British journal of neurosurgery
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The validity of EORTC GBM prognostic calculator on survival of GBM patients in the West of Scotland.
It is now accepted that the addition of temozolomide to radiotherapy in the treatment of patients with newly diagnosed glioblastoma multiforme (GBM) significantly improves survival. In 2008, a subanalysis of the original study data was performed, and an online "GBM Calculator" was made available on the European Organisation for Research and Treatment of Cancer (EORTC) website allowing users to estimate patients' survival outcomes. We tested this calculator against actual local survival data to validate its use in our patients. ⋯ Use of the EORTC GBM prognostic calculator would have overestimated the survival of the majority of our patients with GBM. Uncertainty exists as to the cause of overestimation in the cohort although local socioeconomic factors might play a role. The different calculator models yielded different outcomes and the "best" predictor of survival for the cohort under study utilised the tumour MGMT status. We would strongly encourage similar local studies of validity testing prior to employing the online prognostic calculator for other population groups.
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Awake craniotomy is the technique of choice in patients with brain tumours adjacent to primary and accessory language areas (Broca's and Wernicke's areas). Language testing should be aimed to detect preoperative deficits, to promptly identify the occurrence of new intraoperative impairments and to establish the course of postoperative language status. Aim of this case series is to describe our experience with a dedicated language testing work up to evaluate patients with or at risk for language disturbances undergoing awake craniotomy for brain tumour resection. ⋯ Broca's area was identified in 15 patients, in all cases by counting arrest during stimulation and in 12 cases by naming arrest. In this article we describe our experience using a language testing work up to evaluate - pre, intra and postoperatively - patients undergoing awake craniotomy for brain tumour resection with preoperative language disturbances or at risk for postoperative language deficits. This approach allows a systematic evaluation and recording of language function status and can be accomplished even when a neuropsychologist or speech therapist are not involved in the operation crew.
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Historical Article
History of neurosurgery at the Royal Free Hospital in London.
The recent move of the neurosurgical services from The Royal Free London NHS Foundation Trust in Hampstead to The National Hospital for Neurology and Neurosurgery at Queen Square signified the end of an era of neurosurgery in North London. It also represents also another chapter in the history of the remarkable North London hospital that is The Royal Free Hospital. This short article looks at the history of the Department of Neurosurgery at The Royal Free Hospital and the factors contributing to the reorganisation of neurosurgical services in North London.
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In the UK approximately 4000 patients are diagnosed with brain tumours each year. Many patients undergo CT scans of the chest, abdomen and pelvis as part of the investigation of such tumours. We aimed to determine the value of CT body scans in patients with newly diagnosed brain tumours. ⋯ The ability of a specialist neuro-oncology MDT to correctly identify primary and secondary brain tumours on initial imaging is high. If the radiological diagnosis is of a secondary brain tumour, then CT body scans are essential. If the radiological diagnosis is of a primary brain tumour, then CT scans of the body are likely to add little to patient management.
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The inpatient length of stay for lumbar discectomy has been steadily declining, since its original description over 80 years ago. The operation was first described as a day case procedure in 1987, but only sporadically since then, especially in the UK. We describe our initial experience in introducing this service in Manchester. ⋯ Lumbar microdiscectomy as a day case procedure remains a feasible and safe option in selected patients and can help free up in patient beds with a significant economic benefit also.