Middle meningeal artery embolisation reduces chronic subdural haematoma recurrence: A meta-analysis of EMBOLISE, STEM, MAGIC-MT and EMPROTECT trials and cost analysis.

Objective: To assess the effectiveness and cost implications of middle meningeal artery embolisation (MMAE) in reducing recurrence of chronic subdural haematoma (CSDH) requiring surgery, through a meta-analysis of the four largest randomized controlled trials (RCTs) published to date.

Methods: A systematic review and meta-analysis were conducted on four RCTs (EMBOLISE, STEM, MAGIC-MT, EMPROTECT) comparing MMAE to standard treatment in adult patients with CSDH. The primary outcome was recurrence requiring surgery.

The state of cerebrovascular training in the United Kingdom.

Background: Cerebrovascular training for neurosurgical residents has been impacted by the decrease in open surgery for aneurysms, the rise of endovascular treatments, and a decline in interventions for arteriovenous malformations (AVMs). Our aim was to explore the open vascular and endovascular experience recorded by residents in the United Kingdom (UK) over a 12-year period (2011-2022, inclusive).

Methods: A retrospective database review of 12 open vascular and endovascular procedures logged by UK residents over a 12-year period was conducted.

The changing landscape of traumatic brain injuries at a district general hospital in a trauma network.

Background: Major trauma networks were introduced in 2012 onwards with a major trauma centre (MTC) linked to district general hospitals (DGH). Most traumatic brain injuries (TBI) are managed in DGHs, without on-site neurosurgical services. It is unclear whether the characteristics of TBIs at DGHs have differed since the network was introduced.

Improving Patient Care and Streamlining Follow-Up: Compliance With National Institute for Health and Care Excellence (NICE) Guidelines for Pediatric Distal Radius Buckle Fractures.

Introduction: Torus fractures, also known as buckle fractures, are among the most common types of fractures seen in children who present to the emergency department (ED). These injuries usually occur when a child falls onto an outstretched hand, resulting in the compression and buckling of the dorsal cortex of the radius while the volar cortex remains intact. These fractures generally have a good prognosis and heal well with simple immobilization with a low risk of complications.

A cross-sectional survey of patient perceptions of the National Neurosurgical Audit Programme (NNAP).

Background: The National Neurosurgical Audit Programme (NNAP) publishes mortality outcomes of consultants and neurosurgical units across the United Kingdom. It is unclear how useful outcomes data is for patients and whether it influences their decision-making process. Our aim was to identify patients' perceptions and understanding of the NNAP data and its influences.

The Pathogenesis of Chiari Malformation and Syringomyelia: A Case Report and Systematic Review of Current Theories.

We report a case of a 42-year-old female presenting with left axillary pain radiating down the arm and weakness in the ipsilateral hand. Specialist examinations of neurological and musculoskeletal systems were insignificant. Magnetic resonance imaging (MRI) of the whole spine and brain revealed cerebellar tonsillar herniation of 9-10mm indicating a Chiari type 1 malformation and a large tubular T2 high-intensity lesion in the cervical cord, extending from the C2/3-disc level down to C6/C7 as well as a similar but smaller lesion behind the bodies of C7 and T1.

Reducing the neurosurgical waiting list burden: is it a futile endeavour?

Background: Cancellation of elective operations during the COVID-19 pandemic has led to a significant increase in the number of patients waiting for treatment. In neurosurgery, treatment for spinal diseases, in particular, has been disproportionately delayed. We aim to describe the waiting list burden at our institution and forecast the time and theatre capacity required to return to pre-pandemic levels.

Variations in the Neurosurgical Management of Depressed Skull Fractures in Adults: An International Cross-Sectional Survey.

Background:  Depressed skull fractures have been well described since antiquity, yet its management remains controversial. Contentious issues include the use of prophylactic antibiotics and antiepileptics, the role of nonoperative management, and the replacement/removal of bone fragments. Our objective was to explore the management patterns of closed and open depressed skull fractures across the world.

Decompressive craniectomy for intracranial hypertension in vaccine-induced immune thrombotic thrombocytopaenia: a case series.

Background: Vaccines have been key in preventing COVID-19 infections and the AstraZeneca (AZ) vaccine has been widely used. However, increased rates of thromboembolic events were identified in recipients and, subsequently, a syndrome of vaccine-induced immune thrombotic thrombocytopaenia (VITT) was described whereby recipients presented with venous sinus thromboses, haemorrhagic infarctions, and - consequently - raised intracranial pressure. National guidance recommended decompressive craniectomies for refractory intracranial hypertension.

Use of an Online Referral Service for Acute Neurosurgical Referrals: An Institutional Experience.

Objective: We sought to review the current scope of emergency neurosurgical referrals and examine the long-term use of a web-based referral system.

Methods: This was a single-center retrospective observational study. Referral information was collected retrospectively over a 1-year period after the implementation of a web-based referral system (June 2019-June 2020).

Limb Length Inequality in Patients After Primary Total Hip Arthroplasty: Analysis of Radiological Assessment and Influencing Risk Factors Based on a District General Hospital Experience of 338 Cases.

Background and objective Limb length inequality (LLI) is a frequent and recurring issue after total hip arthroplasty (THA). It is often a source of patient dissatisfaction and litigation. This study reviewed the incidence of LLI in a UK District General Hospital in light of published evidence and identified the preoperative and intraoperative risk factors for LLI.

A Tale of Two Cities: Residents' Operative Experience in the United Kingdom and Germany During the Coronavirus Disease 2019 Pandemic.

Background: The coronavirus disease 2019 (COVID-19) pandemic has had a detrimental effect on residents' operative training. Our aim was to identify the proportion of procedures performed by residents across 2 neurosurgical centers (1 in the United Kingdom and 1 in Germany) during the pandemic-affected months of March 2020-May 2020, inclusive, compared with March 2019-May 2019, inclusive.

Methods: All neurosurgical procedures performed at the United Kingdom and German institutions, between March 1, 2019 and May 31, 2019 (pre-COVID months) and March 1, 2020 and May 31, 2020 (COVID months), were extracted and operative notes evaluated.

COVID-19 and Changes in Neurosurgical Workload in the United Kingdom.

Background: Cessation of elective procedures and lower bed capacity during the COVID-19 pandemic have led to a rise in the waiting lists for surgery, but it is unclear if workload has recovered sufficiently to account for this backlog. We describe the change in neurosurgical workload at a tertiary neurosciences center in the United Kingdom after the first pandemic wave in comparison with the months before and during the first wave.

Methods: A retrospective review of theatre records and electronic referrals-between December 1, 2019, and August 31, 2020-was performed.

Surgical decompressions for cauda equina syndrome during COVID-19.

Background: The novel coronarvirus disease (COVID-19) has had a major impact on provision of spinal neurosurgery across the world, especially in the UK, with a significant fall in operating and patient volumes, and elective clinical activities. It is unclear whether the pandemic has affected the volume of urgent spinal procedures in the UK, especially surgical decompressions for cauda equina syndrome (CES).

Methods: Therefore, we conducted a retrospective analysis of theatre records and electronic operation notes at our institution to identify all procedures performed for CES before (December 2019 to February 2020) and during (March 2020 to May 2020) the COVID-19 pandemic.

Neurosurgical Referral Patterns During the Coronavirus Disease 2019 Pandemic: A United Kingdom Experience.

Background: Coronavirus disease 2019 (COVID-19) is a severe respiratory viral illness that has spread rapidly across the world. However, the United Kingdom has been particularly affected. Evidence has suggested that stroke, cardiac, and spinal presentations decreased during the pandemic as the public avoided seeking care.

Seasonal variation in trauma admissions to a level III trauma unit over 10 years.

Introduction: Major trauma centres have improved morbidity and mortality for moderate and severely injured patients. Less injured patients may be treated in facilities less resourced for trauma care. In these units, understanding the variations in injury presentation and treatment over time allows service delivery to be tailored to demand.

Where do these cadavers come from?

Cadaveric surgical courses are highly useful in developing operative skills, however, the provenance of the cadavers themselves remains opaque. Trade in cadaveric parts is an important source of material for courses, and this has spawned the unique service of body brokerage. Body brokers, however, operate in an unregulated market and obtain bodies by exploiting family members' altruistic instincts and financial concerns.

Obstructive hydrocephalus secondary to a perianeurysmal cyst: a case report.

Perianeurysmal cysts are an extremely rare association with cerebral aneurysms. We report the case of a 64 year old male who presented with obstructive hydrocephalus due to a perianeurysmal cyst. The cyst originated in association with a thrombosed, right-sided, terminal internal carotid artery aneurysm.

Bedside teaching with unwell patients: Can it ever be appropriate?

Bedside teaching has seen a decline in its popularity since the heady days of Boerhaave and Osler; a number of hurdles have been noted in the literature including time constraints on senior clinicians. While organizing a bedside teaching course for final-year medical students, it was apparent that the availability of suitable patients was also a limiting factor. Often, we would be turned away from patients with physical signs because they were deemed to be too unwell for an examination.

Which peer teaching methods do medical students prefer?

Background: The beneficial effects of peer teaching in medical education have been well-described in the literature. However, it is unclear whether students prefer to be taught by peers in small or large group settings. This study's aim was to identify differences in medical students' preferences and perceptions of small-group versus large-group peer teaching.

Factors affecting UK medical students' decision to train in urology: a national survey.

Background: Our aim was to understand the specific factors which influence medical students' choice to train in urology, in order to attract the best and the brightest into the specialty during a challenging time for surgical training in the United Kingdom

Methods: A cross-sectional web-based survey was generated to evaluate: 1) perceptions of urology; 2) attitudes about urology as a career; 3) exposure to urology at medical school; and 4) proficiency in common urological procedures. The survey was sent to all 33 medical schools in the UK and advertised to all medical students.

Results: The survey received 488 responses were received from 14 medical schools; 59.

e-Learning in Surgical Education: A Systematic Review.

Objective: e-Learning involves the delivery of educational content through web-based methods. Owing to work-hour restrictions and changing practice patterns in surgery, e-learning can offer an effective alternative to traditional teaching. Our aims were to (1) identify current modalities of e-learning, (2) assess the efficacy of e-learning as an intervention in surgical education through a systematic review of the literature, and (3) discuss the relevance of e-learning as an educational tool in surgical education.