Matthew Crocker

• St George's Healthcare NHS Trust

Cauda equina syndrome is considered to be a clinical emergency and is an area associated with a high risk of litigation. An understanding of cauda equina syndrome is important not only to orthopaedic surgeons and neurosurgeons, but also to GPs, emergency department staff, and other specialists to whom these patients may initially present. Diagnosis...

Background Our aim was to develop a new protocol for MGMT immunohistochemistry with good agreement between observers and good correlation with molecular genetic tests of tumour methylation. We examined 40 primary brain tumours (30 glioblastomas and 10 oligodendroglial tumours) with our new technique, namely double-labelling immunohistochemistry for...

Tumor vasculature is a promising therapeutic target in glioblastoma. Imaging tumor blood flow may help assess the efficacy of anti-angiogenic treatments. We determined the clinical usefulness of stable xenon CT performed preoperatively in patients with glioblastoma. This is a prospective cohort study. We determined absolute tumor blood flow before...

To describe a novel technique for constructing polymethylmethacrylate (acrylic) cranioplasty to repair large cranial defects. A rim of bone is cut from the edge of the skull defect using a craniotome. This bony rim provides a scaffold to fashion the acrylic cement away from the patient thus avoiding thermal injury to the brain. The inner edge of th...

We report a case of artefactual C2 fracture caused by a superimposed incisor tooth in a seven-year-old boy. CT refuted the diagnosis. Trauma clinicians should be aware of this entity to guide correct interpretation of trauma X-rays.

This chapter considers surgical management of spinal tumours. Surgical considerations for spinal tumours relate to various clinical aspects: the nature of the patient’s symptoms and the prospect of surgery improving them or at least preventing decline, either due to continued growth of the tumour or bony destruction and instability. There is in add...

A patient marked preoperatively for ulnar nerve decompression under general anaesthesia was found to have symmetrical operative site markings. The correct skin mark was transferred to the other side by her sleeping position the night before surgery. Skin marking is an adjunct to safe surgery but is not failsafe.

In response to the paper by Al-Jabi and El-Shawarby (Value of C-reactive protein after neurosurgery: a prospective study. Br J Neurosurg 2010; 24(6): 653-9.), our own study of C-reactive protein (CRP) trends in 146 intracranial abscess patients produced contradictory findings. We have found that CRP levels during hospital stay had neither a correla...

Sir Victor Horsley is well known for his pioneering work as a neurological surgeon but his vital contributions to the regulation and advancement of the medical profession are less well understood. This archived literature review of The Horsley collection of papers (UCL Special Collections Library) documents Sir Victor's campaign for the autonomy of...

Spontaneous aneurysmal subarachnoid haemorrhage (SAH) is managed as a neurosurgical priority with guidelines and published literature emphasising the identification and the treatment of the ruptured aneurysm within 48 h of ictus. We audited the timing of management of good grade (WFNS 1 & 2) SAH in a neurosurgical unit in Greater London. We also re...

We present a case of spontaneous migration of a metal rod into the brain. No causative factor was identified but possible mechanisms for this occurrence are considered, and the importance of correct early management of this unusual injury emphasised.

Angiogenesis plays a key role in glioblastoma biology and antiangiogenic agents are under clinical investigation with promising results. However, the angiogenic profiles of patients with glioblastoma and their clinical significance are not well understood. Here we characterize the serum angiogenic profile of patients with glioblastoma, and examine...

District general hospital scanners have historically been linked to regional neuroscience units for specialist opinions on scans and to make decisions on transfer of patients requiring neurosurgical management. The implementation of digital picture archiving and communication systems (PACS) in all hospitals in the UK has disrupted these dedicated l...

The Excimer Laser Assisted Non-occlusive cerebral vascular Anastomosis (ELANA) has been proposed as a major advance in the field of cerebral revascularisation. Appreciable challenges remain, however. We report our experience with introducing this technique to the UK and review the field of cerebral revascularisation and flow replacement. Retrospect...

Implementation of the European Working Time Directive (EWTD) raises questions about reduced surgical training opportunities and lost continuity of patient care. We studied the effect that the EWTD has had in these areas for residents in the neurosurgical unit at St. George's Hospital, London, UK. Case notes for 50 emergency and 50 elective operativ...

Chondromyxoid fibroma (CMF) is a rare bone tumor representing less than 1% of total bone neoplasms. It is a slow-growing, locally destructive tumor that usually affects the metaphyseal region of long bones. The occurrence of this tumor in the skull base or cervical spine is exceptionally rare. We present the first case of CMF originating in the cli...

We report two new cases of chordoid glioma of the third ventricle and review all previously published cases of this rare tumor with regard to presentation, optimum management, and outcome. Two new cases are reported with the radiological and histopathologic findings. We searched and cross-referenced PubMed and published reports of this tumor to ret...

MRI scanning has historically been considered difficult to interpret in the early period following lumbar spine surgery, and hence of limited value. We investigate the hypothesis that MRI scanning within 6 weeks of lumbar spine surgery cannot accurately diagnose neural compression in symptomatic patients, and define the utility of postoperative MRI...

Low-grade primary T-cell lymphoma of the central nervous system is extremely rare. We present a case developing in a previously fit young woman presenting with symptoms of raised intracranial pressure and found on CT to have a cerebellar mass. Biopsy of this lesion revealed features of non-Hodgkin's lymphoma with histochemical analysis confirming T...

In this paper the authors' goal was to report on and examine (in the context of a large hospital with good endovascular intervention provisions) the activities of a neurosurgeon with a dedicated vascular interest in the era after the International Subarachnoid Aneurysm Trial in the United Kingdom. They also aimed to establish therapeutic trends and...

Objectives: To report a new case of cavernous hemangioma of the optic chiasm and to review all previously published cases with regard to presentation, surgical treatment, and outcomes. Design: Case report and literature review. Main outcome measures: Cases identified though PubMed and published literature. Presentation states of patients in te...

Malignant triton tumors (MTTs) are malignant peripheral nerve sheath tumors with rhabdomyosarcomatous differentiation. Malignant triton tumors affecting the spine are rare but present special challenges to the neurosurgeon. The authors report on 2 new cases of spinal MTTs, and analyze the 8 previously reported cases found via database search. The p...

We present two cases of vertebral body tumours presenting with neurological compromise treated with posterior approach vertebrectomy and three-column reconstruction using in situ expandable cage and pedicle screw reconstruction. One was performed in a staged procedure, the second as a single procedure. This approach avoids the requirement, and asso...

We report an artefactual middle cerebral artery territory infarct on CT scan. This anomaly is suggested by the discrepancy between the clinical and radiological findings. Awareness of this possibility may avoid unnecessary further investigation or treatment.

The authors report two cases of neurological deterioration following long commercial flights. Both individuals harbored intracranial space-occupying lesions. The authors assert that preexisting reduced intracranial compliance diminishes an individual's reserve to accommodate the physiological changes resulting from a commercial flight. Airline pass...

We report a case of complete extracranial displacement of the proximal part of a ventriculo-peritoneal shunt following trauma. The possible mechanism of the delayed displacement of the shunt is discussed. The importance of early recognition of this unusual cause of shunt dysfunction is considered.

Disorders of sodium and water balance are common in critically ill adult neurologic patients. Normal aspects of sodium and water regulation are reviewed. The etiology of possible causes of sodium disturbance is discussed in both the general inpatient and the neurologic populations. Areas of importance are highlighted with regard to the differential...

Disorders of sodium and water balance are common in critically ill adult neurologic patients. Normal aspects of sodium and water regulation are reviewed. The etiology of possible causes of sodium disturbance is discussed in both the general inpatient and the neurologic populations. Areas of importance are highlighted with regard to the differential...