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Tzioras M, Daniels MJD, Davies C, Baxter P, King D, McKay S, Varga B, Popovic K, Hernandez M, Stevenson AJ, Barrington J, Drinkwater E, Borella J, Holloway RK, Tulloch J, Moss J, Latta C, Kandasamy J, Sokol D, Smith C, Miron VE, Káradóttir RT, Hardingham GE, Henstridge CM, Brennan PM, McColl BW, Spires-Jones TL. Human astrocytes and microglia show augmented ingestion of synapses in Alzheimer's disease via MFG-E8. Cell Rep Med 2023; 4:101175. [PMID: 37652017 PMCID: PMC10518633 DOI: 10.1016/j.xcrm.2023.101175] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/30/2023] [Accepted: 08/07/2023] [Indexed: 09/02/2023]
Abstract
Synapse loss correlates with cognitive decline in Alzheimer's disease (AD). Data from mouse models suggests microglia are important for synapse degeneration, but direct human evidence for any glial involvement in synapse removal in human AD remains to be established. Here we observe astrocytes and microglia from human brains contain greater amounts of synaptic protein in AD compared with non-disease controls, and that proximity to amyloid-β plaques and the APOE4 risk gene exacerbate this effect. In culture, mouse and human astrocytes and primary mouse and human microglia phagocytose AD patient-derived synapses more than synapses from controls. Inhibiting interactions of MFG-E8 rescues the elevated engulfment of AD synapses by astrocytes and microglia without affecting control synapse uptake. Thus, AD promotes increased synapse ingestion by human glial cells at least in part via an MFG-E8 opsonophagocytic mechanism with potential for targeted therapeutic manipulation.
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Affiliation(s)
- Makis Tzioras
- UK Dementia Research Institute, the University of Edinburgh, Edinburgh EH8 9JZ, UK; Centre for Discovery Brain Sciences, the University of Edinburgh, Edinburgh EH8 9JZ, UK
| | - Michael J D Daniels
- UK Dementia Research Institute, the University of Edinburgh, Edinburgh EH8 9JZ, UK; Centre for Discovery Brain Sciences, the University of Edinburgh, Edinburgh EH8 9JZ, UK
| | - Caitlin Davies
- UK Dementia Research Institute, the University of Edinburgh, Edinburgh EH8 9JZ, UK; Centre for Discovery Brain Sciences, the University of Edinburgh, Edinburgh EH8 9JZ, UK
| | - Paul Baxter
- UK Dementia Research Institute, the University of Edinburgh, Edinburgh EH8 9JZ, UK; Centre for Discovery Brain Sciences, the University of Edinburgh, Edinburgh EH8 9JZ, UK
| | - Declan King
- UK Dementia Research Institute, the University of Edinburgh, Edinburgh EH8 9JZ, UK; Centre for Discovery Brain Sciences, the University of Edinburgh, Edinburgh EH8 9JZ, UK
| | - Sean McKay
- UK Dementia Research Institute, the University of Edinburgh, Edinburgh EH8 9JZ, UK; Centre for Discovery Brain Sciences, the University of Edinburgh, Edinburgh EH8 9JZ, UK
| | - Balazs Varga
- Wellcome - MRC Cambridge Stem Cell Institute, University of Cambridge, Cambridge CB2 0AW, UK
| | - Karla Popovic
- UK Dementia Research Institute, the University of Edinburgh, Edinburgh EH8 9JZ, UK; Centre for Discovery Brain Sciences, the University of Edinburgh, Edinburgh EH8 9JZ, UK
| | - Madison Hernandez
- UK Dementia Research Institute, the University of Edinburgh, Edinburgh EH8 9JZ, UK; Centre for Discovery Brain Sciences, the University of Edinburgh, Edinburgh EH8 9JZ, UK
| | - Anna J Stevenson
- UK Dementia Research Institute, the University of Edinburgh, Edinburgh EH8 9JZ, UK; Centre for Discovery Brain Sciences, the University of Edinburgh, Edinburgh EH8 9JZ, UK
| | - Jack Barrington
- UK Dementia Research Institute, the University of Edinburgh, Edinburgh EH8 9JZ, UK; Centre for Discovery Brain Sciences, the University of Edinburgh, Edinburgh EH8 9JZ, UK
| | - Elizabeth Drinkwater
- UK Dementia Research Institute, the University of Edinburgh, Edinburgh EH8 9JZ, UK; Centre for Discovery Brain Sciences, the University of Edinburgh, Edinburgh EH8 9JZ, UK
| | - Julia Borella
- UK Dementia Research Institute, the University of Edinburgh, Edinburgh EH8 9JZ, UK; Centre for Discovery Brain Sciences, the University of Edinburgh, Edinburgh EH8 9JZ, UK
| | - Rebecca K Holloway
- MRC Centre for Reproductive Health, the University of Edinburgh, Edinburgh EH16 4TJ, UK
| | - Jane Tulloch
- UK Dementia Research Institute, the University of Edinburgh, Edinburgh EH8 9JZ, UK; Centre for Discovery Brain Sciences, the University of Edinburgh, Edinburgh EH8 9JZ, UK
| | - Jonathan Moss
- MRC Centre for Reproductive Health, the University of Edinburgh, Edinburgh EH16 4TJ, UK; The Roslin Institute, the Royal (Dick) School of Veterinary Studies, the University of Edinburgh, Edinburgh EH25 9RG, UK
| | - Clare Latta
- UK Dementia Research Institute, the University of Edinburgh, Edinburgh EH8 9JZ, UK; Centre for Discovery Brain Sciences, the University of Edinburgh, Edinburgh EH8 9JZ, UK
| | - Jothy Kandasamy
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Drahoslav Sokol
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Colin Smith
- Centre for Clinical Brain Sciences, the University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Veronique E Miron
- UK Dementia Research Institute, the University of Edinburgh, Edinburgh EH8 9JZ, UK; MRC Centre for Reproductive Health, the University of Edinburgh, Edinburgh EH16 4TJ, UK; Barlo Multiple Sclerosis Centre at St. Michael's Hospital, Keenan Research Centre for Biomedical Science, Toronto, ON M5B 1T8, Canada
| | | | - Giles E Hardingham
- UK Dementia Research Institute, the University of Edinburgh, Edinburgh EH8 9JZ, UK; Centre for Discovery Brain Sciences, the University of Edinburgh, Edinburgh EH8 9JZ, UK
| | | | - Paul M Brennan
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK; Centre for Clinical Brain Sciences, the University of Edinburgh, Edinburgh EH16 4SB, UK
| | - Barry W McColl
- UK Dementia Research Institute, the University of Edinburgh, Edinburgh EH8 9JZ, UK; Centre for Discovery Brain Sciences, the University of Edinburgh, Edinburgh EH8 9JZ, UK.
| | - Tara L Spires-Jones
- UK Dementia Research Institute, the University of Edinburgh, Edinburgh EH8 9JZ, UK; Centre for Discovery Brain Sciences, the University of Edinburgh, Edinburgh EH8 9JZ, UK.
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Salloum NL, Sokol D, Kandasamy J, Torgerson A, Wallace HB, Kaliaperumal C. A rare presentation of a bilateral intracranial parameningeal embryonal rhabdomyosarcoma mimicking vestibular schwannoma in a two-year-old child: a case report. Childs Nerv Syst 2023; 39:815-819. [PMID: 36355193 PMCID: PMC10024656 DOI: 10.1007/s00381-022-05735-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022]
Abstract
Intracranial parameningeal rhabdomyosarcomas are rare, aggressive, rapidly progressive paediatric malignancies that carry a poor prognosis. The authors report a case of a 2-year-old boy who initially presented with a left facial palsy, ataxia and, shortly after, bloody otorrhoea. MRI imaging was initially suggestive of a vestibular schwannoma. However, there was rapid progression of symptoms and further MRI imaging showed very rapid increase in tumour size with mass effect and development of a similar tumour on the contralateral side. A histological diagnosis of bilateral parameningeal embryonal rhabdomyosarcoma was made. Despite treatment, progression led to hydrocephalus and diffuse leptomeningeal disease, from which the patient did not survive. Few intracranial parameningeal rhabdomyosarcomas have previously been reported and these report similar presenting symptoms and rapid disease progression. However, this is the first reported case of a bilateral intracranial parameningeal embryonal rhabdomyosarcoma which, on initial presentation and imaging, appeared to mimic a vestibular schwannoma.
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Affiliation(s)
- Nadia Liber Salloum
- Department of Paediatric Neurosurgery, Royal Hospital for Sick Children, Edinburgh, UK.
| | - Drahoslav Sokol
- Department of Paediatric Neurosurgery, Royal Hospital for Sick Children, Edinburgh, UK
| | - Jothy Kandasamy
- Department of Paediatric Neurosurgery, Royal Hospital for Sick Children, Edinburgh, UK
| | - Antonia Torgerson
- Department of Neuropathology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Hamish B Wallace
- Department of Paediatric Oncology, Royal Hospital for Sick Children, Edinburgh, UK
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3
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Spitzer H, Ripart M, Whitaker K, D’Arco F, Mankad K, Chen AA, Napolitano A, De Palma L, De Benedictis A, Foldes S, Humphreys Z, Zhang K, Hu W, Mo J, Likeman M, Davies S, Güttler C, Lenge M, Cohen NT, Tang Y, Wang S, Chari A, Tisdall M, Bargallo N, Conde-Blanco E, Pariente JC, Pascual-Diaz S, Delgado-Martínez I, Pérez-Enríquez C, Lagorio I, Abela E, Mullatti N, O’Muircheartaigh J, Vecchiato K, Liu Y, Caligiuri ME, Sinclair B, Vivash L, Willard A, Kandasamy J, McLellan A, Sokol D, Semmelroch M, Kloster AG, Opheim G, Ribeiro L, Yasuda C, Rossi-Espagnet C, Hamandi K, Tietze A, Barba C, Guerrini R, Gaillard WD, You X, Wang I, González-Ortiz S, Severino M, Striano P, Tortora D, Kälviäinen R, Gambardella A, Labate A, Desmond P, Lui E, O’Brien T, Shetty J, Jackson G, Duncan JS, Winston GP, Pinborg LH, Cendes F, Theis FJ, Shinohara RT, Cross JH, Baldeweg T, Adler S, Wagstyl K. Interpretable surface-based detection of focal cortical dysplasias: a Multi-centre Epilepsy Lesion Detection study. Brain 2022; 145:3859-3871. [PMID: 35953082 PMCID: PMC9679165 DOI: 10.1093/brain/awac224] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/22/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
One outstanding challenge for machine learning in diagnostic biomedical imaging is algorithm interpretability. A key application is the identification of subtle epileptogenic focal cortical dysplasias (FCDs) from structural MRI. FCDs are difficult to visualize on structural MRI but are often amenable to surgical resection. We aimed to develop an open-source, interpretable, surface-based machine-learning algorithm to automatically identify FCDs on heterogeneous structural MRI data from epilepsy surgery centres worldwide. The Multi-centre Epilepsy Lesion Detection (MELD) Project collated and harmonized a retrospective MRI cohort of 1015 participants, 618 patients with focal FCD-related epilepsy and 397 controls, from 22 epilepsy centres worldwide. We created a neural network for FCD detection based on 33 surface-based features. The network was trained and cross-validated on 50% of the total cohort and tested on the remaining 50% as well as on 2 independent test sites. Multidimensional feature analysis and integrated gradient saliencies were used to interrogate network performance. Our pipeline outputs individual patient reports, which identify the location of predicted lesions, alongside their imaging features and relative saliency to the classifier. On a restricted 'gold-standard' subcohort of seizure-free patients with FCD type IIB who had T1 and fluid-attenuated inversion recovery MRI data, the MELD FCD surface-based algorithm had a sensitivity of 85%. Across the entire withheld test cohort the sensitivity was 59% and specificity was 54%. After including a border zone around lesions, to account for uncertainty around the borders of manually delineated lesion masks, the sensitivity was 67%. This multicentre, multinational study with open access protocols and code has developed a robust and interpretable machine-learning algorithm for automated detection of focal cortical dysplasias, giving physicians greater confidence in the identification of subtle MRI lesions in individuals with epilepsy.
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Affiliation(s)
- Hannah Spitzer
- Institute of Computational Biology, Helmholtz Center Munich, Munich 85764, Germany
| | - Mathilde Ripart
- Department of Developmental Neuroscience, UCL Great Ormond Street Institute for Child Health, London WC1N 1EH, UK
| | | | - Felice D’Arco
- Great Ormond Street Hospital NHS Foundation Trust, London WC1N 3JH, UK
| | - Kshitij Mankad
- Great Ormond Street Hospital NHS Foundation Trust, London WC1N 3JH, UK
| | - Andrew A Chen
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA
- Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Antonio Napolitano
- Medical Physics Department, Bambino Gesù Children’s Hospital, Rome 00165, Italy
| | - Luca De Palma
- Rare and Complex Epilepsies, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, Rome 00165, Italy
| | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, Rome 00165, Italy
| | - Stephen Foldes
- Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ 85016, USA
| | - Zachary Humphreys
- Barrow Neurological Institute at Phoenix Children’s Hospital, Phoenix, AZ 85016, USA
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100054, China
| | - Wenhan Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100054, China
| | - Jiajie Mo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100054, China
| | - Marcus Likeman
- Bristol Royal Hospital for Children, Bristol BS2 8BJ, UK
| | - Shirin Davies
- School of Psychology, Cardiff University Brain Research Imaging Centre, Cardiff CF24 4HQ, UK
- The Welsh Epilepsy Unit, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff CF14 4XW, UK
| | | | - Matteo Lenge
- Neuroscience Department, Children’s Hospital Meyer-University of Florence, Florence 50139, Italy
| | - Nathan T Cohen
- Center for Neuroscience, Children’s National Hospital, Washington, DC 20012, USA
| | - Yingying Tang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu 610093, China
- Epilepsy Center, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Shan Wang
- Epilepsy Center, Cleveland Clinic, Cleveland, OH 44106, USA
- Department of Neurology, Epilepsy Center, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Aswin Chari
- Department of Developmental Neuroscience, UCL Great Ormond Street Institute for Child Health, London WC1N 1EH, UK
- Great Ormond Street Hospital NHS Foundation Trust, London WC1N 3JH, UK
| | - Martin Tisdall
- Department of Developmental Neuroscience, UCL Great Ormond Street Institute for Child Health, London WC1N 1EH, UK
- Great Ormond Street Hospital NHS Foundation Trust, London WC1N 3JH, UK
| | - Nuria Bargallo
- Department of Neuroradiology, Hospital Clinic Barcelona and Magnetic Resonance Imaging, Core Facility, IDIBAPS, Barcelona 08036, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid 28029, Spain
| | | | | | - Saül Pascual-Diaz
- Magnetic Resonance Imaging, Core Facility, IDIBAPS, Barcelona 08036, Spain
| | | | | | | | - Eugenio Abela
- Center for Neuropsychiatry and Intellectual Disability, Psychiatrische Dienste Aargau AG, Windisch 5120, Switzerland
| | - Nandini Mullatti
- Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK
| | - Jonathan O’Muircheartaigh
- Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK
- Department of Perinatal Imaging and Health, St. Thomas’ Hospital, King’s College London, London SE1 7EH, UK
| | - Katy Vecchiato
- Department of Perinatal Imaging and Health, St. Thomas’ Hospital, King’s College London, London SE1 7EH, UK
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London SE5 8AF, UK
| | - Yawu Liu
- Department of Neurology, University of Eastern Finland, Kuopio 70210, Finland
| | - Maria Eugenia Caligiuri
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro 88100, Italy
| | - Ben Sinclair
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Lucy Vivash
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
- Department of Neurology, Monash University, Melbourne, VIC 3004, Australia
| | - Anna Willard
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
| | - Jothy Kandasamy
- Royal Hospital for Children and Young People, Edinburgh EH16 4TJ, UK
| | - Ailsa McLellan
- Royal Hospital for Children and Young People, Edinburgh EH16 4TJ, UK
| | - Drahoslav Sokol
- Royal Hospital for Children and Young People, Edinburgh EH16 4TJ, UK
| | - Mira Semmelroch
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC 3052, Australia
| | - Ane G Kloster
- Neurobiology Research Unit, Copenhagen University Hospital—Rigshospitalet, Copenhagen 2100, Denmark
| | - Giske Opheim
- Neurobiology Research Unit, Copenhagen University Hospital—Rigshospitalet, Copenhagen 2100, Denmark
- Department of Neuroradiology, Copenhagen University Hospital—Rigshospitalet, Copenhagen 2100, Denmark
| | - Letícia Ribeiro
- Department of Neurology, University of Campinas, Campinas 13083-888, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas 13083-888, Brazil
| | - Clarissa Yasuda
- Department of Neurology, University of Campinas, Campinas 13083-888, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas 13083-888, Brazil
| | | | - Khalid Hamandi
- School of Psychology, Cardiff University Brain Research Imaging Centre, Cardiff CF24 4HQ, UK
- The Welsh Epilepsy Unit, University Hospital of Wales, Cardiff CF14 4XW, UK
| | - Anna Tietze
- Charité University Hospital, Berlin 10117, Germany
| | - Carmen Barba
- Neuroscience Department, Children’s Hospital Meyer-University of Florence, Florence 50139, Italy
| | - Renzo Guerrini
- Neuroscience Department, Children’s Hospital Meyer-University of Florence, Florence 50139, Italy
| | | | - Xiaozhen You
- Center for Neuroscience, Children’s National Hospital, Washington, DC 20012, USA
| | - Irene Wang
- Epilepsy Center, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Sofía González-Ortiz
- Department of Neuroradiology, Hospital del Mar, Barcelona 08003, Spain
- Magnetic Resonance Imaging Core Facility, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona 08036, Spain
| | | | - Pasquale Striano
- IRCCS Istituto Giannina Gaslini, Genova 16147, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | | | - Reetta Kälviäinen
- Department of Neurology, University of Eastern Finland, Kuopio 70210, Finland
- Kuopio Epilepsy Center, Neurocenter, Kuopio University Hospital, Kuopio 70210, Finland
| | - Antonio Gambardella
- Institute of Neurology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro 88100, Italy
| | - Angelo Labate
- Neurology Unit, Department of BIOMORF, University of Messina, Messina 98168, Italy
| | - Patricia Desmond
- Department of Radiology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC 3050, Australia
| | - Elaine Lui
- Department of Radiology, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC 3050, Australia
| | - Terence O’Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, VIC 3004, Australia
- Department of Medicine, The Royal Melbourne Hospital, Parkville, VIC, 3052, Australia
| | - Jay Shetty
- Royal Hospital for Children and Young People, Edinburgh EH16 4TJ, UK
| | - Graeme Jackson
- The Florey Institute of Neuroscience and Mental Health, Austin Campus, Heidelberg, VIC 3071, Australia
- Department of Neurology, Austin Health, Heidelberg, VIC 3084, Australia
| | - John S Duncan
- UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
| | - Gavin P Winston
- UCL Queen Square Institute of Neurology, London WC1N 3BG, UK
- Department of Medicine, Division of Neurology, Queen’s University, Kingston, ON, Canada K7L 3N6
| | - Lars H Pinborg
- Neurobiology Research Unit, Copenhagen University Hospital—Rigshospitalet, Copenhagen 2100, Denmark
- Epilepsy Clinic, Department of Neurology, Copenhagen University Hospital—Rigshopsitalet, Copenhagen 2100, Denmark
| | - Fernando Cendes
- Department of Neurology, University of Campinas, Campinas 13083-888, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas 13083-888, Brazil
| | - Fabian J Theis
- Institute of Computational Biology, Helmholtz Center Munich, Munich 85764, Germany
- Department of Mathematics, Technical University of Munich, Garching 85748, Germany
| | - Russell T Shinohara
- Penn Statistics in Imaging and Visualization Center, Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - J Helen Cross
- Department of Developmental Neuroscience, UCL Great Ormond Street Institute for Child Health, London WC1N 1EH, UK
- Young Epilepsy, Lingfield, Surrey RH7 6PW, UK
| | - Torsten Baldeweg
- Department of Developmental Neuroscience, UCL Great Ormond Street Institute for Child Health, London WC1N 1EH, UK
- Great Ormond Street Hospital NHS Foundation Trust, London WC1N 3JH, UK
| | - Sophie Adler
- Department of Developmental Neuroscience, UCL Great Ormond Street Institute for Child Health, London WC1N 1EH, UK
| | - Konrad Wagstyl
- Department of Developmental Neuroscience, UCL Great Ormond Street Institute for Child Health, London WC1N 1EH, UK
- Wellcome Centre for Human Neuroimaging, University College London, London WC1N 3AR, UK
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4
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Sohn SY, Russell CD, Jamjoom AAB, Poon MT, Lawson McLean A, Ahmed AI, Abdulla MAH, Alalade A, Bailey M, Basu S, Baudracco I, Bayston R, Bhattacharya A, Bodkin P, Boissaud-Cooke M, Bojanic S, Brennan PM, Bulters DO, Buxton N, Chari A, Corns R, Coulter C, Coulter I, Critchley G, Dando A, Dardis R, Duddy J, Dyson E, Edwards R, Garnett M, Gatcher S, Georges H, Glancz LJ, Gray WP, Hallet J, Harte J, Haylock-Vize P, Hutchinson PJ, Humphreys H, Jenkinson MD, Joannides AJ, Kandasamy J, Kitchen J, Kolias AG, Loan JJM, Ma R, Madder H, Mallucci CL, Manning A, Mcelligott S, Mukerji N, Narayanamurthy H, O’Brien D, Okasha M, Papadopoulos M, Phan V, Phang I, Poots J, Rajaraman C, Roach J, Ross N, Sharouf F, Shastin D, Simms N, Steele L, Solth A, Tajsic T, Talibi S, Thanabalasundaram G, Vintu M, Wan Y, Wang D, Watkins L, Whitehouse K, Whitfield PC, Williams A, Zaben M. Comparison of suspected and confirmed internal EVD-related infections: a prospective multi-centre U.K. observational study. Open Forum Infect Dis 2022; 9:ofac480. [PMID: 36267249 PMCID: PMC9578167 DOI: 10.1093/ofid/ofac480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background Diagnosis of internal external ventricular drain (EVD)-related infections (iERI) is an area of diagnostic difficulty. Empiric treatment is often initiated on clinical suspicion. There is limited guidance around antimicrobial management of confirmed versus suspected iERI. Methods Data on patients requiring EVD insertion were collected from 21 neurosurgical units in the United Kingdom from 2014 to 2015. Confirmed iERI was defined as clinical suspicion of infection with positive cerebrospinal fluid (CSF) culture and/or Gram stain. Cerebrospinal fluid, blood, and clinical parameters and antimicrobial management were compared between the 2 groups. Mortality and Modified Rankin Scores were compared at 30 days post-EVD insertion. Results Internal EVD-related infection was suspected after 46 of 495 EVD insertions (9.3%), more common after an emergency insertion. Twenty-six of 46 were confirmed iERIs, mostly due to Staphylococci (16 of 26). When confirmed and suspected infections were compared, there were no differences in CSF white cell counts or glucose concentrations, nor peripheral blood white cell counts or C-reactive protein concentrations. The incidence of fever, meningism, and seizures was also similar, although altered consciousness was more common in people with confirmed iERI. Broad-spectrum antimicrobial usage was prevalent in both groups with no difference in median duration of therapy (10 days [interquartile range {IQR}, 7–24.5] for confirmed cases and 9.5 days [IQR, 5.75–14] for suspected, P = 0.3). Despite comparable baseline characteristics, suspected iERI was associated with lower mortality and better neurological outcomes. Conclusions Suspected iERI could represent sterile inflammation or lower bacterial load leading to false-negative cultures. There is a need for improved microbiology diagnostics and biomarkers of bacterial infection to permit accurate discrimination and improve antimicrobial stewardship.
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Affiliation(s)
- Sei Yon Sohn
- Division of Anaesthesia, University of Cambridge , Cambridge , U.K
| | - Clark D Russell
- University of Edinburgh Centre for Inflammation Research, Queen’s Medical Research Institute , Edinburgh , U.K
| | - Aimun AB Jamjoom
- Department of Clinical Neuroscience, Royal Infirmary of Edinburgh , Edinburgh , U.K
| | - Michael T Poon
- Department of Clinical Neuroscience, Royal Infirmary of Edinburgh , Edinburgh , U.K
| | - Aaron Lawson McLean
- Department of Neurosurgery, Jena University Hospital – Friedrich Schiller University Jena , Jena , Germany
| | - Aminul I Ahmed
- Wolfson CARD, King’s College London and Department of Neurosurgery, King’s College Hospital , London , U.K
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Shekhar H, Mancuso-Marcello M, Emelifeonwu J, Gallo P, Sokol D, Kandasamy J, Kaliaperumal C. Management of traumatic atlanto-occipital dislocation in a 10-year-old with noninvasive halo immobilization: A case report. Surg Neurol Int 2022; 13:222. [PMID: 35673640 PMCID: PMC9168337 DOI: 10.25259/sni_17_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/03/2022] [Indexed: 11/27/2022] Open
Abstract
Background Traumatic atlanto-occipital dislocation is an unstable injury of the craniocervical junction. For pediatric patients, surgical arthrodesis of the occipitocervical junction is the recommended management. While having a high success rate for stabilization, the fusion comes with obvious morbidity of limitation in cervical spine flexion, extension, and rotation. An alternative is external immobilization with a conventional halo. Case Description We describe the case of a 10-year-old boy who was treated successfully for traumatic AOD with a noninvasive pinless halo. Following initial brain trauma management, we immobilized the craniocervical junction with a pinless halo after reducing the atlanto-occipital dislocation. The pinless halo was kept on at all times for the next 3 months. The craniocervical junction alignment was monitored with weekly cervical spine X-rays and CT craniocervical junction on day 15th, day 30th, and day 70th. A follow-up MRI C-spine 3 months from presentation confirmed resolution of the soft-tissue injury and the pinless halo was removed. Dynamic cervical spine X-rays revealed satisfactory alignment in both flexion and extension views. The patient has been followed up for 2 years postinjury and no issues were identified. Conclusion Noninvasive pinless halo is a potential treatment option for traumatic pediatric atlanto-occipital dislocation. This should be considered bearing in mind multiple factors including age and weight of the patient, severity of the atlanto-occipital dislocation (Grade I vs. Grade II and incomplete vs. complete), concomitant skull and scalp injury, and patient's ability to tolerate the halo. It is vital to emphasize that this necessitates close clinicoradiological monitoring.
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Affiliation(s)
- Himanshu Shekhar
- Department of Trauma and Orthopaedics, NHS Tayside, Ninewells Hospital, Dundee, United Kingdom
| | - Marco Mancuso-Marcello
- Department of Neurosurgery, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - John Emelifeonwu
- Department of Neurosurgery, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Pasquale Gallo
- Department of Paediatric Neurosurgery, Birmingham Children’s Hospital, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Drahoslav Sokol
- Department of Paediatric Neurosurgery, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Jothy Kandasamy
- Department of Paediatric Neurosurgery, NHS Lothian, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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Wagstyl K, Whitaker K, Raznahan A, Seidlitz J, Vértes PE, Foldes S, Humphreys Z, Hu W, Mo J, Likeman M, Davies S, Lenge M, Cohen NT, Tang Y, Wang S, Ripart M, Chari A, Tisdall M, Bargallo N, Conde‐Blanco E, Pariente JC, Pascual‐Diaz S, Delgado‐Martínez I, Pérez‐Enríquez C, Lagorio I, Abela E, Mullatti N, O'Muircheartaigh J, Vecchiato K, Liu Y, Caligiuri M, Sinclair B, Vivash L, Willard A, Kandasamy J, McLellan A, Sokol D, Semmelroch M, Kloster A, Opheim G, Yasuda C, Zhang K, Hamandi K, Barba C, Guerrini R, Gaillard WD, You X, Wang I, González‐Ortiz S, Severino M, Striano P, Tortora D, Kalviainen R, Gambardella A, Labate A, Desmond P, Lui E, O'Brien T, Shetty J, Jackson G, Duncan JS, Winston GP, Pinborg L, Cendes F, Cross JH, Baldeweg T, Adler S. Atlas of lesion locations and postsurgical seizure freedom in focal cortical dysplasia: A MELD study. Epilepsia 2022; 63:61-74. [PMID: 34845719 PMCID: PMC8916105 DOI: 10.1111/epi.17130] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Drug-resistant focal epilepsy is often caused by focal cortical dysplasias (FCDs). The distribution of these lesions across the cerebral cortex and the impact of lesion location on clinical presentation and surgical outcome are largely unknown. We created a neuroimaging cohort of patients with individually mapped FCDs to determine factors associated with lesion location and predictors of postsurgical outcome. METHODS The MELD (Multi-centre Epilepsy Lesion Detection) project collated a retrospective cohort of 580 patients with epilepsy attributed to FCD from 20 epilepsy centers worldwide. Magnetic resonance imaging-based maps of individual FCDs with accompanying demographic, clinical, and surgical information were collected. We mapped the distribution of FCDs, examined for associations between clinical factors and lesion location, and developed a predictive model of postsurgical seizure freedom. RESULTS FCDs were nonuniformly distributed, concentrating in the superior frontal sulcus, frontal pole, and temporal pole. Epilepsy onset was typically before the age of 10 years. Earlier epilepsy onset was associated with lesions in primary sensory areas, whereas later epilepsy onset was associated with lesions in association cortices. Lesions in temporal and occipital lobes tended to be larger than frontal lobe lesions. Seizure freedom rates varied with FCD location, from around 30% in visual, motor, and premotor areas to 75% in superior temporal and frontal gyri. The predictive model of postsurgical seizure freedom had a positive predictive value of 70% and negative predictive value of 61%. SIGNIFICANCE FCD location is an important determinant of its size, the age at epilepsy onset, and the likelihood of seizure freedom postsurgery. Our atlas of lesion locations can be used to guide the radiological search for subtle lesions in individual patients. Our atlas of regional seizure freedom rates and associated predictive model can be used to estimate individual likelihoods of postsurgical seizure freedom. Data-driven atlases and predictive models are essential for evidence-based, precision medicine and risk counseling in epilepsy.
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Copley PC, Emelifeonwu J, Gallo P, Sokol D, Kandasamy J, Wallace H, Kaliaperumal C. Guideline for the management of long tunnelled external ventricular drains in chronic hydrocephalus. ACTA ACUST UNITED AC 2021; 30:416-421. [PMID: 33830799 DOI: 10.12968/bjon.2021.30.7.416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article reports on the journey of a child with an inoperable hypothalamic-origin pilocytic astrocytoma causing hydrocephalus, which was refractory to treatment with shunts, and required a new approach. With multidisciplinary support, excellent nursing care and parental education, the child's hydrocephalus was managed long term in the community with bilateral long-tunnelled external ventricular drains (LTEVDs). This article describes the patient's journey and highlights the treatment protocols that were created to achieve this feat. Despite the difficulties in initially setting up these protocols, they proved successful and thus the team managing the patient proposed that LTEVDs are a viable treatment option for children with hydrocephalus in the context of inoperable tumours to help maximise quality of life.
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Affiliation(s)
- Phillip Correia Copley
- Neurosurgery Registrar, Department of Paediatric Neurosurgery, Royal Hospital For Sick Children, Edinburgh
| | - John Emelifeonwu
- Neurosurgery Registrar, Department of Paediatric Neurosurgery, Royal Hospital For Sick Children, Edinburgh
| | - Pasquale Gallo
- Neurosurgery Consultant, Department of Paediatric Neurosurgery, Royal Hospital For Sick Children, Edinburgh
| | - Drahoslav Sokol
- Neurosurgery Consultant, Department of Paediatric Neurosurgery, Royal Hospital For Sick Children, Edinburgh
| | - Jothy Kandasamy
- Neurosurgery Consultant, Department of Paediatric Neurosurgery, Royal Hospital For Sick Children, Edinburgh
| | - Hamish Wallace
- Paediatric Oncology Consultant, Department of Paediatric Oncology, Royal Hospital For Sick Children, Edinburgh
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Gew J, Sokol D, Gallo P, Kandasamy J, Keston P, Downer J, Fouyas I, Kaliaperumal C. De novo distal middle cerebral artery aneurysm post-excision of intracerebral arteriovenous malformation in an 8-year old. Childs Nerv Syst 2019; 35:2211-2218. [PMID: 31401680 DOI: 10.1007/s00381-019-04328-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 07/28/2019] [Indexed: 11/27/2022]
Abstract
Cerebral arteriovenous malformations (AVMs) are frequently associated with concurrent aneurysms. These aneurysms are commonly haemodynamically related to the AVM and can be classified into extranidal or intranidal in reference to the AVM nidus. An aneurysm arising from an artery that does not angiographically contribute to the blood flow to the AVM is uncommon. A distal middle cerebral artery (dMCA) aneurysm itself is also a rare presentation, especially in paediatric population. We present a rare case of dMCA aneurysm that was noted after successful surgical management of a ruptured AVM in an 8-year-old child and its management. BACKGROUND: About 10-30% of patients with cerebral arteriovenous malformation (AVM) have an associated artery aneurysm. The majority of these aneurysms are flow-related to the malformation. These aneurysms can be classified into extranidal or intranidal in reference to the AVM nidus Rammos et al Am J Neuroradiol 37:1966-1971, [1]. An aneurysm arising from a different artery that does not angiographically contribute to the blood flow associated with the AVM is less common and would generally be regarded as unrelated to the AVM. Distal cerebral artery aneurysm itself is also a rare presentation, comprising of 1-7% of all middle cerebral artery aneurysm. In children, mycotic infection and dissection are the two most common causes for aneurysm in this location. Unlike in adults, berry aneurysms are uncommon in children. We describe a young patient who was found to have distal middle cerebral artery (dMCA) aneurysm in follow-up DSA (Digital Subtraction Angiogram) after the initial successful surgical treatment for a cerebral frontal AVM. In this particular case, endovascular repair is thought to be the best strategy to treat the aneurysm. However, there still remains a lack of consensus of the best management strategy (surgery or endovascular) in treating flow-related aneurysms in general. This is usually based on an individual case scenario and the treatment is tailored depending on various factors including the expertise of the treating team.
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Agresta G, Sokol D, Kaliaperumal C, Kandasamy J, Gallo P. A novel management proposal for intrinsic brainstem neurenteric cysts: case report. J Neurosurg Pediatr 2019; 25:1-5. [PMID: 31628284 DOI: 10.3171/2019.8.peds19336] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 08/19/2019] [Indexed: 11/06/2022]
Abstract
Neurenteric cysts (NCs) are rare congenital lesions with epithelial mucin-secreting walls. They can occur anywhere along the neural axis, and an intrinsic midbrain cyst is extraordinary. Surgical management may pose a challenge due to the location of the lesion and adhesion of the cyst wall to the surrounding brainstem. The authors describe the first case of pediatric NC that was treated successfully with intracystic interferon-α (IFN-α).A 16-month-old baby girl presented with a 2-week history of progressive croup, vomiting, and swallowing difficulty. MRI revealed a 1.8-cm cystic intrinsic lesion in the pontomedullary region. She initially underwent posterior fossa craniotomy and drainage of the cyst under intraoperative neurophysiology monitoring. Three weeks following the procedure, her symptoms recurred, and follow-up MRI demonstrated cystic recurrence. She underwent repeat aspiration of the cyst and biopsy of the cyst wall, and INF-α-2b was injected into the cystic cavity. Her symptoms improved and completely resolved after 5 months. A 9-month follow-up brain MRI study showed complete resolution of the NC. Intracystic IFN-α injection after cystic content aspiration may be a safe treatment option for the management of intrinsic brainstem NCs. Long-term clinical and radiological follow-up is recommended.
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Raghu ALB, Wiggins A, Kandasamy J. Surgical management of lumbar disc herniation in children and adolescents. Clin Neurol Neurosurg 2019; 185:105486. [DOI: 10.1016/j.clineuro.2019.105486] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/15/2019] [Accepted: 08/08/2019] [Indexed: 11/27/2022]
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Kaliaperumal C, Gallo P, Campbell D, Stewart K, Kandasamy J, Rose M. P97 Utility of computer technology in management of non-syndromic craniosynostosis- is it cost effective? J Neurol Psychiatry 2019. [DOI: 10.1136/jnnp-2019-abn.154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
ObjectivesTo discuss the utility of Computer technology for non-syndromic craniosynostosis (Metopic craniosynostosis) in the form of 3D printed models that could be utilised intraoperatively to aid fronto-orbital remodelling.DesignProspective study form 2015–2017.SubjectsPaediatric non-syndromic metopic craniosynostosis cohort.MethodsWe present a series of 7 patients with non-syndromic metopic craniosynostosis operated on by the craniofacial team Edinburgh over a three year period. The Edinburgh Craniofacial service is supported by the Managed Service Network (MSN) for Neurosurgery, Scotland as a part of nationally delivered Craniofacial service. We utilised 3D printing models of the orbital bar to plan a fronto-orbital advancement technique. The models were then subsequently sterilised and used intra operatively. 3D printer utility is available to us as a part of the NHS Lothian craniomaxillofacial and plastics surgery service.ResultsNo intra-operative or post operative complications were noted in our series. All patients undergo standardised pre and post operative 3D CT and photography follow up to objectively measure the outcome.ConclusionsThe utility of Computer technology is a useful and safe adjunct for non-syndromic craniosynostosis, particularly metopic craniosynostosis. A careful pre-operative planning and 3D printed model is helpful to achieve the desired bespoke surgical outcome and to reduce operative time. Post operative 3D CT and 3D photography were utilised to objectively measure the outcome. No extra costs were incurred to our service. We believe that this could be incorporated in preoperative planning as an essential tool.
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Shetty J, Kandasamy J, Sokol D, Gallo P. Clinical deterioration despite syringomyelia resolution after successful foramen magnum decompression for Chiari malformation - Case series. Eur J Paediatr Neurol 2019; 23:333-337. [PMID: 30683486 DOI: 10.1016/j.ejpn.2019.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 12/27/2018] [Accepted: 01/08/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Neurosurgical treatment is recommended for symptomatic syringomyelia and the post-operative radiological resolution of the syringomyelia is associated with an improvement or at least stability of the patient's pre-operative symptoms. METHODS We reviewed syringomyelia treatment in our centre over the last five years for clinical outcome, surgical complications, post operative MRI and long term symptom resolution. RESULTS 50 cases of symptomatic syringomyelia underwent foramen magnum decompression and expansile watertight duroplasty. While the outcomes for majority are similar to what published in literature, three of them developed typical syringomyelia symptoms after initial good recovery and radiological resolution of syrinx. CONCLUSION Syringomyelia symptoms may appear or worsen following successful surgical treatment and radiological resolution of syrinx and it is important to counsel young people and their family regarding this.
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Affiliation(s)
- J Shetty
- Department of Paediatric Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK; University of Edinburgh, UK.
| | - J Kandasamy
- Department of Paediatric Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK
| | - D Sokol
- Department of Paediatric Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK
| | - P Gallo
- Department of Paediatric Neurosciences, Royal Hospital for Sick Children, Edinburgh, UK
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Jamjoom AAB, Joannides AJ, Poon MTC, Chari A, Zaben M, Abdulla MAH, Roach J, Glancz LJ, Solth A, Duddy J, Brennan PM, Bayston R, Bulters DO, Mallucci CL, Jenkinson MD, Gray WP, Kandasamy J, Hutchinson PJ, Kolias AG, Ahmed AI. Prospective, multicentre study of external ventricular drainage-related infections in the UK and Ireland. J Neurol Neurosurg Psychiatry 2018; 89:120-126. [PMID: 29070645 PMCID: PMC5800336 DOI: 10.1136/jnnp-2017-316415] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 09/16/2017] [Accepted: 10/09/2017] [Indexed: 11/14/2022]
Abstract
OBJECTIVES External ventricular drain (EVD) insertion is a common neurosurgical procedure. EVD-related infection (ERI) is a major complication that can lead to morbidity and mortality. In this study, we aimed to establish a national ERI rate in the UK and Ireland and determine key factors influencing the infection risk. METHODS A prospective multicentre cohort study of EVD insertions in 21 neurosurgical units was performed over 6 months. The primary outcome measure was 30-day ERI. A Cox regression model was used for multivariate analysis to calculate HR. RESULTS A total of 495 EVD catheters were inserted into 452 patients with EVDs remaining in situ for 4700 days (median 8 days; IQR 4-13). Of the catheters inserted, 188 (38%) were antibiotic-impregnated, 161 (32.5%) were plain and 146 (29.5%) were silver-bearing. A total of 46 ERIs occurred giving an infection risk of 9.3%. Cox regression analysis demonstrated that factors independently associated with increased infection risk included duration of EVD placement for ≥8 days (HR=2.47 (1.12-5.45); p=0.03), regular sampling (daily sampling (HR=4.73 (1.28-17.42), p=0.02) and alternate day sampling (HR=5.28 (2.25-12.38); p<0.01). There was no association between catheter type or tunnelling distance and ERI. CONCLUSIONS In the UK and Ireland, the ERI rate was 9.3% during the study period. The study demonstrated that EVDs left in situ for ≥8 days and those sampled more frequently were associated with a higher risk of infection. Importantly, the study showed no significant difference in ERI risk between different catheter types.
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Affiliation(s)
- Aimun A B Jamjoom
- Department of Clinical Neuroscience, Western General Hospital, Edinburgh, UK
| | - Alexis J Joannides
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
| | | | - Aswin Chari
- Department of Neurosurgery, Royal London Hospital, London, UK
| | - Malik Zaben
- Department of Neurosurgery, University Hospital of Wales, Cardiff, UK
| | - Mutwakil A H Abdulla
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
- Department of Neurosurgery, University Hospital of Wales, Cardiff, UK
| | - Joy Roach
- Wessex Neurological Centre, University Hospitals Southampton, Southampton, UK
| | | | - Anna Solth
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle, UK
| | - John Duddy
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
| | - Paul M Brennan
- Department of Clinical Neuroscience, Western General Hospital, Edinburgh, UK
| | - Roger Bayston
- Division of Rheumatology, Orthopaedics and Dermatology, The University of Nottingham, Nottingham, UK
| | - Diederik O Bulters
- Department of Neurosurgery, Alder Hey Children's NHS Trust, Liverpool, UK
| | - Conor L Mallucci
- Department of Neurosurgery, Alder Hey Children's NHS Trust, Liverpool, UK
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre, Liverpool, UK
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - William P Gray
- Department of Neurosurgery, University Hospital of Wales, Cardiff, UK
| | - Jothy Kandasamy
- Department of Clinical Neuroscience, Western General Hospital, Edinburgh, UK
| | - Peter J Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
| | - Angelos G Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
| | - Aminul I Ahmed
- Wessex Neurological Centre, University Hospitals Southampton, Southampton, UK
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Gallo P, Sokol D, Kaliaperumal C, Kandasamy J. Comparison of Three Different Cranio-Cervical Decompression Procedures in Children with Chiari Malformation Type I: Does the Surgical Technique Matter? Pediatr Neurosurg 2017; 52:289-297. [PMID: 28848212 DOI: 10.1159/000479327] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 07/07/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS A broad spectrum of cranio-cervical decompression techniques (CCD) is employed for the treatment of Chiari malformation type I (CM1). The aim of this study was to compare the clinical and radiological outcome of 3 different CCD performed in a single paediatric centre. METHODS A retrospective analysis of children treated between 2008 and 2014 was performed. Three different surgical techniques were offered to the patients: an extradural osseo-ligamentous bony decompression (BD), or a BD plus opening of the dura either without duroplasty (DOWD) or with watertight expansile duroplasty (DOPD). The primary clinical outcome was measured by utilizing the Chicago Chiari Outcome Scale (CCOS). RESULTS Forty-six children underwent 51 CCD: 17 BD, 17 DOWD, and 17 DOPD. The median follow-up period was 46 months (16-98 months). Patients who underwent BD had a shorter length of hospital stay than those who underwent DPTC and DOWD. Clinical improvement, defined by the mean CCOS score, was comparable in patients receiving BD (n = 14.6) and DOPD (n = 14.5), but lower in patients with DOWD (n = 12). Post-operative complications were noted in 7 DOWD patients (41%) and 3 DOPD patients (17.6%). CONCLUSIONS BD is a safe and effective procedure with comparable clinical and radiological outcomes to DOPD in children with CM1. The risk of post-operative complications and worse clinical outcome was noted to be higher when performing a DOWD.
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Affiliation(s)
- Pasquale Gallo
- Department of Paediatric Neurosurgery, Royal Hospital for Sick Children, Edinburgh, UK
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Emelifeonwu JA, Sokol D, Gallo P, Kandasamy J, Kaliaperumal C. Long-tunnelled external ventricular drain as a long-term treatment option for hydrocephalus in a child with an unresectable low-grade supratentorial tumor: case report. J Neurosurg Pediatr 2016; 18:430-433. [PMID: 27258590 DOI: 10.3171/2016.4.peds161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report a case of a child with hypothalamic-origin pilocytic astrocytoma and hydrocephalus, which was refractory to treatment with a ventriculoperitoneal shunt due to high CSF protein content. With parental education, the child's hydrocephalus was managed long-term in the community with a long-tunnelled external ventricular drain, which was maintained by his parents. To the authors' knowledge this is the first report of this management option as a long-term measure. No harm has come to the patient. The authors propose long-term, long-tunnelled external ventricular drain as a viable treatment option for such patients.
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Affiliation(s)
- John A Emelifeonwu
- Department of Paediatric Neurosurgery, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Drahoslav Sokol
- Department of Paediatric Neurosurgery, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Pasquale Gallo
- Department of Paediatric Neurosurgery, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Jothy Kandasamy
- Department of Paediatric Neurosurgery, Royal Hospital for Sick Children, Edinburgh, United Kingdom
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Piper RJ, Hughes MA, Moran CM, Kandasamy J. Focused ultrasound as a non-invasive intervention for neurological disease: a review. Br J Neurosurg 2016; 30:286-93. [DOI: 10.3109/02688697.2016.1173189] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Johir MAH, Pradhan M, Loganathan P, Kandasamy J, Vigneswaran S. Phosphate adsorption from wastewater using zirconium (IV) hydroxide: Kinetics, thermodynamics and membrane filtration adsorption hybrid system studies. J Environ Manage 2016; 167:167-174. [PMID: 26686069 DOI: 10.1016/j.jenvman.2015.11.048] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 10/18/2015] [Accepted: 11/23/2015] [Indexed: 06/05/2023]
Abstract
Excessive phosphate in wastewater should be removed to control eutrophication of water bodies. The potential of employing amorphous zirconium (Zr) hydroxide to remove phosphate from synthetic wastewater was studied in batch adsorption experiments and in a submerged membrane filtration adsorption hybrid (MFAH) reactor. The adsorption data satisfactorily fitted to Langmuir, pseudo-first order and pseudo-second order models. Langmuir adsorption maxima at 22 °C and pHs of 4.0, 7.1, and 10.0 were 30.40, 18.50, and 19.60 mg P/g, respectively. At pH 7.1 and temperatures of 40 °C and 60 °C, they were 43.80 and 54.60 mg P/g, respectively. The thermodynamic parameters, ΔG° and ΔS° were negative and ΔH° was positive. FTIR, zeta potential and competitive phosphate, sulphate and nitrate adsorption data showed that the mechanism of phosphate adsorption was inner-sphere complexation. In the submerged MFAH reactor experiment, when Zr hydroxide was added at doses of 1-5 g/L once only at the start of the experiment, the removal of phosphate from 3 L of wastewater containing 10 mg P/L declined after 5 h of operation. However, when Zr hydroxide was repeatedly added at 5 g/L dose every 24 h, satisfactory removal of phosphate was maintained for 3 days.
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Affiliation(s)
- M A H Johir
- Faculty of Engineering and Information Technology, University of Technology, Sydney, Broadway, NSW 2007, Australia
| | - M Pradhan
- Faculty of Engineering and Information Technology, University of Technology, Sydney, Broadway, NSW 2007, Australia
| | - P Loganathan
- Faculty of Engineering and Information Technology, University of Technology, Sydney, Broadway, NSW 2007, Australia
| | - J Kandasamy
- Faculty of Engineering and Information Technology, University of Technology, Sydney, Broadway, NSW 2007, Australia
| | - S Vigneswaran
- Faculty of Engineering and Information Technology, University of Technology, Sydney, Broadway, NSW 2007, Australia.
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Sounthararajah DP, Loganathan P, Kandasamy J, Vigneswaran S. Adsorptive removal of heavy metals from water using sodium titanate nanofibres loaded onto GAC in fixed-bed columns. J Hazard Mater 2015; 287:306-316. [PMID: 25668299 DOI: 10.1016/j.jhazmat.2015.01.067] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/27/2015] [Accepted: 01/30/2015] [Indexed: 06/04/2023]
Abstract
Heavy metals are serious pollutants in aquatic environments. A study was undertaken to remove Cu, Cd, Ni, Pb and Zn individually (single metal system) and together (mixed metals system) from water by adsorption onto a sodium titanate nanofibrous material. Langmuir adsorption capacities (mg/g) at 10(-3)M NaNO3 ionic strength in the single metal system were 60, 83, 115 and 149 for Ni, Zn, Cu, and Cd, respectively, at pH 6.5 and 250 for Pb at pH 4.0. In the mixed metals system they decreased at high metals concentrations. In column experiments with 4% titanate material and 96% granular activated carbon (w/w) mixture at pH 5.0, the metals breakthrough times and adsorption capacities (for both single and mixed metals systems) decreased in the order Pb>Cd, Cu>Zn>Ni within 266 bed volumes. The amounts adsorbed were up to 82 times higher depending on the metal in the granular activated carbon+titanate column than in the granular activated carbon column. The study showed that the titanate material has high potential for removing heavy metals from polluted water when used with granular activated carbon at a very low proportion in fixed-bed columns.
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Affiliation(s)
- D P Sounthararajah
- Faculty of Engineering and Information Technology, University of Technology Sydney, Broadway, NSW 2007, Australia
| | - P Loganathan
- Faculty of Engineering and Information Technology, University of Technology Sydney, Broadway, NSW 2007, Australia
| | - J Kandasamy
- Faculty of Engineering and Information Technology, University of Technology Sydney, Broadway, NSW 2007, Australia
| | - S Vigneswaran
- Faculty of Engineering and Information Technology, University of Technology Sydney, Broadway, NSW 2007, Australia.
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Williams T, Wilkinson AG, Kandasamy J, Cooper S, Boardman JP. Antenatal diagnosis of intracranial haemorrhage and porencephalic cyst. BMJ Case Rep 2015; 2015:bcr-2014-209130. [PMID: 25716048 DOI: 10.1136/bcr-2014-209130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- T Williams
- Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A G Wilkinson
- Department of Radiology, Royal Hospital for Sick Children, Edinburgh, UK
| | - J Kandasamy
- Department of Neurosurgery, Royal Hospital for Sick Children, Edinburgh, UK
| | - S Cooper
- Simpson Centre for Reproductive Health, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - J P Boardman
- University of Edinburgh / MRC Centre for Reproductive Health, Edinburgh, UK
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21
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Thankappan R, Nguyen T, Srinivasan S, Vigneswaran S, Kandasamy J, Loganathan P. Removal of leather tanning agent syntan from aqueous solution using Fenton oxidation followed by GAC adsorption. J IND ENG CHEM 2015. [DOI: 10.1016/j.jiec.2014.03.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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22
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Jamjoom AAB, Kolias AG, Zaben M, Chari A, Kitchen J, Joannides A, Brennan PM, Kandasamy J, Gatscher S, Gray WP, Jenkinson MD, Bulters DO, Mallucci CL, Schuster H, Hutchinson PJ, Ahmed AI. External ventricular drainage: Is it time to look at national practice? Br J Neurosurg 2014; 29:9-10. [PMID: 25188651 DOI: 10.3109/02688697.2014.957162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Aimun A B Jamjoom
- a Division of Neurosurgery, Department of Clinical Neurosciences , Western General Hospital & University of Edinburgh , Edinburgh , UK
| | - Angelos G Kolias
- b Division of Neurosurgery, Department of Clinical Neurosciences , Addenbrooke's Hospital & University of Cambridge , Cambridge , UK
| | - Malik Zaben
- c Institute of Psychological Medicine and Clinical Neurosciences, National Neuroscience and Mental Health Research Institute, Cardiff University , Cardiff , UK
| | - Aswin Chari
- b Division of Neurosurgery, Department of Clinical Neurosciences , Addenbrooke's Hospital & University of Cambridge , Cambridge , UK
| | - John Kitchen
- d Department of Neurosurgery , The Walton Centre , Liverpool , UK
| | - Alexis Joannides
- b Division of Neurosurgery, Department of Clinical Neurosciences , Addenbrooke's Hospital & University of Cambridge , Cambridge , UK
| | - Paul M Brennan
- a Division of Neurosurgery, Department of Clinical Neurosciences , Western General Hospital & University of Edinburgh , Edinburgh , UK
| | - Jothy Kandasamy
- a Division of Neurosurgery, Department of Clinical Neurosciences , Western General Hospital & University of Edinburgh , Edinburgh , UK
| | - Silvia Gatscher
- e Department of Neurological Surgery , The John Radcliffe Hospital , Oxford , UK
| | - William P Gray
- c Institute of Psychological Medicine and Clinical Neurosciences, National Neuroscience and Mental Health Research Institute, Cardiff University , Cardiff , UK
| | | | - Diederik O Bulters
- f Wessex Neurological Centre, University Hospital Southampton & University of Southampton , Southampton , UK
| | - Conor L Mallucci
- g Department of Paediatric Neurosurgery , Alder Hey Children's Hospital , Liverpool , UK
| | - Helmut Schuster
- h Department of Microbiology , University Hospital Southampton , Southampton , UK
| | - Peter J Hutchinson
- b Division of Neurosurgery, Department of Clinical Neurosciences , Addenbrooke's Hospital & University of Cambridge , Cambridge , UK
| | - Aminul I Ahmed
- f Wessex Neurological Centre, University Hospital Southampton & University of Southampton , Southampton , UK
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Nur T, Johir M, Loganathan P, Nguyen T, Vigneswaran S, Kandasamy J. Phosphate removal from water using an iron oxide impregnated strong base anion exchange resin. J IND ENG CHEM 2014. [DOI: 10.1016/j.jiec.2013.07.009] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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24
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Piper RJ, Yoong M, McLellan A, Kandasamy J, Chin RF. Visual field defects after radiosurgery for mesial temporal lobe epilepsy. Epilepsia 2013; 54:2019. [PMID: 24199828 DOI: 10.1111/epi.12385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Rory J Piper
- Muir Maxwell Epilepsy Centre, University of Edinburgh, Edinburgh, United Kingdom.
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25
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Johir MA, Shanmuganathan S, Vigneswaran S, Kandasamy J. Performance of submerged membrane bioreactor (SMBR) with and without the addition of the different particle sizes of GAC as suspended medium. Bioresour Technol 2013; 141:13-18. [PMID: 23545069 DOI: 10.1016/j.biortech.2013.03.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Revised: 03/04/2013] [Accepted: 03/07/2013] [Indexed: 06/02/2023]
Abstract
In this study the effect of different particle sizes of granular activated carbon (GAC) on the performance of a submerged membrane bioreactor (SMBR) was investigated. The sizes of GAC used were 150-300, 300-600 and 600-1200 μm. The SMBR was operated at a filtration flux of 20 L/m(2)h. The removal of dissolved organic carbon (DOC) and chemical oxygen demand (COD) with the addition of GAC was 95%. The concentration of biopolymers, humic, building block and low molecular weight neutral and acids in the SMBR effluent was reduced by 20%, 66-76%, 20-50%, 30-56%, respectively. It helped to reduce the sludge volume index (SVI) and transmembrane pressure (TMP) development by 30-40% and 58%, respectively. However, the removal of NH₄(+) and PO₄(3-) was relatively low of 35-45% and 34-43%, respectively. The SMBR effluent was rich in PO₄(3-) and was removed/recovered using hydrated ferric oxide (HFO). The removal of PO₄(3-) was almost 90%.
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Affiliation(s)
- M A Johir
- Faculty of Engineering and Information Technology, University of Technology, Sydney, Broadway, NSW 2007, Australia
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Addo NK, Javadpour S, Kandasamy J, Sillifant P, May P, Sinha A. Central sleep apnea and associated Chiari malformation in children with syndromic craniosynostosis: treatment and outcome data from a supraregional national craniofacial center. J Neurosurg Pediatr 2013; 11:296-301. [PMID: 23240845 DOI: 10.3171/2012.11.peds12297] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The association of Chiari malformation Type I (CM-I) with syndromic craniosynostosis (SC) in children is well established. Central sleep apnea (CSA) may subsequently occur. However, sleep studies performed in these patients have been focused mainly on assessing the severity of obstructive sleep apnea. Therefore, the incidence and management of CSA in these patients remains poorly defined. Authors of this study aimed to assess the efficacy of foramen magnum decompression (FMD) in resolving CSA, initially detected incidentally, in a small cohort of patients with CM-I and SC. METHODS The clinical data for 5 children who underwent FMD for CSA at Alder Hey Children's Hospital between December 2007 and December 2009 were retrospectively analyzed. Outcomes were evaluated with respect to FMDs by utilizing pre- and postdecompression sleep studies. Of the 5 patients, 2 had Crouzon syndrome and 3 had Pfeiffer syndrome. RESULTS Patient age at the time of surgery ranged from 1.1 to 12.6 years (median 4.1 years). The median postoperative follow-up was 3.6 years. Sleep studies revealed that 2 children experienced a > 80% reduction in CSAs at 1.5 and 21 months after decompression. The remaining 3 children experienced a > 60% reduction in CSAs when reevaluated between 2 and 10 months after decompression. The associated central apnea index improved for all patients. CONCLUSIONS Findings suggested that FMD is an effective treatment modality for improving CSA in patients with SC and associated CM-I. The use of multimodal polysomnography technology may improve the evaluation and management of these patients.
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Affiliation(s)
- Nii K Addo
- Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.
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Clark S, Powell G, Kandasamy J, Lee M, Nahser H, Pigott T. Spinal dural arteriovenous fistulas – presentation, management and outcome in a single neurosurgical institution. Br J Neurosurg 2012; 27:465-70. [DOI: 10.3109/02688697.2012.752433] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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28
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Attia M, Patel KS, Kandasamy J, Stieg PE, Spinelli HM, Riina HA, Anand VK, Schwartz TH. Combined cranionasal surgery for spheno-orbital meningiomas invading the paranasal sinuses, pterygopalatine, and infratemporal fossa. World Neurosurg 2012; 80:e367-73. [PMID: 23072879 DOI: 10.1016/j.wneu.2012.10.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Accepted: 10/09/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the efficacy of combining an endonasal endoscopic skull-base approach and repair with a transcranial orbitozygomatic approach for spheno-orbital meningiomas (SOMs). METHODS Three patients with recurrent SOMs underwent combined orbitozygomatic and endonasal endoscopic surgery. In 2 patients both procedures were done in 1 operation and in 1 patient the endonasal surgery was done 2.5 months after the craniotomy. Extent of resection, complications, morbidity, and mortality were evaluated. RESULTS Gross total resection was achieved in 1 patient and near total resection in the other 2 patients with tumor left in the cavernous sinus and parapharyngeal space. Two patients suffered cranial neuropathy from the transcranial surgery and the other developed a pseudomeningocele. There were no complications from the endonasal surgery. Patients having combined single setting cranionasal surgery were discharged on day 6 and 8, whereas the patient having only the endonasal component on a later date was discharged on day 2. CONCLUSIONS A combined cranionasal approach involving transcranial orbitozygomatic and endonasal endoscopic approaches is an effective 2-stage surgery for resecting SOMs invading into the sinuses and paranasal compartments. The ability to perform a multilayer closure involving a vascularized nasoseptal flap additionally decreases the risk of postoperative cerebrospinal fluid leak.
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Affiliation(s)
- Moshe Attia
- Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA
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29
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Johir MAH, George J, Vigneswaran S, Kandasamy J, Sathasivan A, Grasmick A. Effect of imposed flux on fouling behavior in high rate membrane bioreactor. Bioresour Technol 2012; 122:42-49. [PMID: 22424923 DOI: 10.1016/j.biortech.2012.02.107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 02/23/2012] [Accepted: 02/23/2012] [Indexed: 05/31/2023]
Abstract
The influence of imposed flux and aeration rates on membrane fouling in a submerged membrane bioreactor was studied. The experiments were conducted at four imposed fluxes and three aeration rates. The effect of flux on the reduction of membrane fouling was much higher than that caused by aeration rate. A lower flux of 20 L/m(2) h produced 75 times more water than a higher flux of 40 L/m(2) h with an aeration rate of 2 L/min. Low flux showed slightly higher removal of NH(4)-N and 93-96% removal of dissolved organic matter and chemical oxygen demand. Imposed flux also had a significant effect on the composition of organics present in the soluble microbial product (SMP) and extracellular polymeric substances (EPS). At a higher flux, both SMP and EPS had organics of high molecular weight (MW) of around 48 kDa as well as lower MW organics below 200 Da.
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Affiliation(s)
- M A H Johir
- Faculty of Engineering and Information Technology, University of Technology, Sydney, Broadway, NSW 2007, Australia
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30
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Silva D, Attia M, Kandasamy J, Alimi M, Anand VK, Schwartz TH. Endoscopic endonasal transsphenoidal "above and below" approach to the retroinfundibular area and interpeduncular cistern--cadaveric study and case illustrations. World Neurosurg 2012; 81:374-84. [PMID: 23022634 DOI: 10.1016/j.wneu.2012.08.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 06/23/2012] [Accepted: 08/17/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To evaluate the feasibility of reaching the interpeduncular cistern (IC) through an endoscopic endonasal approach that leaves the pituitary gland in place. METHODS In a series of 10 injected cadaver heads, the transtuberculum ("above") and transclival ("below") approaches were combined, without pituitary transposition. Using 0-degree, 30-degree, and 45-degree endoscopes, the extent of overlap and if a blind spot occurred were determined. Also, the visualization of the IC was compared with the transposition of the pituitary gland approach. Nonparametric statistics were used to evaluate the results. The approach was implemented in 2 patients. RESULTS For both the "above" and "below" views, there was a statistically significant increase in field of view when comparing the 0-degree endoscope with either the 30-degree endoscope (P < 0.05) or the 45-degree endoscope (P < 0.05). There was no difference between the 30-degree endoscope and the 45-degree endoscope (P > 0.05) in the "below" approach, but there was a difference (P < 0.05) in the "above" approach. There was no blind spot with any combination of endoscopes. There was no practical statistically significant difference between the transposition approach and the "above and below" approach. The "above and below" approach was used successfully in 2 surgeries. CONCLUSIONS It is possible to work both "above" and "below" the pituitary gland to reach the IC through an endoscopic endonasal approach. The advantages are the maintenance of normal pituitary and parasellar anatomy and the minimization of the size of the skull base defect. There is no blind spot using this approach that would be revealed with a pituitary transposition. The feasibility of this approach has been confirmed in 2 patients.
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Affiliation(s)
- Danilo Silva
- Department of Neurosurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA
| | - Moshe Attia
- Department of Neurosurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA
| | - Jothy Kandasamy
- Department of Neurosurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA
| | - Marjan Alimi
- Department of Neurosurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA
| | - Vijay K Anand
- Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA
| | - Theodore H Schwartz
- Department of Neurosurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA; Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA; Department of Neurology and Neuroscience, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York, USA.
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Abstract
Background: Posterior clinoidectomy is a useful procedure for maximizing exposure to the interpeduncular cistern via transcranial approaches for basilar tip aneurysms and select intracranial tumors. The value of posterior clinoidectomy during endonasal endoscopic transclival surgery is not well described. Methods: We performed endoscopic endonasal transsphenoidal extradural bilateral posterior clinoidectomy and dorsum sella removal on five silicon-injected cadaveric heads. The dorsum sella was split in the midline and removed from medial to lateral until the posterior clinoids were encountered. The posterior clinoid was dissected from the medial wall of the cavernous sinus and mobilized medially in order to detach it from the ligaments and carefully fractured it from the bony attachment to the petrous apex and carotid canal. Following this, the clival and dorsum sella dura was opened to expose the interpeduncular cistern and its contents. Results: The technical feasibility of endoscopic endonasal extradural posterior clinoidectomy was reproduced in all five cadaveric specimens. This technique was performed without damaging the vital structures, including preservation of the pituitary gland. After performing bilateral posterior clinoidectomy, the retrosellar dura was opened, allowing good visualization of the contents of the prepontine and interpeduncular cistern. Conclusion: We describe the technique of endoscopic endonasal extradural posterior clinoidectomy. We believe this approach is best suited for retrosellar pathology located in the interpeduncular cistern and is a useful adjunct to the transclival approach to increase the field of view and maximize the extent of resection.
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Affiliation(s)
- Danilo Silva
- Department of Neurosurgery, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York
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Johir MAH, Vigneswaran S, Sathasivan A, Kandasamy J, Chang CY. Effect of organic loading rate on organic matter and foulant characteristics in membrane bio-reactor. Bioresour Technol 2012; 113:154-160. [PMID: 22206913 DOI: 10.1016/j.biortech.2011.12.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Revised: 11/30/2011] [Accepted: 12/01/2011] [Indexed: 05/31/2023]
Abstract
In this study, the influence of organic loading rate (OLR) on the performance of a membrane bio-reactor (MBR) was investigated. The MBR was operated with 6 different OLRs between 0.5 and 3.0 kg COD/m(3)d. The hydrodynamic parameters of the MBR were kept constant. The hydraulic retention time and sludge retention time were kept at 8h and 40 d respectively. From the experimental investigation, it was found that the removal efficiency of DOC, COD and NH(4)-N decreased when OLRs were increased from 0.5 to 3.0 kg COD/m(3)d. Higher OLRs of 2.75-3.0 kg COD/m(3)d resulted in a higher transmembrane pressure development. The fractionation of organic matters showed more hydrophilic substances with higher OLRs. A detailed organic matter characterization of membrane foulant, soluble microbial product and extracellular polymeric substances showed that bio-polymers type substances together with humic acid and lower molecular neutral and acids were responsible for membrane fouling.
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Affiliation(s)
- M A H Johir
- Faculty of Engineering and Information Technology, University of Technology, Sydney, Broadway, NSW 2007, Australia
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Attia M, Kandasamy J, Jakimovski D, Bedrosian J, Alimi M, Lee DL, Anand VK, Schwartz TH. The Importance and Timing of Optic Canal Exploration and Decompression During Endoscopic Endonasal Resection of Tuberculum Sella and Planum Sphenoidale Meningiomas. Oper Neurosurg (Hagerstown) 2012; 71:58-67. [DOI: 10.1227/neu.0b013e318258e23d] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND:
Suprasellar meningiomas often invade the optic canals (OCs). The feasibility of removing these tumors through a minimal-access endonasal route has been demonstrated, but the importance, safety, and timing of OC exploration and decompression are not well described.
OBJECTIVE:
To create a simple decision-tree algorithm for OC exploration and decompression in the endonasal endoscopic surgery for planum sphenoidale and tuberculum sella meningiomas.
METHODS:
We identified a consecutive series of 8 planum sphenoidale and tuberculum sella meningiomas resected endonasally. “Late” OC exploration and decompression was performed in 4 of 8 patients. The extent of resection, visual outcome, and complications were recorded.
RESULTS:
Five patients had OC invasion on magnetic resonance imaging. Endoscopic inspection did not reveal additional OC invasion. The OC was opened bilaterally in 2 patients and unilaterally in 2 patients. Gross total resection was achieved in 6 of 7 patients in whom it was the goal. Vision improved in 3 patients (3 of 3 OCs opened) and was stable in 4 (1 of 4 OCs opened). In 1 patient, the bitemporal hemianopsia improved, but there was unilateral deterioration (no OC invasion) because the tumor was extremely adherent to 1 optic nerve. After an average follow-up of 20.9 months, all patients had an Glasgow Outcome Scale score of 5, and there were no cerebrospinal fluid leaks.
CONCLUSION:
Exploration and decompression of the OC are feasible, safe, and important to optimize visual outcome and to minimize recurrence in planum sphenoidale and tuberculum sella meningiomas resected endonasally. It may not be important to open the canal early during surgery because tumor debulking can be performed without manipulating the optic nerves. Early decompression, however, is technically feasible.
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Affiliation(s)
| | | | | | | | | | - Dennis L.Y. Lee
- Departments of Otolaryngology, and
- Department of Ear, Nose and Throat, United Christian Hospital, affiliated unit of the Chinese University of Hong Kong, Hong Kong
| | | | - Theodore H. Schwartz
- Departments of Neurosurgery
- Departments of Otolaryngology, and
- Departments of Neurology and Neuroscience, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York
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Affiliation(s)
- Jothy Kandasamy
- Department of Neurological Surgery, New York Presbyterian Hospital, Weill Medical College, Cornell University, and
- Department of Clinical Neurosciences, Western General Hospital, and
- Department of Paediatric Neuroscience, Royal Hospital for Sick Children, Edinburgh, Scotland, United Kingdom
| | - Mark Souweidane
- Department of Neurological Surgery, New York Presbyterian Hospital, Weill Medical College, Cornell University, and
- Department of Neurological Surgery, Memorial Sloan–Kettering Cancer Center, New York, New York
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Zakaria R, Kandasamy J, Khan Y, Jenkinson MD, Hall SR, Brodbelt A, Pigott T, Mallucci CL. Raised intracranial pressure and hydrocephalus following hindbrain decompression for Chiari I malformation: a case series and review of the literature. Br J Neurosurg 2012; 26:476-81. [PMID: 22280544 DOI: 10.3109/02688697.2011.650738] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECT Chiari-syringomyelia is a heterogeneous condition that may be treated by decompression of the foramen magnum. Raised intracranial pressure (ICP) and/or hydrocephalus is a rare complication of this treatment. We aim to describe the incidence, clinical presentation, radiographic findings, management and outcome of patients developing raised ICP and/or hydrocephalus after hindbrain decompression for Chiari I malformation. METHODS Retrospective analysis of 138 consecutive adult and paediatric patients with Chiari I malformation who underwent foramen magnum decompression. RESULTS The incidence of post-operative symptomatic raised ICP and/or hydrocephalus in this series was 8.7%. Overall, 9 of 12 patients developing raised ICP or hydrocephalus required a VP shunt, an overall incidence of 6.5%. However, 3 of 12 patients were successfully managed with external ventricular drainage or conservatively. Presentation was with headache or CSF wound leak at a median of 13 days post-operatively. Subdural hygromata were observed in five cases in association with hydrocephalus and urgent drainage to relieve mass effect was required in two cases. At a mean follow up of 36 months, 9 of 12 patients were asymptomatic. CONCLUSIONS There is a risk of requiring a permanent VP shunt associated with decompression for Chiari I even in the absence of ventriculomegaly or signs of raised ICP pre-operatively. Patients presenting with new symptoms or CSF wound leak following FMD mandate investigation to exclude hydrocephalus, raised ICP or subdural hygroma.
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Affiliation(s)
- Rasheed Zakaria
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, Liverpool, UK.
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36
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Affiliation(s)
- Jothy Kandasamy
- Department of Neurosurgery, Walton Centre for Neurology and Neurosurgery, Liverpool L9 7LJ
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37
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Kandasamy J, Hayhurst C, Clark S, Jenkinson MD, Byrne P, Karabatsou K, Mallucci CL. Electromagnetic stereotactic ventriculoperitoneal csf shunting for idiopathic intracranial hypertension: a successful step forward? World Neurosurg 2011; 75:155-60; discussion 32-3. [PMID: 21492681 DOI: 10.1016/j.wneu.2010.10.025] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 10/11/2010] [Accepted: 10/11/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The optimal management of medically refractory idiopathic intracranial hypertension (IIH) remains a point of debate. The senior author's practice evolved after a review of our units' practice in placing lumboperitoneal shunts revealed an unacceptably high rate of complication and revision. We now preferentially perform custom-designed electromagnetic (EM) image-guided ventriculoperitoneal shunt placement instead of lumboperitoneal shunting in treating medically refractory IIH and present our outcome data with this technique. PATIENTS AND METHODS Retrospective case note review was carried out with prospective follow-up of 17 patients treated consecutively over a 3-year period. OUTCOME MEASURES The article aims to assess the implication of using EM image-guided tracking technology in ventricular catheter placement in patients with IIH and to assess outcome. RESULTS All of the patients improved clinically at the last follow-up compared to their preoperative condition. None of the patients experienced intra- or perioperative complications. All patients underwent ventriculoperitoneal shunt placement using EM guidance navigation. All patients in the EM subgroup were cannulated with a single pass, and satisfactory catheter placement was confirmed on a postoperative CT scan with concordant patient symptom improvement. CONCLUSION Our series suggests that EM image-guided ventriculoperitoneal cerebrospinal fluid (CSF) shunting for IIH is a safe and effective procedure for ventricular cannulation and placement.
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Affiliation(s)
- Jothy Kandasamy
- Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery NHS Trust, Liverpool, United Kingdom.
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Jenkinson MD, Campbell S, Hayhurst C, Clark S, Kandasamy J, Lee MK, Flynn A, Murphy P, Mallucci CL. Cognitive and functional outcome in spina bifida-Chiari II malformation. Childs Nerv Syst 2011; 27:967-74. [PMID: 21193992 DOI: 10.1007/s00381-010-1368-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2010] [Accepted: 12/08/2010] [Indexed: 11/29/2022]
Abstract
PURPOSE The long-term outcome in spina bifida-Chiari II-hydrocephalus complex is poorly understood. Traditional neurosurgical outcome measures are crude. Neuropsychological testing is increasingly important in outcome assessment. We investigated the health, disability, lifestyle and cognitive function in adults who had myelomeningocoele closure at birth. METHODS Adult patients under routine follow-up were assessed in a joint neurosurgery/neuropsychology clinic. Patients completed lifestyle questionnaires, the hydrocephalus outcome questionnaire (HOQ) and underwent cognitive testing. Clinical variables including number of shunt revisions, shunt infection and surgical decompression of foramen magnum, which may influence outcome, were investigated. RESULTS Twenty-one adults with a median age of 35 years were investigated. All had treated hydrocephalus, and eight had foramen magnum decompression for headache or progressive brainstem symptoms with stabilisation of symptoms in seven and improvement in one. Only eight patients were living independently, five were in paid employment and five work voluntarily. HOQ scores for cognitive function were lower (0.56 ± 0.20; mean ± standard deviation (SD)) than those for physical (0.64 ± 0.15) and social-emotional (0.65 ± 0.17) health. Cognitive function varied across the cohort with attention most severely affected (73.9 ± 17.0; mean ± SD). Repeated episodes of shunt malfunction or foramen magnum decompression were not associated with a worse cognitive function. CONCLUSIONS Despite intervention in childhood and adequate cerebrospinal fluid diversion the prognosis for independent living into adulthood remains poor. All patients have elements of cognitive impairment. Structural brain abnormalities may be more important determinants of cognitive outcome than shunt malfunction.
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Affiliation(s)
- Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre Foundation NHS Trust, Lower Lane, Liverpool, L9 7LJ, UK.
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Abstract
This paper presents the results of the long term biofilter experiments conducted with raw stormwater collected from a canal at Carlton, in Sydney. Anthracite and granular activated carbon (GAC) were used as a single filter media in biofilter columns. Media heights of 75 and 40 cm were used. The filter columns were operated at filtration velocities of 0.12 and 0.25 m/h. The removal efficiency for turbidity and DOC for the GAC filter media were found to be 75% and almost 100% respectively. The removal efficiency for the anthracite filter was much lower. Molecular weight distribution analysis showed an almost similar trend to the DOC removal. Compared with anthracite filter media, the GAC biofilter removed a much larger range of organic compounds present in the stormwater. The GAC biofilter removes organic matter earlier as compared to anthracite. Based on a limited sample of stormwater, the removal efficiency for phosphorus was upto 74% and that of nitrogen was up to 30%. In general GAC filter shows higher heavy metal removal efficiency than anthracite. The removal of zinc, iron, lead and nickel were good. However the concentration of heavy metal in the raw surface water sample was low.
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Affiliation(s)
- T Mohammed
- Faculty of Engineering and IT, University of Technology, Sydney, Australia
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Hayhurst C, Beems T, Jenkinson MD, Byrne P, Clark S, Kandasamy J, Goodden J, Tewarie RDN, Mallucci CL. Effect of electromagnetic-navigated shunt placement on failure rates: a prospective multicenter study. J Neurosurg 2010; 113:1273-8. [DOI: 10.3171/2010.3.jns091237] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
As many as 40% of shunts fail in the first year, mainly due to proximal obstruction. The role of catheter position on failure rates has not been clearly demonstrated. The authors conducted a prospective cohort study of navigated shunt placement compared with standard blind shunt placement at 3 European centers to assess the effect on shunt failure rates.
Methods
All adult and pediatric patients undergoing de novo ventriculoperitoneal shunt placement were included (patients with slit ventricles were excluded). The first cohort underwent standard shunt placement using anatomical landmarks. All centers subsequently adopted electromagnetic (EM) navigation for routine shunt placements, forming the second cohort. Catheter position was graded on postoperative CT in both groups using a 3-point scale developed for this study: (1) optimal position free-floating in CSF; (2) touching choroid or ventricular wall; or (3) intraparenchymal. Episodes and type of shunt revision were recorded. Early shunt failure was defined as that occurring within 30 days of surgery. Patients with shunts were followed-up for 12 months in the standard group, for a median of 6 months in the EM-navigated group, or until shunt failure.
Results
A total of 75 patients were included in the study, 41 with standard shunts and 34 with EM-navigated shunts. Seventy-four percent of navigated shunts were Grade 1 compared with 37% of the standard shunts (p = 0.001, chi-square test). There were no Grade 3 placements in the navigated group, but 8 in the standard group, and 75% of these failed. Early shunt failure occurred in 9 patients in the standard group and in 2 in the navigated group, reducing the early revision rate from 22 to 5.9% (p = 0.048, Fisher exact test). Early shunt failures were due to proximal obstruction in 78% of standard shunts (7 of 9) and in 50% of EM-navigated shunts (1 of 2).
Conclusions
Noninvasive EM image guidance in shunt surgery reduces poor shunt placement, resulting in a significant decrease in the early shunt revision rate.
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Affiliation(s)
- Caroline Hayhurst
- 1Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Lower Lane, Fazakerley, Liverpool
| | - Tjemme Beems
- 4Department of Neurosurgery, University Medical Center Radboud Nijmegen, The Netherlands
| | - Michael D. Jenkinson
- 1Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Lower Lane, Fazakerley, Liverpool
- 3School of Cancer Studies, University of Liverpool, United Kingdom; and
| | - Patricia Byrne
- 1Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Lower Lane, Fazakerley, Liverpool
| | - Simon Clark
- 1Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Lower Lane, Fazakerley, Liverpool
| | - Jothy Kandasamy
- 1Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Lower Lane, Fazakerley, Liverpool
| | - John Goodden
- 2Department of Neurosurgery, The Royal Liverpool Children's NHS Trust, Alder Hey, Liverpool
| | | | - Conor L. Mallucci
- 2Department of Neurosurgery, The Royal Liverpool Children's NHS Trust, Alder Hey, Liverpool
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Shon HK, Phuntsho S, Vigneswaran S, Kandasamy J, Nghiem LD, Kim GJ, Kim JB, Kim JH. Preparation of titanium dioxide nanoparticles from electrocoagulated sludge using sacrificial titanium electrodes. Environ Sci Technol 2010; 44:5553-5557. [PMID: 20560597 DOI: 10.1021/es100333s] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A comprehensive investigation of electrocoagulation using sacrificial titanium (Ti) electrodes in wastewater was carried out. The effects of specific process variables, such as initial pH, mixing, current density, initial organic loading, and ionic/electrolyte strength were first optimized to produce recyclable Ti-based sludge. The sludge was incinerated at 600 degrees C to produce functional TiO(2) photocatalyst. X-ray diffraction analysis revealed that TiO(2) produced at optimum electrocoagulation conditions was mostly anatase structure. The specific surface area of the synthesized TiO(2) photocatalyst was higher than that of the commercially available and widely used Degussa P-25 TiO(2). Furthermore, energy dispersive X-ray and X-ray photoelectron spectroscopy analyses showed that in additional to titanium and oxygen, this photocatalyst is also composed of carbon and phosphorus. These elements were mainly doped as a substitute site for the oxygen atom. Transmission electron microscopy images exhibited sharply edged nanorods, round nanoparticles, and nanotubes with nonuniform shapes showing some structural defects. Photodecomposition of gaseous acetaldehyde by this photocatalyst was also conducted under UV and visible light irradiation to study the photocatalytic properties of the doped TiO(2) photocatalyst. While no photocatalytic activity was observed under visible light irradiation, this doped TiO(2) photocatalyst exhibited high photocatalytic activity under UV light.
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Affiliation(s)
- H K Shon
- Faculty of Engineering, University of Technology, Sydney (UTS), Broadway, NSW 2007, Australia
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Spacca B, Kandasamy J, Mallucci CL, Genitori L. Endoscopic treatment of middle fossa arachnoid cysts: a series of 40 patients treated endoscopically in two centres. Childs Nerv Syst 2010; 26:163-72. [PMID: 19629494 DOI: 10.1007/s00381-009-0952-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2009] [Revised: 05/12/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE Middle fossa arachnoid cysts (MFAC) are a relatively common, benign pathology that pose a therapeutic challenge for both symptomatic and asymptomatic patients. The optimal surgical strategy and indication to treat are still debated by neurosurgeons. We reviewed our experience and results in a group of patients treated with endoscopic fenestration with the aim to assess indications to treat and clinical and neuroradiological results. METHODS The data on 40 patients operated with endoscopic fenestration for MFAC in two centres, "Anna Meyer" Children's Hospital, Florence, Italy, and Royal Liverpool Children's Hospital "Alder Hey", Liverpool, UK, between 2001 and 2007 were retrospectively reviewed with prospective follow-up. We analysed clinical and neuroradiological presentation, indications to treat, surgical technique, complications, and clinical and neuroradiological follow-up. RESULTS There were 30 males and ten females: mean age, 7.8 years; mean follow-up, 21 months. The neuronavigation system was used in 12 patients in the English cohort. Thirty-seven patients (92.5%) had a satisfactory clinical outcome. The cyst was reduced in size or completely disappeared in 29 patients (72.5%). There was no death or significant morbidity associated with the procedure. Four patients required further surgical treatment. Four patients experienced a post-traumatic intracystic bleeding after surgery. CONCLUSION Compared to microsurgical fenestration and cyst shunting, our experience with endoscopic fenestration was as effective and safe but less invasive. Each case must be assessed with its individual characteristics to define the optimal surgical strategy. Successful treatment may not reduce the risk of post-traumatic head injury haemorrhage.
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Affiliation(s)
- Barbara Spacca
- Department of Pediatric Neurosurgery, Anna Meyer Children's Hospital, Florence, Italy
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Abstract
In this study the hybrid filtration process (combining fibre filter with deep bed dual media filtration) was investigated as pre-treatment to stormwater. This process was investigated in-terms of reduction in turbidity, dissolved organic carbon (DOC), colour, headloss development across the filters, suspended solids removal, organic matter removal, nutrients and heavy matter (such as iron, copper, lead, zinc) removal efficiency. A comparison was made between the hybrid filter with single media (sand) deep bed filter and fibre filter. It was found that the hybrid filtration system successfully removed turbidity (98%), colour (99%), suspended solids (99%), and DOC (55%). The removal efficiency of heavy metal was relatively low as the concentration of heavy metals present in stormwater was low. The removal efficiency of nitrate, nitrite and phosphorous (as orthophosphate) was 27, 35 and 72% respectively. Hybrid filtration processes showed a better reduction of Modified Fouling Index (MFI) value (from 15.500 s/l(2) to 9 s/l(2)) compared with single media sand, anthracite and fibre filter which were 35 s/l(2), 13 s/l(2)and 14 s/l(2) respectively when operated at FeCl(3) dose of 15 mg/l.
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Affiliation(s)
- M A H Johir
- Faculty of Engineering and Information and Technology, University of Technology, Sydney, Broadway, Australia
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Guo WS, Zhang R, Vigneswaran S, Ngo HH, Kandasamy J. Membranes coupled with physico chemical treatment in water reuse. Water Sci Technol 2010; 61:513-519. [PMID: 20107279 DOI: 10.2166/wst.2010.843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In this study, short-term experiments were conducted with different configurations of membrane hybrid systems to treat biological treated sewage effluent containing refractory organic pollutants: (i) submerged hollow fiber microfiltration (SMF) alone; (ii) spiral flocculator (SF)-SMF without settling; (iii) SF-PAC-SMF without settling and (iv) SMF with magnetic ion exchange resin MIEX pretreatment. The results indicated that the pre-flocculation of SF could improve the mitigation of membrane fouling significantly even when the system was operated at a high membrane filtration rate. The transmembrane pressure (TMP) of SF-PAC-SMF only increased marginally (0.8 kPa over 8 hours). SF-SMF without the addition of powdered activated carbon (PAC) also took a relatively long duration for the TMP to increase. The TMP only increased by 2.5 kPa over 8 hours. The SF-PAC-MF system resulted in a high dissolved organic carbon (DOC) removal of more than 96%. When used as pre-treatment to submerged membranes, the fluidized bed MIEX contactor could remove a significant amount of organic matter in wastewater. This pre-treatment helped to reduce the membrane fouling and kept the TMP low during the membrane operation.
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Affiliation(s)
- W S Guo
- Faculty of Engineering and Information Technology, University of Technology, Sydney, Broadway NSW, Australia.
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Chanan A, Vigneswaran S, Kandasamy J. Valuing stormwater, rainwater and wastewater in the soft path for water management: Australian case studies. Water Sci Technol 2010; 62:2854-2861. [PMID: 21123915 DOI: 10.2166/wst.2010.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A Water Sensitive City is now commonly acknowledged best practice for designing the cities of the future. In Australia, the National Water Initiative has allocated high priority towards offering insight into successful water sensitive urban development projects, to facilitate capacity building within the industry. This paper shares innovative water sensitive projects implemented at Kogarah City Council, in Sydney. Four key projects are discussed, demonstrating how stormwater, rainwater and wastewater can be incorporated into decentralised water systems to offer sustainable water management of the future. The case studies included in the paper highlight Kogarah's journey towards the Soft Path for Water Management.
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Affiliation(s)
- A Chanan
- University of Technology, Sydney, Broadway, NSW 2007, Australia.
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Abstract
Although most Australians receive their domestic supply from reticulated mains or town water, there are vast areas with very low population densities and few reticulated supplies. In many of these areas rainwater collected in tanks is the primary source of drinking water. Heavy metals have recently become a concern as their concentration in rain water tanks was found to exceed recommended levels suitable for human consumption. Rainwater storage tanks also accumulate contaminants and sediments that settle to the bottom. Although not widely acknowledged, small amounts of contaminants such as lead found in rain water (used as drinking water) may have a cumulative and poisonous effect on human health over a life time. This is true for certain factors that underlie many of the chronic illnesses that are becoming increasingly common in contemporary society. The paper reports on a study which is part of a project that aims to develop a cost effective in-line filtration system to improve water quality in rainwater tanks. To enable this, the characteristics of rainwater need to be known. One component of this characterization is to observe the effects of the first flush on a rainwater tank. Samples of the roof runoff collected from an urban residential roof located in the Sydney Metropolitan Area in the initial first few millimetres of rain were analysed. The results show that bypassing the first 2 mm of rainfall gives water with most water quality parameters compliant with the Australian Drinking Water Guidelines (ADWG) standards. The parameters that did not comply were lead and turbidity, which required bypassing approximately the first 5 mm of rainfall to meet ADWG standards. Molecular weight distribution (MWD) analysis showed that the concentration of rainwater organic matter (RWOM) decreased with increasing amount of roof runoff.
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Affiliation(s)
- B Kus
- School of Civil and Environmental Engineering, University of Technology Sydney, Broadway NSW, Australia.
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Areerachakul N, Kitiphatmontree M, Kandasamy J, Kus B, Duangduen C, Pivsa-Art S, Vigneswaran S. Submerged Membrane System with Biofilter as a Treatment to Rainwater. ACTA ACUST UNITED AC 2009. [DOI: 10.1007/s11267-009-9227-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jenkinson MD, Hayhurst C, Al-Jumaily M, Kandasamy J, Clark S, Mallucci CL. The role of endoscopic third ventriculostomy in adult patients with hydrocephalus. J Neurosurg 2009; 110:861-6. [PMID: 19284240 DOI: 10.3171/2008.10.jns17667] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Endoscopic third ventriculostomy (ETV) is the treatment of choice for hydrocephalus, but the outcome is dependent on the cause of this disorder, and the procedure remains principally the preserve of pediatric neurosurgeons. The role of ETV in adult patients with hydrocephalus was therefore investigated.
Methods
One hundred ninety adult patients underwent ETV for hydrocephalus. Cases were defined as primary ETV (newly diagnosed, without a previously placed shunt) and secondary ETV (performed for shunt malfunctions due to infection or mechanical blockage). Causes of hydrocephalus included tumor, long-standing overt ventriculomegaly (LOVA), Chiari malformation Types I and II (CM-I and -II), aqueduct stenosis, spina bifida, and intraventricular hemorrhage (IVH). Successful ETV was defined as resolution of symptoms with shunt independence. Operative complications and ETV failure rate were investigated according to the causes of hydrocephalus and between the primary and secondary ETV groups.
Results
In the primary group, ETV was successful in 107 (83%) of 129 patients, including those with tumors (52 of 66), LOVA (21 of 24), CM-I (11 of 11 cases), CM-II (8 of 9), aqueduct stenosis (8 of 9), and IVH (2 of 2). In the secondary group, ETV was successful in 41 (67%) of 61 patients and was equally successful in cases of mechanical shunt malfunction (35 of 52 patients) and infected shunt malfunction (6 of 9 patients). The median time to ETV failure was 1.7 months in the primary group and 0.5 months in the secondary group. The majority of ETV failures occurred within the first 3 months, and thereafter, the Kaplan-Meier survival curves plateaued. There were no procedure-related deaths, and complications were seen in only 5.8% of cases.
Conclusions
The success rate of ETVs in adults is comparable, if not better, than in children. In addition to the well-defined role of ETV in the treatment of hydrocephalus caused by tumors and aqueduct stenosis, ETV may also have a role in the management of CM-I, LOVA, persistent shunt infection, and IVH resistant to other CSF diversion procedures.
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Affiliation(s)
- Michael D. Jenkinson
- 1Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Liverpool
- 2Division of Neuroscience, University of Liverpool; and
| | - Caroline Hayhurst
- 1Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Liverpool
| | - Mohammed Al-Jumaily
- 1Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Liverpool
| | - Jothy Kandasamy
- 1Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Liverpool
| | - Simon Clark
- 1Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Liverpool
| | - Conor L. Mallucci
- 1Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Liverpool
- 3Department of Neurosurgery, Royal Liverpool Children's Hospital, Liverpool, United Kingdom
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Shon HK, Vigneswaran S, Kandasamy J, Zareie MH, Kim JB, Cho DL, Kim JH. Preparation and Characterization of Titanium Dioxide (TiO2) from Sludge produced by TiCl4Flocculation with FeCl3, Al2(SO4)3and Ca(OH)2Coagulant Aids in Wastewater. SEP SCI TECHNOL 2009. [DOI: 10.1080/01496390902775810] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Osman Farah J, Kandasamy J, May P, Buxton N, Mallucci C. Subdural empyema secondary to sinus infection in children. Childs Nerv Syst 2009; 25:199-205. [PMID: 18575871 DOI: 10.1007/s00381-008-0665-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2007] [Revised: 03/22/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the impact, on morbidity and mortality, of aggressive surgical management of subdural empyema of sinus origin in children. METHOD The authors conducted a retrospective review of 20 children admitted between 2000-2007 to Alder Hay Children Hospital and The Walton centre for Neurology and Neurosurgery for subdural empyema secondary to sinus infection. Clinical presentation, duration of symptoms, radiological investigations, surgical treatment and post-operative outcome were evaluated. RESULTS Outcome was favourable in 19 cases. In four cases, there were re-accumulation requiring surgical evacuation, four patients experienced post-operative seizures but were seizure-free at follow-up. There was only one mortality in the series. CONCLUSION Subdural empyema secondary to sinus infection, although uncommon, it could be associated with a relative high morbidity and mortality rate. Early aggressive surgical and medical management with drainage of intracranial or sinus collections and antibiotics therapy lead to a low mortality or morbidity rate and good clinical outcome.
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Affiliation(s)
- Jibril Osman Farah
- Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Liverpool, UK.
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