Challenging Concepts in Neurosurgery
Titles in the Challenging Concepts in series
Anaesthesia (Edited by Dr Phoebe Syme, Dr Robert Jackson, and Professor Tim Cook)
Cardiovascular Medicine (Edited by Dr Aung Myat, Dr Shouvik Haldar, and Professor Simon Redwood)
Emergency Medicine (Edited by Dr Sam Thenabadu, Dr Fleur Cantle, and Dr Chris Lacy)
Infectious Diseases and Clinical Microbiology (Edited by Dr Amber Arnold and Professor George E. Griffin)
Interventional Radiology (Edited by Dr Irfan Ahmed, Dr Miltiadis Krokidis, and Dr Tarun Sabharwal)
Neurology (Edited by Dr Krishna Chinthapalli, Dr Nadia Magdalinou, and Professor Nicholas Wood)
Obstetrics and Gynaecology (Edited by Dr Natasha Hezelgrave, Dr Danielle Abbott, and Professor Andrew H. Shennan)
Oncology (Edited by Dr Madhumita Bhattacharyya, Dr Sarah Payne, and Professor Iain McNeish)
Oral and Maxillofacial Surgery (Edited by Mr Matthew Idle and Group Captain Andrew Monaghan)
Respiratory Medicine (Edited by Dr Lucy Schomberg, Dr Elizabeth Sage, and Dr Nick Hart)
Challenging Concepts in Neurosurgery
Cases with Expert Commentary
Edited by
Mr Robin Bhatia MA PhD FRCS(SN)
Consultant Spinal Neurosurgeon, Great Western Hospitals NHS Foundation
Trust & Oxford University Hospitals NHS Trust, Oxford, UK
Mr Ian Sabin BMSc(Hons) MB ChB FRCS(Eng) FRCS(Ed)
Consultant Neurosurgeon at St Barts and the Royal London NHS Trust and at The Wellington Hospital, London, UK
Series editors
Dr Aung Myat BSc (Hons) MBBS MRCP
BHF Clinical Research Training Fellow, King’s College London British Heart Foundation Centre of Research Excellence, Cardiovascular Division, St Thomas’ Hospital, London, UK
Dr Shouvik Haldar MBBS MRCP
Electrophysiology Research Fellow & Cardiology SpR, Heart Rhythm Centre, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton & Harefield NHS Foundation Trust, Imperial College London, London, UK
Professor Simon Redwood MD FRCP
Professor of Interventional Cardiology and Honorary Consultant Cardiologist, King’s College London British Heart Foundation Centre of Research Excellence, Cardiovascular Division and Guy’s and
St Thomas’ NHS Foundation Trust, Dr Thomas’ Hospital, London, UK
1
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PREFACE
What is a challenge in neurosurgery? It might be better to ask what isn’t. Of all the surgical specialties, neurosurgery is arguably the discipline with the greatest number of controversial and unresolved issues, and these confront the neurosurgeon whenever he or she manages a patient with a central or peripheral nervous problem.
For instance, one of the first and most ‘basic’ operations a neurosurgical trainee will learn is burr hole evacuation of a chronic subdural haematoma (CSDH). What could be challenging about this simple operation? Perhaps the training neurosurgeon should remember that the aetiology and natural history of CSDH; when (and when not) to carry out burr hole drainage; how many burr holes to drill; whether or not to leave a drain; the outcomes of burr hole versus twist drill versus craniotomy for CSDH, represent just a few of the hotly debated and largely unresolved issues to this day. Before putting knife to skin, the neurosurgeon must supply answers to these important questions, but how is this possible when the answers are not clearly known?
The purpose of this book is to present twenty-two case-based topics in neurosurgery, and our remit to contributing authors was to tackle the questions that frequently get asked, presenting evidence-based answers in an easy-to-read manner. We chose these cases after surveying both junior and senior neurosurgeons and asking ‘What challenges you in your practice?’ Somewhat surprisingly, the challenge was to be found in the everyday cases, rather than the atypical.
Textbooks of neurosurgery tend to contain editor bias in topic selection. Challenging Concepts in Neurosurgery reflects the subject matter and questions that are important to neurosurgical clinicians, both in training and as a guide to senior neurosurgeons who wish to read concise and up-to-date overviews of a broad spectrum of neurosurgical pathology.
There are clear benefits of learning by the case-based approach. Indeed, the casebased discussion has become a pivotal tool of learning and assessment laid out by the Intercollegiate Surgical Curriculum Programme in the UK, and is gaining popularity across the world. The wide scope of authors from different units in the UK and overseas helps to bring together in one book varying perspectives on patient management, and there are clear benefits of allowing trainees and expert reviewers to co-write—most notably, that one asks the questions we all want to ask and the other supplies the answers.
Robin Bhatia
Ian Sabin
CONTENTS
Experts
Contributors
Abbreviations
Case 1 The management of chronic subdural haematoma
Nick Borg, Angelos G. Kolias, Thomas Santarius, and Peter J. Hutchinson
Case 2 Glioblastoma multiforme
Mohammed Awad and Kevin O’Neill
Case 3 Spondylolisthesis
Eoin Fenton and Ciaran Bolger
Case 4 Intramedullary spinal cord tumour
Ruth-Mary deSouza and David Choi
Case 5 Surgery for temporal lobe epilepsy
Victoria Wykes, Anna Miserocchi, and Andrew McEvoy
Case 6 Management of lumbosacral lipoma in childhood
Martin M. Tisdall, Greg James, and Dominic N. P. Thompson
Case 7 Idiopathic intracranial hypertension
David Sayer and Raghu Vindindlacheruvu
Case 8 Colloid cyst of the third ventricle
Robin Bhatia and Ian Sabin
Case 9 Bilateral vestibular schwannomas: the challenge of neurofibromatosis type 2
Patrick Grover and Robert Bradford
Case 10 Multimodality monitoring in severe traumatic brain injury
Adel Helmy and Peter J. Hutchinson
vii |
Case 11 Intracranial abscess |
103 |
ix |
Ciaran Scott Hill and George Samandouras |
|
|
|
|
xi |
Case 12 Deep brain stimulation for debilitating |
|
|
Parkinson’s disease |
115 |
|
Jonathan A. Hyam, Alexander L. Green, and |
|
1 |
Tipu Z. Aziz |
|
|
Case 13 Endoscopic resection of a growth hormone- |
|
|
secreting pituitary macroadenoma |
125 |
11 |
Alessandro Paluzzi and Paul Gardner |
|
|
Case 14 Trigeminal neuralgia |
135 |
23 |
Isaac Phang and Nigel Suttner |
|
|
Case 15 Cerebral metastasis |
143 |
33 |
Melissa C. Werndle and Henry Marsh |
|
|
Case 16 The surgical management of the |
|
43 |
rheumatoid spine |
149 |
|
Robin Bhatia and Adrian Casey |
|
|
Case 17 Cervical spondylotic myelopathy |
161 |
|
Ellie Broughton and Nick Haden |
|
59 |
Case 18 Brainstem cavernous malformation |
171 |
|
||
|
Harith Akram and Mary Murphy |
|
69 |
Case 19 Peripheral nerve injury |
177 |
Sophie J. Camp and Rolfe Birch |
|
|
|
|
|
75 |
Case 20 Spontaneous intracerebral haemorrhage |
189 |
Peter Bodkin and Patrick Statham |
|
|
|
|
|
|
Case 21 Low-grade glioma |
205 |
83 |
Deepti Bhargava and Michael D. Jenkinson |
|
|
|
|
|
Case 22 Intracranial arteriovenous malformation |
215 |
|
Jinendra Ekanayake and Neil Kitchen |
|
91 |
Index |
231 |
|
EXPERTS
Tipu Z. Aziz
Professor of Neurosurgery,
Nuffield Department of Surgical Sciences,
Oxford University, Oxford, UK
Rolfe Birch
Consultant in Charge,
War Nerve Injuries Clinic at the Defence Medical
Rehabilitation Centre,
Headley Court, Leatherhead, UK
Ciaran Bolger
Professor of Clinical Neuroscience, RCSI, Consultant
Neurosurgeon, Department of Neurosurgery,
Beaumont Hospital, Dublin, Ireland
Robert Bradford
Consultant Neurosurgeon, National Hospital for Neurology & Neurosurgery, London, UK
Adrian Casey
Consultant Neurosurgeon, Royal National Orthopaedic Hospital, Stanmore (Spinal Unit) and National Hospital for Neurology & Neurosurgery, London, UK
David Choi
Consultant Neurosurgeon, National Hospital for Neurology & Neurosurgery, London, UK
Paul Gardner
Associate Professor of Neurological Surgery, Executive Vice Chairman, Surgical Services, CoDirector, Center for Skull Base Surgery, UPMC Presbyterian, Pittsburgh, MA, USA
Alexander L. Green
Consultant Neurosurgeon, Nuffield Department of
Surgical Sciences, Oxford University, Oxford, UK
Nick Haden
Consultant Neurosurgeon, Derriford Hospital,
Plymouth, UK
Peter J. Hutchinson
Professor of Neurosurgery, NIHR Research
Professor, University of Cambridge, Academic
Division of Neurosurgery, Addenbrooke’s Hospital,
Cambridge, UK
Michael D. Jenkinson
Consultant Neurosurgeon at The Walton Centre NHS
Foundation Trust, Liverpool, UK
Neil Kitchen
Consultant Neurosurgeon, National Hospital for Neurology & Neurosurgery and Institute of Neurology, London, UK
Henry Marsh
Senior Consultant Neurosurgeon, St George’s
Healthcare NHS Trust, London, UK
Andrew McEvoy
Consultant Neurosurgeon, National Hospital for Neurology & Neurosurgery and Institute of Neurology, London, UK
Mary Murphy
Neurosurgical Tutor at the Royal College of Surgeons, National Hospital for Neurology & Neurosurgery, London, UK
Kevin O’Neill
Consultant Neurosurgeon, Charing Cross, St Mary’s and Hammersmith hospitals, Imperial College Healthcare NHS Trust, London, UK
Ian Sabin
Consultant Neurosurgeon, St Barts and the Royal
London NHS Trust and at Wellington Hospital,
London, UK
George Samandouras
Victor Horsley Department of Neurosurgery, National Hospital for Neurology & Neurosurgery, London, UK
viii Experts |
|
Thomas Santarius |
Dominic N. P. Thompson |
Consultant Neurosurgeon, Addenbrooke’s Hospital, |
Consultant in Paediatric Neurosurgery, Great |
Cambridge University Hospitals NHS Trust, |
Ormond Street Hospital for Children, NHS |
Cambridge, UK |
Foundation Trust, Great Ormond Street, London, UK |
Patrick Statham |
Raghu Vindindlacheruvu |
Consultant Neurosurgeon, Spire Edinburgh |
Consultant Neurosurgeon, Spire Hartswood Private |
Hospitals, Edinburgh, UK |
Hospital, Brentwood, and Spire Roding Hospital, |
Nigel Suttner |
Redbridge, Essex, UK |
|
|
Consultant Neurosurgeon, Department of |
|
Neurosurgery, Institute of Neurological Sciences, |
|
Glasgow, UK |
|
CONTRIBUTORS
Harith Akram
Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, UK
Mohammed Awad
George Pickard Clinical Research Fellow,
Imperial College London, London, UK
Deepti Bhargava
Walton Centre for Neurology and Neurosurgery, Liverpool, UK
Robin Bhatia
Consultant Spinal Neurosurgeon,
Great Western Hospitals NHS Foundation Trust &
Oxford University Hospitals NHS Trust,
Oxford, UK
Peter Bodkin
Consultant Neurosurgeon,
Aberdeen Royal Infirmary, Aberdeen, UK
Nick Borg
Department of Neurosurgery,
Wessex Neurological Centre,
Southampton General Hospital, Southampton,
Hampshire, UK
Ellie Broughton
South West Neurosurgical Centre,
Derriford Hospital, Plymouth, UK
Sophie J. Camp
Neurosurgery ST8, Department of Neurosurgery,
Charing Cross Hospital, Fulham Palace Road,
London, UK
Ruth-Mary deSouza
ST4 Neurosurgery Registrar,
South Thames London Neurosurgery Training Programme,
Department of Neurosurgery, King’s College Hospital, London, UK
Jinendra Ekanayake
Wellcome Trust Clinical Research Fellow, Wellcome Trust Centre for Neuroimaging, University College London, London, UK
Eoin Fenton
Combined Spine Fellow,
University of Calgary Spine Program,
Department of Surgery,
Health Sciences Centre, Calgary, Alberta, Canada
Patrick Grover
Royal London Hospital, Whitechapel Road,
Whitechapel, London, UK
Adel Helmy
Specialist Registrar Neurosurgery,
Chief Resident Neurosciences,
Division of Neurosurgery,
Department of Clinical Neurosciences,
University of Cambridge, and
Department of Neurosurgery,
Addenbrooke’s Hospital,
Cambridge University Hospitals Trust,
Cambridge, UK
Ciaran Scott Hill
Neurosurgery Registrar,
Royal London Hospital, London, and
Honorary Senior Lecturer in Neuroscience,
University College London, and
Prehospital Care Physician,
London’s Air Ambulance, London, UK
Jonathan A. Hyam
Oxford Functional Neurosurgery, University of
Oxford,
John Radcliffe Hospital, Oxford, UK
Greg James
Department of Neurosurgery, Great Ormond Street Hospital for Children,
NHS Foundation Trust, Great Ormond Street, London, UK
x Contributors
Angelos G. Kolias
RESCUEicp Trial Research Fellow,
Department of Clinical Neurosciences,
University of Cambridge, and
Honorary Consultant Neurosurgeon,
Addenbrooke’s Hospital,
Cambridge University Hospitals NHS Trust,
Cambridge, UK
Anna Miserocchi
Institute of Neurology, National Hospital for Neurology and Neurosurgery,
London, UK
Alessandro Paluzzi
Department of Neurological Surgery, UPMC
Presbyterian Hospital,
University of Pittsburgh School of Medicine,
Pittsburgh, PA, USA
Isaac Phang
Specialty Registrar in Neurosurgery,
Department of Neurosurgery,
Institute of Neurological Sciences,
Glasgow, UK
David Sayer
Department of Neurosurgery, Charing Cross
Hospital,
Imperial Healthcare, Fulham Palace Road,
London, UK
Martin M. Tisdall
Consultant in Paediatric Neurosurgery,
Great Ormond Street Hospital for Children, NHS Foundation Trust,
Great Ormond Street, London, UK
Melissa C. Werndle
Department of Neurosurgery, St. George’s University
of London,
London, UK
Victoria Wykes
Institute of Neurology, National Hospital for Neurology and Neurosurgery,
London, UK