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Gleeson M.,The National Hospital for Neurology and Neurosurgery
Operative Techniques in Otolaryngology - Head and Neck Surgery | Year: 2016

The prerequisites for surgical resection of tumors arising in the jugular foramen are adequate access, control of the major vessels, and the ability to move the facial nerve safely of the operative field if necessary. Without it the surgeon risks catastrophic hemorrhage, cranial nerve palsies that might have been avoided, and insufficient access to remove the whole tumor. The aim of this article is to help the surgeon select the best approach for their patient and summarize the key steps in each. Consideration of a staged approach is prudent for paragangliomas that have significant intracranial extension, Fisch Di tumors. Paragangliomas confined to the temporal bone and intimately related to the internal carotid artery (ICA), Fisch C2-4, are better resected through a type A infratemporal fossa approach. Small jugular paragangliomas, Fisch C1, can be removed using a Fallopian bridge technique though limited rerouting of the facial nerve may sometimes be required. © 2016 Elsevier Inc. Source


Choi D.,The National Hospital for Neurology and Neurosurgery
ArgoSpine News and Journal | Year: 2012

Surgery for spine tumours can be challenging, and due to the increased complexity of surgery, the dura may be transgressed either for purposeful resection of tumour margins or by inadvertent breach whilst removing extradural tumour. If leakage of CSF occurs, this may affect the patient's quality of life, at a time when maintaining function and good outcome is paramount. Surgical planning should aim to minimise the risk of CSF leakage, but if dural breach does occur, the defect should be repaired by using sutures, dural patch techniques and application of tissue adhesives. We outline and illustrate the methods of dural closure that can be used to prevent leakage of CSF during surgery for spine tumours. © 2012 ARGOS and Springer-Verlag France. Source


Keenan E.,The National Hospital for Neurology and Neurosurgery
Nursing times | Year: 2010

Specialist nurse roles appear to beunder threat in the UK and the role of the clinical nurse specialist has been subject to scrutiny recently. A trust developed a database so that data on the CNS workload and contribution to patient care could be collected and analysed. This showed the components of the role and the dear benefits to patient care. Source


Schreiber B.E.,Royal Free Hampstead NHS Trust | Agrup C.,University College London | Haskard D.O.,Imperial College London | Luxon L.M.,The National Hospital for Neurology and Neurosurgery
The Lancet | Year: 2010

Sudden sensorineural hearing loss is usually unilateral and can be associated with tinnitus and vertigo. In most cases the cause is not identified, although various infective, vascular, and immune causes have been proposed. A careful examination is needed to exclude life threatening or treatable causes such as vascular events and malignant diseases, and patients should be referred urgently for further assessment. About half of patients completely recover, usually in about 2 weeks. Many treatments are used, including corticosteroids, antiviral drugs, and vasoactive and oxygen-based treatments. Although no treatment is proven, we recommend a short course of oral high-dose corticosteroids. There is much to learn about pathogenesis of sudden sensorineural hearing loss, and more clinical trials are needed to establish evidence-based management. © 2010 Elsevier Ltd. All rights reserved. Source


Akram H.,The National Hospital for Neurology and Neurosurgery | Mirza B.,The National Hospital for Neurology and Neurosurgery | Kitchen N.,The National Hospital for Neurology and Neurosurgery | Zakrzewska J.M.,University College London
Neurosurgical Focus | Year: 2013

Object. The aim of this study was to design a checklist with a scoring system for reporting on studies of surgical interventions for trigeminal neuralgia (TN) and to validate it by a review of the recent literature. Methods. A checklist with a scoring system, the Surgical Trigeminal Neuralgia Score (STNS), was devised partially based on the validated STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) criteria and customized for TN after a literature review and then applied to a series of articles. These articles were identified using a prespecified MEDLINE and Embase search covering the period from 2008 to 2010. Of the 584 articles found, 59 were studies of interventional procedures for TN that fulfilled the inclusion criteria and 56 could be obtained in full. The STNS was then applied independently by 3 of the authors. Results. The maximum STNS came to 30, and was reliable and reproducible when used by the 3 authors who performed the scoring. The range of scores was 6-23.5, with a mean of 14 for all the journals. The impact factor scores of the journals in which the papers were published ranged from 0 to 4.8. Twenty-four of the studies were published in the Journal of Neurosurgery or in Neurosurgery. Studies published in neurosurgical journals ranked higher on the STNS scale than those published in nonneurosurgical journals. There was no statistically significant correlation between STNS and impact factors. Stereotactic radiosurgery (n = 25) and microvascular decompression (n = 15) were the most commonly reported procedures. The diagnostic criteria were stated in 35% of the studies, and 4 studies reported subtypes of TN. An increasing number of studies (46%) used the recommended Kaplan-Meier methodology for pain survival outcomes. The followup period was unclear in 8 studies, and 26 reported follow-ups of more than 5 years. Complications were reported fairly consistently but the temporal course was not always indicated. Direct interview, telephone conversation, and questionnaires were used to measure outcomes. Independent assessment of outcome was only clearly stated in 7 studies. Only 2 studies used the 36-Item Short Form Health Survey to measure quality of life and 4 studies reported on the severity of preoperative pain. The Barrow Neurological Institute pain questionnaire was the most commonly used outcome measure (n = 13), followed by the visual analog scale. Conclusions. Similar to the STROBE criteria that provide a checklist of items that should be included in reports of observational studies in general, the authors' suggested checklist for the STNS could help editors and reviewers ensure that quality reports are published, and could prove useful for colleagues when reporting their results specifically on the surgical management of TN. It would help the patient and clinicians make a decision about selecting the appropriate neurosurgical procedure. © AANS, 2013. Source

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