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Woodfield J, Hoeritzauer I, Jamjoom AA, Jung J, Lammy S, Pronin S, Hannan CJ, Watts A, Hughes L, Moon RD, Darwish S, Roy H, Copley PC, Poon MT, Thorpe P, Srikandarajah N, Grahovac G, Demetriades AK, Eames N, Sell PJ, Statham PF, Abdelsadg M, Abulaila MMS, Ahmed U, Ajmi Q, Al-Mahfoudh R, Ali C, Amarouche M, Andalib A, Arora M, Arora M, Awan M, Baig Mirza A, Bateman A, Bennett I, Bhatti I, Bodkin P, Bommireddy L, Bonanos G, Borg A, Boukas A, Bourne J, Brennan R, Brown J, Brown K, Burton O, Busby C, Chiverton N, Clark S, Copley PC, Cudlip S, Cunningham Y, Dardis R, Darwish S, Davies B, Demetriades AK, Deore S, Derham C, Dherijha M, Dobson G, Duncan J, Durnford A, Durst AZE, Dyson EW, Eames N, Edlmann E, Edwards-Bailey A, Elserius A, Elson B, Fadelalla M, Fountain DM, Gardner A, Ghosh A, Gill JR, Glasmacher SA, Gordon R, Grahovac G, Grenfell R, Habeebullah A, Haliasos N, Hammett T, Hannan CJ, Hill CS, Hoeritzauer I, Holmes D, Hossain-Ibrahim K, Hughes L, Hussain M, Hussain S, Ibrahim R, Jamjoom AAB, John B, Joshi S, Jung J, Kennion O, Khan M, Klejnotowska A, Kumaria A, LaCava R, Lammy S, Lawrence A, Lea M, Leung AHC, Liew I, Luo W, MacCormac O, Manfield J, Mannion R, Merola J, Mishra P, Mohmoud KA, Moon R, Morrison R, Murray O, Nader-Sepahi A, Nnandi C, Pandit A, Patel N, Philip A, Poon MTC, Prasad KSM, Pronin S, Pujara S, Purushothaman B, Rajwani K, Rasul FT, Roy H, Sadek AR, Schramm M, Scicluna G, Sell PJ, Shafafy R, Sharma H, Sheikh A, Sivasubramaniam V, Sofela A, Spink G, Srikandarajah N, Statham PFX, Stokes S, Strachan E, Thakar C, Thanabalasundaram G, Thorpe P, Ulbricht C, Watts A, Whitcher A, White D, Whitehouse K, Wilby M, Woodfield J, Zolnourian A. Presentation, management, and outcomes of cauda equina syndrome up to one year after surgery, using clinician and participant reporting: A multi-centre prospective cohort study. Lancet Reg Health Eur 2023; 24:100545. [PMID: 36426378 PMCID: PMC9678980 DOI: 10.1016/j.lanepe.2022.100545] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/25/2022] [Accepted: 10/27/2022] [Indexed: 11/19/2022] Open
Abstract
Background Cauda equina syndrome (CES) results from nerve root compression in the lumbosacral spine, usually due to a prolapsed intervertebral disc. Evidence for management of CES is limited by its infrequent occurrence and lack of standardised clinical definitions and outcome measures. Methods This is a prospective multi-centre observational cohort study of adults with CES in the UK. We assessed presentation, investigation, management, and all Core Outcome Set domains up to one year post-operatively using clinician and participant reporting. Univariable and multivariable associations with the Oswestry Disability Index (ODI) and urinary outcomes were investigated. Findings In 621 participants with CES, catheterisation for urinary retention was required pre-operatively in 31% (191/615). At discharge, only 13% (78/616) required a catheter. Median time to surgery from symptom onset was 3 days (IQR:1–8) with 32% (175/545) undergoing surgery within 48 h. Earlier surgery was associated with catheterisation (OR:2.2, 95%CI:1.5–3.3) but not with admission ODI or radiological compression. In multivariable analyses catheter requirement at discharge was associated with pre-operative catheterisation (OR:10.6, 95%CI:5.8–20.4) and one-year ODI was associated with presentation ODI (r = 0.3, 95%CI:0.2–0.4), but neither outcome was associated with time to surgery or radiological compression. Additional healthcare services were required by 65% (320/490) during one year follow up. Interpretation Post-operative functional improvement occurred even in those presenting with urinary retention. There was no association between outcomes and time to surgery in this observational study. Significant healthcare needs remained post-operatively. Funding DCN Endowment Fund funded study administration. Castor EDC provided database use. No other study funding was received.
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Sohn SY, Russell CD, Jamjoom AAB, Poon MT, Lawson McLean A, Ahmed AI, Abdulla MAH, Alalade A, Bailey M, Basu S, Baudracco I, Bayston R, Bhattacharya A, Bodkin P, Boissaud-Cooke M, Bojanic S, Brennan PM, Bulters DO, Buxton N, Chari A, Corns R, Coulter C, Coulter I, Critchley G, Dando A, Dardis R, Duddy J, Dyson E, Edwards R, Garnett M, Gatcher S, Georges H, Glancz LJ, Gray WP, Hallet J, Harte J, Haylock-Vize P, Hutchinson PJ, Humphreys H, Jenkinson MD, Joannides AJ, Kandasamy J, Kitchen J, Kolias AG, Loan JJM, Ma R, Madder H, Mallucci CL, Manning A, Mcelligott S, Mukerji N, Narayanamurthy H, O’Brien D, Okasha M, Papadopoulos M, Phan V, Phang I, Poots J, Rajaraman C, Roach J, Ross N, Sharouf F, Shastin D, Simms N, Steele L, Solth A, Tajsic T, Talibi S, Thanabalasundaram G, Vintu M, Wan Y, Wang D, Watkins L, Whitehouse K, Whitfield PC, Williams A, Zaben M. Comparison of suspected and confirmed internal EVD-related infections: a prospective multi-centre U.K. observational study. Open Forum Infect Dis 2022; 9:ofac480. [PMID: 36267249 PMCID: PMC9578167 DOI: 10.1093/ofid/ofac480] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background Diagnosis of internal external ventricular drain (EVD)-related infections (iERI) is an area of diagnostic difficulty. Empiric treatment is often initiated on clinical suspicion. There is limited guidance around antimicrobial management of confirmed versus suspected iERI. Methods Data on patients requiring EVD insertion were collected from 21 neurosurgical units in the United Kingdom from 2014 to 2015. Confirmed iERI was defined as clinical suspicion of infection with positive cerebrospinal fluid (CSF) culture and/or Gram stain. Cerebrospinal fluid, blood, and clinical parameters and antimicrobial management were compared between the 2 groups. Mortality and Modified Rankin Scores were compared at 30 days post-EVD insertion. Results Internal EVD-related infection was suspected after 46 of 495 EVD insertions (9.3%), more common after an emergency insertion. Twenty-six of 46 were confirmed iERIs, mostly due to Staphylococci (16 of 26). When confirmed and suspected infections were compared, there were no differences in CSF white cell counts or glucose concentrations, nor peripheral blood white cell counts or C-reactive protein concentrations. The incidence of fever, meningism, and seizures was also similar, although altered consciousness was more common in people with confirmed iERI. Broad-spectrum antimicrobial usage was prevalent in both groups with no difference in median duration of therapy (10 days [interquartile range {IQR}, 7–24.5] for confirmed cases and 9.5 days [IQR, 5.75–14] for suspected, P = 0.3). Despite comparable baseline characteristics, suspected iERI was associated with lower mortality and better neurological outcomes. Conclusions Suspected iERI could represent sterile inflammation or lower bacterial load leading to false-negative cultures. There is a need for improved microbiology diagnostics and biomarkers of bacterial infection to permit accurate discrimination and improve antimicrobial stewardship.
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Affiliation(s)
- Sei Yon Sohn
- Division of Anaesthesia, University of Cambridge , Cambridge , U.K
| | - Clark D Russell
- University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute , Edinburgh , U.K
| | - Aimun AB Jamjoom
- Department of Clinical Neuroscience, Royal Infirmary of Edinburgh , Edinburgh , U.K
| | - Michael T Poon
- Department of Clinical Neuroscience, Royal Infirmary of Edinburgh , Edinburgh , U.K
| | - Aaron Lawson McLean
- Department of Neurosurgery, Jena University Hospital – Friedrich Schiller University Jena , Jena , Germany
| | - Aminul I Ahmed
- Wolfson CARD, King’s College London and Department of Neurosurgery, King’s College Hospital , London , U.K
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Georgiou I, Bhatt P, Bodkin P, Giamouriadis A, Ross S, Walkden J, Olson S, Neelakantan A, Torgersen A, Whibley M, Moleron R. PO-1165 Pattern of recurrence of glioblastoma treated with non-coplanar volumetric modulated arc therapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03129-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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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.
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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
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Newall N, Gajuryal S, Bidari S, Karki A, Karki P, Bodkin P, Pant B. Epidemiology and Pattern of Traumatic Brain Injuries at Annapurna Neurological Institute & Allied Sciences, Kathmandu, Nepal. World Neurosurg 2020; 141:413-420. [PMID: 32407914 DOI: 10.1016/j.wneu.2020.04.250] [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: 02/03/2020] [Revised: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Traumatic brain injury (TBI) constitutes a major health and socioeconomic problem worldwide. It represents the greatest contribution to death and disability among all trauma-related injuries globally. TBIs are a leading cause of death and disability in Nepal, despite improvements in safety regulations and implementation of strict drunk driving laws. We describe the epidemiology of patients with TBI following admission to our hospital. We discuss the implementation of specific strategies to reduce its incidence. METHODS We conducted a retrospective cross-sectional study of patients presenting to Annapurna Neurological Institute & Allied Sciences (ANIAS), Kathmandu, with a TBI between September 2018 to September 2019. RESULTS One-hundred and sixty-seven patients presented with a TBI. The most common age groups were younger than 15 years old and 15-25 years old, and the majority were male (73%). The commonest cause of TBI was road traffic accidents (RTA) (59%). Drivers riding motorcycles were the predominant mechanism of RTA (38%). Helmet use was seen in 57% of patients riding 2-wheelers. Alcohol consumption was reported in 22% of all patients. Skull fractures were the most common diagnosis. Most patients were managed conservatively (84%). CONCLUSIONS TBI should be recognized as an important public health problem in Nepal. TBI is responsible for a considerable number of neurosurgical admissions to ANIAS. Our study showed patients most vulnerable to TBI are males younger than 25 years old. The implementation of stricter traffic rules and regulations, helmet law enforcement, and public education programs may be helpful in decreasing the number of TBI.
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Affiliation(s)
- Nicola Newall
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, Scotland, United Kingdom; Department of Neurosurgery, Annapurna Neurological Institute & Allied Sciences, Kathmandu, Nepal.
| | - Sharad Gajuryal
- Department of Neurosurgery, Annapurna Neurological Institute & Allied Sciences, Kathmandu, Nepal
| | - Sangita Bidari
- Department of Neurosurgery, Annapurna Neurological Institute & Allied Sciences, Kathmandu, Nepal
| | - Ashmita Karki
- Department of Neurosurgery, Annapurna Neurological Institute & Allied Sciences, Kathmandu, Nepal
| | - Prashmita Karki
- Department of Neurosurgery, Annapurna Neurological Institute & Allied Sciences, Kathmandu, Nepal
| | - Peter Bodkin
- Department of Neurosurgery, Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom
| | - Basant Pant
- Department of Neurosurgery, Annapurna Neurological Institute & Allied Sciences, Kathmandu, Nepal
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Andijani M, Jamjoom A, Togersen A, Ram B, Bodkin P, Kamel M. An unusual presentation of clival chordoma: a case report and review of the literature. Br J Neurosurg 2019; 34:549-551. [PMID: 31226887 DOI: 10.1080/02688697.2019.1630548] [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: 10/26/2022]
Abstract
Chordomas are rare bone tumours that are aggressive and locally invasive. When arising from the clivus, they typically present with cranial nerve deficits and headache. We report a case of a 58-year-old male who presented acutely with hydrocephalus and suspected encephalitis. He had evidence of clival erosion but no obvious tumour mass on imaging. After stabilisation, he developed CSF rhinorrhoea for which he underwent endoscopic repair. Biopsy samples diagnosed chordoma.
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Affiliation(s)
| | - Aimun Jamjoom
- Department of Neurosurgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Antonia Togersen
- Department of Neuropathology, Western General Hospital, Edinburgh, UK
| | - Bhashkar Ram
- Department of Ear, Nose and Throat surgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Peter Bodkin
- Department of Neurosurgery, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Mahmoud Kamel
- Department of Neurosurgery, Aberdeen Royal Infirmary, Aberdeen, UK
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Newall N, Bodkin P. Neurosurgery in Aberdeen Royal Infirmary c. 1920-c.1940: knowledge, skills and styles. J R Coll Physicians Edinb 2019; 49:70-77. [PMID: 30838997 DOI: 10.4997/jrcpe.2019.115] [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: 11/19/2022] Open
Abstract
A neurosurgical unit was established in Aberdeen Royal Infirmary (ARI) in 1948 with the appointment of Martin Nichols as its first full-time neurosurgeon. Despite there being no formal neurosurgical ward or specialist dedicated to neurosurgery in ARI prior to this, a number of neurosurgical procedures were undertaken between 1920 and 1940. From 1923 to 1932, the procedures were predominantly cranial and were performed by general surgeons. The operations evolved in 1933 to include the spine and peripheral nerves after the arrival of Sir James Learmonth. This paper chronicles the development of surgical neurology at the ARI in the 30 years preceding a formal unit. It considers the factors and background that enabled neurosurgical practices to be undertaken and led to evolution of neurosurgery from general surgery.
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Abstract
We report on a patient who developed winged scapula on the contralateral side to the approach for a cerebellopontine tumour excision, an unreported complication following this procedure. We think this was due to damage of the long thoracic nerve in the dependant side, while in the park bench position.
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Affiliation(s)
- A Paluzzi
- Neurosurgery Department, James Cook University Hospital, Middlesbrough, UK.
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