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  1. Article ; Online: Local recurrence of melanocytoma of the cervical spine.

    Moncur, Eleanor M / Al-Ahmad, Selma / Thom, Maria / Craven, Claudia L / Choi, David

    Acta neurologica Belgica

    2024  

    Language English
    Publishing date 2024-02-06
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 127315-2
    ISSN 2240-2993 ; 0300-9009
    ISSN (online) 2240-2993
    ISSN 0300-9009
    DOI 10.1007/s13760-023-02459-9
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Chemical angioplasty vs. balloon plus chemical angioplasty for delayed cerebral ischemia: a pilot study of PbtO

    Moncur, Eleanor M / Craven, Claudia L / Al-Ahmad, Selma / Jones, Bethany / Robertson, Fergus / Reddy, Ugan / Toma, Ahmed K

    Acta neurochirurgica

    2024  Volume 166, Issue 1, Page(s) 179

    Abstract: Background: Delayed cerebral ischaemia (DCI) is a major cause of morbidity and mortality after aneurysmal subarachnoid haemorrhage (aSAH). Chemical angioplasty (CA) and transluminal balloon angioplasty (TBA) are used to treat patients with refractory ... ...

    Abstract Background: Delayed cerebral ischaemia (DCI) is a major cause of morbidity and mortality after aneurysmal subarachnoid haemorrhage (aSAH). Chemical angioplasty (CA) and transluminal balloon angioplasty (TBA) are used to treat patients with refractory vasospasm causing DCI. Multi-modal monitoring including brain tissue oxygenation (PbtO
    Methods: Retrospective case series of patients with DCI who had PbtO
    Results: There were immediate significant improvements in PbtO
    Conclusion: Combined balloon plus chemical angioplasty results in more sustained improvement in brain tissue oxygenation compared with chemical angioplasty alone. Our findings suggest that PbtO
    MeSH term(s) Humans ; Pilot Projects ; Retrospective Studies ; Brain Ischemia/etiology ; Brain Ischemia/therapy ; Cerebral Infarction ; Subarachnoid Hemorrhage/diagnostic imaging ; Subarachnoid Hemorrhage/therapy ; Subarachnoid Hemorrhage/complications ; Angioplasty/adverse effects ; Vasospasm, Intracranial/etiology ; Vasospasm, Intracranial/therapy
    Language English
    Publishing date 2024-04-16
    Publishing country Austria
    Document type Journal Article
    ZDB-ID 80010-7
    ISSN 0942-0940 ; 0001-6268
    ISSN (online) 0942-0940
    ISSN 0001-6268
    DOI 10.1007/s00701-024-06066-2
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  3. Article ; Online: The initial intracranial pressure spike phenomenon.

    Magni, Francesco / Khawari, Sogha / Pandit, Anand / Moncur, Eleanor M / Watkins, Laurence / Toma, Ahmed / Thorne, Lewis

    Acta neurochirurgica

    2023  Volume 165, Issue 11, Page(s) 3239–3242

    Abstract: Background: Elective use of intraparenchymal intracranial pressure (ICP) monitoring is a valuable resource in the investigation of hydrocephalus and other cerebrospinal fluid disorders. Our preliminary study aims to investigate ICP changes in the ... ...

    Abstract Background: Elective use of intraparenchymal intracranial pressure (ICP) monitoring is a valuable resource in the investigation of hydrocephalus and other cerebrospinal fluid disorders. Our preliminary study aims to investigate ICP changes in the immediate period following dural breach, which has not yet been reported on.
    Method: This is a prospective cohort study of patients undergoing elective ICP monitoring, recruited between March and May 2022. ICP readings were obtained at opening and then at 5-min intervals for a 30-min duration.
    Results: Ten patients were recruited, mean age 45 years, with indications of a Chiari malformation (n = 5), idiopathic intracranial hypertension (n = 3) or other ICP-related pathology (n = 2). Patients received intermittent bolus sedation (80%) vs general anaesthesia (20%). Mean opening pressure was 22.9 mmHg [± 6.0], with statistically significant decreases present every 5 min, to a total reduction of 15.2 mmHg at 20 min (p = < 0.0001), whereafter the ICP plateaued with no further statistical change.
    Discussion: Our results highlight an intracranial opening pressure 'spike' phenomenon. This spike was 15.2 mmHg higher than the plateau, which is reached at 20 min after insertion. Several possible causes exist which require further research in larger cohorts, including sedation and pain response. Regardless of causation, this study provides key information on the use of ICP monitoring devices, guiding interpretation and when to obtain measurements.
    MeSH term(s) Humans ; Middle Aged ; Intracranial Pressure/physiology ; Prospective Studies ; Hydrocephalus/complications ; Pseudotumor Cerebri/complications ; Arnold-Chiari Malformation/complications ; Monitoring, Physiologic/methods ; Intracranial Hypertension/diagnosis ; Intracranial Hypertension/etiology
    Language English
    Publishing date 2023-09-11
    Publishing country Austria
    Document type Journal Article
    ZDB-ID 80010-7
    ISSN 0942-0940 ; 0001-6268
    ISSN (online) 0942-0940
    ISSN 0001-6268
    DOI 10.1007/s00701-023-05780-7
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Ambulatory intracranial pressure in humans: ICP increases during movement between body positions.

    Moncur, Eleanor M / D'Antona, Linda / Peters, Amy L / Favarato, Graziella / Thompson, Simon / Vicedo, Celine / Thorne, Lewis / Watkins, Laurence D / Day, Brian L / Toma, Ahmed K / Bancroft, Matthew J

    Brain & spine

    2024  Volume 4, Page(s) 102771

    Abstract: Introduction: Positional changes in intracranial pressure (ICP) have been described in humans when measured over minutes or hours in a static posture, with ICP higher when lying supine than when sitting or standing upright. However, humans are often ... ...

    Abstract Introduction: Positional changes in intracranial pressure (ICP) have been described in humans when measured over minutes or hours in a static posture, with ICP higher when lying supine than when sitting or standing upright. However, humans are often ambulant with frequent changes in position self-generated by active movement.
    Research question: We explored how ICP changes during movement between body positions.
    Material and methods: Sixty-two patients undergoing clinical ICP monitoring were recruited. Patients were relatively well, ambulatory and of mixed age, body habitus and pathology. We instructed patients to move back and forth between sitting and standing or lying and sitting positions at 20 s intervals after an initial 60s at rest. We simultaneously measured body position kinematics from inertial measurement units and ICP from an intraparenchymal probe at 100 Hz.
    Results: ICP increased transiently during movements beyond the level expected by body position alone. The amplitude of the increase varied between participants but was on average ∼5 mmHg during sit-to-stand, stand-to-sit and sit-to-lie movements and 10.8 mmHg [95%CI: 9.3,12.4] during lie-to-sit movements. The amplitude increased slightly with age, was greater in males, and increased with median 24-h ICP. For lie-to-sit and sit-to-lie movements, higher BMI was associated with greater mid-movement increase (β = 0.99 [0.78,1.20]; β = 0.49 [0.34,0.64], respectively).
    Discussion and conclusion: ICP increases during movement between body positions. The amplitude of the increase in ICP varies with type of movement, age, sex, and BMI. This could be a marker of disturbed ICP dynamics and may be particularly relevant for patients with CSF-diverting shunts in situ.
    Language English
    Publishing date 2024-02-29
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2772-5294
    ISSN (online) 2772-5294
    DOI 10.1016/j.bas.2024.102771
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: The Impact of Intracranial Pressure Telesensors: An Observational Propensity-Matched Control Analysis of Service Demand and Costs.

    Pandit, Anand S / Kamal, Muhammad A / Reischer, Gerda / Aldabbagh, Yousif / Alradhawi, Mohammad / Lee, Faith M Y / Sekhon, Priya P / Moncur, Eleanor M / Banks, Ptolemy D W / Thompson, Simon / Thorne, Lewis / Watkins, Laurence D / Toma, Ahmed K

    Neurosurgery

    2024  

    Abstract: Background and objectives: Implantable telemetric intracranial pressure (ICP) sensors (telesensors) enable routine, noninvasive ICP feedback, aiding clinical decision-making and attribution of pressure-related symptoms in patients with cerebrospinal ... ...

    Abstract Background and objectives: Implantable telemetric intracranial pressure (ICP) sensors (telesensors) enable routine, noninvasive ICP feedback, aiding clinical decision-making and attribution of pressure-related symptoms in patients with cerebrospinal fluid shunt systems. Here, we aim to explore the impact of these devices on service demand and costs in patients with adult hydrocephalus.
    Methods: We performed an observational propensity-matched control study, comparing patients who had an MScio/Sensor Reservoir (Christoph Miethke, GmbH & Co) against those with a nontelemetric reservoir inserted between March 2016 and March 2018. Patients were matched on demographics, diagnosis, shunt-type, and revision status. Service usage was recorded with frequencies of neurosurgical admissions, outpatient clinics, scans, and further surgical procedures in the 2 years before and after shunt insertion.
    Results: In total, 136 patients, 73 telesensors, and 63 controls were included in this study (48 matched pairs). Telesensor use led to a significant decrease in neurosurgical inpatient admissions, radiographic encounters, and procedures including ICP monitoring. After multivariate adjustment, the mean cumulative saving after 2 years was £5236 ($6338) in telesensor patients (£5498 on matched pair analysis). On break-even analysis, cost-savings were likely to be achieved within 8 months of clinical use, postimplantation. Telesensor patients also experienced a significant reduction in imaging-associated radiation (4 mSv) over 2 years.
    Conclusion: The findings of this exploratory study reveal that telesensor implantation is associated with reduced service demand and provides net financial savings from an institutional perspective. Moreover, telesensor patients required fewer appointments, invasive procedures, and had less radiation exposure, indicating an improvement in both their experience and safety.
    Language English
    Publishing date 2024-03-06
    Publishing country United States
    Document type Journal Article
    ZDB-ID 135446-2
    ISSN 1524-4040 ; 0148-396X
    ISSN (online) 1524-4040
    ISSN 0148-396X
    DOI 10.1227/neu.0000000000002893
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Characterization of patients with idiopathic normal pressure hydrocephalus using natural language processing within an electronic healthcare record system.

    Funnell, Jonathan P / Noor, Kawsar / Khan, Danyal Z / D'Antona, Linda / Dobson, Richard J B / Hanrahan, John G / Hepworth, Christopher / Moncur, Eleanor M / Thomas, Benjamin M / Thorne, Lewis / Watkins, Laurence D / Williams, Simon C / Wong, Wai Keong / Toma, Ahmed K / Marcus, Hani J

    Journal of neurosurgery

    2022  , Page(s) 1–9

    Abstract: Objective: Idiopathic normal pressure hydrocephalus (iNPH) is an underdiagnosed, progressive, and disabling condition. Early treatment is associated with better outcomes and improved quality of life. In this paper, the authors aimed to identify features ...

    Abstract Objective: Idiopathic normal pressure hydrocephalus (iNPH) is an underdiagnosed, progressive, and disabling condition. Early treatment is associated with better outcomes and improved quality of life. In this paper, the authors aimed to identify features associated with patients with iNPH using natural language processing (NLP) to characterize this cohort, with the intention to later target the development of artificial intelligence-driven tools for early detection.
    Methods: The electronic health records of patients with shunt-responsive iNPH were retrospectively reviewed using an NLP algorithm. Participants were selected from a prospectively maintained single-center database of patients undergoing CSF diversion for probable iNPH (March 2008-July 2020). Analysis was conducted on preoperative health records including clinic letters, referrals, and radiology reports accessed through CogStack. Clinical features were extracted from these records as SNOMED CT (Systematized Nomenclature of Medicine Clinical Terms) concepts using a named entity recognition machine learning model. In the first phase, a base model was generated using unsupervised training on 1 million electronic health records and supervised training with 500 double-annotated documents. The model was fine-tuned to improve accuracy using 300 records from patients with iNPH double annotated by two blinded assessors. Thematic analysis of the concepts identified by the machine learning algorithm was performed, and the frequency and timing of terms were analyzed to describe this patient group.
    Results: In total, 293 eligible patients responsive to CSF diversion were identified. The median age at CSF diversion was 75 years, with a male predominance (69% male). The algorithm performed with a high degree of precision and recall (F1 score 0.92). Thematic analysis revealed the most frequently documented symptoms related to mobility, cognitive impairment, and falls or balance. The most frequent comorbidities were related to cardiovascular and hematological problems.
    Conclusions: This model demonstrates accurate, automated recognition of iNPH features from medical records. Opportunities for translation include detecting patients with undiagnosed iNPH from primary care records, with the aim to ultimately improve outcomes for these patients through artificial intelligence-driven early detection of iNPH and prompt treatment.
    Language English
    Publishing date 2022-11-18
    Publishing country United States
    Document type Journal Article
    ZDB-ID 3089-2
    ISSN 1933-0693 ; 0022-3085
    ISSN (online) 1933-0693
    ISSN 0022-3085
    DOI 10.3171/2022.9.JNS221095
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