Asfand Baig Mirza

Barking, Havering and Redbridge University Hospitals NHS Trust

Background 5-Aminolevulic Acid guided surgery (5-ALA-GS) improves the extent of resection and progression free survival in patients with glioblastoma multiforme (GBM). Methods Single-center retrospective cohort study of adult patients with GBM who had surgical resection between 2013 and 2019, 5-ALA guided versus a non 5-ALA cohort. Primary outcome...

Introduction Cauda equina syndrome (CES) can have devastating neurological sequelae if surgical treatment is delayed. Out-of-hours surgeries (weekdays 1800-0800 and all weekend operations) can potentially result in higher rates of intra-operative complications, resulting in worse outcomes. In this study, we present our outcomes in CES patients over...

Objectives Cerebrospinal fluid (CSF) leak following endoscopic transsphenoidal surgery (TSS) remains a challenge and is associated with high morbidity. We perform a primary repair with fat in the pituitary fossa and further fat in the sphenoid sinus (FFS). We compare the efficacy of this FFS technique with other repair methods and perform a systema...

BACKGROUND: Spontaneous spinal epidural hematoma (SSEH) is a rare pathology, which carries a significant morbidity. OBJECTIVE: To review our institutional experience of surgically managed patients with SSEH, seeking to better understand clinical prognostic factors related to postoperative outcomes and thereby improve counseling of patients befor...

MGMT promoter methylation is related to the increased sensitivity of tumour tissue to chemotherapy with temozolomide (TMZ) and thus to improved patient survival. However, it is unclear how the extent of MGMT promoter methylation affects outcomes. In our study, a single-centre retrospective study, we explore the impact of MGMT promoter methylation i...

Introduction The integration of novel electronic informed consent platforms in healthcare has undergone significant growth over the last decade. Adoption of uniform, accessible, and robust electronic online consenting applications is likely to enhance the informed consent process and improve the patient experience and has the potential to reduce me...

Introduction Germinal matrix / intraventricular haemorrhage (GMIVH) remains a significant complication of prematurity. The more severe grades are associated with parenchymal haemorrhagic infarction (PHI) and hydrocephalus. A temporising procedure is usually the first line in management of neonatal post-haemorrhagic hydrocephalus (nPHH) as the risk...

Simple Summary To optimise patient outcomes in tumour surgery in visual eloquent areas, it is crucial to preserve the integrity of the visual pathways. The aim of our prospective study is to examine the use of visual evoked potentials (VEPs), utilising different techniques such as transcranial and direct cortical recording. In a cohort of 39 patien...

Background: In patients with intracranial aneurysm presenting with spontaneous subarachnoid hemorrhage (SAH), 15% of them could be missed by the initial diagnostic imaging. Repeat delayed imaging can help to identify previously undetected aneurysms, however, the cost-effectiveness of this strategy remains uncertain. Objective: The aim of this st...

Background Diffuse hemispheric glioma, H3 G34-mutant, is a novel paediatric tumour type in the fifth edition of the WHO classification of CNS tumours associated with an invariably poor outcome. We present a comprehensive clinical, imaging and pathological review of this entity. Methods Patients with confirmed H3 G34R-mutant high-grade glioma were...

Primary meningeal melanocytomas are extremely rare, benign tumours arising from the leptomeninges. While they are considered to be benign lesions, there is potential for their growth and transformation into malignant melanomas. They are commonly found in the cervical spine, with a decreased incidence in the thoracic and lumbar regions. We present a...

Objective Despite progress in endonasal skull-base neurosurgery, cerebrospinal fluid (CSF) rhinorrhoea remains common and significant. The CRANIAL study sought to determine 1) the scope of skull-base repair methods used, and 2) corresponding rates of postoperative CSF rhinorrhoea in the endonasal transsphenoidal approach (TSA) and the expanded endo...

Background Cauda equina syndrome (CES) results from nerve root compression in the lumbosacral spine, usually due to a prolapsed intervertebral disc. Evidence for management of CES is limited by its infrequent occurrence and lack of standardised clinical definitions and outcome measures. Methods This is a prospective multi-centre observational coho...

Parkinson’s disease (PD) is a complex neurodegenerative disorder, leading to impairment of various neurological faculties, including motor, planning, cognitivity, and executive functions. Motor- and non-motor symptoms of the disease may intensify a patient’s restrictions to performing usual tasks of daily living, including driving. Deep Brain Stimu...

Spontaneous spinal epidural haematoma (SSEH) is a rare disease defined as blood accumulation within the vertebral epidural space without a cause identified, which can lead to severe neurological deficits. We aim to provide a comprehensive understanding of the prognostic factors affecting surgical outcomes in true SSEH and propose a critical time fr...

Augmented and virtual reality (AR, VR) are becoming promising tools in neurosurgery. AR and VR can reduce challenges associated with conventional approaches via the simulation and mimicry of specific environments of choice for surgeons. Awake craniotomy (AC) enables the resection of lesions from eloquent brain areas while monitoring higher cortical...

Study Design Retrospective cohort study. Objectives Intraoperative neurophysiological monitoring (IONM) is widely used in spinal neurosurgery, particularly for intramedullary tumours. However, its validity in intradural extramedullary (IDEM) spinal tumours is less clearly defined, this being the focus of this study. Methods We compared outcomes f...

A Proposal for Supplemental Cortical and novel Subcortical Maps to the Motor Homunculus

Background Augmented and virtual reality (AR, VR) are becoming promising tools in neurosurgery. AR and VR can reduce challenges associated with conventional approaches via the simulation and mimicry of specific environments of choice for the surgeons. Awake craniotomy (AC) enables the resection of lesions from eloquent brain areas while monitoring...

Background Despite operative and adjuvant therapies, glioblastoma remains incurable, with the extent of resection being one of few treatments that can improve survival. To improve resection, operative adjuncts are used, with neuronavigation and 5-aminolevulinic acid (5-ALA) recommended as a standard of care in those aimed for maximal safe resection...

Introduction Craniopharyngiomas are benign tumours mainly confined to the cranial cavity in the suprasellar region. Research Question and Case Description: We present a rare case of an aggressive papillary craniopharyngioma with disseminated spinal intradural disease. A 67-year-old woman presented with a 4-month history of headache, visual disturba...

Objectives To develop a nomogram that could predict spontaneous stone passage (SSP) in patients presenting with acute ureteric colic who are suitable for conservative management. Patients and Methods A 2517 patient dataset was utilised from an international multicentre cohort study (MIMIC, A Multi-centre Cohort Study Evaluating the role of Inflamma...

Abstract Purpose Intramedullary spinal cord tumours (IMSCTs) are comparatively rare neoplasms. We present a single-centre clinical case series of adult patients with surgically managed IMSCTs. Methods We performed a retrospective analysis of electronic patient records in the time period spanning July 2010 to July 2021. All adult patients that had...

Infected cephalhaematomas are rare and can lead to complications such as sepsis, meningitis and osteomyelitis. We present an infected cephalhaematoma in a neonate with resultant underlying osteomyelitis and a review of the literature. Our patient presented 6 days following birth with a fever and a swelling consistent with cephalhaematoma. He was ma...

Purpose Evaluation of the presentation and outcomes of different surgical treatment approaches for spinal intradural arachnoid cysts (SIAC). Methods Cases were identified from electronic records of two major neurosurgical centres in London over the last 10 years (October 2009–October 2019) that have been surgically treated in both institutions. Cl...

Objective: The growth characteristics of vestibular schwannomas (VSs) under surveillance can be studied using a Bayesian method of growth risk stratification by time after surveillance onset, allowing dynamic evaluations of growth risks. There is no consensus on the optimum surveillance strategy in terms of frequency and duration, particularly for...

Background: The benefits of using 5-aminolevulinic acid (5-ALA) in resection of grade IV tumors have been extensively researched. However, few studies have investigated the use of 5-ALA in grade III gliomas. Objective: To discover whether 5-ALA provides significant benefit in assisting resection of grade III gliomas. Methods: A single-center,...

Neurosurgery has provided an alternative option for patients with refractory psychiatric indications. Lesion procedures were the initial techniques used, but deep brain stimulation (DBS) has the advantage of relative reversibility and adjustability. This chapter sets out to delineate the current evidence for DBS use in paediatric psychiatric condit...

To the Editor: We read with great enthusiasm the article published by Khalafallah et al.1 The authors address an utmost point of importance in contemporary glioma surgery: an operational definition for supratotal resection (SpTR) in glioblastoma (GBM). We believe this is a potential landmark article on this subject because it paves the way toward...

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The terminal ventricle (TV) of Krause is a rare cystic dilation of the conus’ central canal. Due to limited understanding surrounding its pathophysiology, optimal management remains controversial. We report a 25-year-old female presenting with acute paraparesis. Magnetic resonance imaging spine revealed a cystic conus medullaris lesion in keeping w...

We propose a supplemental map to Penfield motor homunculus in the pre-central cortex and a novel subcortical map of the cortico-spinal tract that are accurate and essential for safe surgery in patients with eloquent brain lesions.

The identification of the visual pathway during surgery for tumors in visual areas is challenging. We present our experience in visual pathway mapping and monitoring, describing the role of direct mapping of the optic radiations and different techniques of VEPs monitoring, employing both Scalp Recording (SR) and the use of strip electrode positione...

Objective Spinal intradural arachnoid cysts (SIACs) are a rare pathology that can arise via outpouchings of the arachnoid layer in the spinal canal resulting in neurological deficit. We present a systematic literature review regarding current surgical techniques employed in the management of SIACs as well as discussing the prevailing hypotheses sur...

Objectives Chordoma is a rare neoplasm of the neuraxis derived from remnants of the primitive notochord. The importance of wide margins and use of adjuvant therapy in spinal chordomas are still contentious points in the management of spinal chordomas. We conducted a systematic review of the surgical management of spinal chordomas alongside our 10-y...

Ki67 is a marker for proliferation of a given cell population. Low expression of Ki67 may be associated with a favourable outcome. We investigate how the proliferation index correlates with the location, morphology and behaviour of WHO grade II ependymomas with a single-centre cohort study of adult patients admitted for surgery of WHO grade II epen...

Background: There are many questions that remain unanswered regarding outcomes following cranioplasty including the timing of cranioplasty following craniectomy as well as the material used. Objective: To establish and evaluate 30-d outcomes for all cranial reconstruction procedures in the United Kingdom (UK) and Ireland through a prospective mu...

Penfield's motor homunculus describes a caricaturised yet useful representation of the map of various body parts on the pre-central cortex. We propose a supplemental map of the clinically represented areas of human body in pre-central cortex and a novel subcortical corticospinal tract map. We believe this knowledge is essential for safe surgery in...

Objective: The study analyzes the monitoring and subcortical mapping techniques for intra-axial visual eloquent tumors and their impact in the visual outcome. Design: It is a single-center prospective study from 2018- 2020. Subjects: Patients with intra-axial visual eloquent tumors(n=34) were included in the study. Methods: Single-center prospec...

Abstract Objective: We summarise our experience and challenges faced with the non-navigated intraoperative ultrasound in cranial neuro-oncological surgery at a tertiary neurosurgical centre in UK. Design: It is a retrospective single-centre cohort study for a period of 2 years between Dec 2017-Dec 2019. Subjects: Adult patients(n=90) referred t...

Abstract Objective: The study aims to propose a supplemental map of the clinically represented areas of human body in pre-central cortex and a novel subcortical corticospinal tract map that are accurate and essential for safe surgery in patients with eloquent brain lesions. Design: It is a 5-year single-centre retrospective cohort study between 2...

Objective: Intradural-extramedullary tumours are rare tumours. Advancements in imaging, surgical techniques, and intraoperative monitoring has led to greatly improved prognosis over the years. However, it is difficult to establish specific guidelines for diagnosis and management of IDEM tumours. We present a clinical case series of surgically opera...

Objectives: The SELKaM Major Trauma Network serves a population of 5.5 million people, enlisting 12 regional hospitals. A weekly Trauma Network Virtual Clinic has expanded the reach of written Consultant Neurosurgical advice for inpatients ineligible for transfer to a major trauma centre. The initiative aims to improve equity of access to neurosur...

Aim Results Of the 439 patients: 276 underwent multilayer repair 68 underwent FFS repair 95 required no repair. In total, 71(16.2%) of patients had a significant persistent postoperative CSF leak following eTSS surgery at our institution over the past 10 years The CSF leak rate was significantly lower in the FFS group (4.4% vs 16.2% p<0.001). Patie...

Objectives: The neurosurgical workplace is fast-paced with workflow extensions to a multitude of services managing dynamic situations. To aid assimilation for junior trainees during inductions to the neurosurgery department, a comprehensive handbook was implemented for their perusal. The initiative aimed to streamline transitions into the role and...

Method Results • Our LD infection rate over 10 years in 450 patients is 14%. • Factors associated with increased incidence of LD infection • Time between LD insertion and removal (unadjusted OR 1.884 [1.330, 2.668]) • Number of CSF samples (unadjusted OR 8.877[4.975, 15.840]). • Factors associated with reduced incidence of lumbar drain infection •...

Method Results A total of 166 patient cases were reviewed throughout our quality improvement period. Following interventions in cycle 2, a reassessment of compliance with BTS guidelines was undertaken in October 2020, 18 weeks after our baseline measurement.  A percentage of 60.9% (53 of 87) of all patients had a valid oxygen prescription, includi...

Objectives Having previously published some of our initiatives to increase exposure to neurosurgery at the undergraduate level as well as their positive impact, we set out to assess the impact of a neurosurgical shadowing scheme open to medical students. We assessed the efficacy of the scheme at harnessing the medical students’ interest in the spec...

Objectives Chordoma is a rare neoplasm of the neuraxis derived from remnants of the primitive notochord. These tumours are slow growing and osseodestructive in nature, and are challenging to manage from both surgical and oncological perspectives. Chordomas most commonly arise in the sacrum and clivus but can on occasion be found in the mobile spine...

Objectives Chordoma is a rare tumour of the primitive notochord that can arise anywhere along the neuraxis with a tendency to occur at the clivus and in the sacro-coccygeal region. Despite being histologically low-grade, they exhibit malignant behaviour owing to their high recurrence rate and challenges with total excision. We present a single inst...

Objectives: Cauda Equina Syndrome (CES) is a surgical emergency that can have devastating consequences if surgery is delayed. Despite this, performing surgery out of hours can result in considerably higher rates of serious intraoperative complications, potentially worsening outcomes for patients. Due to this, the impact of expediting surgery is con...

Objectives: With increasing availability and frequency of neurological imaging over the past decades, greater numbers of unruptured intracranial aneurysms (UIAs) are being detected, resulting in a dilemma for both patient and clinician. Our health economic study uses real-world data to compare the lifetime costs and consequences of current manageme...

We have recently introduced a full sized operative table beanbag surgical positioner (Vacuform 2.0©) to our operating theatres. • The operative beanbag is able to be positioned while soft, mould to the patients position and then solidify with vacuum suction. • Benefits include: speed, avoiding pressure complications, achieving maximal surgical acce...

Introduction Isolated acute bilateral foot drop due to degenerative spine disease is an extremely rare neurosurgical presentation, whilst the literature is rich with accounts of chronic bilateral foot drop occurring as a sequela of systemic illnesses. We present, to our knowledge, the largest case series of acute bilateral foot drop, with trauma an...

Objectives Chordomas are rare, slow-growing, and osteo-destructive tumors of the primitive notochord. There is still contention in the literature as to the optimal management of chordoma. We conducted a systematic review of the surgical management of chordoma along with our 10-year institutional experience. Design A systematic search of the litera...

Tarlov cysts are cyst like lesions of the spinal nerve roots. With a reported incidence ranging from 1 to 5%, these lesions are fairly rare, benign and often asymptomatic. When they cause neural compression they may become symptomatic with sensory, motor, bowel/bladder and sexual dysfunction. The treatment of Tarlov cysts with symptoms is controver...

Introduction: Penfield’s motor homunculus describes a caricaturised yet useful representation of the map of various body parts on the pre-central cortex. We propose a supplemental map of the clinically represented areas of human body in pre-central cortex and a novel subcortical corticospinal tract map that are accurate and essential for safe surge...

Introduction Neurosurgery has provided an alternative option for patients with refractory psychiatric indications. Lesion procedures were the initial techniques used, but deep brain stimulation (DBS) has the advantage of relative reversibility and adjustability. This review sets out to delineate the current evidence for DBS use in psychiatric condi...

Objective Spontaneous spinal subdural hematoma (SSSDH) is exceedingly rare, with significant morbidity in most patients. Acute neurologic deficit in the context of a SSSDH is considered a neurosurgical emergency. We performed a literature review and compared the results with our institutional experience to evaluate the risk factors and neurologic o...

Background: Type II odontoid fractures are a common cervical fracture in older people. Lower osseous-union rates are reported in those treated conservatively compared to surgically; however, the clinical relevance of a nonunion is unknown. Objective: To compare pain, disability, and quality of life in older people following conservative manageme...

Background: The authors present the first reported case of a fibroblastic reticular cell tumor (FRCT) presenting with spinal cord compression. FRCTs are the rarest subset of dendritic cell tumors, a specific group of hematologic malignancies. FRCTs reportedly behave similar to low-grade sarcomas as opposed to malignant tumors. Case description:...

Background: Cauda Equina Syndrome (CES) is a neurosurgical emergency warranting urgent surgical decompression. Treatment delay may precipitate permanent adverse neurological sequelae. CES is a clinical diagnosis, corroborated by radiological findings. Atypical presentations should be acknowledged to avoid inappropriately rejected diagnoses. Case...

Objectives: To assess the relationship of white blood cell count (WBC) and other routinely collected inflammatory and clinical markers including stone size, stone position, and medical expulsive therapy use (MET), with spontaneous stone passage (SSP) in a large contemporary cohort of patients with acute ureteric colic, as there are conflicting data...

Introduction & Objectives There is conflicting evidence on the role of medical expulsive therapy (MET) in spontaneous stone passage in patients with acute ureteric colic. Randomised trial data has not shown a role for MET use, though these have been underpowered to explore its role in specific patient subgroups. It is unknown whether MET use may h...

In neurosurgery, much emphasis has recently been placed on theatre cancellation and time utilization as a key hospital management performance indicator. We sought to evaluate our unit's theatre throughput efficiency and identify the causes of elective surgery cancellations. We retrospectively audited all scheduled elective neurosurgical procedures...

Introduction Disorders of growth and metabolism are a significant public health problem, responsible for the majority of paediatric endocrinology referrals and a significant number of consultations with general practitioners. Correlation of skeletal age (SA) and chronological age (CA) alongside other clinical findings is key to the diagnosis and ma...