Alistair Jukes

Royal Adelaide Hospital | RAH · Department of Neurosurgery

The authors present a case of an orbital apex venous malformation that presented with an intermittent oculomotor nerve palsy over a 15-year period. Radiologically, the lesion presented as a well-circumscribed orbital mass with T2 hyperintensity and enhancement that could only be demonstrated on 2-hour delayed phase imaging. The venous malformation...

Objective Radiological prediction of Ki-67 plays a crucial role in determining the clinical outcomes of meningioma patients. The aim of this review is to comprehensively review the literature to synthesize evidence on how accurate radiological prediction of the Ki-67 proliferation index is to determine the Ki-67 index's association with clinical ou...

Prolactinomas are the most common hypersecretory pituitary adenoma. The traditional first line therapy is dopamine agonists, which are highly effective and tolerated in the majority of cases. However, dopamine agonists have the potential for psychiatric complications such as psychosis, impulse control disorders and anxiety/depression. It has been r...

Background Endovascular thrombectomy (EVT) is the standard of care for patients with acute ischemic stroke (AIS) and intracranial vessel occlusion. Tandem occlusions (TO) comprise 20% of all anterior circulation AIS and are related to a poorer prognosis. The optimal EVT treatment strategy remains controversial. Our main objective was to determine i...

Introduction: Pituitary neuroendocrine tumours (PitNETs) are common accounting for 10 to 25 % of all intracranial tumours. This project describes the feasibility of developing a novel membrane-based biomarker that could be used for fluorescent guided surgery. The aim was to catalogue the differential expression of membrane proteins between non-fun...

BACKGROUND AND OBJECTIVES Endoscopic skull base surgery is a subspecialty field which would benefit significantly from high-fidelity surgical simulators. Giving trainees the opportunity to flatten their learning curve by practicing a variety of procedures on surgical simulators will inevitably improve patient outcomes. METHODS Four neurosurgeons,...

Background The outcomes in pituitary surgery have dramatically changed over the past 130 years. Endoscopic endonasal transsphenoidal approaches are now an accepted method for operating on pituitary tumors, a skillset which takes time to develop. The Australian health care framework provides a unique mixture of public and private care for a geograph...

Objective: In South Australia endoscopic endonasal approach (EEA) pituitary surgery has been practiced since 2006, largely by two neurosurgeons with a small fellowship-trained otolaryngology team. The aim of this cohort study was to determine if a “learning curve” can be established over this time period, as represented by structural and endocrine...

The cloverleaf skull deformity remains among the most complicated craniofacial conditions to successfully manage. Many cases achieve largely unsatisfactory outcomes due to the requirement for frequent reoperation on the cranial vault and failure to deal with all the elements of the craniofaciostenosis in a timely fashion. Early cranial vault surger...

Recent literature demonstrates that a learning curve exists for endoscopic pituitary surgery. However, there is significant variability in the way these studies report their outcomes. This study aims to systematically review the literature regarding outcomes for endoscopic pituitary surgery and how this may be related to a surgical learning curve....

Olfactory groove meningiomas (OGM) are a skull base neoplasm that represents between 8 and 13% of all intracranial meningiomas. Approach selection focuses on achieving frontal lobe decompression, gross total resection and vision preservation. Recently, there has been a focus on olfaction and considering its preservation as a quality-of-life outcome...

Objective: Rapid and efficacious haemostasis is paramount in neurosurgery. Assessing the efficacy and short- and long-term safety of haemostatic agents utilised within cerebral tissue is essential. This pilot study investigates the haemostatic efficacy and long-term safety of a novel beta-chitin patch against traditionally used agents, bipolar and...

Background Intraoperative hemorrhage is a major cause of poor post-operative outcome. Beta-chitin patch has previously been found to be an effective haemostat, but whether modifying the patch can improve its efficacy and safety, remains unknown. In this study, beta-chitin patches were modified using polyethylene oxide, Pluronic-F127 (Chi/F127), cal...

Background: Statistically significant positive results are more likely to be published than negative or insignificant outcomes. This phenomenon, also termed publication bias, can skew the interpretation of meta-analyses. The widespread presence of publication bias in the biomedical literature has led to the development of various statistical appro...

Haemorrhage is a major nuance in neurosurgery since blood can distort the surgeon’s field of view and increase the risk of post-operative complications. Currently a variety of commercially available haemostats have been approved for use in neurosurgery, but they have caveats to their use in the brain, including, localised tissue compression, neural...

Background Small studies are prone to lower methodological quality and publication bias, and are more likely to report greater beneficial effects. A meta-epidemiological study was undertaken to investigate and quantify the impact of small study effects on meta-analyses in the neurosurgical literature. Methods A PubMed search was used to procure me...

Beta-chitin patch has previously been proven to be an effective haemostat, but whether modifying the patch affects its efficacy and safety, remains unanswered. In this study, the patch was modified using polyethylene oxide, Pluronic-F127, calcium, increased thickness or polyphosphate, and their effect on the process of haemostasis and cytotoxicity...

Objectives The COVID-19 pandemic has resulted in huge disruption to healthcare delivery worldwide. There is a need to balance the urgent needs of the neurovascular patient population with the desire to preserve critical inpatient hospital capacity. It is incumbent on neurointerventionalists to advocate for their patients to minimise future disabili...

Carotid artery pseudoaneurysm is a rare complication of transsphenoidal surgery, usually diagnosed within 90 days post procedure. Sequelae of pseudoaneurysm rupture, such as severe epistaxis or carotid cavernous fistula (CCF), have significant morbidity and mortality. A case of epistaxis from pseudoa-neurysm rupture over a decade after transsphenoi...

Introduction: Spinal laminectomy is a common procedure performed to relieve neural compression in patients suffering from myelopathy or radiculopathy. However, up to 40% of patients suffer from persistent post-operative pain and disability, a condition known as Failed Back Surgery Syndrome (FBSS). Excessive scarring in the surgical bed is implicat...

OBJECTIVE The objective of this study was to evaluate the trends in reporting of p values in the neurosurgical literature from 1990 through 2017. METHODS All abstracts from the Journal of Neurology, Neurosurgery, and Psychiatry (JNNP), Journal of Neurosurgery (JNS) collection (including Journal of Neurosurgery: Spine and Journal of Neurosurgery: P...

Vestibular schwannoma (VS) is a brain tumour arising from Schwann cells that is typically closely associated with the vestibulocochlear nerve. Post-operative headaches (POH) are a potentially common complication of surgery for VS. Greatly differing rates of POH have previously been reported, particularly with different surgical approaches. The aim...

Background: Malignant squamous cell differentiation of an epidermoid cyst can carry a significantly poor prognosis and very little is known about this entity. Case description: We present the case of a 35-year-old lady, with primary malignant squamous cell carcinoma (SCC) arising from a previously partially resected cerebellopontine angle epider...

Background: Crushed autologous muscle is used in skull base surgery in the acute phase of major arterial hemorrhage to stop bleeding. The mechanism of this is not yet clear, but is thought to involve the formation of a platelet plug, which seals the vessel wall defect but still allows ongoing blood flow to the brain. Methods: In this study we us...

Background: Major vessel hemorrhage in endoscopic, endonasal skull-base surgery is a rare but potentially fatal event. Surgical simulation models have been developed to train surgeons in the techniques required to manage this complication. This mixed-methods study aims to quantify the stress responses the model induces, determine how realistic the...

Introduction: Endoscopic transsphenoidal pituitary surgery has become the mainstay of pituitary surgery and evidence suggests that it results in better surgical outcomes in terms of removal of tumor burden. Aim: To present the surgical results of a single neurosurgeon operating in a Skull Base Unit over ten years of endoscopic pituitary surgery and...

Introduction: As indications and approaches in endoscopic skull base surgery expand, the potential for major vessel hemorrhage in areas that are relatively anatomically constrained increases. These expanded endonasal approaches can carry risks of cavernous carotid injury of up to 5–9%. This study examines methods to expand the surgeon’s armamentari...

Introduction: Muscle patches are considered the current gold standard for hemorrhage control in major vessel hemorrhage in the skull base, with many case reports of its use in situations such as cavernous carotid injury during pituitary surgery. This is thought to be due to the formation of a platelet plug seal at the site of the vessel defect, how...

Carotid endarterectomy is a commonly performed operation to remove plaque at the region of the carotid bifurcation. We present our technique to keep the field clear and to minimize potential trauma to the carotid using a neurosurgical external ventricular drain passed behind the common carotid and placed in the dependent position under the arteriot...

Nano-hemostats are synthetic amino acid chains that self-assemble into a scaffold under certain conditions. These have been shown to be effective in stopping bleeding in small animal models of hemorrhage. Proposed mechanisms for their effect are that they form a mesh analogous to the fibrin plug in native hemostasis and that they may potentiate bot...

Pituitary adenomas are the most common tumours found in the sellar region and, when both functioning and non-functioning adenomas are combined, account for 7-15% of primary brain tumours in adults. Rarely, admixed or discrete groups of cells comprising two or more tumour subtypes are seen; the so-called 'collision tumour'. We present a case of a 54...