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Biomedical subjects

A W McEvoy

Publications and source records attributed to A W McEvoy.

At least 19 recordsLinked to original sources
PubMed2003

Rapid enlargement of a vestibular schwannoma following gamma knife treatment.

Stereotactic radiosurgery has been proposed as the first line treatment for acoustic tumours and has been particularly advocated in cases of Type 2 Neurofibromatosis (NF2) with bilateral acoustic nerve tumours. We present the case of a 22-year-old male with NF2 and bilateral acoustic nerve tumours. He underwent an uncomplicated excision of the larger, left sided lesion. Histology showed a benign acoustic schwannoma with no atypical features. One year later he underwent stereotactic radiosurgery (Gamma Knife 1500 cGy) to the right sided lesion. After initial swelling, within 12 months the tumour had reduced in size and undergone central necrosis. However, 2 years later MRI of the brain revealed a dramatic increase in the size of the right sided tumour, with considerable brain stem compression. The patient subsequently died. This highly unusual case highlights the need for careful clinical and radiological follow up. in patients with acoustic tumours, regardless of the treatment method employed.

Adult↗
PubMed2003

Clinical databases and data protection: are they compatible?

In the current climate of clinical governance and audit, and in the setting of an active academic unit, an effective clinical database is an invaluable tool. In this article, we will present our neurovascular database, discuss the issues related to setting up the ideal clinical database, discuss the problems related to accurate data input and review the legal requirements of data protection. The success of a clinical database is reflected by the completeness of the data, the accessibility of the information and how useful it has proven to be. After 4 years of experimentation we currently use a database designed on Microsoft Access. The form is a single page. Junior medical staff input the information as medical staff have been found to be the most reliable personnel for data input in terms of accuracy. However, time is generally in short supply amongst this group. For our purposes, the ideal database is one that is simple, that can be used to flag up cases, rather than provide all of the information and ensures a complete dataset. The arrival of the UK 1998 Data Protection Act has put many clinical databases and registries in jeopardy, and introduced further bureaucracy to research. We discuss the Act and its interpretation by the General Medical Council, Medical Research Council, British Medical Association, Department of Health and our own trust with respect to databases and research.

Cerebrovascular Disorders↗
PubMed2002

Auditing patient experience and satisfaction with neurosurgical care: results of a questionnaire survey.

The objective of this study was to determine the current level of patient satisfaction with neurosurgical services from the time of initial referral to hospital discharge. The survey was camed out by a self-administered postal questionnaire survey from the National Hospital for Neurology and Neurosurgery, London, UK. The participants were 364 patients discharged from the unit within one calendar year. The main outcome measures were level of satisfaction with various aspects of care, as measured by fixed response and free text style questions. Most patients are happy with the waiting time to see a neurosurgeon and the wait for subsequent admission acceptable, but many would have preferred it to be shorter. Twenty-seven had their original admission date cancelled, but most were happy with the explanation offered. Weaknesses in the management of outpatient clinics were highlighted, 35% of patients waiting more than half an hour to be seen. The great majority were happy with various aspects of communication with the neurosurgical team. Few patients were given the opportunity to follow up their visit with literature provided or a visit to a specialist nurse (17 and 9%, respectively). However, both were considered very useful, in particular, 93% highly valued a meeting with the specialist nurse. There was a dichotomy of opinion over the course of the inpatient stay. While most aspects of care received 70-80% satisfaction, the management of discharge received the most criticism. This was thought to represent a pooling of resources around the most needy patients. The majority of patients were discharged home (76%), only a third feeling that staff did everything possible to help this process. Very few received printed information. Again, those who had seen the specialty nurse had much higher levels of satisfaction. Patient satisfaction audit gives useful data on patients' perception and satisfaction with care that may not be apparent on more traditional audit measures such as length of stay, which focus more on a unit's efficiency. This study shows generally high levels of patient satisfaction with neurosurgical practice but highlights areas needing attention and expansion, such as access to a specialist nurse and relevant literature. Dissatisfaction with various administrative arrangements are clearly shown and provide an opportunity for patient centred improvements.

Adult↗
PubMed2001

Plasma total homocysteine and subarachnoid haemorrhage in a co-factor replete population.

Mild hyperhomocysteinaemia is a postulated risk factor for occlusive vascular disease, including stroke. Subarachnoid haemorrhage (SAH) has an annual incidence of 10-20 per 100,000 and accounts for 5-10% of all strokes. Measurement of plasma total homocysteine (tHcy) in a cohort of vitamin B12 and folate replete patients did not reveal any association between tHcy and the aetiology of SAH.

Adult↗
PubMed2001

Giant temporo-occipital sinus pericranii. A case report.

A rare case of a giant, temporo-occipital sinus pericranii is presented. A 38-year-old male presented with minor symptoms of headache and heaviness over an enlarging temporo-occipital bone defect. Within the defect a soft, compressible, mass lesion was observed, which varied in size with changes in intracranial pressure. Radiological imaging demonstrated bone erosion around a fluid filled mass, which on angiography communicated via a series of channels with the transverse sinus. A diagnosis of sinus pericranii was made. Due to the risk of future complication the patient elected to undergo surgery, which successfully resected the mass and obliterated the venous communications with the diploic veins and transverse sinus. The classification, aetiology, differential diagnosis, radiological characteristics and management options relating to sinus pericranii are discussed.

Adult↗
PubMed2000

Haemangioblastoma of a cervical sensory nerve root in Von Hippel-Lindau syndrome.

Spinal haemangioblastomas are rare, accounting for only about 7% of all central nervous system cases. The case of a 40-year-old woman with a haemangioblastoma arising solely from a cervical sensory nerve root is presented. At operation via a cervical laminectomy, it was possible to resect the tumour en masse with the sensory ramus, by extending the laminectomy through the exit foramen for C6. Haemangioblastomas are commonly intramedullary, and have only been reported in this location on one previous occasion. The patient has Von Hippel-Lindau syndrome and a history of multiple solid tumours. The possible role of the Von Hippel-Lindau tumour suppressor gene in the pathogenesis of these neoplasms is discussed.

Adult↗
PubMed2000

Intracerebral haemorrhage and drug abuse in young adults.

The epidemic of abuse of the so-called 'designer drugs' amphetamine, cocaine and ecstasy--is fast replacing traditional aetiological factors as the largest cause of intracerebral haemorrhage among young adults. Traditional teaching is that these represent hypertensive haemorrhages. Recent reports, however, have indicated that these patients may harbour underlying vascular malformations. We review 13 patients with a positive history of drug abuse preceding the onset of intracerebral haemorrhage. These patients presented to the National Hospital for Neurology and Neurosurgery in central London over a 7-month period. Of the 13 patients (eight male, five female), average age 31 years (19-43) years), 10 were well enough to undergo cerebral angiography. Intracranial aneurysms were demonstrated in six patients and arteriovenous malformations in three patients. In only one of the patients was the angiogram normal. A further patient was subsequently shown to have a middle cerebral artery aneurysm at autopsy. The epidemiology, pharmacology and systemic effects of these drugs are considered. The mechanisms by which these compounds cause intracerebral complications and their influence on prognosis are discussed. The incidence of intracerebral haemorrhage (ICH), ischaemic cerebral infarctions and subarachnoid haemorrhage (SAH) following drug abuse is increasing. Contrary to historical opinion, drug-related ICH is frequently related to an underlying vascular malformation. Arteriography should be part of the evaluation of most young patients with nontraumatic ICH. A thorough history focusing on the use of illicit substances and toxicological screening of urine and serum should be part of the evaluation of any young patient with a stroke.

Adult↗
PubMed2000

Management of choroid plexus tumours in children: 20 years experience at a single neurosurgical centre.

OBJECTIVE: Tumours of the choroid plexus are rare tumours of neuro-ectodermal origin, accounting for less than 1% of all intracranial tumours. Most cases present in children less than 2 years of age. While choroid plexus carcinomas (CPC) are reported to have an extremely poor prognosis, choroid plexus papillomas (CPP) are generally regarded as benign tumours with a very favourable long-term outcome. Management dilemmas are associated with the choice of surgical procedure, tumour vascularity, the treatment of hydrocephalus and the value of adjuvant therapy. The objective of this study was to review our experience with this rare tumour over a 20-year period. METHODS: Patients were identified from the Great Ormond Street Neurosurgical Brain Tumour Database. Over a 20-year period (1979-1999), 34 children were identified with a choroid plexus tumour. There were 25 cases of CPP and 9 cases of CPC. A retrospective review of case notes, radiological imaging, operation reports and pathology was performed. RESULTS: The median age at presentation was 17 months (1-138) for CPP and 13 months (2-102) for CPC. There was no sex difference for CPP. However, 8 of the 9 CPCs were male (89%). A complete surgical resection was achieved in all 25 cases of CPP and in 3 cases of CPC (33%). The median survival for CPPs was 75.5 months (2-228), with a median follow-up of 73.5 months (2-228). The median survival for CPCs was 6 months (1-90), with a median follow-up of 6 months (1-90). CONCLUSION: With modern neurosurgical practise, a cure should be the aim for all children with CPP. There is no evidence that adjuvant therapy has any role in the primary management of these children. However, CPC still has an extremely poor prognosis, and the efficacy of adjuvant therapy remains to be established.

Age of Onset↗
PubMed1999

Intra-operative localisation of skull base tumours. A case report using the ISG viewing wand in the management of trigeminal neuroma.

Deep-seated skull base tumours provide as much a challenge to the surgeons' skills of localisation as to his technical abilities during the resection. These lesions are frequently inaccessible and lie adjacent to vital structures requiring extensive cerebral retraction for adequate exposure and direct visualisation. The ISG viewing wand is a newly developed image guidance system to aid direction of the operative approach and localisation of intracerebral pathology. We discuss its use in the management of a trigeminal neuroma.

Cranial Nerve Neoplasms↗
PubMed1997

Intramedullary thoracic cord metastasis managed effectively without surgery.

Spinal intramedullary metastases present with rapidly progressing neurological deficits and have an extremely poor prognosis. Prompt investigation and management are required. This case history illustrates that radiotherapy and steroids can be effective in returning motor function. The behaviour of the primary tumour and the stage of the disease influence whether surgery is appropriate.

Bronchial Neoplasms↗
PubMed1997

Bitemporal hemianopia caused by metastatic carcinoma in a patient with Wegener's granulomatosis: an unexpected finding.

Metastatic lesions in the suprasellar region are extremely rare. The differential diagnosis of a focal lesion at this site is wide ranging and lesions often have a similar radiological appearance. We present a woman with known Wegener's granulomatosis who lost vision while on medical treatment for a presumed granuloma at this site. Exploration revealed a metastatic carcinoma of unknown origin. Attention is drawn to the importance of making a histological diagnosis in cases of suprasellar lesions.

Adenocarcinoma↗