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Biomedical subjects

N Buxton

Publications and source records attributed to N Buxton.

At least 19 recordsLinked to original sources
PubMed2006

Congenital spinal dermal sinuses: poor awareness leads to delayed treatment.

OBJECTIVE: Congenital spinal dermal sinuses are relatively uncommon congenital abnormalities that result from abnormal neurulation. Lack of awareness about this problem, especially at the primary care level, results in these patients not being managed appropriately. This issue is highlighted in this case series of nine patients. MATERIALS AND METHODS: The nine patients--six males and three females--were treated over a 3-year period in two centres in the UK and India. The age varied from 212 months to 19 years. Clinical presentations included meningitis or neurological deficits. One was asymptomatic. MRI was done in all cases and showed the sinus tracts in all cases. In five cases, there were intramedullary dermoids and in the others the sinus tract ended either on the dura or blindly. All cases were treated surgically by excision of the sinus and tumour if any. In terms of the neurological status, one became normal, four improved and four remained the same. Of the four who remained the same, two had had normal neurological examination preoperatively. The mean duration from first assessment by a medical practitioner to correct diagnosis and referral to a neurosurgeon was 5 years (range 2 months to 18 years). Proper diagnosis and appropriate management was delayed in these cases because professionals were not aware of this condition. CONCLUSIONS: Primary care physicians should be made more aware about congenital spinal dermal sinuses. This will facilitate early diagnosis and referral to specialist services.

Adolescent↗
PubMed2006

Antenatal ultrasound and magnetic resonance imaging in localizing the level of lesion in spina bifida and correlation with postnatal outcome.

OBJECTIVE: To compare prenatal ultrasonography and magnetic resonance imaging (MRI) in the diagnosis of spina bifida with postnatal MRI/surgical findings and to study the postnatal outcome in relation to the level of lesion and head signs on antenatal imaging. METHODS: A retrospective study of babies referred to a tertiary neurosurgical unit with a diagnosis of spina bifida in the years 2000-2002 was performed. The levels of lesions and head signs diagnosed using antenatal ultrasonography and MRI were compared with postnatal MRI and operative findings. The levels of lesions and head signs diagnosed pre- and postnatally were used to study the correlation with neurological outcome at a mean follow-up period of 12 months. RESULTS: Twelve antenatally diagnosed and five postnatally diagnosed cases of spina bifida were seen. The level of lesion as identified by antenatal ultrasound correlated with that observed postnatally in 8/12 cases and the antenatal ultrasound diagnosis of ventriculomegaly was confirmed postnatally in all cases. The level of lesion as identified by antenatal MRI correlated with that observed postnatally in 4/8 cases (50%) and the antenatal MRI diagnosis of ventriculomegaly was confirmed postnatally in 5/8 (63%) cases. 12/17 babies were found to have residuals in the immediate postnatal urodynamic studies, of which 83% (n = 10) required intermittent catheterization of the bladder at 12 months of age. Low spinal lesions were associated with increased bladder morbidity when compared to high spinal lesions (8/10 vs. 4/7, P < 0.05) (odds ratio (OR) = 10.0; 95% CI, 1.05-95.01). The level of spinal lesion and the presence of ventriculomegaly did not have any statistically significant correlation with motor functions, morbidity and developmental milestones. CONCLUSIONS: Antenatal ultrasonography is a good tool in the diagnosis of spina bifida. We could not demonstrate any advantage of antenatal MRI over ultrasonography. There is better correlation of ultrasonography than MRI with postnatal MRI/operative findings in terms of level of lesion and head signs. Low spinal lesions appear to be associated with increased bladder morbidity.

Adult↗
PubMed2004

Lumboperitoneal shunts: are the complications acceptable?

BACKGROUND: Lumboperitoneal shunts have long been used in the treatment of benign intracranial hypertension, postoperative pseudomeningocele, CSF leak and communicating hydrocephalus. Although they can provide a rapid and effective resolution of the symptoms there are major disadvantages associated with their use. METHOD: We retrospectively analyzed the records of 21 patients who underwent LP shunt insertion in our institution during the study period. FINDINGS: Eighteen patients (85.7%) underwent at least one shunt revision with a total of 63 revisions. Shunt related infections were observed in 7 cases and 7 patients developed Chiari malformation, 2 (9%) of these requiring further treatment. CONCLUSIONS: Despite the symptomatic control achieved with lumboperitoneal shunts we find the complication and revision rates unacceptably high. The technique should be re-evaluated and other treatment strategies considered.

Adolescent↗
PubMed2002

Treatment of Chiari malformation, syringomyelia and hydrocephalus by neuroendoscopic third ventriculostomy.

This short paper illustrates a case with cervical myelomeningocoele, a Chiari malformation (CM), hydrocephalus (HC) and cervical syringomyelia treated by neuroendoscopic third ventriculostomy (NTV) with resolution of both the hydrocephalus and the syrinx. Two similar cases are discussed. The technique is advocated for the treatment of such complex dysraphic conditions.

Arnold-Chiari Malformation↗
PubMed2002

The role of neuroendoscopy in the management of brain tumours.

Neuroendoscopy is increasingly used in the management of brain tumours and tumour related hydrocephalus and this study reviews the efficacy of neuroendoscopic interventions in this unit in patients with brain tumours. A series of 87 neuroendoscopic operations carried out in 77 patients with brain tumours over a 6-year period is reported. The age range of the patients was from 5 months to 70 years (median 13 years). In 56 cases (64%) presentation was with a newly-diagnosed tumour and hydrocephalus. The majority of the remaining patients had varying degrees of worsening hydrocephalus on the background of a previously diagnosed tumour. Neuroendoscopic third ventriculostomy (NTV) was successful in relieving hydrocephalus in the short term in 63/66 cases (95%) and in the longer term in 55/66 cases (83%). Neuroendoscopic tumour biopsies were successful in providing a tissue diagnosis in 17/28 cases (61%) and four extensive and three partial resections of tumour were carried out. There were two deaths within 30 days of the procedure with only one of these, secondary to intraventricular haemorrhage, directly related to neuroendoscopy. Few significant complications were noted otherwise. For selected intraventricular and paraventricular tumours neuroendoscopy offers the opportunity to combine relief of hydrocephalus with tumour biopsy and sampling of CSF in a single procedure.

Adolescent↗
PubMed2002

Changes in third ventricular size with neuroendoscopic third ventriculostomy: a blinded study.

The objective was to study the relation between changes in cerebral ventricular size and clinical outcome after neuroendoscopic third ventriculostomy (NTV) in both primary (no previous surgery) and secondary (previous CSF diversion for hydrocephalus) NTV. Changes in ventricular size were related to the need for further surgery for CSF diversion. A blinded retrospective study of the pre-NTV and post-NTV sizes of the ventricles in an unselected series of patients undergoing this procedure was done. A decrease in third ventricular size was seen in significantly more patients in the primary group than in the secondary group. Median change in third ventricle width for those who did not require further CSF diversion was significantly greater than those with no clinical benefit (p=0.01). Positive predictive power for successful outcome was highest for measures of the third ventricle; 73% and 68% for third ventricle width and height respectively, 88% for anterior to posterior commissure distance. In conclusion, third ventricular size reduces after NTV. The use of such a change as an arbiter of success in this procedure is questionable as clinically successful cases can have no change in ventricular size. It is considered that clinical outcome is the most important guide to success or failure as reduction in ventricular size is by no means guaranteed. Radiological outcomes alone may be misleading and reliance on them should be avoided.

Adolescent↗
PubMed2002

Anterior sacral meningocoele presenting as a peri-anal abscess.

Anterior sacral meningoceole is a rare occurrence and presentation as a perianal abscess has not been previously reported. The case is presented and the condition discussed. The potential risks of failing to establish the diagnosis, prior to surgery, are outlined.

Abscess↗
PubMed2001

The effectiveness of neuroendoscopic interventions in children with brain tumours.

OBJECT: The purpose of this study was to review the efficacy of neuroendoscopic interventions in children with brain tumours and tumour-related hydrocephalus. METHODS: In all, 61 consecutive neuroendoscopic operations carried out in 53 children with brain tumours over a 6-year period were reviewed. The patients ranged in age from 5 months to 18 years (median 9 years). Forty of 61 presentations were with a newly diagnosed tumour and hydrocephalus - the remainder predominantly had a known tumour and worsening hydrocephalus. CONCLUSIONS: Neuroendoscopic third ventriculostomy (NTV) successfully relieved hydrocephalus in the short term in 45 of 47 cases and in the longer term in 39 of 47 cases. Neuroendoscopic biopsy provided definitive tissue diagnosis in 10 of 16 cases and 5 tumours were resected. There was 1 postoperative death, which not directly related to the neuroendoscopy and few significant complications otherwise. Neuroendoscopic methods allow effective immediate and longer term control of hydrocephalus as well as the opportunity for CSF sampling and tumour biopsy in selected cases.

Adolescent↗
PubMed2001

Neuroendoscopic third ventriculostomy for hydrocephalus in adults: report of a single unit's experience with 63 cases.

BACKGROUND: Neuroendoscopic third ventriculostomy (NTV) is becoming a first line treatment for hydrocephalus in this center. Its use in a consecutive series of adults is reported. METHOD: Initially a retrospective data collection after 7 months becoming prospective studying all patients who underwent NTV in this center. The adults (17 years or older) have been studied. RESULTS: Sixty-three patients met the criteria for inclusion: 38 male, 25 female. Mean age at first NTV 37.5 years. There was an 80% success rate (i.e., no further therapy for the hydrocephalus required). Follow-up was for a mean of 3.1 years. The largest subgroup were patients with third ventricular tumours (35%), of whom 86% were successfully treated. Mean time to failure for the whole series was 8.5 months (range immediate--30 months). Complications occurred in 17.5%; those deemed serious in 11%. There were three deaths (4.7%) within 30 days of the procedure. There were six other deaths during follow-up, five because of tumour progression and one because of pneumonia. CONCLUSIONS: This procedure lends itself to the treatment of hydrocephalus in adults and appears to be more successful than in young children. It is efficacious in both previously shunted and non shunted patients. It is now the first-line treatment for noncommunicating hydrocephalus in this center and also for patients with shunt failure who are anatomically suitable, having cerebrospinal fluid spaces large enough to admit the endoscope. The complication and mortality rates compare favorably with those for shunts.

Adolescent↗
PubMed2001

Lymphocytic and granulocytic hypophysitis: a single centre experience.

Lymphocytic and granulocytic hypophysitis are rare pituitary masses. A series of five dealt with at a single centre is presented and discussed. Retrospective analysis of pathology records revealed the cases. Of pituitary mass lesions dealt with in this centre, 0.8% have the diagnosis. Five females presented, one pregnant at the time of presentation, three presenting with signs and symptoms of panhypopituitarism, and two with visual problems. All were treated by surgical means. All had good postoperative visual function, but all were panhypopituitary. Follow-up was for a mean of 4 years and 1 month. This rare condition should be treated by surgical means to obtain a diagnosis. Further treatment of residual tumour can be with corticosteroids. Good visual function should be expected, but so should permanent loss of pituitary function.

Adult↗
PubMed2001

Sildenafil (Viagra)-induced spontaneous intracerebral haemorrhage.

Sildenafil (Viagra) has been developed as a drug to help male impotence. It has a direct effect on the vasculature of the corpus cavernosum. A case of spontaneous intracerebral haemorrhage (ICH) following the illicit use of Viagra is reported. A discussion of drug-induced ICH is included.

Adult↗
PubMed2001

Warfarin and chronic subdural haematomas.

There is a perception that patients who develop a chronic subdural haematoma (CSDH), whilst taking warfarin, do less well than those not taking warfarin. This study looks at such patients to determine the truth of this perception. A retrospective analysis of two time periods (1990-1992 and 1995-1997) looking at all patients with CSDH admitted to this neurosurgical unit for treatment, to determine the incidence and to look more closely at those on warfarin. The influence of warfarin on the incidence, severity and outcome has been studied. Between 1990 and 1992, 11.8% of those patients with CSDH were taking warfarin, whilst in 1995-1997 20% were on warfarin. The overall number of referrals of CSDH increased from 34 to 150 patients during these time periods. There were no differences in age, sex or other medical disorders between the two groups. No adverse events occurred when the warfarin was stopped temporarily for treatment of the CSDH. There was no increase in recurrence rate in those on warfarin, compared with those not on warfarin. This study, whilst demonstrating an increase in the number of referrals of CSDH and patients with CSDH taking warfarin, has not demonstrated an adverse effect of the warfarin on the outcome of treatment for CSDH. The authors suggest recommencing warfarin 3 weeks after surgical evacuation of CSDH in anticoagulated patients.

Aged↗
PubMed2001

Arachnoid telangiectasia causing meningeal fibrosis and secondary syringomyelia.

A case of syringomyelia secondary to arachnoiditis associated with arachnoid telangiectasia is reported in a female patient with no other stigmata of hereditary haemorrhagic telangiectasia. Such a case has not been reported before. She underwent surgical decompression of the spinal cord with successful outcome.

Arachnoiditis↗