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IntroductionChiari 1 malformation (CM1) is a structural abnormality of the hindbrain characterised by the descent of the cerebellar tonsils through the foramen magnum. The management of patients with CM1 remains contentious since there are currently no UK or international guidelines for clinicians. We therefore propose a collaborative, prospective, multicentre study on the investigation, management and outcome of CM1 in the UK: the UK Chiari 1 Study (UKC1S). Our primary objective is to determine the health-related quality of life (HRQoL) in patients with a new diagnosis of CM1 managed either conservatively or surgically at 12 months of follow-up. We also aim to: (A) determine HRQoL 12 months following surgery; (B) measure complications 12 months following surgery; (C) determine the natural history of patients with CM1 treated conservatively without surgery; (D) determine the radiological correlates of presenting symptoms, signs and outcomes; and (E) determine the scope and variation within UK practice in referral patterns, patient pathways, investigations and surgical decisions.Methods and analysisThe UKC1S will be a prospective, multicentre and observational study that will follow the British Neurosurgical Trainee Research Collaborative model of collaborative research. Patients will be recruited after attending their first neurosurgical outpatient clinic appointment. Follow-up data will be collected from all patients at 12 months from baseline regardless of whether they are treated surgically or not. A further 12-month postoperative follow-up timepoint will be added for patients treated with decompressive surgery. The study is expected to last three years.Ethics and disseminationThe UKC1S received a favourable ethical opinion from the East Midlands Leicester South Research Ethics Committee (REC reference: 20/EM/0053; IRAS 269739) and the Health Research Authority. The results of the study will be published in peer-reviewed medical journals, presented at scientific conferences, shared with collaborating sites and shared with participant patients if they so wish.

Summary Background Insertion of a ventriculoperitoneal shunt for hydrocephalus is one of the commonest neurosurgical procedures worldwide. Infection of the implanted shunt affects up to 15% of these patients, resulting in prolonged hospital treatment, multiple surgeries, and reduced cognition and quality of life. Our aim was to determine the clinical and cost-effectiveness of antibiotic (rifampicin and clindamycin) or silver shunts compared with standard shunts at reducing infection. Methods In this parallel, multicentre, single-blind, randomised controlled trial, we included patients with hydrocephalus of any aetiology undergoing insertion of their first ventriculoperitoneal shunt irrespective of age at 21 regional adult and paediatric neurosurgery centres in the UK and Ireland. Patients were randomly assigned (1:1:1 in random permuted blocks of three or six) to receive standard shunts (standard shunt group), antibiotic-impregnated (0·15% clindamycin and 0·054% rifampicin; antibiotic shunt group), or silver-impregnated shunts (silver shunt group) through a randomisation sequence generated by an independent statistician. All patients and investigators who recorded and analysed the data were masked for group assignment, which was only disclosed to the neurosurgical staff at the time of operation. Participants receiving a shunt without evidence of infection at the time of insertion were followed up for at least 6 months and a maximum of 2 years. The primary outcome was time to shunt failure due the infection and was analysed with Fine and Gray survival regression models for competing risk by intention to treat. This trial is registered with ISRCTN 49474281. Findings Between June 26, 2013, and Oct 9, 2017, we assessed 3505 patients, of whom 1605 aged up to 91 years were randomly assigned to receive either a standard shunt (n=536), an antibiotic-impregnated shunt (n=538), or a silver shunt (n=531). 1594 had a shunt inserted without evidence of infection at the time of insertion (533 in the standard shunt group, 535 in the antibiotic shunt group, and 526 in the silver shunt group) and were followed up for a median of 22 months (IQR 10–24; 53 withdrew from follow-up). 32 (6%) of 533 evaluable patients in the standard shunt group had a shunt revision for infection, compared with 12 (2%) of 535 evaluable patients in the antibiotic shunt group (cause-specific hazard ratio [csHR] 0·38, 97·5% CI 0·18–0·80, p=0·0038) and 31 (6%) of 526 patients in the silver shunt group (0·99, 0·56–1·74, p=0·96). 135 (25%) patients in the standard shunt group, 127 (23%) in the antibiotic shunt group, and 134 (36%) in the silver shunt group had adverse events, which were not life-threatening and were mostly related to valve or catheter function. Interpretation The BASICS trial provides evidence to support the adoption of antibiotic shunts in UK patients who are having their first ventriculoperitoneal shunt insertion. This practice will benefit patients of all ages by reducing the risk and harm of shunt infection. Funding UK National Institute for Health Research Health Technology Assessment programme.

Medical implant devices have evolved in the past decade and now many surgical specialties have turned to polyetheretherketone (PEEK) devices for its ideal properties. In Neurosurgery, PEEK has its role in many operations such as cervical cages after anterior cervical discectomy and as a prosthetic implant for cranioplasty where autologous cranioplasty is not possible. We discuss our case of a poorly differentiated destructive tumour that was surgically removed and the skull deformity replaced with a PEEK implant, assisted by state of the art neuro-navigational technology.

Introduction: In recent years balloon kyphoplasty has become increasingly implemented in the treatment of vertebral compression fractures and has been shown to be safe and efficacious at long term follow up particularly for patients with metastatic disease to the spine. At Waikato hospital, New Zealand, we looked at our outcomes compared with current literature. Methods: All patients who underwent balloon kyphoplastybetween 2008-2012 were included in the study and outcomes measured were pain scores and functional disability using the Oswestry disability index. Results: 12 patients were included in the study and average pain scores both at rest and on activity improved post-operatively. Functional disability significantly improved at short and long term follow-up. Conclusion: Balloon kyphoplasty is a safe and effective procedure and our results so far concur with current literature.

We present a case of intracranial abscess in a young female with Ectopia Cordis, an exceptionally rare cardiac condition. The neurosurgical implication is the predisposition to intracranial abscess formation. A heightened awareness of this association will aid diagnosis in similar clinical scenarios.

INTRODUCTION: Pelvic floor injury from obstetric trauma has been associated with increase in future pelvic floor dysfunction. Thus, analysis of factors in women who have had a third- or fourth-degree laceration may help to identify those at risk of developing pelvic floor dysfunction. Several factors such as operative vaginal delivery and median episiotomy have been shown to be risk factors for these lacerations. In this study we attempt search for additional risk factors for obstetric trauma. METHODS: We identified 100 women who had a third- and fourth-degree laceration and 100 randomly selected women in a control group from the same time period. Parity, presence of stretch marks, prepregnancy body mass index, age, smoking, fetal weight, operative vaginal delivery, median episiotomy, and duration of second stage were compared between each group. Odds ratios (ORs) were calculated for each of the listed risk factors. RESULTS: Prepregnancy body mass index greater than 30 kg/m (OR 5.3, P=.01), fetal weight greater than 4,000 g (OR 20.7, P=.01), duration of second stage between 1 and 2 hours (OR 10.8, PCONCLUSION: Of the listed risk factors, duration of second stage as little as 1 hour may increase the risk of obstetric trauma. This may represent a modifiable risk factor to decrease the risk of future pelvic floor dysfunction. Language: en