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Due to the risk of intracranial aneurysm (IA) recurrence and the potential requirement for re-treatment following endovascular treatment (EVT), radiological follow-up of these aneurysms is necessary. There is little evidence to guide the duration and frequency of this follow-up. The aim of this study was to establish the current practice in neurosurgical units in the UK and Ireland.A survey was designed with input from interventional neuroradiologists and neurosurgeons. Neurovascular consultants in each of the 30 neurosurgical units providing a neurovascular service in the UK and Ireland were contacted and asked to respond to questions regarding the follow-up practice for IA treated with EVT in their department.Responses were obtained from 28/30 (94%) of departments. There was evidence of wide variations in the duration and frequency of follow-up, with a minimum follow-up duration for ruptured IA that varied from 18 months in 5/28 (18%) units to 5 years in 11/28 (39%) of units. Young patient age, previous subarachnoid haemorrhage and incomplete IA occlusion were cited as factors that would prompt more intensive surveillance, although larger and broad-necked IA were not followed-up more closely in the majority of departments.There is a wide variation in the radiological follow-up of IA treated with EVT in the UK and Ireland. Further standardisation of this aspect of patient care is likely to be beneficial, but further evidence on the behaviour of IA following EVT is required in order to inform this process.

Objective An operative workflow systematically compartmentalizes operations into hierarchal components of phases, steps, instrument, technique errors, and event errors. Operative workflow provides a foundation for education, training, and understanding of surgical variation. In this Part 2, we present a codified operative workflow for the translabyrinthine approach to vestibular schwannoma resection. Methods A mixed-method consensus process of literature review, small-group Delphi's consensus, followed by a national Delphi's consensus was performed in collaboration with British Skull Base Society (BSBS). Each Delphi's round was repeated until data saturation and over 90% consensus was reached. Results Seventeen consultant skull base surgeons (nine neurosurgeons and eight ENT [ear, nose, and throat]) with median of 13.9 years of experience (interquartile range: 18.1 years) of independent practice participated. There was a 100% response rate across both the Delphi rounds. The translabyrinthine approach had the following five phases and 57 unique steps: Phase 1, approach and exposure; Phase 2, mastoidectomy; Phase 3, internal auditory canal and dural opening; Phase 4, tumor debulking and excision; and Phase 5, closure. Conclusion We present Part 2 of a national, multicenter, consensus-derived, codified operative workflow for the translabyrinthine approach to vestibular schwannomas. The five phases contain the operative, steps, instruments, technique errors, and event errors. The codified translabyrinthine approach presented in this manuscript can serve as foundational research for future work, such as the application of artificial intelligence to vestibular schwannoma resection and comparative surgical research.

Objective An operative workflow systematically compartmentalizes operations into hierarchal components of phases, steps, instrument, technique errors, and event errors. Operative workflow provides a foundation for education, training, and understanding of surgical variation. In this Part 1, we present a codified operative workflow for the retrosigmoid approach to vestibular schwannoma resection. Methods A mixed-method consensus process of literature review, small-group Delphi's consensus, followed by a national Delphi's consensus, was performed in collaboration with British Skull Base Society (BSBS). Each Delphi's round was repeated until data saturation and over 90% consensus was reached. Results Eighteen consultant skull base surgeons (10 neurosurgeons and 8 ENT [ear, nose, and throat]) with median 17.9 years of experience (interquartile range: 17.5 years) of independent practice participated. There was a 100% response rate across both Delphi's rounds. The operative workflow for the retrosigmoid approach contained three phases and 40 unique steps as follows: phase 1, approach and exposure; phase 2, tumor debulking and excision; phase 3, closure. For the retrosigmoid approach, technique, and event error for each operative step was also described. Conclusion We present Part 1 of a national, multicenter, consensus-derived, codified operative workflow for the retrosigmoid approach to vestibular schwannomas that encompasses phases, steps, instruments, technique errors, and event errors. The codified retrosigmoid approach presented in this manuscript can serve as foundational research for future work, such as operative workflow analysis or neurosurgical simulation and education.

IntroductionUnruptured intracranial aneurysms (UIA) are common in the adult population, but only a relatively small proportion will rupture. It is therefore essential to have accurate estimates of rupture risk to target treatment towards those who stand to benefit and avoid exposing patients to the risks of unnecessary treatment. The best available UIA natural history data are the PHASES study. However, this has never been validated and given the known heterogeneity in the populations, methods and biases of the constituent studies, there is a need to do so. There are also many potential predictors not considered in PHASES that require evaluation, and the estimated rupture risk is largely based on short-term follow-up (mostly 1 year). The aims of this study are to: (1) test the accuracy of PHASES in a UK population, (2) evaluate additional predictors of rupture and (3) assess long-term UIA rupture rates.Methods and analysisThe Risk of Aneurysm Rupture study is a longitudinal multicentre study that will identify patients with known UIA seen in neurosurgery units. Patients will have baseline demographics and aneurysm characteristics collected by their neurosurgery unit and then a single aggregated national cohort will be linked to databases of hospital admissions and deaths to identify all patients who may have subsequently suffered a subarachnoid haemorrhage. All matched admissions and deaths will be checked against medical records to confirm the diagnosis of aneurysmal subarachnoid haemorrhage. The target sample size is 20 000 patients. The primary outcome will be aneurysm rupture resulting in hospital admission or death. Cox regression models will be built to test each of the study’s aims.Ethics and disseminationEthical approval has been given by South Central Hampshire A Research Ethics Committee (21SC0064) and Confidentiality Advisory Group support (21CAG0033) provided under Section 251 of the NHS Act 2006. The results will be disseminated in peer-reviewed journals.Trial registration numberISRCTN17658526.

Serious games provide a way for stakeholders to become engaged in and understand the issues and constraints on a real-world system. An application of a serious game is explored, as a way to improve engagement and learning of participants in a water management planning process. Bow River Sim is a single-player game that helps the user to understand the Water Resources Management Model (WRMM) and to visualize the implications and impacts around system interactions in the basin. The Bow River Sim simulates water management decision-making based on maximizing social, economic, and environmental benefits while managing limited water supply. The game incorporates the principles of ‘meaningful play’ and provides a user-friendly interface, a fun game, and visual elements. The paper aims to (a) provide an overview of Bow River Sim, (b) illustrate how innovations such as serious games enhance learning processes for the user, and (c) illustrate the application of Bow River Sim and key learnings.

Neuro-oncology surgery would benefit from detailed intraoperative tissue characterization provided by noncontact, contrast-agent-free, noninvasive optical imaging methods. In-depth knowledge of target tissue optical properties across a wide-wavelength spectrum could inform the design of optical imaging and computational methods to enable robust tissue analysis during surgery. We adapted a dual-beam integrating sphere to analyse small tissue samples and investigated ex vivo optical properties of five types of human brain tumour (meningioma, pituitary adenoma, schwannoma, low- and high-grade glioma) and nine different types of healthy brain tissue across a wavelength spectrum of 400 to 1800 nm. Fresh and frozen tissue samples were analysed. All tissue types demonstrated similar absorption spectra, but the reduced scattering coefficients of tumours show visible differences in the obtained optical spectrum compared to those of surrounding normal tissue. These results underline the potential of optical imaging technologies for intraoperative tissue characterization. ispartof: JOURNAL OF BIOPHOTONICS vol:15 issue:4 ispartof: location:Germany status: published

Oil and gas pipelines are subjected to multiple types of geohazards which cause pipeline failures (loss of containment); two of the most common types occur at watercourse crossings and at landslides. At watercourse crossings, the most common geohazard which causes pipeline failures is flooding during which excessive scour may result in the exposure of the buried pipeline and if the exposure results in a free spanning pipeline, then this may fail due to fatigue caused by cyclic loading from vortex-induced vibration. Fortunately the free span length and water velocity combinations that lead to failure can be defined and can be used to identify the flood discharge that should be monitored for in order to trigger actions to manage the hazard and avoid failure. Most watercourse crossings in a pipeline network are on ungauged watercourses and necessitate the use of a proxy gauged watercourse. The “proxy” gauged watercourse is used to infer whether flooding is occurring on the ungauged crossing, and the owner can take appropriate actions. Often the proxy gauged watercourse is too far away or the watercourse may not be representative of the crossing of concern (e.g. large difference in the drainage areas). Real-time rainfall data can be used in conjunction with streamflow monitoring to determine when extreme precipitation has occurred within the ungauged watercourses catchment which may result in flooding. Where pipelines cross landslide prone areas, large scale movements can be initiated, or slow on-going movement rates increased when extreme rainfall occurs. The definition of the extreme rainfall event for slope sites is the key component of providing a suitable warning of potentially dangerous conditions; shallow slides can be caused by short term events from sub-hourly to 3 day duration precipitation events whereas large deep seated (creeping) landslides can be driven by annual and intra-annual rainfall amounts. Monitoring of real time rainfall can be used to determine when extreme rainfall occurs at a landslide site. The density of in-situ weather stations collecting real-time rainfall data prevents the application along remote sections of pipeline routes and within large sections of Canada. Gridded real time rainfall from quantitative precipitation estimations which integrate a multiple data sources including in-situ, numerical weather prediction, satellite and weather radar, can be used to overcome this problem and provide warnings when pre-determined rainfall thresholds are exceeded on a site-specific basis.

We sought to quantify the risks of neurosurgical excision of cerebral cavernous malformations (CCMs) in a systematic review of cohort studies. We updated our previous systematic review by searching OVID Medline, OVID EMBASE, and the Cochrane Library from 1 January 2013 to 30 April 2019. The primary outcome was a composite of death attributed to CCM or surgery, non-fatal symptomatic intracerebral haemorrhage (ICH), or new or worsened persistent non-haemorrhagic focal neurological deficit (FND). We included 70 cohorts, 67 reporting surgery alone, and three compared surgery to conservative management. A total of 5,089 patients (median age 36 years, 52% female) underwent surgery (total follow-up 19,404 patient-years). The annual rate of the composite outcome was 4.2% (95% CI 2.9 to 5.7; 46 cohorts; I2 = 93%), which was higher in cohorts reporting exclusively brainstem CCM (6.0%, 95% CI 4.1–8.3; 25 cohorts, I2 = 92%) versus predominantly supratentorial CCM (2.4%, 95% CI 1.3–3.8, 21 cohorts, I2 = 86%, phet = 0.001). The annual rate of the composite outcome was higher in cohorts with > 95% presenting with ICH (6.1%, 95% CI 4.2–8.4; 23 cohorts, I2 = 93%) versus others (2.3%, 95% CI 1.2–3.7; 23 cohorts, I2 = 83%, phet = 0.001). The incidence of the composite outcome did not change over time in cohorts of exclusively brainstem CCM (p = 0.7) or predominantly supratentorial CCM (p = 0.5). The risk of death, ICH, or FND after CCM excision is ~ 4%. This risk is higher for brainstem CCM and CCM that have caused ICH but has not changed over time. This systematic review was registered (PROSPERO CRD42019131246).

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The craniocervical junction is an area with unique biomechanical properties and injuries conferred often represent high-impact trauma. The vital structures traversing this region are susceptible to injury with frequent, only subtle findings identified on unenhanced CT, with MRI and CT angiography often revealing the full extent of injuries. This article reviews the osseous and ligamentous anatomy of the region and common injury patterns. Endovascular and neurosurgical management will also be discussed.

There is disagreement in the literature as to whether a shear stress-based approach can be used to accurately predict sediment transport over dunes. This study aims to address this disagreement. To this end, use is made of an experiment involving the study of naturally formed, fully developed dunes produced in a laboratory flume. The bed shear stress is estimated through a combination of velocity, Reynolds stress measurements, and results of a CFD RANS rough wall model. The validity of using Bagnold’s equation to predict the bed-load rate is subsequently analyzed. In contrast to what has been previously suggested by some authors, it is found from the present experiment that the bed-load rate correlates well with the bed shear stress, and that Bagnold’s equation yields realistic values of the bed-load rate over the stoss side of the dune downstream of the reattachment point. This work also highlights the difficulties in reliably estimating the bed shear stress in complex flows. Such difficulties are overcome in this paper through a combination of flow velocity measurements and modeled results.

Vestibular schwannomas are benign tumours that are said to originate predominantly from the superior vestibular nerve. Their incidence is estimated to be between 2-20 cases per million worldwide, comprising approximately 5-10% of intracranial tumours. They arise in the cerebellopontine angle accounting for approximately 90% of mass lesions in this location. This chapter discusses how to recognise and treat vestibular schwannomas. Vestibular schwannomas may be managed conservatively, surgically or with radiotherapy. Combined modality treatment has also been successfully reported, for example sub-total debulking followed by gamma knife therapy for large vestibular schwannomas. Tumours may be approached surgically via three approaches. The two most commonly used are retrosigmoid transmeatal and translabyrinthine, with the middle cranial fossa approach less prevalent. Treatment of these tumours will increasingly depend on less invasive modalities including focussed radiation techniques and molecular chemotherapeutics. Radiosurgery is significantly less effective in NF2 associated schwannomas and this represents a particular challenge in management. Clinical trials of bevacizumab (a VEGF inhibitor), and Lapatinib (a tyrosine kinase inhibitor) in NF2 are ongoing.

The Fjarðaal Smelter Potline buildings are designed to achieve ventilation of heat and fugitive emissions using a system based on natural convection. The design of the Potline buildings is based on Alcoa’s Aluminerie Deschambault, located in Deschambault, Quebec, Canada. The Fjarðaal Smelter Potline buildings, located adjacent to a fjord in Eastern Iceland, are longer and are situated on a sloping site. The Fjarðaal Project is faced with additional unique factors — local terrain, high wind speed, and multiple approach wind directions — that interact in a complex manner, thus making the performance of the ventilation system difficult to predict.