and fifty-four (90%) were males. At the time of response, nine (15.0%) were clinical trainees, four (6.7%) were Academic Clinical Fellows (ACF), six (10.0%) were Academic Clinical Lecturers (ACL), four (6.7%) were post-CCT fellows, eight (13.3%) were NHS consultants, eight (13.3%) were academic consultants, eighteen (30.0%) were out of the programme (OOP) pursuing a PhD potentially returning to training, whilst three (5.0%) had left neurosurgery training entirely and no longer performing clinical neurosurgery. The mentorship was sought in most programmes, which tended to be informal. Self-reported success on a scale of 0 to 10 with 10 being the most successful, was greatest in the MD and the "Other research degree/fellowship group" which does not include a PhD. There was a significant positive association between completing a PhD and having an academic consultant appointment (Pearson Chi-Square = 5.33, p = 0.021). CONCLUSIONS This study provides a snapshot to better understand the opinions of academic training in neurosurgery within the UK. Establishing clear, modifiable, and achievable goals, as well as providing tools for research success, may contribute to the success of this nationwide academic training.
Collapse
Affiliation(s)
- Keng Siang Lee
- Department of Neurosurgery, King's College Hospital, London, UK
- Department of Basic and Clinical Neurosciences, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Conor S Gillespie
- Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Aswin Chari
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
- Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Sheikh Momin
- Department of Neurosurgery, Queen Elizabeth Hospital, Birmingham, UK
| | - Carole Turner
- Division of Neurosurgery, Department of Clinical Neurosciences, Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | | | - Robert Brownstone
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
- UCL Queen Square Institute of Neurology, University College London, London, UK
| |
Collapse
|
21
|
Henney AE, Gillespie CS, Alam U, Hydes TJ, Cuthbertson DJ. Ultra-Processed Food Intake Is Associated with Non-Alcoholic Fatty Liver Disease in Adults: A Systematic Review and Meta-Analysis. Nutrients 2023; 15:nu15102266. [PMID: 37242149 DOI: 10.3390/nu15102266] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/02/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is associated with overweight/obesity, metabolic syndrome and type 2 diabetes (T2D) due to chronic caloric excess and physical inactivity. Previous meta-analyses have confirmed associations between ultra-processed food (UPF) intake and obesity and T2D. We aim to ascertain the contribution of UPF consumption to the risk of developing NAFLD. We performed a systematic review and meta-analysis (PROSPERO (CRD42022368763)). All records registered on Ovid Medline and Web of Science were searched from inception until December 2022. Studies that assessed UPF consumption in adults, determined according to the NOVA food classification system, and that reported NAFLD determined by surrogate (steatosis) scores, imaging or liver biopsy were included. The association between UPF consumption and NAFLD was assessed using random-effects meta-analysis methods. Study quality was assessed, and evidence credibility evaluated, using the Newcastle Ottawa Scale and NutriGrade systems, respectively. A total of 5454 records were screened, and 112 records underwent full text review. From these, 9 studies (3 cross-sectional, 3 case-control and 3 cohort), analysing 60,961 individuals, were included in the current review. Both moderate (vs. low) (pooled relative risk 1.03 (1.00-1.07) (p = 0.04) (I2 = 0%)) and high (vs. low) (1.42 (1.16-1.75) (<0.01) (I2 = 89%)) intake of UPF significantly increased the risk of NAFLD. Funnel plots demonstrate low risk of publication bias. Consumption of UPF is associated with NAFLD with a dose-response effect. Public health measures to reduce overconsumption of UPF are imperative to reduce the burden of NAFLD, and the related conditions, obesity and T2D.
Collapse
Affiliation(s)
- Alex E Henney
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool L3 5TR, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK
| | - Conor S Gillespie
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 1TN, UK
| | - Uazman Alam
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool L3 5TR, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK
| | - Theresa J Hydes
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool L3 5TR, UK
- Department of Gastroenterology and Hepatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK
| | - Daniel J Cuthbertson
- Department of Cardiovascular & Metabolic Medicine, University of Liverpool, Liverpool L3 5TR, UK
- Metabolism & Nutrition Research Group, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, UK
| |
Collapse
|
22
|
Clynch AL, Gillespie CS, Richardson GE, Mustafa MA, Islim AI, Keshwara SM, Bakhsh A, Kumar S, Zakaria R, Millward CP, Mills SJ, Brodbelt AR, Jenkinson MD. Tranexamic acid use in meningioma surgery - A systematic review and meta-analysis. J Clin Neurosci 2023; 110:53-60. [PMID: 36796271 DOI: 10.1016/j.jocn.2023.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 01/02/2023] [Accepted: 01/25/2023] [Indexed: 02/16/2023]
Abstract
Tranexamic Acid (TXA) has been used in medical and surgical practice to reduce haemorrhage. The aim of this review was to evaluate the effect of TXA use on intraoperative and postoperative outcomes of meningioma surgery. A systematic review and meta-analysis was conducted in accordance with the PRISMA statement and registered in PROSPERO (CRD42021292157). Six databases were searched up to November 2021 for phase 2-4 control trials or cohort studies, in the English language, examining TXA use during meningioma surgery. Studies ran outside of dedicated neurosurgical departments or centres were excluded. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool. Random effects meta-analysis were performed to delineate differences in operative and postoperative outcomes. Four studies (281 patients) were included. TXA use significantly reduced intraoperative blood loss (mean difference 315.7 mls [95% confidence interval [CI] -532.8, -98.5]). Factors not affected by TXA use were transfusion requirement (odds ratio = 0.52; 95% CI 0.27, 0.98), operation time (mean difference = -0.2 h; 95% CI -0.8, 0.4), postoperative seizures (Odds Ratio [OR] = 0.88; 95% CI 0.31, 2.53), hospital stay (mean difference = -1.2; 95% CI -3.4, 0.9) and disability after surgery (OR = 0.50; 95% CI 0.23, 1.06). The key limitations of this review were the small sample size, limited data for secondary outcomes and a lack of standardised method for measuring blood loss. TXA use reduces blood loss in meningioma surgery, but not transfusion requirement or postoperative complications. Larger trials are required to investigate the impact of TXA on patient-reported postoperative outcomes.
Collapse
Affiliation(s)
- Abigail L Clynch
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK.
| | - Conor S Gillespie
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK.
| | - George E Richardson
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Mohammad A Mustafa
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Abdurrahman I Islim
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Manchester, UK; Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Sumirat M Keshwara
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, Prescot, UK
| | - Ali Bakhsh
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Siddhant Kumar
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Rasheed Zakaria
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Christopher P Millward
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Samantha J Mills
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Andrew R Brodbelt
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Michael D Jenkinson
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| |
Collapse
|
23
|
Gillespie CS, Richardson GE, Mustafa MA, Taweel BA, Bakhsh A, Kumar S, Keshwara SM, Islim AI, Mehta S, Millward CP, Brodbelt AR, Mills SJ, Jenkinson MD. Volumetric Growth and Growth Curve Analysis of Residual Intracranial Meningioma. Neurosurgery 2023; 92:734-744. [PMID: 36656062 PMCID: PMC9988310 DOI: 10.1227/neu.0000000000002268] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/23/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND After meningioma surgery, approximately 1 in 3 patients will have residual tumor that requires ongoing imaging surveillance. The precise volumetric growth rates of these tumors are unknown. OBJECTIVE To identify the volumetric growth rates of residual meningioma, growth trajectory, and factors associated with progression. METHODS Patients with residual meningioma identified at a tertiary neurosurgery center between 2004 and 2020 were retrospectively reviewed. Tumor volume was measured using manual segmentation, after surgery and at every follow-up MRI scan. Growth rates were ascertained using a linear mixed-effects model and nonlinear regression analysis of growth trajectories. Progression was defined according to the Response Assessment in Neuro-Oncology (RANO) criteria (40% volume increase). RESULTS There were 236 patients with residual meningioma. One hundred and thirty-two patients (56.0%) progressed according to the RANO criteria, with 86 patients being conservatively managed (65.2%) after progression. Thirteen patients (5.5%) developed clinical progression. Over a median follow-up of 5.3 years (interquartile range, 3.5-8.6 years), the absolute growth rate was 0.11 cm 3 per year and the relative growth rate 4.3% per year. Factors associated with residual meningioma progression in multivariable Cox regression analysis were skull base location (hazard ratio [HR] 1.60, 95% CI 1.02-2.50) and increasing Ki-67 index (HR 3.43, 95% CI 1.19-9.90). Most meningioma exhibited exponential and logistic growth patterns (median R 2 value 0.84, 95% CI 0.60-0.90). CONCLUSION Absolute and relative growth rates of residual meningioma are low, but most meet the RANO criteria for progression. Location and Ki-67 index can be used to stratify adjuvant treatment and surveillance paradigms.
Collapse
Affiliation(s)
- Conor S. Gillespie
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - George E. Richardson
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Mohammad A. Mustafa
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Basel A. Taweel
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Ali Bakhsh
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Siddhant Kumar
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Sumirat M. Keshwara
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Abdurrahman I. Islim
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Shaveta Mehta
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Oncology, Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Christopher P. Millward
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Andrew R. Brodbelt
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Samantha J. Mills
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Michael D. Jenkinson
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| |
Collapse
|
24
|
Gillespie CS, Stephanie Fang WY, Lee KS, Clynch AL, Alam AM, McMahon CJ. Long standing overt ventriculomegaly in adults (LOVA): a systematic review and meta-analysis of endoscopic third ventriculostomy vs ventriculoperitoneal shunt as first line treatment. World Neurosurg 2023:S1878-8750(23)00386-8. [PMID: 36958719 DOI: 10.1016/j.wneu.2023.03.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Long standing overt ventriculomegaly in adults (LOVA) is a heterogenous term describing forms of adult hydrocephalus. LOVA incidence is increasing, yet the optimal treatment strategy for symptomatic cases remains unclear. We compared the success and complication rates between Endoscopic Third Ventriculostomy (ETV) and Ventriculoperitoneal Shunt (VPS) as a first line treatment for LOVA. METHODS A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines (PROSPEROID CRD42021277542). Three databases were searched, and articles published from 2000 to October 2022 included (last search date 30th September 2022). Success rates and complications of both ETV and VPS were compared using random effects models. RESULTS Of 895 articles identified, 22 studies were included in the analysis (556 patients- 346 treated with ETV, 210 VPS). Mean age was 44.8 years. The most common presenting symptoms were gait disturbance (N=178), headache (N=156), and cognitive decline (N=134). Combined success rates were 81.8% (N=283/346) in the ETV group and 86.7% (N=182/210) in the VPS group (median follow up 41 months). There was no difference in success rates between ETV and VPS groups (Odds Ratio [OR] 0.94, 95% CI 0.86-1.03, I2 = 0%). Combined complication rates were 4.6% (N=16/346) in the ETV group and 27.1% (N=57/210) in the VPS group. ETV had a lower rate of postoperative complications (OR 0.22, 95% CI 0.11-0.33, I2 = 0%). CONCLUSIONS Symptomatic LOVA can be successfully managed with surgical intervention. ETV and VPS have similar success rates when used as first line treatment. However, VPS has a higher complication rate.
Collapse
Affiliation(s)
- Conor S Gillespie
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
| | | | - Keng Siang Lee
- Department of Neurosurgery, King's College Hospital, London, UK; Department of Basic and Clinical Neurosciences, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Abigail L Clynch
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Ali M Alam
- Institution of Infection, Veterinary and Ecological Science, University of Liverpool, UK
| | - Catherine J McMahon
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| |
Collapse
|
25
|
Clynch AL, Norrington M, Mustafa MA, Richardson GE, Doherty JA, Humphries TJ, Gillespie CS, Keshwara SM, McMahon CJ, Islim AI, Jenkinson MD, P Millward C, Brodbelt AR. Cranial meningioma with bone involvement: surgical strategies and clinical considerations. Acta Neurochir (Wien) 2023; 165:1355-1363. [PMID: 36877330 PMCID: PMC10140130 DOI: 10.1007/s00701-023-05535-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 02/11/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Intracranial meningioma with bone involvement and primary intraosseous meningioma is uncommon. There is currently no consensus for optimal management. This study aimed to describe the management strategy and outcomes for a 10-year illustrative cohort, and propose an algorithm to aid clinicians in selecting cranioplasty material in such patients. METHODS A single-centre, retrospective cohort study (January 2010-August 2021). All adult patients requiring cranial reconstruction due to meningioma with bone involvement or primary intraosseous meningioma were included. Baseline patient and meningioma characteristics, surgical strategy, and surgical morbidity were examined. Descriptive statistics were performed using SPSS v24.0. Data visualisation was performed using R v4.1.0. RESULTS Thirty-three patients were identified (mean age 56 years; SD 15) There were 19 females. Twenty-nine patients had secondary bone involvement (88%). Four had primary intraosseous meningioma (12%). Nineteen had gross total resection (GTR; 58%). Thirty had primary 'on-table' cranioplasty (91%). Cranioplasty materials included pre-fabricated polymethyl methacrylate (pPMMA) (n = 12; 36%), titanium mesh (n = 10; 30%), hand-moulded polymethyl methacrylate cement (hPMMA) (n = 4; 12%), pre-fabricated titanium plate (n = 4; 12%), hydroxyapatite (n = 2; 6%), and a single case combining titanium mesh with hPMMA cement (n = 1; 3%). Five patients required reoperation for a postoperative complication (15%). CONCLUSION Meningioma with bone involvement and primary intraosseous meningioma often requires cranial reconstruction, but this may not be evident prior to surgical resection. Our experience demonstrates that a wide variety of materials have been used successfully, but that pre-fabricated materials may be associated with fewer postoperative complications. Further research within this population is warranted to identify the most appropriate operative strategy.
Collapse
Affiliation(s)
- Abigail L Clynch
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK.
| | - Max Norrington
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK
| | - Mohammad A Mustafa
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - George E Richardson
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - John A Doherty
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK
| | - Thomas J Humphries
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK
| | - Conor S Gillespie
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - Sumirat M Keshwara
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - Catherine J McMahon
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK
| | - Abdurrahman I Islim
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK.,Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - Michael D Jenkinson
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK.,Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - Christopher P Millward
- The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK.,Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK
| | - Andrew R Brodbelt
- School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK.,The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK
| |
Collapse
|
26
|
Lee KS, Chari A, Gillespie CS, Ekert JO, Saffari SE, James G, Aquilina K. Endoscopic third ventriculostomy for shunt malfunction in the pediatric population: a systematic review, meta-analysis, and meta-regression analysis. J Neurosurg Pediatr 2023; 31:423-432. [PMID: 36787128 DOI: 10.3171/2023.1.peds22427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 01/17/2023] [Indexed: 02/12/2023]
Abstract
OBJECTIVE Despite growing published evidence of the merits of endoscopic third ventriculostomy (ETV) instead of shunt revision at the time of shunt malfunction (secondary ETV), concerns about its efficacy and complications remain and ETV is still not used widely in this context. This study aimed to carry out a comprehensive meta-analysis and reports on the success and safety of secondary ETV in the pediatric age group. METHODS In accordance with the PRISMA guidelines, systematic searches of Medline, Embase, and Cochrane Central were undertaken from database inception to September 7, 2022. ETV success was defined as the lack of need for a shunt and was the primary outcome measure. Secondary outcome measures were the rates of complications and mortality. A random-effects model was used. Summary-level meta-regression was performed to identify predictors for success in accordance with the ETV Success Score (ETVSS). RESULTS Sixteen studies reporting on 584 patients who underwent secondary ETV for shunt malfunction were included in the meta-analysis. The overall pooled mean (95% CI) age was 6.1 (3-9) years, and 57.0% of patients were male. The pooled prevalence rates of the hydrocephalus etiologies were as follows: aqueduct stenosis (39.3%); myelomeningocele (27.6%); postinfectious (17.1%); posthemorrhagic (13.0%); neoplasm (13.0%); and malformation (11.3%). The overall pooled success rates of ETV for shunt malfunction at 3 months, 6 months, and 12 months were 65.69% (95% CI 52%-77%, prediction interval 47%-81%, I2 = 0, p = 0.775); 63.25% (95% CI 54%-72%, prediction interval 38%-83%, I2 = 65, p < 0.001); and 53.37% (95% CI 24%-81%, prediction interval 1%-99%, I2 = 47, p = 0.154). The overall pooled prevalence of intraoperative bleeding was 4.96% (95% CI 0%-64%, prediction interval 0%-99%, I2 = 85, p < 0.001). The overall rates of complications were low, with new neurological deficit (transient or permanent) having the highest rate at 1.61% (95% CI 0.68%-3.72%, prediction interval 0.67%-3.78%, I2 = 0, p > 0.999). On meta-regression, age (p = 0.138), proportion of patients with postinfectious hydrocephalus (p = 0.8736), and number of shunt revisions (p = 0.1775) were not statistically significant predictors of secondary ETV success at 6 months. CONCLUSIONS This meta-analysis demonstrates that secondary ETV after shunt malfunction in pediatric patients is a feasible option with acceptable success rates and low complication rates. Clinical trial registration no.: CRD42022359573 (PROSPERO).
Collapse
Affiliation(s)
- Keng Siang Lee
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London, United Kingdom.,4Department of Basic and Clinical Neurosciences, Maurice Wohl Clinical Neuroscience Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Aswin Chari
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London, United Kingdom.,2Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom.,5Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Conor S Gillespie
- 6Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Justyna O Ekert
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London, United Kingdom.,2Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Seyed Ehsan Saffari
- 7Health Services and Systems Research, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore; and.,8National Neuroscience Institute, Singapore, Singapore
| | - Greg James
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London, United Kingdom.,2Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Kristian Aquilina
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London, United Kingdom.,2Developmental Neurosciences, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| |
Collapse
|
27
|
Gillespie CS, Alnaham KE, Richardson GE, Mustafa MA, Taweel BA, Islim AI, Hannan CJ, Chavredakis E. Predictors of future haemorrhage from cerebral cavernous malformations: a retrospective cohort study. Neurosurg Rev 2023; 46:52. [PMID: 36763222 PMCID: PMC9918566 DOI: 10.1007/s10143-023-01949-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 12/17/2022] [Accepted: 01/20/2023] [Indexed: 02/11/2023]
Abstract
Cerebral cavernous malformations (CCMs) are commonly diagnosed, with a low reported rate of haemorrhage on long-term follow-up. The identification of factors predictive of future haemorrhage risk would assist in guiding the management of patients with CCM. The aim of this study was to identify variables associated with haemorrhage, and calculate haemorrhage risk in CCM. We conducted a retrospective study of patients diagnosed with a CCM, managed at a specialist tertiary neuroscience centre (2007-2019). The primary outcome was symptomatic haemorrhage, and secondary outcomes were variables associated with increased risk of haemorrhage, using multivariable Cox regression analysis. Included were 545 patients, with 734 confirmed cavernomas. Median age at diagnosis was 47 (interquartile range [IQR] 35-60), with a median follow-up duration after diagnosis of 46 months (IQR 19-85). Of the patients, 15.0% had multiple lesions (N = 82/545). Symptomatic presentation was observed in 52.5% of patients (N = 286/545). The annual haemorrhage rate was 1.00% per lesion-year (25 events in 2512 lesion-years), and higher in those with symptoms at presentation (1.50% per lesion-year, 22 events vs 0.29%, 3 events, P < 0.001). The variables associated with symptomatic haemorrhage were increased size (hazard ratio [HR] 1.04, 95% confidence interval [CI] 1.01-1.07, P = 0.004), eloquent location (HR 2.63, 95% CI 1.12-6.16, P = 0.026), and symptomatic haemorrhage at presentation (HR 5.37, 95% CI 2.40-11.99, P < 0.001). This study demonstrated that CCMs have a low haemorrhage rate. Increased size, eloquent location, and haemorrhage at presentation appear to be predictive of a higher risk of haemorrhage, and could be used to stratify management protocols.
Collapse
Affiliation(s)
- Conor S Gillespie
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Biosciences Building, Crown Street, Liverpool, L69 7BE, UK.
- The Walton Centre NHS Foundation Trust, Liverpool, UK.
| | | | - George E Richardson
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Biosciences Building, Crown Street, Liverpool, L69 7BE, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Mohammad A Mustafa
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Biosciences Building, Crown Street, Liverpool, L69 7BE, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Basel A Taweel
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Biosciences Building, Crown Street, Liverpool, L69 7BE, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Abdurrahman I Islim
- The Walton Centre NHS Foundation Trust, Liverpool, UK
- Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Cathal John Hannan
- The Walton Centre NHS Foundation Trust, Liverpool, UK
- Academic Health Science Centre, University of Manchester, Manchester, UK
| | | |
Collapse
|
28
|
Takoutsing BD, Yanez Touzet A, Park JJ, Lee SH, Bligh ER, Egiz A, Gillespie CS, Figaji A. Management and outcomes of myelomeningocele-associated hydrocephalus in low-income and middle-income countries: a systematic review and meta-analysis protocol. BMJ Open 2023; 13:e066339. [PMID: 36750288 PMCID: PMC9906258 DOI: 10.1136/bmjopen-2022-066339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
INTRODUCTION Hydrocephalus and myelomeningocele (MMC) place disproportionate burdens of disease on low-income and middle-income countries (LMICs). MMC-associated hydrocephalus and its sequelae result in a spectrum of severely devastating clinical manifestations, for which LMICs are disproportionately unprepared in terms of human, capital and technological resources. This study aims to review and compare the management and outcomes of infant MMC-associated hydrocephalus in LMICs and high-income countries. METHODS AND ANALYSIS This systematic review and meta-analysis will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. The following databases will be searched without restrictions on language, publication date or country of origin: EMBASE, MEDLINE, The Cochrane Library, Global Index Medicus, African Journals Online and SciELO. All peer-reviewed studies of primary data reporting management and outcomes of infant MMC-associated hydrocephalus will be included. Where high-quality homogeneous studies exist, meta-analyses will be conducted to compare the management and outcomes of MMC-associated hydrocephalus across socioeconomic and geographical regions of the world. The primary outcome will be treatment failure of the first-line hydrocephalus treatment, which we defined operationally as the performance of a second intervention for the same reason as the first. Secondary outcomes include time to failure, rates of mortality and postoperative complications. ETHICS AND DISSEMINATION Ethical approval was not applicable because this study does not involve human participants. Dissemination strategies will include publication in a peer-reviewed journal, oral and poster presentations at conferences and an interactive web application to facilitate interaction with the findings and promote the discussion and sharing of findings on social media. PROSPERO REGISTRATION NUMBER CRD42021285850.
Collapse
Affiliation(s)
- Berjo Dongmo Takoutsing
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Alvaro Yanez Touzet
- School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom, University of Manchester, Manchester, UK
| | - Jay J Park
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Seong Hoon Lee
- Academic Critical Care & Neurosurgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Emily R Bligh
- Surgical Specialties, The Queen Elizabeth University Hospital, Glasgow, UK
- Academic Foundation Programme, The University of Glasgow, Glasgow, UK
| | - Abdullah Egiz
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Conor S Gillespie
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Anthony Figaji
- Division of Paediatric Neuroscience (Neurosurgery), School of Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
- Red Cross Children's Hospital, Cape Town, South Africa
| |
Collapse
|
29
|
Takoutsing BD, Ooi SZY, Egu CB, Gillespie CS, Bandyopadhyay S, Dada OE, Dokponou YCH, Dalle DU, Ciuculete AC, Awad AK, Khan M, Erhabor J, Ikwuegbuenyi CA, Kesici Ö, Bankole NDA. Management and outcomes of intracranial fungal infections in children and adults in Africa: a scoping review protocol. BMJ Open 2023; 13:e065943. [PMID: 36731932 PMCID: PMC9896247 DOI: 10.1136/bmjopen-2022-065943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION The protocol presents the methodology of a scoping review that aims to synthesise contemporary evidence on the management and outcomes of intracranial fungal infections in Africa. METHODS AND ANALYSIS The scoping review will be conducted in accordance with the Arksey and O'Malley's framework. The research question, inclusion and exclusion criteria and search strategy were developed based on the Population, Intervention, Comparator, Outcome framework. A search will be conducted in electronic bibliographic databases (Medline (OVID), Embase, African Journals Online, Cochrane Library and African Index Medicus). No restrictions on language or date of publication will be made. Quantitative and qualitative data extracted from included articles will be presented through descriptive statistics and a narrative description. ETHICS AND DISSEMINATION This study protocol does not require ethical approval. Findings will be reported in a peer-reviewed medical journal and presented at local, regional, national and international conferences.
Collapse
Affiliation(s)
| | | | - Chinedu Brian Egu
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Conor S Gillespie
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Soham Bandyopadhyay
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | | | - David Ulrich Dalle
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | - Ahmed K Awad
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Mehdi Khan
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Joshua Erhabor
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | | - Özgür Kesici
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | | |
Collapse
|
30
|
Gillespie CS, Khanna S, Vivian ME, McKoy S, Yanez Touzet A, Edlmann E, Stubbs DJ, Davies BM. Is information provided within chronic subdural haematoma education resources adequate? A scoping review. PLoS One 2023; 18:e0283958. [PMID: 37023014 PMCID: PMC10079037 DOI: 10.1371/journal.pone.0283958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 03/21/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Chronic subdural haematoma (CSDH) is becoming increasingly prevalent, due to an aging population with increasing risk factors. Due to its variable disease course and high morbidity, patient centred care and shared decision making are essential. However, its occurrence in frail populations, remote from specialist neurosurgeons who currently triage treatment decisions, challenges this. Education is an important component of enabling shared decisions. This should be targeted to avoid information overload. However, it is unknown what this should be. OBJECTIVES Our objectives were to conduct analysis of the content of existing CSDH educational materials, to inform the development of patient and relative educational resources to facilitate shared decision making. METHODS A literature search was conducted (July 2021) of MEDLINE, Embase and grey literature, for all self-specified resources on CSDH education, and narrative reviews. Resources were classified into a hierarchical framework using inductive thematic analysis into 8 core domains: Aetiology, epidemiology and pathophysiology; natural history and risk factors; symptoms; diagnosis; surgical management; nonsurgical management; complications and recurrence; and outcomes. Domain provision was summarised using descriptive statistics and Chi-squared tests. RESULTS 56 information resources were identified. 30 (54%) were resources designed for healthcare professionals (HCPs), and 26 (46%) were patient-orientated resources. 45 (80%) were specific to CSDH, 11 (20%) covered head injury, and 10 (18%) referenced both acute and chronic SDH. Of 8 core domains, the most reported were aetiology, epidemiology and pathophysiology (80%, n = 45) and surgical management (77%, n = 43). Patient orientated resources were more likely to provide information on symptoms (73% vs 13%, p<0.001); and diagnosis (62% vs 10%, p<0.001) when compared to HCP resources. Healthcare professional orientated resources were more likely to provide information on nonsurgical management (63% vs 35%, p = 0.032), and complications/recurrence (83% vs 42%, p = 0.001). CONCLUSION The content of educational resources is varied, even amongst those intended for the same audience. These discrepancies indicate an uncertain educational need, that will need to be resolved in order to better support effective shared decision making. The taxonomy created can inform future qualitative studies.
Collapse
Affiliation(s)
- Conor S Gillespie
- Department of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Samuel Khanna
- University Division of Anaesthesia, University of Cambridge, Cambridge, United Kingdom
| | - Mark E Vivian
- University Division of Anaesthesia, University of Cambridge, Cambridge, United Kingdom
| | - Samuel McKoy
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Alvaro Yanez Touzet
- School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Ellie Edlmann
- Department of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Daniel J Stubbs
- University Division of Anaesthesia, University of Cambridge, Cambridge, United Kingdom
| | - Benjamin M Davies
- Department of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
31
|
Mustafa MA, Richardson GE, Gillespie CS, Islim AI, Wilby M, Clark S, Srikandarajah N. Definition and surgical timing in cauda equina syndrome-An updated systematic review. PLoS One 2023; 18:e0285006. [PMID: 37141301 PMCID: PMC10159340 DOI: 10.1371/journal.pone.0285006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/14/2023] [Indexed: 05/06/2023] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES To conduct a systematic review identifying existing definitions of cauda equina syndrome (CES) and time to surgery in the literature for patients with CES. METHODS A systematic review was conducted in accordance with the PRISMA statement. Ovid Medline, Embase, CINAHL Plus, and trial registries were searched from October 1st, 2016, to 30th December 2022, and combined with articles identified from a previous systematic review by the same authors (studies published 1990-2016). RESULTS A total of 110 studies (52,008 patients) were included. Of these only 16 (14.5%) used established definitions in defining CES, including Fraser criteria (n = 6), British Association of Spine Surgeons (BASS) (n = 5), Gleave and MacFarlane (n = 2), and other (n = 3). Most reported symptoms were urinary dysfunction (n = 44, 40%%), altered sensation in the perianal region (n = 28, 25.5%) and bowel dysfunction (n = 20, 18.2%). Sixty-eight (61.8%) studies included details on time to surgery. There was an increase in percentage of studies defining CES published in the last 5 years compared to ones from 1990-2016 (58.6% vs 77.5.%, P = .045). CONCLUSIONS Despite Fraser recommendations, substantial heterogeneity exists in reporting of CES definitions, and a start point for time to surgery, with most authors using self-defined criteria. A consensus is required to define CES and time to surgery, to allow consistency in reporting and study analysis.
Collapse
Affiliation(s)
- Mohammad A Mustafa
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - George E Richardson
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Conor S Gillespie
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Abdurrahman I Islim
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Martin Wilby
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Simon Clark
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Nisaharan Srikandarajah
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| |
Collapse
|
32
|
George AM, Gupta S, Keshwara SM, Mustafa MA, Gillespie CS, Richardson GE, Steele AC, Zamanipoor Najafabadi AH, Dirven L, Marson AG, Islim AI, Jenkinson MD, Millward CP. Meningioma systematic reviews and meta-analyses: an assessment of reporting and methodological quality. Br J Neurosurg 2022; 36:678-685. [PMID: 36263847 DOI: 10.1080/02688697.2022.2115008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Systematic reviews (SR) and systematic reviews with meta-analysis (SRMA) can constitute the highest level of research evidence. Such evidence syntheses are relied upon heavily to inform the clinical knowledge base and to guide clinical practice for meningioma. This review evaluates the reporting and methodological quality of published meningioma evidence syntheses to date. METHODS Eight electronic databases/registries were searched to identify eligible meningioma SRs with and without meta-analysis published between January 1990 and December 2020. Articles concerning spinal meningioma were excluded. Reporting and methodological quality were assessed against the following tools: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2), and Risk Of Bias in Systematic reviews (ROBIS). RESULTS 116 SRs were identified, of which 57 were SRMAs (49.1%). The mean PRISMA score for SRMA was 20.9 out of 27 (SD 3.9, 77.0% PRISMA adherence) and for SR without meta-analysis was 13.8 out of 22 (SD 3.4, 63% PRISMA adherence). Thirty-eight studies (32.8%) achieved greater than 80% adherence to PRISMA. Methodological quality assessment against AMSTAR 2 revealed that 110 (94.8%) studies were of critically low quality. Only 21 studies (18.1%) were judged to have a low risk of bias against ROBIS. CONCLUSION The reporting and methodological quality of meningioma evidence syntheses was poor. Established guidelines and critical appraisal tools may be used as an adjunct to aid methodological conduct and reporting of such reviews, in order to improve the validity and transparency of research which may influence clinical practice.
Collapse
Affiliation(s)
- Alan M George
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Shubhi Gupta
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Sumirat M Keshwara
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Mohammad A Mustafa
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Conor S Gillespie
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - George E Richardson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Amy C Steele
- School of Life Sciences, University of Liverpool, Liverpool, UK
| | - Amir H Zamanipoor Najafabadi
- University Neurosurgical Center Holland, Leiden University Medical Centre, Haaglanden Medical Center, Haga Teaching Hospitals, Leiden, The Netherlands
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anthony G Marson
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK.,Institute of Systems, Molecular, & Integrative Biology, University of Liverpool, Liverpool, UK
| | - Abdurrahman I Islim
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK.,Institute of Systems, Molecular, & Integrative Biology, University of Liverpool, Liverpool, UK
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK.,Institute of Systems, Molecular, & Integrative Biology, University of Liverpool, Liverpool, UK
| | - Christopher P Millward
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK.,Institute of Systems, Molecular, & Integrative Biology, University of Liverpool, Liverpool, UK
| |
Collapse
|
33
|
Alam AM, Gillespie CS, Goodall J, Damodar T, Turtle L, Vasanthapuram R, Solomon T, Michael BD. Neurological manifestations of scrub typhus infection: A systematic review and meta-analysis of clinical features and case fatality. PLoS Negl Trop Dis 2022; 16:e0010952. [PMID: 36441812 PMCID: PMC9731453 DOI: 10.1371/journal.pntd.0010952] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 12/08/2022] [Accepted: 11/07/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Scrub typhus has become a leading cause of central nervous system (CNS) infection in endemic regions. As a treatable condition, prompt recognition is vital. However, few studies have focused on describing the symptomology and outcomes of neurological scrub typhus infection. We conducted a systematic review and meta-analysis to report the clinical features and case fatality ratio (CFR) in patients with CNS scrub typhus infection. METHODS A search and analysis plan was published in PROSPERO [ID 328732]. A systematic search of PubMed and Scopus was performed and studies describing patients with CNS manifestations of proven scrub typhus infection were included. The outcomes studied were weighted pooled prevalence (WPP) of clinical features during illness and weighted CFR. RESULTS Nineteen studies with 1,221 (656 adults and 565 paediatric) patients were included. The most common clinical features in CNS scrub typhus were those consistent with non-specific acute encephalitis syndromes (AES), such as fever (WPP 100.0% [99.5%-100.0%, I2 = 47.8%]), altered sensorium (67.4% [54.9-78.8%, I2 = 93.3%]), headache (65.0% [51.5-77.6%, I2 = 95.1%]) and neck stiffness 56.6% (29.4-80.4%, I2 = 96.3%). Classical features of scrub typhus were infrequently identified; an eschar was found in only 20.8% (9.8%-34.3%, I2 = 95.4%) and lymphadenopathy in 24.1% (95% CI 11.8% - 38.9%, I2 = 87.8%). The pooled CFR (95% CI) was 3.6% (1.5%- 6.4%, I2 = 67.3%). Paediatric cohorts had a CFR of 6.1% (1.9-12.1%, I2 = 77%) whilst adult cohorts reported 2.6% (0.7-5.3%, I2 = 43%). CONCLUSION Our meta-analyses illustrate that 3.6% of patients with CNS manifestations of scrub typhus die. Clinicians should have a high index of suspicion for scrub typhus in patients presenting with AES in endemic regions and consider starting empiric treatment whilst awaiting results of investigations, even in the absence of classical signs such as an eschar or lymphadenopathy.
Collapse
Affiliation(s)
- Ali M. Alam
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Science, University of Liverpool, Liverpool, United Kingdom
- Barts Health NHS Trust, London, United Kingdom
| | - Conor S. Gillespie
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
| | - Jack Goodall
- Tropical & Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Tina Damodar
- Department of Neurovirology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Lance Turtle
- Tropical & Infectious Disease Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- The Pandemic Institute, Liverpool, United Kingdom
- The NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom
| | - Ravi Vasanthapuram
- Department of Neurovirology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Tom Solomon
- The Pandemic Institute, Liverpool, United Kingdom
- The NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom
| | - Benedict D. Michael
- Department of Clinical Infection Microbiology and Immunology, Institute of Infection, Veterinary, and Ecological Science, University of Liverpool, Liverpool, United Kingdom
- The NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| |
Collapse
|
34
|
Gillespie CS, Bligh ER, Poon MTC, Solomou G, Islim AI, Mustafa MA, Rominiyi O, Williams ST, Kalra N, Mathew RK, Booth TC, Thompson G, Brennan PM, Jenkinson MD. Imaging timing after glioblastoma surgery (INTERVAL-GB): protocol for a UK and Ireland, multicentre retrospective cohort study. BMJ Open 2022; 12:e063043. [PMID: 36100297 PMCID: PMC9472166 DOI: 10.1136/bmjopen-2022-063043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Glioblastoma is the most common malignant primary brain tumour with a median overall survival of 12-15 months (range 6-17 months), even with maximal treatment involving debulking neurosurgery and adjuvant concomitant chemoradiotherapy. The use of postoperative imaging to detect progression is of high importance to clinicians and patients, but currently, the optimal follow-up schedule is yet to be defined. It is also unclear how adhering to National Institute for Health and Care Excellence (NICE) guidelines-which are based on general consensus rather than evidence-affects patient outcomes such as progression-free and overall survival. The primary aim of this study is to assess MRI monitoring practice after surgery for glioblastoma, and to evaluate its association with patient outcomes. METHODS AND ANALYSIS ImagiNg Timing aftER surgery for glioblastoma: an eVALuation of practice in Great Britain and Ireland is a retrospective multicentre study that will include 450 patients with an operated glioblastoma, treated with any adjuvant therapy regimen in the UK and Ireland. Adult patients ≥18 years diagnosed with glioblastoma and undergoing surgery between 1 August 2018 and 1 February 2019 will be included. Clinical and radiological scanning data will be collected until the date of death or date of last known follow-up. Anonymised data will be uploaded to an online Castor database. Adherence to NICE guidelines and the effect of being concordant with NICE guidelines will be identified using descriptive statistics and Kaplan-Meier survival analysis. ETHICS AND DISSEMINATION Each participating centre is required to gain local institutional approval for data collection and sharing. Formal ethical approval is not required since this is a service evaluation. Results of the study will be reported through peer-reviewed presentations and articles, and will be disseminated to participating centres, patients and the public.
Collapse
Affiliation(s)
- Conor S Gillespie
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Emily R Bligh
- Department of Neurosurgery, Institute of Neurological Sciences, Glasgow, UK
| | - Michael T C Poon
- Usher Institute, The University of Edinburgh, Edinburgh, UK
- Translational Neurosurgery, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Georgios Solomou
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Abdurrahman I Islim
- Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Manchester, UK
- Division of Neuroscience and Experimental Psychology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Mohammad A Mustafa
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Ola Rominiyi
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Neuroscience, The University of Sheffield, Sheffield, UK
| | - Sophie T Williams
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Neeraj Kalra
- Department of Neurosurgery, Centre for Neurosciences, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ryan K Mathew
- Department of Neurosurgery, Centre for Neurosciences, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- School of Medicine, University of Leeds, Leeds, UK
| | - Thomas C Booth
- Department of Neuroradiology, King's College Hospital, London, UK
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Gerard Thompson
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
- Edinburgh Neuro-oncology Translational Imaging Research (ENTIRe), Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Paul M Brennan
- Translational Neurosurgery, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, NHS Lothian, Edinburgh, UK
| | - Michael D Jenkinson
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| |
Collapse
|
35
|
Solomou G, Christou A, Gillespie CS, Khouli O, Plaha P. P07.06.B The Impact of Using Intraoperative Ultrasound on Surgical Resection of High-Grade Glioma: A Systematic Review and Meta-Analysis. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Despite operative and adjuvant therapies, high-grade glioma (HGG) remains incurable, with the extent of surgical resection being one of the modalities that can improve patient survival. Enabling maximal safe and minimising post-operative neurological morbidity is a key aim of surgical resection. Numerous intraoperative surgical adjuncts are used at surgery and intraoperative ultrasound (IoUS), is one such adjunct. IoUS is a cost-effective, easy to use, repeatable surgical adjunct, safe for the patient and potentially available in all centres. Although it’s commonly used, no up to date systematic review exists collating and quantifying the level of evidence, delineating its impact on the extent of surgical resection.
Material and Methods
A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The study was registered with the PROSPERO database (CRD42022300034). Keywords across Medline/PubMed and Embase between 1996 and November 2021 were used. We included articles with adult supratentorial, histopathologically confirmed HGG patients aimed for resection, evaluating the correlation of IoUS use and gross-total resection (GTR). Meta-analyses were conducted according to the statistical heterogeneity between the studies using the Open Meta Analyst software.
Results
2942 articles were identified of which 16 were qualitative assessed and 10 used for quantitative meta-analysis. In qualitative assessment, a mean 4.63/8 Newcastle-Ottawa-Scale score was found for studies with no cohorts (no use of IoUS) and a mean score of 6/9, for studies including exposed versus non-exposed cohorts. The RCT was of moderate quality according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool. A pooled analysis across 10 studies of HGG aimed for resection with the use of IoUS, led to GTR achieved in 168/365 cases, resulting in an overall GTR rate of 51.1% (95% CI, 33.9%-68.3%, p<0.001), with great heterogeneity across studies (93.02% p<0.001). In a subgroup meta-analysis of 3 studies of HGG aimed for complete resection only, GTR was achieved in 43/62 cases, yielding a 72.7% GTR rate (95% CI 41.6%-100%, p<0.001) with significant heterogeneity across studies (I2 92.1%, p<0.001). In 4 case-controlled studies, a total of 43.6% (48/110) GTR rate was achieved when IoUS was used versus 24.7% (65/263) when IoUS was not used, resulting in an odds ratio = 2.009 (95% CI 1.157-3.490, p <0.001) for achieving GTR.
Conclusion
The meta-analysis showed a high GTR rate (72.7%) when HGG were aimed for complete resection and a two-fold probability of achieving GTR when IoUS is used than not used.
Collapse
Affiliation(s)
- G Solomou
- University of Cambridge , Cambridge , United Kingdom
| | - A Christou
- Kings Mill Hospital, Sherwood Forest Hospital, NHS Trust , Nottingham , United Kingdom
| | - C S Gillespie
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool , Liverpool , United Kingdom
| | - O Khouli
- NHS Greater Glasgow and Clyde , Glasgow , United Kingdom
| | - P Plaha
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust , Oxford , United Kingdom
| |
Collapse
|
36
|
Solomou G, Gharooni AA, Patel W, Gillespie CS, Gough M, Venkatesh A, Poon MTC, Wykes V, Price SJ, Jenkinson MD, Watts C, Plaha P. Utility of 5-ALA for resection of CNS tumours other than high-grade gliomas: a protocol for a systematic review. BMJ Open 2022; 12:e056059. [PMID: 35868820 PMCID: PMC9315896 DOI: 10.1136/bmjopen-2021-056059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION 5-aminolevulinic acid (5-ALA) is a proagent developed for fluorescent-guided surgery for high-grade glioma patients associated with a significant increase in resection conferring survival. 5-ALA was shown to penetrate the blood-brain barrier accumulating in malignant glioma cells with high selectivity, sensitivity and positive predictive value. However, those have yet to be explored aiding diagnosis for tumours of the central nervous system (CNS) other than high-grade gliomas (HGG). No up-to-date systematic review exists reporting the major surgical outcomes and diagnostic accuracy. We sought to conduct a systematic review of the literature summarising surgical outcomes, evaluate the quality of diagnostic accuracy reported in the literature and qualitatively assess the evidence to inform future studies. METHODS AND ANALYSIS We will search electronic databases (Medline, Embase) with subsequent interrogation of references lists of articles reporting the use of 5-ALA for brain tumours other than high-grade glioma adult patients, which also report the extent of resection and/or survival. Prospective and retrospective cohort and case-control studies with more than five patients will be included. Two independent reviewers will screen the abstracts and full articles, with a third reviewer resolving any conflicts. The data will be extracted in a standardised template and outcomes will be reported using descriptive statists. The quality of non-randomised studies will be appraised. ETHICS AND DISSEMINATION The study will summarise the available evidence on the effect of the clinical utility of 5-ALA in achieving resection and improving survival and its diagnostic accuracy for tumours of the CNS other than HGG. The data will be presented nationally and internationally and the manuscript will be published in a peer-reviewed journal. No ethical approvals were needed. The aim is to inform prospective studies minimising reporting bias allowing for more reliable, reproducible and generalisable results. The study has been registered in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.PROSPERO registration numberCRD42021260542.
Collapse
Affiliation(s)
- Georgios Solomou
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Aref-Ali Gharooni
- Department of Clinical Neuroscience, Addenbrooke's Hospital, Cambridge, UK
| | - Waqqas Patel
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | - Conor S Gillespie
- Neurosurgery Division, Dept. Clinical Neurosciences, Cambridge University, Cambridge, UK
| | - Melissa Gough
- Department of Neurosurgery, Royal Victoria Infirmary Newcastle Hospitals NHS Trust, Newcastle, UK
| | - Ashwin Venkatesh
- Blizard Institute, Centre for Neuroscience Surgery and Trauma, Barts Health NHS Trust, London, UK
| | - Michael T C Poon
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neuroscience, Royal Infirmary Edinburgh, Edinburgh, UK
| | - Victoria Wykes
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Stephen John Price
- Neurosurgery Division, Dept. Clinical Neurosciences, Cambridge University, Cambridge, UK
| | - Michael D Jenkinson
- Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Clinical and Molecular Cancer, University of Liverpool, Liverpool, UK
| | - Colin Watts
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
- Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Puneet Plaha
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
| |
Collapse
|
37
|
Taweel BA, Gillespie CS, Richardson GE, Mustafa MA, Ali T, Islim AI, Hannan CJ, Chavredakis E. External validation of brain arteriovenous malformation haemorrhage scores, AVICH, ICH and R2eD. Acta Neurochir (Wien) 2022; 164:1685-1692. [PMID: 35435515 PMCID: PMC9160159 DOI: 10.1007/s00701-022-05190-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/15/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE To externally validate the arteriovenous malformation-related intracerebral haemorrhage (AVICH), intracerebral haemorrhage (ICH), and novel haemorrhage presentation risk score (R2eD) in brain arteriovenous malformations. METHODS Adult patients diagnosed radiologically with an arteriovenous malformation (AVM) at a tertiary neurosurgical centre between 2007 and 2018 were eligible for inclusion. Both the AVICH and ICH scores were calculated for AVM-related symptomatic haemorrhage (SH) and compared against the modified Rankin scale (mRS) at discharge and last follow-up, with unfavourable outcome defined as mRS > 2. R2eD scores were stratified based on presentation with SH. External validity was assessed using Harrel's C-statistic. RESULTS Two hundred fifty patients were included. Mean age at diagnosis was 46.2 years [SD = 16.5]). Eighty-seven patients (34.8%) had a SH, with 83 included in the analysis. Unfavourable mRS outcome was seen in 18 (21.6%) patients at discharge and 18 (21.6%) patients at last follow-up. The AVICH score C-statistic was 0.67 (95% confidence interval [CI], 0.53-0.80) at discharge and 0.70 (95% CI, 0.56-0.84) at last follow-up. The ICH score C-statistic was 0.78 (95% CI 0.67-0.88), at discharge and 0.80 (95% CI 0.69-0.91) at last follow-up. The R2eD score C-statistic for predicting AVM haemorrhage was 0.60 (95% CI, 0.53-0.67). CONCLUSIONS The AVICH score showed fair-poor performance, while the ICH score showed good-fair performance. The R2eD score demonstrated poor performance, and its clinical utility in predicting AVM haemorrhage remains unclear.
Collapse
Affiliation(s)
- Basel A Taweel
- Institute of Systems, Integrative and Molecular Biology (ISMIB), University of Liverpool, Liverpool, UK.
- The Walton Centre NHS Foundation Trust, Liverpool, UK.
- Clinical Sciences Centre, Aintree University Hospital, Fazakerley, Longmoor Lane, Liverpool, L9 7AL, UK.
| | - Conor S Gillespie
- Institute of Systems, Integrative and Molecular Biology (ISMIB), University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - George E Richardson
- Institute of Systems, Integrative and Molecular Biology (ISMIB), University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Mohammad A Mustafa
- Institute of Systems, Integrative and Molecular Biology (ISMIB), University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Tamara Ali
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | | | - Emmanuel Chavredakis
- Institute of Systems, Integrative and Molecular Biology (ISMIB), University of Liverpool, Liverpool, UK
- The Walton Centre NHS Foundation Trust, Liverpool, UK
| |
Collapse
|
38
|
Millward CP, Doherty JA, Mustafa MA, Humphries TJ, Islim AI, Richardson GE, Clynch AL, Gillespie CS, Keshwara SM, Kolamunnage-Dona R, Brodbelt AR, Jenkinson MD, Duncan C, Sinha A, McMahon CJ. Cranioplasty with hydroxyapatite or acrylic is associated with a reduced risk of all-cause and infection-associated explantation. Br J Neurosurg 2022; 36:385-393. [DOI: 10.1080/02688697.2022.2077311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Christopher P. Millward
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - John A. Doherty
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | | | - Thomas J. Humphries
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Abdurrahman I. Islim
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | | | - Abigail L. Clynch
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | | | | | | | - Andrew R. Brodbelt
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Michael D. Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Christian Duncan
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Ajay Sinha
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Catherine J. McMahon
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| |
Collapse
|
39
|
Solomou G, Venkatesh A, Patel W, Chari A, Mohan M, Bandyopadhyay S, Gillespie CS, Mendoza N, Watts C, Jenkins A. A career in neurosurgery: perceptions and the impact of a national SBNS/NANSIG neurosurgery careers day. Br J Neurosurg 2022; 36:620-626. [PMID: 35603975 DOI: 10.1080/02688697.2022.2076807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Entrance to neurosurgical training is highly competitive. Without proper advice, information and opportunities, talented individuals may be dissuaded from applying. The Neurology and Neurosurgery Interest Group (NANSIG) organises a Careers Day in Neurosurgery every year. Our objective was to assess the overall utility of a neurosurgery careers day and the perceived factors that attract and detract from the specialty, from attendees of the ninth annual neurosurgery careers day. METHODS Eighteen-item pre-conference and 19-item post-conference questionnaires were disseminated electronically to conference attendees. Questions aimed to capture: (i) baseline demographics; (ii) previous experience and exposure in neurosurgery; (iii) interest in neurosurgery; (iv) understanding training and a career in neurosurgery; (v) perceived factors of attraction and dissuasion of neurosurgery; and (vi) perceived value, quality and educational purpose of the conference. RESULTS In total, 77 delegates attended the careers day. Most did not have a formal neurosurgical rotation during medical school (24.7%, n = 19), but almost half had gained neurosurgical experience and presented research work. The careers day increased knowledge of the neurosurgical application process (median Likert score 3/5 to 4/5, p < 0.01), duration of training (72.7-88.3%), and desire to pursue a career in neurosurgery (75.3-81.8%). The most commonly reported factors attracting delegates to neurosurgery were interest in neuroanatomy (80.5%, n = 62), practical skills (64.9%, n = 50), and impact on patients (62.3%, n = 48). The most common dissuasive factors were competition to entry (64.9%, n = 50), long working hours (40.3%, n = 31), and other career interests (35.1%, n = 27). Almost all would recommend the event to a colleague (94.9%, n = 73). CONCLUSIONS Formal undergraduate exposure to neurosurgery is limited. Neurosurgery careers days increase awareness and understanding of the application process and improve interest in a selected cohort. The factors attracting applicants to neurosurgery remain practical links to neuroanatomy, opportunities in neurosurgery for innovation and research, and direct impact on patients.
Collapse
Affiliation(s)
- Georgios Solomou
- Institute of Cancer and Genome Sciences, University of Birmingham, Birmingham, UK.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Ashwin Venkatesh
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Waqqas Patel
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Aswin Chari
- Great Ormond Street Institute of Child Health, University College London, London, UK.,Department of Neurosurgery, Great Ormond Street Hospital, London, UK
| | - Midhun Mohan
- Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Soham Bandyopadhyay
- Oxford University Global Surgery Group, Medical Sciences Division, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Conor S Gillespie
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Nigel Mendoza
- West London Neurosciences Unit, Charing Cross Hospital NHS Trust, London, UK
| | - Colin Watts
- Institute of Cancer and Genome Sciences, University of Birmingham, Birmingham, UK
| | - Alistair Jenkins
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
| | | |
Collapse
|
40
|
Richardson GE, Gillespie CS, Mantle O, Clynch A, Ooi SZY, Park JJ, Bligh ER, Kundu S, Georgiou I, Bandyopadhyay S, Saunders KE. Social and psychological impact of the COVID-19 pandemic on UK medical and nursing students: protocol for a national medical and nursing student survey. BMJ Open 2022; 12:e057467. [PMID: 35523504 PMCID: PMC9082730 DOI: 10.1136/bmjopen-2021-057467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Healthcare students have played a significant role in the National Health Service during the COVID-19 pandemic. We captured data on the well-being of medical students during the acute phase of the pandemic with the Social and Psychological Impact of COVID-19 on medical students: a national survey Evaluation (SPICE-19) study. We will evaluate changes in mental health and well-being of medical and nursing students 1 year after SPICE-19, in a cross-sectional study, to understand the impact of the pandemic, and inform well-being policies. METHODS AND ANALYSIS This study will be a national, multi-institution, cross-discipline study. An online 53-item survey of demographics, mental health and well-being will be used to record responses. Students studying for a medical or nursing degree at any UK universities will be eligible to participate. The survey will be advertised through the Neurology and Neurosurgery Interest Group national network. Participation is anonymous and voluntary, with relevant mental health resources made available to participants. ETHICS AND DISSEMINATION Ethical approval was granted by the University of Oxford Central University Research Ethics Committee (R75719/RE001) on 21 May 2021. Study findings will be presented at national and international meetings, and submitted for publication in a peer-reviewed journal.
Collapse
Affiliation(s)
- George E Richardson
- Institute of Translational Medicine, University of Liverpool School of Medicine, Liverpool, UK
| | - Conor S Gillespie
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Orla Mantle
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Abigail Clynch
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | | | - Jay J Park
- The University of Edinburgh Medical School, Edinburgh, UK
| | - Emily R Bligh
- School of Medicine, The University of Sheffield, Sheffield, UK
| | - Shantanu Kundu
- School of Medicine, University of Liverpool, Liverpool, UK
| | | | | | - Kate E Saunders
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| |
Collapse
|
41
|
Park JJ, Ooi SZY, Gillespie CS, Bandyopadhyay S, Chowdhury YA, Solomou G, Gough M, Kanmounye US, Yanez Touzet A, Poon MTC, Demetriades AK, Jenkinson MD, Jenkins A. The Neurology and Neurosurgery Interest Group (NANSIG)-ten years of cultivating interest in clinical neurosciences. Acta Neurochir (Wien) 2022; 164:937-946. [PMID: 35039958 PMCID: PMC8763620 DOI: 10.1007/s00701-022-05113-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/02/2022] [Indexed: 11/03/2022]
Abstract
Collaboration and successful teamworking are important components of clinical practise, and these skills should be cultivated early in medical school. The breadth of current medical school curricula means that students often have limited exposure to clinical neurosciences. Since its inception in 2009, the Neurology and Neurosurgery Interest Group (NANSIG) has become a national (UK and Republic of Ireland) example of student and junior doctor synergistic collaboration to deliver educational materials, research, conferences, seminars and workshops, as well as advocating for diversity in this field. Recently, it has expanded to incorporate an international audience and cater for a larger group of young medical professionals. The organisation has overcome numerous challenges and is constantly innovating new approaches to harness the necessary knowledge, skills and network to succeed in a career in neurosciences, neurology and neurosurgery. This article summarises the initiatives undertaken by the group over its first 10 years of existence and its organisational structure, as well as its future plans.
Collapse
Affiliation(s)
- Jay J Park
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Setthasorn Zhi Yang Ooi
- Cardiff University School of Medicine, University Hospital of Wales Main Building, Heath Park, Cardiff, UK
| | - Conor S Gillespie
- Institute of Systems, Molecular and Integrative Biology (ISMIB), University of Liverpool, Biosciences Building, Crown Street, Liverpool, L69 7BE, UK.
| | - Soham Bandyopadhyay
- Nuffield Department of Surgical Sciences, Oxford University Global Surgery Group, University of Oxford, Oxford, UK
| | - Yasir A Chowdhury
- Department of Neurosurgery, University Hospitals Birmingham, Edgbaston, Birmingham, UK
| | - Georgios Solomou
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Melissa Gough
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | - Alvaro Yanez Touzet
- School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Michael T C Poon
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Michael D Jenkinson
- Institute of Systems, Molecular and Integrative Biology (ISMIB), University of Liverpool, Biosciences Building, Crown Street, Liverpool, L69 7BE, UK
| | - Alistair Jenkins
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| |
Collapse
|
42
|
Richardson GE, Gillespie CS, Bandyopadhyay S, Norton EJ, Joshi JM, Mantle O, Ciuculete C, Nazari A, Ong J, Anand A, Park J, De Koning R, Ooi SZY, Erhabor J, Daler HK, Borbas B, Sibanda Z, Lerou I, Touzet AY, Mcelnay P, Murray S, Hutchinson PJ, Jenkins A. Hosting an Educational Careers Day Within the Virtual Paradigm: The Neurology and Neurosurgery Interest Group Experience. Cureus 2022; 14:e21162. [PMID: 35165612 PMCID: PMC8836971 DOI: 10.7759/cureus.21162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction: To explore our experience of hosting the 10th Annual Neurology and Neurosurgery Interest Group-Society of British Neurological Surgeons (NANSIG-SBNS) Neurosurgery Careers Day, held virtually for the first time. Methods: Reflective feedback and review of an international, virtual neurosurgery careers day. The authors reflect on the logistics of organizing the event, and the pre- and post-event feedback provided by delegates. Recommendations have been made on how to successfully host a virtual event. The key themes that permeated the event have been outlined and discussed in the context of the feedback received. Results: The event was attended by 231 delegates from 20 countries worldwide. Knowledge of neurosurgery as a career and the application process increased after attending the careers day (4.27/5 to 4.51/5, p=0.003 and 3.12/5 to 4.31/5, p<0.001 respectively). The key themes identified from the event include attendance, networking, and education. Qualitative feedback was positive and indicated a positive perception of the careers day. Conclusions: The future of educational events is unclear, and a hybrid approach is recommended to retain the benefits of the online space when in-person events eventually return.
Collapse
|
43
|
Gillespie CS, Richardson GE, Mustafa MA, Evans D, George AM, Islim AI, Mallucci C, Jenkinson MD, McMahon CJ. How should we treat long-standing overt ventriculomegaly in adults (LOVA)? A retrospective cohort study. Neurosurg Rev 2022; 45:3193-3200. [PMID: 35688957 PMCID: PMC9492616 DOI: 10.1007/s10143-022-01812-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/16/2022] [Accepted: 05/10/2022] [Indexed: 02/03/2023]
Abstract
Long-standing overt ventriculomegaly in adults (LOVA) is a heterogenous group of conditions with differing presentations. Few studies have evaluated success rates of available surgical treatments, or ascertained the natural history. There is a need to assess the efficacy of both endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunt (VPS) as first-line treatments. We conducted a retrospective, single-centre study of adults with LOVA at a tertiary neurosurgery centre in England, UK, aiming to identify presentation, management strategy, and outcome following treatment. A total of 127 patients were included (mean age 48.1 years, 61/127 male). Most patients were symptomatic (73.2%, n = 93/127, median symptom duration 10 months). The most common symptoms were gait ataxia, headache, and cognitive decline (52.8%, 50.4%, and 33.9%, respectively). Fourteen patients had papilloedema. Ninety-one patients (71.7%) underwent surgery (84 ETV, 7 VPS). Over a median follow-up of 33.0 months (interquartile range [IQR] 19.0-65.7), 82.4% had a clinical improvement after surgery, and 81.3% had radiological improvement. Clinical improvement rates were similar between ETV and VP shunt groups (82.1% vs 85.7%, p = 0.812). Surgical complication rates were significantly lower in the ETV group than the VP shunt group (4.8% vs 42.9%, p < 0.001). Of the patients treated surgically, 20 (22.0%) underwent further surgery, with 14 patients improving. This study demonstrates the efficacy of ETV as a first-line treatment for LOVA.
Collapse
Affiliation(s)
- Conor S. Gillespie
- Institute of Systems, Molecular and Integrative Biology, School of Medicine, University of Liverpool, Cedar House, Ashton Street, Liverpool, L69 3GE UK ,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - George E. Richardson
- Institute of Systems, Molecular and Integrative Biology, School of Medicine, University of Liverpool, Cedar House, Ashton Street, Liverpool, L69 3GE UK ,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Mohammad A. Mustafa
- Institute of Systems, Molecular and Integrative Biology, School of Medicine, University of Liverpool, Cedar House, Ashton Street, Liverpool, L69 3GE UK ,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Daisy Evans
- School of Medicine, Keele University, Staffordshire, UK
| | - Alan M. George
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK ,School of Medicine, University of Birmingham, Birmingham, UK
| | - Abdurrahman I. Islim
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Conor Mallucci
- Department of Neurosurgery, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Michael D. Jenkinson
- Institute of Systems, Molecular and Integrative Biology, School of Medicine, University of Liverpool, Cedar House, Ashton Street, Liverpool, L69 3GE UK ,Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Catherine J. McMahon
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| |
Collapse
|
44
|
Richardson GE, Gillespie CS, Mustafa MA, Taweel BA, Bakhsh A, Kumar S, Keshwara SM, Ali T, John B, Brodbelt AR, Chavredakis E, Mills SJ, May C, Millward CP, Islim AI, Jenkinson MD. Clinical Outcomes Following Re-Operations for Intracranial Meningioma. Cancers (Basel) 2021; 13:cancers13194792. [PMID: 34638276 PMCID: PMC8507983 DOI: 10.3390/cancers13194792] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/10/2021] [Accepted: 09/21/2021] [Indexed: 11/21/2022] Open
Abstract
Simple Summary This study investigated patients who underwent more than one operation for a meningioma, a type of brain tumor. Currently, there is little evidence available for this specific patient group. The purpose of this study was to determine if patients had an improvement or deterioration following a second operation for a recurrent meningioma, and to identify any factors that may influence this change. The results demonstrated that following a second operation for meningioma, patients have poorer outcomes. The findings of this study provide supporting information for surgeons and patients, thereby informing decisions related to patient care and re-operation. Abstract The outcomes following re-operation for meningioma are poorly described. The aim of this study was to identify risk factors for a performance status outcome following a second operation for a recurrent meningioma. A retrospective, comparative cohort study was conducted. The primary outcome measure was World Health Organization performance. Secondary outcomes were complications, and overall and progression free survival (OS and PFS respectively). Baseline clinical characteristics, tumor details, and operation details were collected. Multivariable binary logistic regression was used to identify risk factors for performance status outcome following a second operation. Between 1988 and 2018, 712 patients had surgery for intracranial meningiomas, 56 (7.9%) of which underwent a second operation for recurrence. Fifteen patients (26.8%) had worsened performance status after the second operation compared to three (5.4%) after the primary procedure (p = 0.002). An increased number of post-operative complications following the second operation was associated with a poorer performance status following that procedure (odds ratio 2.2 [95% CI 1.1–4.6]). The second operation complication rates were higher than after the first surgery (46.4%, n = 26 versus 32.1%, n = 18, p = 0.069). The median OS was 312.0 months (95% CI 257.8–366.2). The median PFS following the first operation was 35.0 months (95% CI 28.9–41.1). Following the second operation, the median PFS was 68.0 months (95% CI 49.1–86.9). The patients undergoing a second operation for meningioma had higher rates of post-operative complications, which is associated with poorer clinical outcomes. The decisions surrounding second operations must be balanced against the surgical risks and should take patient goals into consideration.
Collapse
Affiliation(s)
- George E. Richardson
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool L69 7BE, UK; (C.S.G.); (M.A.M.); (B.A.T.); (A.B.); (S.K.); (S.M.K.); (C.P.M.); (A.I.I.); (M.D.J.)
- Correspondence:
| | - Conor S. Gillespie
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool L69 7BE, UK; (C.S.G.); (M.A.M.); (B.A.T.); (A.B.); (S.K.); (S.M.K.); (C.P.M.); (A.I.I.); (M.D.J.)
| | - Mohammad A. Mustafa
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool L69 7BE, UK; (C.S.G.); (M.A.M.); (B.A.T.); (A.B.); (S.K.); (S.M.K.); (C.P.M.); (A.I.I.); (M.D.J.)
| | - Basel A. Taweel
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool L69 7BE, UK; (C.S.G.); (M.A.M.); (B.A.T.); (A.B.); (S.K.); (S.M.K.); (C.P.M.); (A.I.I.); (M.D.J.)
| | - Ali Bakhsh
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool L69 7BE, UK; (C.S.G.); (M.A.M.); (B.A.T.); (A.B.); (S.K.); (S.M.K.); (C.P.M.); (A.I.I.); (M.D.J.)
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK; (T.A.); (B.J.); (A.R.B.); (E.C.)
| | - Siddhant Kumar
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool L69 7BE, UK; (C.S.G.); (M.A.M.); (B.A.T.); (A.B.); (S.K.); (S.M.K.); (C.P.M.); (A.I.I.); (M.D.J.)
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK; (T.A.); (B.J.); (A.R.B.); (E.C.)
| | - Sumirat M. Keshwara
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool L69 7BE, UK; (C.S.G.); (M.A.M.); (B.A.T.); (A.B.); (S.K.); (S.M.K.); (C.P.M.); (A.I.I.); (M.D.J.)
| | - Tamara Ali
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK; (T.A.); (B.J.); (A.R.B.); (E.C.)
| | - Bethan John
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK; (T.A.); (B.J.); (A.R.B.); (E.C.)
| | - Andrew R. Brodbelt
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK; (T.A.); (B.J.); (A.R.B.); (E.C.)
| | - Emmanuel Chavredakis
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK; (T.A.); (B.J.); (A.R.B.); (E.C.)
| | - Samantha J. Mills
- Department of Neuroradiology, The Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK;
| | - Chloë May
- Department of Clinical Oncology, Clatterbridge Cancer Trust, Liverpool CH63 4JY, UK;
| | - Christopher P. Millward
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool L69 7BE, UK; (C.S.G.); (M.A.M.); (B.A.T.); (A.B.); (S.K.); (S.M.K.); (C.P.M.); (A.I.I.); (M.D.J.)
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK; (T.A.); (B.J.); (A.R.B.); (E.C.)
| | - Abdurrahman I. Islim
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool L69 7BE, UK; (C.S.G.); (M.A.M.); (B.A.T.); (A.B.); (S.K.); (S.M.K.); (C.P.M.); (A.I.I.); (M.D.J.)
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK; (T.A.); (B.J.); (A.R.B.); (E.C.)
| | - Michael D. Jenkinson
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool L69 7BE, UK; (C.S.G.); (M.A.M.); (B.A.T.); (A.B.); (S.K.); (S.M.K.); (C.P.M.); (A.I.I.); (M.D.J.)
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool L9 7LJ, UK; (T.A.); (B.J.); (A.R.B.); (E.C.)
| |
Collapse
|
45
|
George AM, Gupta S, Keshwara SM, Mustafa MA, Gillespie CS, Richardson GE, Steele AC, Islim AI, Jenkinson MD, Millward CP. P14.71 An assessment of the reporting and methodological quality of meningioma systematic reviews and meta-analyses. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Systematic reviews and meta-analyses constitute the highest level of research evidence and for a disease with limited clinical trial activity, are often relied upon to help inform clinical practice. This review of reviews evaluates both the reporting & methodological quality of meningioma evidence syntheses.
MATERIAL AND METHODS
Potentially eligible meningioma reviews published between 1st January 1990 and 31st December 2020 were identified from eight electronic databases. Inclusion required the study to meet the Cochrane guideline definition of a systematic review or meta-analysis. Reviews concerning neurofibromatosis type 2, spinal and pediatric meningiomas were excluded. The reporting and methodological quality of articles were assessed against the following modified guidelines: Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA), A MeaSurement Tool to Assess Systematic Reviews (AMSTAR2) and the Risk of Bias in Systematic Reviews (ROBIS) guidelines.
RESULTS
117 systematic reviews were identified, 57 of which included meta-analysis (48.7%). The number of meningioma systematic reviews published each year has increased with 63 studies (53.9%) published between 01/2018 and 12/2020. A median of 17 studies (IQR 9–29) were included per review. Impact factor of journals publishing a systematic review with or without a meta-analysis was similar (median 2.3 vs 1.8, P=0.397). The mean PRISMA scores for systematic reviews with a meta-analysis was 21.11 (SD 4.1, 78% adherence) and without was 13.89 (SD 3.4, 63% adherence). Twenty-nine systematic reviews with meta-analysis (51%) and 11 without meta-analysis (18%) achieved greater than 80% adherence to PRISMA recommendations. Methodological quality assessment using AMSTAR2 revealed one study (0.9%) as high quality whilst 111 (94.8%) studies were graded as critically low. One hundred and two articles (87.2%) did not utilize a comprehensive search strategy as defined by the AMSTAR2 tool. Ninety-nine studies (84.6%) obtained a high level of concern for potential bias as per the ROBIS assessment. One hundred and eight articles (92.3%) failed to present information that a protocol had been established prior to study commencement and 76 articles (65.0%) did not conduct a risk of bias assessment. Across the three tools, domains relating to the establishment of a protocol prior to review commencement and conducting appropriate risk of bias assessments were frequently low scoring.
CONCLUSION
Overall reporting and methodological quality of meningioma systematic reviews was sub-optimal. Established critical appraisal tools and reporting guidelines should be utilized a priori to assist in producing high-quality systematic reviews.
Collapse
Affiliation(s)
- A M George
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | - S Gupta
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | - S M Keshwara
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | - M A Mustafa
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | - C S Gillespie
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | - G E Richardson
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | - A C Steele
- School of Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - A I Islim
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - M D Jenkinson
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - C P Millward
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| |
Collapse
|
46
|
Keshwara SM, Islim AI, Millward CP, Gillespie CS, Richardson GE, Mustafa MA, George AM, Mills SJ, Brodbelt AR, Jenkinson MD. OS09.7.A Quality of life outcomes in patients with incidental and operated meningiomas: the QUALMS study. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Long-term Health-Related Quality of Life (HRQoL) is an important measure of patient wellbeing. There is a paucity of studies evaluating HRQoL in meningioma patients.
MATERIAL AND METHODS
Cross-sectional study of adult patients with an incidental or symptomatic intracranial meningioma. Patients with less than 5 years of follow-up, a history of craniospinal radiation or neurofibromatosis type 2 were excluded. HRQoL was evaluated with SF-36, EORTC QLQ-C30 and EORTC QLQ-BN20 questionnaires. Outcome determinants were evaluated using a multi-variable linear regression analysis, adjusted for patient, tumour and treatment characteristics, and duration of follow-up.
RESULTS
699 patients were invited to participate and 246 responded: 118 (48%) had an incidental meningioma. Mean age at diagnosis was 56.8 years (SD=13) and 81% were female. Median time from diagnosis to completion of questionnaire was 8.5 years (IQR 6.8–11.5). During follow-up, 158 patients (64.2%) had at least one operation for their meningioma and 47 patients (19.1%) had radiotherapy. Of those operated, 126 (79.7%) had WHO grade 1 and 24 (15.2%) had grade 2 meningiomas. Compared to normative population values, meningioma patients reported a worse SF-36 general health score (mean 61.9 vs 56.5, P=0.003) but a similar QLQ-C30 global health score (mean 62.3 vs 65.8, P=0.039), worse SF-36 and QLQ-C30 physical functioning scores (mean 74.1 vs 64.6, P<0.001 and mean 81.8 vs 76.5, P=0.007) and similar SF-36 and QLQ-C30 emotional health scores (mean 72.2 vs 70.9, P=0.367 and mean 71.0 vs 71.9, P=0.960). QLQ-C30 cognitive functioning was worse (mean 80.5 vs 71.4, P<0.001). Compared to the meningioma literature, QLQ-BN20 seizure burden was similar (mean 2.0 vs 1.6, P=0.760). A worse performance status at diagnosis was associated with an inferior QLQ-C30 global health score (β-coefficient=-4.9 [95% CI -9.1-(-)0.6] P=0.024). Number of surgeries was significantly associated with a worse QLQ-C30 cognitive functioning score (β-coefficient=-7.0 [95% CI -13.2-(-)0.9], P=0.025). Anti-epileptic drug use was associated with a significantly worse QLQ-C30 emotional health score (β-coefficient=-10.9 [95% CI -21.7-(-)0.01], P=0.050).
CONCLUSION
Meningioma patients have long-term HRQoL impairments affecting their physical and cognitive functions. An understanding that multiple surgeries affects cognitive function, and the need for anti-epileptic drugs equate to poorer emotional health, could help target appropriate therapies and support in the future.
Collapse
Affiliation(s)
- S M Keshwara
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | - A I Islim
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - C P Millward
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - C S Gillespie
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | - G E Richardson
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | - M A Mustafa
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | - A M George
- School of Medicine, University of Liverpool, Liverpool, United Kingdom
| | - S J Mills
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - A R Brodbelt
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - M D Jenkinson
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| |
Collapse
|
47
|
Richardson GE, Mustafa MA, Gillespie CS, Keshwara SM, Taweel BA, Millward CP, Islim AI, Jenkinson MD. P14.66 Re-operation for recurrent meningioma - are we helping patients? Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Meningioma is the commonest primary brain tumour. Despite surgery, meningiomas can recur. Surgery is usually the first line treatment for recurrent meningioma. The aim was to determine the risk factors associated with clinical outcomes (performance status, morbidity, mortality, recurrence) following re-operation for recurrence of intracranial meningioma.
MATERIAL AND METHODS
Retrospective cohort study (1998–2018). Eligible patients had reoperation for local recurrence of a previously operated meningioma. Collected data included baseline clinical and imaging characteristic. Primary outcome measure was performance status after each reoperation. Secondary outcome measures were medical and surgical morbidity, recurrence-free survival (RFS) and overall survival (OS).
RESULTS
Fifty-eight patients were eligible (37 female, mean age at 1st re-operation 56.1 years (SD=11.6)). Eleven patients (19.6%) had 2 re-operations and 3 patients (5.4%) had 3 re-operations. Median follow up was 128.5 months (IQR=73–194.5). Median time to 1st recurrence and 1st re-operation were 36.5 (IQR=24.3–81.0) and 43.8 months (IQR=20.3–103.4), respectively. Fifteen patients (26.8%) had worse performance status after 1st reoperation, compared to 5.4% (n=3) after the primary operation. Complication rate was 32.1% (n=18) after the primary operation compared to 48.2% (n=27) after 1st reoperation. At primary operation, there were 29 (51.8%) grade 1, 24 (42.9%) grade 2, and 1 (1.8%) grade 3 tumours. Median RFS after first re-operation was 36.5 months (95% CI 29.3–43.9). Median OS was 312 months (95 % CI 257.8–366.2). Increased number of post-operative complications were a risk factor for worsened performance status following reoperation (OR 2.2 [95% CI 1.1–4.6], P=0.029).
CONCLUSION
Re-operation is associated with a worse performance status and increased risk of complications. Re-operating meningiomas for radiological recurrence without symptoms increases patient morbidity. Shared-care management decision should be made with patients when considering operating for radiological recurrence only.
Collapse
Affiliation(s)
| | - M A Mustafa
- University of Liverpool, Liverpool, United Kingdom
| | | | - S M Keshwara
- University of Liverpool, Liverpool, United Kingdom
| | - B A Taweel
- University of Liverpool, Liverpool, United Kingdom
| | - C P Millward
- University of Liverpool, Liverpool, United Kingdom
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - A I Islim
- University of Liverpool, Liverpool, United Kingdom
| | - M D Jenkinson
- University of Liverpool, Liverpool, United Kingdom
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| |
Collapse
|
48
|
Gillespie CS, Richardson GE, Mustafa MA, Islim AI, Keshwara SM, Taweel BA, Bakhsh A, Kumar S, Millward CP, Mehta S, Rathi N, Chavredakis E, Brodbelt AR, Mills SJ, Jenkinson MD. P14.02 The Natural History of a Residual Intracranial Meningioma- Volumetric Growth and Predictors of Progression. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab180.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Resection of meningioma leaves residual solid tumour in ~25% of patients. Selection for further treatment and follow-up strategy may benefit from knowledge of volumetric growth and associated prognostic factors.
MATERIAL AND METHODS
Growth rates were assessed using a linear mixed effects model, in a retrospective adult cohort that underwent subtotal resection of meningioma (2004–2018). Endpoints were re-treatment, end of follow-up or death. Cox regression analysis was used to identify prognostic factors for progression, defined using the Response Assessment in Neuro-Oncology (RANO) volumetric criteria.
RESULTS
236 patients were included. Mean age at surgery was 56.3 years (SD=13.7) and 73.7% were female. WHO grades were 1 (n=195, 82.6%), 2 (n=40, 16.9%) and 3 (n=1, 0.5%). Adjuvant fractionated radiotherapy (fRT) was administered to 34 patients (14.4%), with no propensity towards higher WHO grade or residual volume. Median pre-operative meningioma and post-operative residual volumes were 34.0cm3 (IQR 16.0–63.0) and 2.0cm3 (IQR 0.8–5.2), respectively. Median follow-up was 64 months (IQR 42–104). Median absolute growth rate (AGR) and relative growth rate (RGR) were 0.1cm3/year and 4.3%/year, respectively. According to RANO criteria, 132 (55.9%) patients progressed, of which 13 (9.8%) developed symptoms. Median progression-free survival was 56 months (95% CI 43.1–69.0). Multivariable analysis identified adjuvant fRT (HR 1.7, [95% CI 1.0–2.8], P=0.046), skull base location (HR 1.5, [95% CI 1.0–2.4], P=0.047) and Ki-67 index (HR 3.7 [95% CI 1.3–10.8], P=0.017) as prognostic factors for volumetric progression. WHO grade was not significant (HR 1.0, [95% CI 0.5–1.7], P=0.905). Forty-nine patients who progressed (37.1%) underwent further treatment: fRT (n=19), re-operation (n=15), Stereotactic radiosurgery (SRS) (n=10) and surgery+adjuvant fRT (n=5). Of those, 8 (16.3%) progressed further (after re-operation [n=6] and SRS [n=2]). Seven were treated with a 2nd re-operation (n=3), fRT (n=3), and SRS (n=1). One patient progressed after a 2nd reoperation and was treated with SRS, after which they remained stable. Median survival was not reached. 5- and 10-year overall survival (OS) was 96% and 86% respectively.
CONCLUSION
Growth rates of a residual meningioma vary with a dichotomy observed in progression rates. Half of patients with a residual meningioma showed radiological progression requiring multiple treatment to control the tumour. The other half demonstrate a more indolent course. Skull base location and higher Ki67 are important prognostic factors for progression and therefore, should be considered to stratify patients for adjuvant radiotherapy.
Collapse
Affiliation(s)
- C S Gillespie
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - G E Richardson
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - M A Mustafa
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - A I Islim
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, United Kingdom
| | - S M Keshwara
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - B A Taweel
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - A Bakhsh
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - S Kumar
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - C P Millward
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - S Mehta
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - N Rathi
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - E Chavredakis
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - A R Brodbelt
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - S J Mills
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - M D Jenkinson
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| |
Collapse
|
49
|
Richardson GE, Islim AI, Albanese E, Ahmed A, Aly A, Ammar A, Amoo M, Bhatt H, Bodkin P, Coulter I, Corr P, Elmaadawi I, Elserius A, Fountain DM, George KJ, Gillespie CS, Goel A, Grundy PL, Gurusinghe N, Hartley J, Hasan MT, Javadpour M, Kalra N, Mallucci C, Millward CP, Mohamed B, Mohamed S, Mustafa MA, Nannapaneni R, Nolan D, Patel UJ, Piper RJ, Rajaraman C, Raza-Knight S, Rehman K, Rominiyi O, Sage W, Sharouf F, Sinha S, Sitaraman M, Smith S, Solth A, Stokes S, Taweel BA, Tyagi A, Zaben M, Jenkinson MD, Prasad M. Neurosurgery activity levels in the United Kingdom and republic of Ireland during the first wave of the covid-19 pandemic - a retrospective cross-sectional cohort study. Br J Neurosurg 2021:1-6. [PMID: 34472417 DOI: 10.1080/02688697.2021.1968341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/11/2021] [Accepted: 08/09/2021] [Indexed: 12/27/2022]
Abstract
The impact of Covid-19 on surgical patients worldwide has been substantial. In the United Kingdom (UK) and the Republic of Ireland (RoI), the first wave of the pandemic occurred in March 2020. The aims of this study were to: (1) evaluate the volume of neurosurgical operative activity levels, Covid-19 infection rate and mortality rate in April 2020 with a retrospective cross-sectional cohort study conducted across 16 UK and RoI neurosurgical centres, and (2) compare patient outcomes in a single institution in April-June 2020 with a comparative cohort in 2019. Across the UK and RoI, 818 patients were included. There were 594 emergency and 224 elective operations. The incidence rate of Covid-19 infection was 2.6% (21/818). The overall mortality rate in patients with a Covid-19 infection was 28.6% (6/21). In the single centre cohort analysis, an overall reduction in neurosurgical operative activity by 65% was observed between 2020 (n = 304) and 2019 (n = 868). The current and future impact on UK neurosurgical operative activity has implications for service delivery and neurosurgical training.
Collapse
Affiliation(s)
- George E Richardson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Abdurrahman I Islim
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Erminia Albanese
- Department of Neurosurgery, North Staffordshire Hospital Trust, Stoke on Trent, UK
| | - Ahmed Ahmed
- Department of Neurosurgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Ahmed Aly
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Amr Ammar
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, UK
| | - Michael Amoo
- Department of Neurosurgery, Beaumont Hospital, Dublin, Republic of Ireland
| | - Harsh Bhatt
- Department of Neurosurgery, University Hospital of Wales, Cardiff, UK
| | - Peter Bodkin
- Department of Neurosurgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Ian Coulter
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Paula Corr
- Department of Neurosurgery, Beaumont Hospital, Dublin, Republic of Ireland
| | | | - Anne Elserius
- Department of Neurosurgery, North Staffordshire Hospital Trust, Stoke on Trent, UK
| | - Daniel M Fountain
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - K Joshi George
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - Conor S Gillespie
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Aimee Goel
- Department of Neurosurgery, North Staffordshire Hospital Trust, Stoke on Trent, UK
| | - Paul L Grundy
- Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Jessica Hartley
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, UK
| | - Md Tanvir Hasan
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - Mohsen Javadpour
- Department of Neurosurgery, Beaumont Hospital, Dublin, Republic of Ireland
| | - Neeraj Kalra
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
| | - Conor Mallucci
- Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Christopher P Millward
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Belal Mohamed
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Saffwan Mohamed
- Department of Neurosurgery, The James Cook University Hospital, Middlesbrough, UK
| | - Mohammad A Mustafa
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | | | - Deirdre Nolan
- Department of Neurosurgery, Beaumont Hospital, Dublin, Republic of Ireland
| | - Umang J Patel
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | - Rory J Piper
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | | | | | - Kafeel Rehman
- Department of Neurosurgery, Hull Royal Infirmary, Hull, UK
| | - Ola Rominiyi
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, UK
| | - William Sage
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, UK
| | - Feras Sharouf
- Department of Neurosurgery, University Hospital of Wales, Cardiff, UK
| | - Saurabh Sinha
- Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, UK
| | | | - Stuart Smith
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, UK
| | - Anna Solth
- Department of Neurosurgery, Ninewells Hospital, Dundee, UK
| | - Stuart Stokes
- Department of Neurosurgery, Hull Royal Infirmary, Hull, UK
| | - Basel A Taweel
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Atul Tyagi
- Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
| | - Malik Zaben
- Department of Neurosurgery, University Hospital of Wales, Cardiff, UK
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Manjunath Prasad
- Department of Neurosurgery, The James Cook University Hospital, Middlesbrough, UK
| |
Collapse
|
50
|
Gillespie CS, Taweel BA, Richardson GE, Mustafa MA, Keshwara SM, Babar RK, Alnaham KE, Kumar S, Bakhsh A, Millward CP, Islim AI, Brodbelt AR, Mills SJ, Jenkinson MD. Volumetric growth of residual meningioma - A systematic review. J Clin Neurosci 2021; 91:110-117. [PMID: 34373014 DOI: 10.1016/j.jocn.2021.06.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 12/28/2022]
Abstract
Surgical resection of meningioma leaves residual solid tumour in over 25% of patients. Selection for further treatment and follow-up strategy may benefit from knowledge of volumetric growth and factors associated with re-growth. The aim of this review was to evaluate volumetric growth and variables associated with growth in patients that underwent incomplete resection of a meningioma without the use of adjuvant radiotherapy. A systematic review was conducted in accordance with the PRISMA statement and registered a priori with PROSPERO (registration number: CRD42020177052). Six databases were searched up to May 2020. Full text articles analysing volumetric growth rates in at least 10 patients who had residual meningioma after surgery were assessed. Four single-centre, retrospective studies totalling 238 patients were included, of which 99% of meningioma were WHO grade 1. The absolute tumour growth rate ranged from 0.09 to 4.94 cm3 per year. The relative growth rate ranged from 5.11 to 14.18% per year. Varying methods of volumetric assessment and definitions of growth impeded pooled analysis. Pre-operative and residual tumour volume, and hyperintensity on T2 weighted MRI were identified as variables associated with residual meningioma growth, however this was inconsistent across studies. Risk of bias was high in all studies. Radiological regrowth occurred in 42-67% of cases. Our review identified that volumetric growth of residual meningioma is scarcely reported. Sufficiently powered studies are required to delineate volumetric growth and prognostic factors to stratify management.
Collapse
Affiliation(s)
- Conor S Gillespie
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK.
| | - Basel A Taweel
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - George E Richardson
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Mohammad A Mustafa
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Sumirat M Keshwara
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Roshan K Babar
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - Siddhant Kumar
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK; School of Medicine, University of Liverpool, Liverpool, UK
| | - Ali Bakhsh
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK; School of Medicine, University of Liverpool, Liverpool, UK
| | - Christopher P Millward
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Abdurrahman I Islim
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Andrew R Brodbelt
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Samantha J Mills
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Michael D Jenkinson
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| |
Collapse
|