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Biomedical subjects

R S Maurice-Williams

Publications and source records attributed to R S Maurice-Williams.

At least 19 recordsLinked to original sources
PubMed1994

Ossification of the posterior longitudinal ligament mimicking cord compression from a dorsal disc protrusion: a cautionary tale.

A patient with focal anterior compression of the dorsal cord at the level of the D6/7 disc was mistakenly diagnosed as a dorsal disc protrusion on the basis of CT myelography. The CT scanning had been confined to axial views at the level of the cord compression. A transthoracic exploration failed to reveal a disc protrusion and the correct diagnosis, ossification of the posterior longitudinal ligament, was only revealed by a subsequent sagittal CT scan. This case emphasizes the dangers of relying on limited axial imaging in diagnosing a spinal lesion.

Diagnostic Errors↗
PubMed1994

Ruptured intracranial aneurysms--learning from experience.

The outcome of treatment of 400 consecutive patients with ruptured intracranial aneurysms was assessed at 1 year. The patients were treated by a single surgeon over a period of 13 years. Data sheets completed as each patient was treated included a contemporary analysis of the reasons for any unsatisfactory outcome. Surgery was usually delayed for over 10 days from the last haemorrhage. Over the four successive 100-patient cohorts, in which the composition of the patient population remained unaltered, 1 year overall management mortality fell steadily from 38 to 24%. One year surgical mortality fell from 19 to 3%. The population of those operated on who were in Glasgow Outcome Score 5 at 1 year rose from 73 to 90% (from 51 to 71% for all patients). Of the 123 deaths, 89 occurred prior to operation, 24 after it. Thirty-five patients died from rebleeding prior to operation, but only eight of these occurred in patients judged fit for surgery at the time. All but one of the postoperative deaths resulted from technical problems related to the surgery. Over the successive cohorts, several factors indicated an improvement in operative efficiency, notably a fall in the proportion of cases with technical problems from 15 to 1%. We have demonstrated a steady improvement in management results, resulting largely from increasing operative experience. We do not believe that changes in overall management strategy, such as early surgery, would have any effect on overall outcome.

Adult↗
PubMed1993

Lymphocytic meningitis following insertion of a porcine dermis dural graft.

We describe a case of lymphocytic meningitis following insertion of a porcine dermis implant to repair an operative dural defect. Histology of the excised implant revealed local abscess formation with a granulomatous reaction. Oligoclonal Immunoglobulin G, part of which could be removed by absorbtion with the porcine dermis, was present in the patient's cerebrospinal fluid, and, to a less marked degree, in his serum. The cerebrospinal fluid glucose was markedly depressed. An unusual hypersensitivity reaction to the porcine implant was considered the most likely explanation for this meningitic illness. The patient went on to make a full recovery following excision of the implant.

Adult↗
PubMed1993

The scope of neurosurgery for elderly people.

Patients treated by a single neurosurgeon over a period of 17 years have been reviewed in order to assess the volume and nature of neurosurgical work performed on patients aged over 65 years. Based on this data we report: (1) The age distribution of the principal neurosurgical conditions, drawing attention to those conditions which are over- and under-represented in elderly patients. (2) A steady increase in the number of patients over 65 admitted over the last 15 years. (3) The numbers and types of neurosurgical operations carried out on elderly patients at the present time compared with 10 years ago. (4) The outcome of first-time surgery for intracranial meningiomas in 144 patients analysed by age. It is clear that a large and increasing proportion of neurosurgical work is carried out on persons over the age of 65. Age by itself appears to be no bar to a good outcome after a major neurosurgical operation provided that the surgery is elective and is not accompanied by a diffuse neurological disturbance.

Aged↗
PubMed1992

Spinal dural arteriovenous malformations--a treatable cause of progressive paraparesis in elderly people.

Spinal dural arteriovenous malformations (SDAVMs) were first described in 1977. They present with a progressive paraparesis, principally in men aged 60 years and over. They are usually dorsolumbar in situation and are thought to be acquired lesions which produce symptoms by obstructing the venous drainage of the spinal cord. There are no pathognomonic clinical features and diagnosis depends on a high level of clinical suspicion and myelography extended into the dorsal region. The condition is probably underdiagnosed and may be quite a common cause of progressive leg weakness in elderly people. Surgical treatment is relatively simple, safe, and if carried at an early stage can lead to dramatic neurological recovery. This paper reports nine cases seen over a period of 7 years. All the patients showed marked neurological improvement after surgery.

Aged↗
PubMed1992

Intracranial tumours in the elderly: the effect of age on the outcome of first time surgery for meningiomas.

We have investigated the effect of age on the outcome of first time surgery for intracranial meningiomas. In a retrospective study, 144 consecutive patients were divided into three groups: young (up to 44 years of age, 38 patients), middle-aged (45-64 years, 60 patients) and elderly (65 years and over, 46 patients). Outcome was assessed at the first follow-up appointment 4-6 months after discharge. The surgical mortality was 2.7%. The incidence of significant intercurrent disease increased with age (11, 25 and 35%, respectively), as did the incidence of postoperative complications (16, 23 and 30%). Postoperative intracranial bleeding was especially age-related, occurring in 20% of the elderly group as against 0% of the younger. Although the younger patients did best (100% in Glasgow Outcome Scale Grade 5) there was no difference in outcome between the middle-age and elderly groups (88 and 83%, respectively). Of the elderly patients, 89% showed clear functional improvement after surgery, 2% were unchanged and 9% were worse or dead. The intellectual deterioration apparent in over half of the elderly patients recovered after removal of the tumour in 80%. We conclude that age has little effect on the prospects of success after removal of an intracranial meningioma.

Adult↗
PubMed1991

The cognitive and psychological sequelae of uncomplicated aneurysm surgery.

Many patients are left with psychological symptoms after surgery for a ruptured intracranial aneurysm. Often the reason for these symptoms is not clear. A prospective study was carried out of 27 patients who were in a good (Grade 1 or 2) condition before operation to identify the origin of such symptoms and discover whether the basic techniques of aneurysm surgery could lead to serious psychological sequelae even in the absence of any specific complication. Each patient was given a modified psychometric assessment just before surgery and at the time of discharge from hospital. One year later a full psychometric and social assessment was carried out. Even a temporary worsening of psychometric performance did not occur unless there had been some specific surgical or post-operative problem. Five patients showed worsening of psychometric performance in the immediate post-operative period but by one year, only two of the 27 patients showed any abnormalities on formal psychometric evaluation; in both, clear reasons were evident. Although the majority of patients reported minor psychological symptoms, these had not hindered full functional recovery, and we doubt whether they had any organic basis. It is concluded that aneurysm surgery does not, itself, threaten higher intellectual function unless some specific complication occurs.

Adult↗
PubMed1990

Medical audit: assessment of surgical performance in a low volume specialty.

We describe a simple technique for auditing one aspect of the activity of a neurosurgical unit--the surgical operations performed. A proforma completed by the surgeon at the time of operation was brought up-to-date on subsequent daily ward rounds. Each week, the medical staff of the unit met to review the data sheets of those patients discharged during the previous seven days. This meeting served to ensure the completeness of the data and to discuss any problems in management before the records were computerized. At the end of the first year, problems which had become apparent in the system were identified and corrected. The revised system involves a comprehensive and prospective audit of relevant clinical information. It has led to the accumulation of a considerable quantity of reliable data and it involves frequent positive feedback which appears to be leading to an improvement in treatment outcome. The system is simple to administer and is economical of time. It should be suitable for any surgical specialty which resembles neurosurgery in dealing with a relatively small volume of major procedures, and it could easily be adapted to audit other aspects of the activity of a unit.

Evaluation Studies as Topic↗
PubMed1989

Closed head injuries: where does delay occur in the process of transfer to neurosurgical care?

In the United Kingdom most head injury patients are first admitted to a District General Hospital (DGH); selected patients are later referred to a Neurosurgical Unit (NSU). It is known that this system leads to some avoidable deaths. In an attempt to discover whether the minimum amount of time involved in such a system of secondary referral must of necessity put some patients at risk, and whether any significant delay could be eliminated without radical change in this system, we have carried out a detailed prospective analysis of the sequence of events involved in the emergency transfer of 117 consecutive patients with suspected traumatic intracranial haematoma (TICH). We discovered that once it had been decided to transfer a patient, the actual process of transfer consumed relatively little time regardless of the distance from the DGH to the NSU. Where harmful avoidable delay did occur was at the DGH itself either from failure to institute appropriate treatment for non-cranial injuries or from failure to realise that transfer was necessary. We believe that the geographical dispersal of neurosurgical services would not improve the outlook of patients with head injury. The optimum outcome could be achieved by concentrating head injury admissions at selected DGH's each of which would be equipped both with a CT scanner linked to a neurosurgical unit and a standby ambulance for transferring head injury patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Brain Injuries↗