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Background: Management for simple hydrocephalus in low/middle income countries include insertion of a ventriculoperitoneal shunt (VPS) or performance of an endoscopic third ventriculostomy (ETV). Objective: This present study was carried out to compare presenting features, surgical management and outcomes for patients with simple and loculated hydrocephalus. Methodology: This case-control study was performed in the Department of Paediatric Neurosurgery at National Institute of Neurosciences and Hospital, Dhaka, Bangladesh from July 2017 to June 2019. The patients with loculated hydrocephalus were included in the analysis and comparison made to case matched simple hydrocephalus controls. Presenting features, operative details, and outcomes measured by the Glasgow Outcome Scale- Paediatric (GOS) were recorded over a follow up period of one year. Results: A total number of 17 patients with loculated hydrocephalus were recruited for this study. Loculated patients underwent ETV (n=3), VPS (n=7), aqueductoplasty (n=1) and no procedure (n=6). Simple hydrocephalus patients underwent ETV (n=4), VPS (n=7), no procedure (n=2). Patients undergoing intraoperative irrigation had a mean GOS of 3 compared to a GOS of 6 in non-irrigated patients (p=0.0434). Mortality occurred in 9 patients (5 loculated HCP and 4 simple HCP). Mortality was seen to be higher in male patients (p

BackgroundCauda equina syndrome (CES) results from nerve root compression in the lumbosacral spine, usually due to a prolapsed intervertebral disc. Evidence for management of CES is limited by its infrequent occurrence and lack of standardised clinical definitions and outcome measures.MethodsThis is a prospective multi-centre observational cohort study of adults with CES in the UK. We assessed presentation, investigation, management, and all Core Outcome Set domains up to one year post-operatively using clinician and participant reporting. Univariable and multivariable associations with the Oswestry Disability Index (ODI) and urinary outcomes were investigated.FindingsIn 621 participants with CES, catheterisation for urinary retention was required pre-operatively in 31% (191/615). At discharge, only 13% (78/616) required a catheter. Median time to surgery from symptom onset was 3 days (IQR:1–8) with 32% (175/545) undergoing surgery within 48 h. Earlier surgery was associated with catheterisation (OR:2.2, 95%CI:1.5–3.3) but not with admission ODI or radiological compression. In multivariable analyses catheter requirement at discharge was associated with pre-operative catheterisation (OR:10.6, 95%CI:5.8–20.4) and one-year ODI was associated with presentation ODI (r = 0.3, 95%CI:0.2–0.4), but neither outcome was associated with time to surgery or radiological compression. Additional healthcare services were required by 65% (320/490) during one year follow up.InterpretationPost-operative functional improvement occurred even in those presenting with urinary retention. There was no association between outcomes and time to surgery in this observational study. Significant healthcare needs remained post-operatively.FundingDCN Endowment Fund funded study administration. Castor EDC provided database use. No other study funding was received.

Intracranial abscesses are relatively uncommon, but can result in significant mortality and morbidity. Whilst many potential causes of brain abscesses are recognised, in many cases the origin of infection remains clinically unidentified. Our objective was to investigate the role of bacteria found in the oral cavity in the development of brain abscesses.A retrospective analysis was performed using data from 87 patients admitted to a single UK neurosurgical unit with brain abscesses over a 16-year period. Using microbiological data obtained from abscess sampling and peripheral cultures, species of bacteria were categorised in patients where no primary source of infection was identified (NSI) for their brain abscess (n = 52), or where an infective source (ISI) was identified. The microbiological data was then screened to identify common oral bacteria in each group.Brain abscesses from the ISI group (n = 35) demonstrated a significantly lower preponderance of oral bacteria (n = 8), than the NSI group (n = 29) (p 0.05). Brain abscesses from the NSI group also had significantly higher counts of Streptococcus anginosus compared to ISI (p 0.05), with brain abscesses being most common in the frontal and parietal lobes for both ISI and NSI.These findings suggest that the oral cavity could be considered as a source of occult infection in cases of brain abscess where no clear cause has been identified. Future studies should include oral screening and microbiome analysis to better understand the mechanisms involved and develop approaches for prevention.Oral bacteria may be an under-recognised cause of brain abscesses. Careful review of oral health in brain abscess patients may help establish causation, particularly in patients with no cause for their abscess identified. Good levels of oral health may help prevent the development of brain abscesses in some individuals.

Deep brain stimulation (DBS) is a neurosurgical technology that allows the manipulation of activity within specific brain regions through delivery of electrical stimulation via implanted electrodes. The growth of DBS has led to research around the development of novel interventions for a wide range of neurological and neuropsychiatric conditions, including Parkinson’s disease, dystonia, chronic pain, Tourette’s syndrome, treatment-resistant depression, anorexia nervosa, and Alzheimer’s disease. Some of these treatment approaches have a high level of efficacy as well as an established place in the clinical armamentarium for the diseases in question, such as DBS for movement disorders, including Parkinson’s disease. Other interventions are at a more developmental stage, such as DBS for depression and Alzheimer’s disease. Success both in clinical aspects of DBS and new innovations depends on a close-knit multidisciplinary team incorporating experts in the underlying condition (often neurologists and psychiatrists); neurosurgeons; nurse specialists, who may be involved in device programming and other aspects of patient care; and researchers including neuroscientists, imaging specialists, engineers, and signal analysts. Directly linked to the growth of DBS as a specialty is allied research around neural signals analysis and device development, which feed directly back into further clinical progress. The close links between clinical DBS and basic and translational research make it an exciting and fast-moving area of neuroscience.