Chandrasekaran Kaliaperumal

NHS Lothian · Department of Clinical Neuroscience

BACKGROUND CNS Cancer survivorship is rapidly improving and the awareness of the importance of fertility preservation techniques is increasing. Currently, a range of techniques are available however, oncologists are hesitant to refer patients to a reproductive specialist. OBJECTIVE The primary aim of the proposed systematic review is to assess the...

Background This report describes a case of successful repair of severed thoracic spine in a young man who presented with a penetrating stab injury to spine resulting in Brown-Séquard syndrome. Surgical technique and post-operative management is discussed. Case presentation A 34-year-old fit and well healthy man was admitted with a history of stab...

Objective There has been an increase in number of Neurosurgical publications including open access approach over the recent years. We aim to compare the Journal’s performance and its relationship to the submission fee incurred in publication. We have performed an in-depth analysis of various Neurosurgical journals’ performance in terms of the bibl...

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. Howe...

Purpose Shunt calcification is a known late sequela of ventriculoperitoneal (VP) shunt insertion and is associated with shunt malfunction. However, in some patients, while shunt functionality is preserved despite calcification of the catheters, they experience nociceptive symptoms. In this paper, the authors present their surgical experience in man...

This letter discusses the benefits of electric cars and potential role in reducing TBI.

Purpose Shunt calcification is a known late sequela of ventriculoperitoneal (VP) shunt insertion and is associated with shunt malfunction. However, in some patients, while shunt functionality is preserved despite calcification of the catheters, they experience nociceptive symptoms. In this paper, the authors present their surgical experience in man...

Aim: Perimesencephalic Subarachnoid Haemorrhage (PMSAH) is an uncommon type of SAH. Severity of PMSAH can be graded by the presence of blood in the Sylvian fissure. No study compares the outcomes from PMSAH with blood present or absent in the Sylvian fissure. Furthermore, the use of Nimodipine lacks evidence base in PMSAH. We investigated whether c...

This literature review discusses the potential significance of glymphatic system dysfunction to the pathophysiology of idiopathic intracranial hypertension (IIH). IIH is a clinical syndrome characterised by signs and symptoms which arise from raised intracranial pressure (ICP), in the absence of a clear primary cause of intracranial hypertension. T...

The National Health Service (NHS) faces substantial challenges with staffing in the face of administrative turbulence just following a global pandemic resulting in significant economic losses. This staffing crisis extends to neurosurgical training with pervasive problems with the balance between trainees and consultants. In the face of Brexit, foll...

Idiopathic syringomyelia (IS) and refractory syringomyelia (RS) are types of syringomyelia that often pose a management challenge and are associated with long-term clinical sequela. They are usually an epiphenomenon reflecting an underlying pathology where the treatment of the primary cause should be the aim for any surgical intervention. In the ca...

Smoking is a major cause of morbidity and mortality worldwide and is responsible for the death of more than 8 million people per year globally. Through a systematic literature review, we aim to review the harmful effects of tobacco smoking on degenerative spinal diseases (DSD). DSD is a debilitating disease and there is a need to identify if smokin...

We discuss a case of a young male patient with KRIT1 driven familial cavernous malformation syndrome who developed multiple brain cavernomas and recurrent episodes of intracranial bleeding. Following enrolment in the “Propranolol for Intracranial Cavernoma” (PICC) pilot trial at our institution, the boy was started on 20 - 40mg oral propranolol thr...

This report describes a case of successful repair of severed thoracic spine in a young man who presented with a penetrating stab injury to spine resulting in Brown-Séquard syndrome. Surgical technique and post-operative management is discussed. A 34-year-old fit and well healthy man was admitted with a history of stab injury to the thoracic spine a...

This book chapter is aimed to clarify when a syringomyelia can be truly defined as idiopathic and how to manage it, subsequently it will focus on the syringomyelia refractory to previous surgery proposing an algorithm of treatment for this challenging clinic-radiological condition.

Object This study aimed to retrospectively assess dexamethasone utility in pediatric CNS tumor patients over a 10-year period, to better understand dosing variability, and highlight optimal practice. Methods All pediatric CNS tumor cases managed operatively for a 10-year period at a single center were reviewed. Information was gathered on demograp...

We describe a case of a young male patient with KRIT1 driven familial cavernous malformation syndrome who developed multiple brain cavernomas, intracranial bleeding, and persistent seizures. Due to the relentless growth of cavernous malformations and recurrent intracranial bleeds, it was decided to enrol the patient in the “Propranolol for Intracra...

Abstract: Background Traumatic atlanto-occipital dislocation is an unstable injury of the cranio-cervical junction. For paediatric patients, surgical arthrodesis of the occipito-cervical junction is the recommended management. Whilst having a high success rate for stabilisation, the fusion comes with obvious morbidity of limitation in cervical sp...

e management of IIH during pregnancy is a topic of clinical importance and it may pose a management challenge as most cases of IIH occur in women of childbearing age. Although there is a consensus that pregnant women with IIH should be treated similarly to non-pregnant patients, there are uncertainties regarding optimal management. This review aims...

Abstract Objectives With the recent paradigm shift in neurosurgical publications, open access (OA) publishing is burgeoning along with traditional publishing methods. We aimed to explore costs of publication across 53 journals. Methods We identified 53 journals publishing neurosurgical work. Journal type, submission and open access charges, colour...

Abstract Background Several studies have demonstrated music intervention as a safe and inexpensive option for reducing anxiety and pain perioperatively. We performed a systematic review to evaluate its possible benefit in perioperative neurosurgical management. Methods The following databases were searched with no restrictions on publication date...

Team Edinburgh presented 13 papers in the WFNS 2022.

Background Phytotherapy; the study of extracts of natural origin in the treatment of disease, has scarcely been applied in the management of GBM. A body of literature exists studying in-vitro , the use of natural extracts against GBM cells. Given persisting poor prognoses, we evaluated, through systematic literature-review the therapeutic potential...

Objectives There has been an increasing number of reported errors in neurosurgical publications. Subsequent published correction details in the form of errata and corrigenda has not been analysed previously. Our study aims to review the published errata and corrigenda in neurosurgical literature, and we discuss the characteristics and future implic...

Objectives Neurosurgery is a tertiary specialty, and exposure to medical students limited. One way to increase engagement and offer experience in neurosurgery is through Student Selected Components (SSC), Special Study Modules (SSM), or independent projects. Our aim was to assess the educational value of such projects and evaluate their effectivene...

Sleep-related breathing disorders are a common problem in infancy and childhood. The most common type of sleep-related breathing disorder in this age group is obstructive sleep apnea syndrome (OSAS), generally caused by factors affecting airway patency, such as tonsillar hypertrophy or obesity. However, in adults OSAS can also be caused by processe...

This article focuses on metacognition and mechanisms to deal with fear during a neurosurgical emergency.

Background Mentorship has long since been acknowledged as an integral part of Neurosurgical training. The authors sought to evaluate the state of mentorship in Neurosurgical training in the United Kingdom (UK). Methods A 28-point questionnaire was sent to all neurosurgical trainees in the UK and Ireland via the British Neurosurgical Trainee’s Asso...

One of the aims of the “2021 WHO Classification of Tumours of the Central Nervous System (CNS)” is to provide practical guidance to pathologists and neuro-oncology specialists around the world in order to benefit patients with CNS tumors.¹ This “international standard” incorporates numerous molecular changes with clinicopathologic utility that are...

This report describes a case of successful repair of severed thoracic spine in a young man who presented with a penetrating stab injury to spine resulting in Brown-Séquard syndrome. Surgical technique and post-operative management is discussed. A 34-year-old fit and well healthy man was admitted with a history of stab injury to the thoracic spine a...

Introduction Burnout is becoming an increasingly recognised phenomenon within the medical profession. This study aims to investigate the presence of burnout amongst neurosurgical trainees in the UK and Ireland as well as investigating potential exacerbating and protective factors. Method An online survey was sent to all neurosurgical trainees in t...

This letter explores the psychological assessment for Neurosurgical trainees after their selection to commence Neurosurgical training.

Background: The best surgical treatment for adult Chiari-1 malformation still remains widely debated. Objectives: This study aimed to assess the efficacy of posterior fossa decompression and duraplasty with arachnoid preservation compared to arachnoid dissection for the treatment of adult Chiari-1 malformation. Methods: Two reviewers (MOG and...

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 communit...

Neurosurgeons can learn from High performance sport and this letter describes how and why?

Background Colloid cysts of third ventricle are rare lesions which may present with symptoms of acute hydrocephalus. We report a case of acute obstructive hydrocephalus secondary to third ventricular colloid cyst and its management during 1 st trimester pregnancy. Case Description A 31-years-old lady presented to the emergency department with redu...

At the dawn of neurosurgery, medical illustrators were prominent members of the neurosurgical team, drawing key parts of operations that acted as part of the operation note and were used chiefly to disseminate information and educate the wider medical community. In recent years, written operation notes have become the norm, whether the traditional...

Should Neurosurgeons Care About Their Strength and Conditioning?

Abstract Introduction Cerebellar tonsils descent seen on brain MRI is, along with other findings, a recognized radiological sign of possible spontaneous intracranial hypotension (SIH). The short-term outcome of SIH is usually favorable with symptoms improvement and reversibility of the low-lying tonsils. Nevertheless, data on the long-term outcome...

Objective: This study is aimed to compare and evaluate any differences in clinical and radiological outcomes of different operative techniques of cranio-cervical decompression (CCD) performed in adults with symptomatic Chiari malformation type I (CM-1) within a single tertiary neurosurgical center. Methods: A retrospective review using the Hospital...

Objective This study is aimed to compare and evaluate any differences in clinical and radiological outcomes of different operative techniques of cranio-cervical decompression (CCD) performed in adults with symptomatic Chiari malformation type I (CM-1) within a single tertiary neurosurgical center. Methods A retrospective review using the Hospital...

We aim to address how Balint groups can be utilized for Neurosurgical training.

Vascular Ehlers-Danlos (vEDS) is a rare form of the Ehlers-Danlos Syndrome (EDS) where arterial fragility results from mutations in the gene that encodes type III collagen. The disease can lead to major neurological complications including carotico-cavernous fistulae (CCF), aneurysms of the Circle of Willis and endovascular procedures have an incre...

Objective: Contention exists regarding appropriate classification and management of spinal lipomas (SLs). Given the heterogeneity of SLs, omissions and overlap between surgically incomparable groups exist in conventional classification systems. The new classification of spinal lipoma (NCSL) recently proposed by Morota et al. delineates morphology...

The use of computer-aided design and computer-aided manufacturing in oral and maxillofacial surgery is an ever-growing field.The availability of 3D models, cutting guides, and customised surgical instruments gives surgeons the opportunity to modify and improve their surgical procedures.Here, we discuss the use of computer-aided design-computer-aide...

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...

Neurenteric cysts (NC) are rare, congenital lesions with epithelial mucin-secreting walls.They can occur anywhere along the neuroaxis and an intrinsic midbrain cyst is anecdotal.Surgical management may pose a challenge due to the location and adhesion of the cyst wall to the surrounding brainstem. We describe the first case of paediatric NC that wa...

The use of computer-aided design and computer-aided manufacturing in oral and maxillofacial surgery is an ever-growing field. The availability of 3D models, cutting guides, and customised surgical instruments gives surgeons the opportunity to modify and improve their surgical procedures. Here, we discuss the use of computer-aided design-computeraid...

Objectives To 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. Design Prospective study form 2015–2017. Subjects Paediatric non-syndromic metopic craniosynostosis cohort. Methods We p...

Haemangiopericytomas are a group of aggressive soft tissue sarcomas that originate from the pericytes in the walls of capillaries. Local invasion of the surrounding structures is not uncommon. Symptoms depend on the location, size and grade of tumour. Coexistence with a benign tumour in the same location is very rare. We report an interesting case...

Acute cerebellar ataxia is the most common cause of acute ataxia in children and it usually runs a self-limiting and ultimately benign clinical course. A small proportion of children have evidence of inflammatory swelling in the cerebellum. Many of these children suffer more severe and potentially life-threatening forms of cerebellar ataxia and may...

Acute cerebellar ataxia is the most common cause of acute ataxia in children and it usually runs a self-limiting and ultimately benignclinical course. A small proportion of children have evidence of inflammatory swelling in the cerebellum. Many of these childrensuffer more severe and potentially life-threatening forms of cerebellar ataxia and may n...

Sinus pericranii is a rare cranial venous anomaly in which there is an abnormal communication between intracranial dural sinuses and extracranial venous structures, usually via an emissary transosseous vein. We report the case of a 10-year-old boy who was successfully managed conservatively. The clinical findings, investigations and management are...

OBJECTIVE The aim of this study was to assess the outcome of neurosurgical treatment in children with bleeding diathesis and also to evaluate the current management plan applied in the authors’ service. METHODS The authors retrospectively analyzed all cases in which neurosurgical procedures were performed in pediatric patients presenting with intr...

When can I fly after neurosurgery? Is a common question asked by patients. This letter addresses that question.

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...

The authors describe the case of a 3-year-old boy with a giant congenital vertex hemangioma who underwent presurgical embolization with Onyx (ethylene-vinyl alcohol copolymer dissolved in dimethyl sulfoxide) and Glubran (N-butyl-2-cyanoacrylate). This vascular tumor had no intracranial vascular communication as assessed by pre-embolization MRI and...

A 72 year old Caucasian female presented to the acute medicine unit with an episode of loss of consciousness and reports of daytime sleepiness with descriptions of an apathetic facade and somnolence from her family. Her past medical history includes mechanical aortic valve replacement and paroxysmal AF for which she was anticoagulated with warfarin...

Aims: There is a recent trend toward delivering neurosurgical care in large supraregional centers with intradepartmental subspecialization. We report a 14-year prospective audit of a single surgeon's experience of intracranial tumor surgery with an emphasis on complications. Methods: A total of 616 procedures were performed on 596 patients of which...

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...