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Article: The impact of surgeon's academic leave on surgical outcomes for endoscopic transsphenoidal resection of pituitary tumors.

Yan, Jiun-Lin / Stovell, Matthew G / Chang, Chen-Nen

2024 Volume 13, Issue 2, Page(s) 155–163

Abstract: Background: Endoscopic surgery has become the mainstay of pituitary surgery, but requires comprehensive surgical training. We evaluate the impact of a surgeon's academic leave during endoscopic training on surgical outcomes of patients with pituitary ... ...

Abstract	Background: Endoscopic surgery has become the mainstay of pituitary surgery, but requires comprehensive surgical training. We evaluate the impact of a surgeon's academic leave during endoscopic training on surgical outcomes of patients with pituitary tumors. Methods: This retrospective study reviewed the surgical outcomes of endoscopic transsphenoidal surgery for pituitary tumors performed by a single surgeon. The last 56 surgical cases were performed between July 2010 and August 2014 before academic leave (Phase 1 surgery group), while another 56 consecutive cases were performed between November 2017 and March 2020 immediately after the surgeon's academic leave (Phase 2 surgery group). Demographic and clinical characteristics were collected and compared between the two surgery groups. Results: Overall, most surgical outcomes of endoscopic transsphenoidal surgery were not affected adversely by the period of academic leave. The operative time and length of hospital stay was lower in the Phase 2 surgery group compared to the Phase 1 surgery group (P<0.05). Postoperative tumor residual, intraoperative cerebrospinal fluid (CSF) leaks and reoperation also decreased significantly in the Phase 2 group compared to the Phase 1 group (P<0.05). Similar results were observed in patients operated using a one-hand/mono-nostril and two-hand/one-and-half nostril technique. Conclusions: Academic leave had no negative impact on most surgical outcomes for endoscopic transsphenoidal resection of pituitary tumors. Moreover, a trend toward shorter operative times and length of hospital stays was noted for patients receiving surgery immediately after surgeon's return from leave.
Language	English
Publishing date	2024-02-27
Publishing country	China (Republic : 1949- )
Document type	Journal Article
ZDB-ID	3016969-0
ISSN	2227-8575 ; 2227-684X
ISSN (online)	2227-8575
ISSN	2227-684X
DOI	10.21037/gs-23-347
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Article: An overview of clinical cerebral microdialysis in acute brain injury.

Stovell, Matthew G / Helmy, Adel / Thelin, Eric P / Jalloh, Ibrahim / Hutchinson, Peter J / Carpenter, Keri L H

Frontiers in neurology

2023 Volume 14, Page(s) 1085540

Abstract: Cerebral microdialysis may be used in patients with severe brain injury to monitor their cerebral physiology. In this article we provide a concise synopsis with illustrations and original images of catheter types, their structure, and how they function. ... ...

Abstract	Cerebral microdialysis may be used in patients with severe brain injury to monitor their cerebral physiology. In this article we provide a concise synopsis with illustrations and original images of catheter types, their structure, and how they function. Where and how catheters are inserted, their identification on imaging modalities (CT and MRI), together with the roles of glucose, lactate/pyruvate ratio, glutamate, glycerol and urea are summarized in acute brain injury. The research applications of microdialysis including pharmacokinetic studies, retromicrodialysis, and its use as a biomarker for efficacy of potential therapies are outlined. Finally, we explore limitations and pitfalls of the technique, as well as potential improvements and future work that is needed to progress and expand the use of this technology.
Language	English
Publishing date	2023-02-21
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2564214-5
ISSN	1664-2295
ISSN	1664-2295
DOI	10.3389/fneur.2023.1085540
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Article ; Online: In-vitro

Zimphango, Chisomo / Mada, Marius O / Sawiak, Stephen J / Giorgi-Coll, Susan / Carpenter, T Adrian / Hutchinson, Peter J / Carpenter, Keri L H / Stovell, Matthew G

Frontiers in radiology

2024 Volume 4, Page(s) 1085834

Abstract: Rationale and objectives: Cerebral microdialysis is a technique that enables monitoring of the neurochemistry of patients with significant acquired brain injury, such as traumatic brain injury (TBI) and subarachnoid haemorrhage (SAH). Cerebral ... ...

Abstract	Rationale and objectives: Cerebral microdialysis is a technique that enables monitoring of the neurochemistry of patients with significant acquired brain injury, such as traumatic brain injury (TBI) and subarachnoid haemorrhage (SAH). Cerebral microdialysis can also be used to characterise the neuro-pharmacokinetics of small-molecule study substrates using retrodialysis/retromicrodialysis. However, challenges remain: (i) lack of a simple, stable, and inexpensive brain tissue model for the study of drug neuropharmacology; and (ii) it is unclear how far small study-molecules administered via retrodialysis diffuse within the human brain. Materials and methods: Here, we studied the radial diffusion distance of small-molecule gadolinium-DTPA from microdialysis catheters in a newly developed, simple, stable, inexpensive brain tissue model as a precursor for in-vivo studies. Brain tissue models consisting of 0.65% weight/volume agarose gel in two kinds of buffers were created. The distribution of a paramagnetic contrast agent gadolinium-DTPA (Gd-DTPA) perfusion from microdialysis catheters using magnetic resonance imaging (MRI) was characterized as a surrogate for other small-molecule study substrates. Results: We found the mean radial diffusion distance of Gd-DTPA to be 18.5 mm after 24 h ( Conclusion: Our brain tissue model provides avenues for further tests and research into infusion studies using cerebral microdialysis, and consequently effective focal drug delivery for patients with TBI and other brain disorders.
Language	English
Publishing date	2024-01-31
Publishing country	Switzerland
Document type	Journal Article
ISSN	2673-8740
ISSN (online)	2673-8740
DOI	10.3389/fradi.2024.1085834
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Article ; Online: Neurosurgery in octogenarians.

Stovell, Matthew G / Jenkinson, Michael D

British journal of neurosurgery

2014 Volume 28, Issue 5, Page(s) 611–615

Abstract: Introduction: The developed world has an aging population with an increasing neurosurgical demand. The benefit of neurosurgical intervention in the octogenarian population and the outcome is unclear. The 2010 NCEPOD report on all surgical care for the ... ...

Abstract	Introduction: The developed world has an aging population with an increasing neurosurgical demand. The benefit of neurosurgical intervention in the octogenarian population and the outcome is unclear. The 2010 NCEPOD report on all surgical care for the elderly (> 80 years) concluded that extreme age was an additional risk for which care was often lacking. Methods: Retrospective case review of 134 octogenarian admissions to a regional neurosurgical unit from January to December 2010. Admission pathology, co-morbidities, delay to surgery, length of stay, discharge destination, functional outcome and mortality were assessed. Results: There were 49 elective and 81 emergency admissions. Of which, 51% of elective admissions were for degenerative spine and 20% for functional/pain disorders. Also 55% of emergency admissions were for cranial trauma. Co-morbidities and ASA grade were higher in the emergency group. Peri-operative mortality was 0% for elective admission and 10.4% for emergency patients. Outcome following cranial trauma was good in 62% of patients. Degenerative spine outcome was good in 69% of patients. All patients with pain/functional pathology had immediate initial improvement but 56% had recurrence of pain at 6 months. 88% of elective admissions and 22% of emergency admissions were discharged directly to home with a mean length of stay of 7 days for elective and 13 days for emergency patients. Conclusions: Patient selection is crucial when considering neurosurgery in the octogenarian population. Our octogenarian patients had higher complication rate and 30-day mortality than those < 80 year old, demonstrating the additional risk and need for enhanced peri-operative care.
MeSH term(s)	Age Factors ; Aged, 80 and over ; Emergency Treatment ; Hospital Mortality ; Humans ; Length of Stay/statistics & numerical data ; Neurosurgery ; Neurosurgical Procedures/methods ; Postoperative Complications/etiology ; Postoperative Complications/mortality ; Retrospective Studies ; Risk Factors ; Treatment Outcome
Language	English
Publishing date	2014-10
Publishing country	England
Document type	Journal Article
ZDB-ID	639029-8
ISSN	1360-046X ; 0268-8697
ISSN (online)	1360-046X
ISSN	0268-8697
DOI	10.3109/02688697.2014.889809
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Article ; Online: High-physiological and supra-physiological 1,2-

Stovell, Matthew G / Howe, Duncan J / Thelin, Eric P / Jalloh, Ibrahim / Helmy, Adel / Guilfoyle, Mathew R / Grice, Peter / Mason, Andrew / Giorgi-Coll, Susan / Gallagher, Clare N / Murphy, Michael P / Menon, David K / Carpenter, T Adrian / Hutchinson, Peter J / Carpenter, Keri Lh

Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism

2023 Volume 43, Issue 10, Page(s) 1685–1701

Abstract: How to optimise glucose metabolism in the traumatised human brain remains unclear, including whether injured brain can metabolise additional glucose when supplied. We studied the effect of microdialysis-delivered 1,2- ...

Abstract	How to optimise glucose metabolism in the traumatised human brain remains unclear, including whether injured brain can metabolise additional glucose when supplied. We studied the effect of microdialysis-delivered 1,2-
MeSH term(s)	Humans ; Glucose/metabolism ; Glutamine/metabolism ; Brain/metabolism ; Microdialysis ; Lactic Acid/metabolism ; Pyruvic Acid/metabolism ; Dietary Supplements
Chemical Substances	Glucose (IY9XDZ35W2) ; Glutamine (0RH81L854J) ; Lactic Acid (33X04XA5AT) ; Pyruvic Acid (8558G7RUTR)
Language	English
Publishing date	2023-05-08
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	604628-9
ISSN	1559-7016 ; 0271-678X
ISSN (online)	1559-7016
ISSN	0271-678X
DOI	10.1177/0271678X231173584
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Article ; Online: Image-guided stereotactic biopsy of pineal region tumour using CT venography in patient with a pacemaker: a technical note.

Stovell, Matthew G / Jenkinson, Michael D

British journal of neurosurgery

2013 Volume 27, Issue 3, Page(s) 398–400

Abstract: Image-guided stereotactic biopsy of pineal region tumours requires careful appreciation of neuroanatomy and avoidance of the deep cerebral venous system. A patient with a pineal region lesion obstructing the third ventricle and causing obstructive ... ...

Abstract	Image-guided stereotactic biopsy of pineal region tumours requires careful appreciation of neuroanatomy and avoidance of the deep cerebral venous system. A patient with a pineal region lesion obstructing the third ventricle and causing obstructive hydrocephalus required stereotactic biopsy after cerebrospinal fluid (CSF) diversion. The presence of a pacemaker precluded MR Venography. Fine-cut CT Venography was performed in its stead and merged with image guidance software, and a trajectory was planned avoiding the venous anatomy. Stereotactic biopsy was successfully performed without complication, revealing a pineocytoma.
MeSH term(s)	Aged ; Brain Neoplasms/pathology ; Feasibility Studies ; Female ; Humans ; Hydrocephalus/pathology ; Hydrocephalus/surgery ; Image-Guided Biopsy/methods ; Neuroendoscopy/methods ; Pacemaker, Artificial ; Phlebography/methods ; Pineal Gland/pathology ; Stereotaxic Techniques ; Third Ventricle/surgery ; Tomography, X-Ray Computed ; Ventriculostomy/methods
Language	English
Publishing date	2013-06
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	639029-8
ISSN	1360-046X ; 0268-8697
ISSN (online)	1360-046X
ISSN	0268-8697
DOI	10.3109/02688697.2012.741730
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Article ; Online: Characterising the dynamics of cerebral metabolic dysfunction following traumatic brain injury: A microdialysis study in 619 patients.

Guilfoyle, Mathew R / Helmy, Adel / Donnelly, Joseph / Stovell, Matthew G / Timofeev, Ivan / Pickard, John D / Czosnyka, Marek / Smielewski, Peter / Menon, David K / Carpenter, Keri L H / Hutchinson, Peter J

PloS one

2021 Volume 16, Issue 12, Page(s) e0260291

Abstract: Traumatic brain injury (TBI) is a major cause of death and disability, particularly amongst young people. Current intensive care management of TBI patients is targeted at maintaining normal brain physiology and preventing secondary injury. Microdialysis ... ...

Abstract	Traumatic brain injury (TBI) is a major cause of death and disability, particularly amongst young people. Current intensive care management of TBI patients is targeted at maintaining normal brain physiology and preventing secondary injury. Microdialysis is an invasive monitor that permits real-time assessment of derangements in cerebral metabolism and responses to treatment. We examined the prognostic value of microdialysis parameters, and the inter-relationships with other neuromonitoring modalities to identify interventions that improve metabolism. This was an analysis of prospective data in 619 adult TBI patients requiring intensive care treatment and invasive neuromonitoring at a tertiary UK neurosciences unit. Patients had continuous measurement of intracranial pressure (ICP), arterial blood pressure (ABP), brain tissue oxygenation (PbtO2), and cerebral metabolism and were managed according to a standardized therapeutic protocol. Microdialysate was assayed hourly for metabolites including glucose, pyruvate, and lactate. Cerebral perfusion pressure (CPP) and cerebral autoregulation (PRx) were derived from the ICP and ABP. Outcome was assessed with the Glasgow Outcome Score (GOS) at 6 months. Relationships between monitoring variables was examined with generalized additive mixed models (GAMM). Lactate/Pyruvate Ratio (LPR) over the first 3 to 7 days following injury was elevated amongst patients with poor outcome and was an independent predictor of ordinal GOS (p<0.05). Significant non-linear associations were observed between LPR and cerebral glucose, CPP, and PRx (p<0.001 to p<0.05). GAMM models suggested improved cerebral metabolism (i.e. reduced LPR with CPP >70mmHg, PRx <0.1, PbtO2 >18mmHg, and brain glucose >1mM. Deranged cerebral metabolism is an important determinant of patient outcome following TBI. Variations in cerebral perfusion, oxygenation and glucose supply are associated with changes in cerebral LPR and suggest therapeutic interventions to improve cerebral metabolism. Future prospective studies are required to determine the efficacy of these strategies.
MeSH term(s)	Adult ; Arterial Pressure ; Brain/metabolism ; Brain/physiopathology ; Brain Injuries, Traumatic/pathology ; Brain Injuries, Traumatic/therapy ; Female ; Glasgow Coma Scale ; Glucose/metabolism ; Humans ; Intracranial Pressure ; Lactic Acid/metabolism ; Male ; Microdialysis ; Middle Aged ; Oxygen Saturation ; Pyruvic Acid/metabolism ; Young Adult
Chemical Substances	Lactic Acid (33X04XA5AT) ; Pyruvic Acid (8558G7RUTR) ; Glucose (IY9XDZ35W2)
Language	English
Publishing date	2021-12-16
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0260291
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Article ; Online: A Comparative Cohort Study of Lumbar Microdiscectomy in Obese and Nonobese Patients.

Fakouri, Bahram / Stovell, Matthew G / Allom, Richard

Journal of spinal disorders & techniques

2013 Volume 28, Issue 6, Page(s) E352–7

Abstract: Study design: Prospective comparative cohort study.: Objective: Investigate whether there is a difference in postoperative pain reduction, complication rate, and other markers of operative difficulty in obese and nonobese patients undergoing elective ...

Abstract	Study design: Prospective comparative cohort study. Objective: Investigate whether there is a difference in postoperative pain reduction, complication rate, and other markers of operative difficulty in obese and nonobese patients undergoing elective lumbar microdiscectomy by a single spinal surgeon. Summary of background data: Lumbar radiculopathy is a debilitating condition that affects obese and nonobese patients. There is reluctance among some surgeons to perform lumbar microdiscectomy in the obese population. Methods: Over 3 years a group of 34 obese patients were compared with 34 nonobese patients from the same period. Operative duration, blood loss, unintentional durotomies, infection rate, hospital stay, and pain reduction were compared. Results: Reduction in total pain (control, -82%; obese, -71%) and radicular leg pain (control, -98%; obese, -97%) were similar. The risk of superficial infections was greater in the obese group, but there was no difference in rate of serious complication in our small series. Operative duration was much longer in the obese group (control, 28 min; obese, 70 min), as was total hospital stay. Conclusions: We found good postoperative pain relief in both groups. There was no difference in radicular leg pain between obese and nonobese patients but total pain due to lumbago was greater preoperatively and postoperatively in the obese group making their total pain greater. There was no evidence of higher serious complication rate that would preclude offering operative lumbar microdiscectomy to obese patients due to their obesity alone. However, operative duration was significantly longer in obese patients and should be considered accordingly.
MeSH term(s)	Adult ; Blood Loss, Surgical ; Cohort Studies ; Diskectomy/methods ; Female ; Humans ; Length of Stay ; Low Back Pain/surgery ; Lumbar Vertebrae/surgery ; Male ; Microsurgery/methods ; Middle Aged ; Obesity/surgery ; Pain/etiology ; Pain, Postoperative/epidemiology ; Postoperative Complications/epidemiology ; Postoperative Complications/therapy ; Prospective Studies ; Radiculopathy/surgery ; Treatment Outcome ; Young Adult
Language	English
Publishing date	2013-04-03
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	2075910-1
ISSN	1539-2465 ; 1536-0652
ISSN (online)	1539-2465
ISSN	1536-0652
DOI	10.1097/BSD.0b013e318290bf4a
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Article ; Online: Focally administered succinate improves cerebral metabolism in traumatic brain injury patients with mitochondrial dysfunction.

Khellaf, Abdelhakim / Garcia, Nuria Marco / Tajsic, Tamara / Alam, Aftab / Stovell, Matthew G / Killen, Monica J / Howe, Duncan J / Guilfoyle, Mathew R / Jalloh, Ibrahim / Timofeev, Ivan / Murphy, Michael P / Carpenter, T Adrian / Menon, David K / Ercole, Ari / Hutchinson, Peter J / Carpenter, Keri Lh / Thelin, Eric P / Helmy, Adel

Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism

2021 Volume 42, Issue 1, Page(s) 39–55

Abstract: Following traumatic brain injury (TBI), raised cerebral lactate/pyruvate ratio (LPR) reflects impaired energy metabolism. Raised LPR correlates with poor outcome and mortality following TBI. We prospectively recruited patients with TBI requiring ... ...

Abstract	Following traumatic brain injury (TBI), raised cerebral lactate/pyruvate ratio (LPR) reflects impaired energy metabolism. Raised LPR correlates with poor outcome and mortality following TBI. We prospectively recruited patients with TBI requiring neurocritical care and multimodal monitoring, and utilised a tiered management protocol targeting LPR. We identified patients with persistent raised LPR despite adequate cerebral glucose and oxygen provision, which we clinically classified as cerebral 'mitochondrial dysfunction' (MD). In patients with TBI and MD, we administered disodium 2,3-
MeSH term(s)	Adult ; Brain/metabolism ; Brain Injuries, Traumatic/drug therapy ; Brain Injuries, Traumatic/metabolism ; Energy Metabolism/drug effects ; Female ; Humans ; Intracranial Pressure/drug effects ; Lactic Acid/metabolism ; Male ; Microdialysis ; Middle Aged ; Mitochondria/metabolism ; Nuclear Magnetic Resonance, Biomolecular ; Pyruvic Acid/metabolism ; Succinic Acid/administration & dosage
Chemical Substances	Lactic Acid (33X04XA5AT) ; Pyruvic Acid (8558G7RUTR) ; Succinic Acid (AB6MNQ6J6L)
Language	English
Publishing date	2021-09-08
Publishing country	United States
Document type	Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	604628-9
ISSN	1559-7016 ; 0271-678X
ISSN (online)	1559-7016
ISSN	0271-678X
DOI	10.1177/0271678X211042112
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Article ; Online: Decompressive Craniectomy versus Craniotomy for Acute Subdural Hematoma.

Hutchinson, Peter J / Adams, Hadie / Mohan, Midhun / Devi, Bhagavatula I / Uff, Christopher / Hasan, Shumaila / Mee, Harry / Wilson, Mark H / Gupta, Deepak K / Bulters, Diederik / Zolnourian, Ardalan / McMahon, Catherine J / Stovell, Matthew G / Al-Tamimi, Yahia Z / Tewari, Manoj K / Tripathi, Manjul / Thomson, Simon / Viaroli, Edoardo / Belli, Antonio /

King, Andrew T / Helmy, Adel E / Timofeev, Ivan S / Pyne, Sarah / Shukla, Dhaval P / Bhat, Dhananjaya I / Maas, Andrew R / Servadei, Franco / Manley, Geoffrey T / Barton, Garry / Turner, Carole / Menon, David K / Gregson, Barbara / Kolias, Angelos G

The New England journal of medicine

2023 Volume 388, Issue 24, Page(s) 2219–2229

Abstract: Background: Traumatic acute subdural hematomas frequently warrant surgical evacuation by means of a craniotomy (bone flap replaced) or decompressive craniectomy (bone flap not replaced). Craniectomy may prevent intracranial hypertension, but whether it ... ...

Abstract	Background: Traumatic acute subdural hematomas frequently warrant surgical evacuation by means of a craniotomy (bone flap replaced) or decompressive craniectomy (bone flap not replaced). Craniectomy may prevent intracranial hypertension, but whether it is associated with better outcomes is unclear. Methods: We conducted a trial in which patients undergoing surgery for traumatic acute subdural hematoma were randomly assigned to undergo craniotomy or decompressive craniectomy. An inclusion criterion was a bone flap with an anteroposterior diameter of 11 cm or more. The primary outcome was the rating on the Extended Glasgow Outcome Scale (GOSE) (an 8-point scale, ranging from death to "upper good recovery" [no injury-related problems]) at 12 months. Secondary outcomes included the GOSE rating at 6 months and quality of life as assessed by the EuroQol Group 5-Dimension 5-Level questionnaire (EQ-5D-5L). Results: A total of 228 patients were assigned to the craniotomy group and 222 to the decompressive craniectomy group. The median diameter of the bone flap was 13 cm (interquartile range, 12 to 14) in both groups. The common odds ratio for the differences across GOSE ratings at 12 months was 0.85 (95% confidence interval, 0.60 to 1.18; P = 0.32). Results were similar at 6 months. At 12 months, death had occurred in 30.2% of the patients in the craniotomy group and in 32.2% of those in the craniectomy group; a vegetative state occurred in 2.3% and 2.8%, respectively, and a lower or upper good recovery occurred in 25.6% and 19.9%. EQ-5D-5L scores were similar in the two groups at 12 months. Additional cranial surgery within 2 weeks after randomization was performed in 14.6% of the craniotomy group and in 6.9% of the craniectomy group. Wound complications occurred in 3.9% of the craniotomy group and in 12.2% of the craniectomy group. Conclusions: Among patients with traumatic acute subdural hematoma who underwent craniotomy or decompressive craniectomy, disability and quality-of-life outcomes were similar with the two approaches. Additional surgery was performed in a higher proportion of the craniotomy group, but more wound complications occurred in the craniectomy group. (Funded by the National Institute for Health and Care Research; RESCUE-ASDH ISRCTN Registry number, ISRCTN87370545.).
MeSH term(s)	Humans ; Craniotomy/adverse effects ; Craniotomy/methods ; Decompressive Craniectomy/adverse effects ; Decompressive Craniectomy/methods ; Glasgow Outcome Scale ; Hematoma, Subdural, Acute/surgery ; Quality of Life ; Retrospective Studies ; Skull/surgery ; Treatment Outcome ; Surgical Flaps/surgery
Language	English
Publishing date	2023-04-23
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article
ZDB-ID	207154-x
ISSN	1533-4406 ; 0028-4793
ISSN (online)	1533-4406
ISSN	0028-4793
DOI	10.1056/NEJMoa2214172
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