{"title":"The management of spinal fractures","authors":"Narendra Rath, Masna B. Inam","doi":"10.1016/j.mpsur.2024.05.010","DOIUrl":"10.1016/j.mpsur.2024.05.010","url":null,"abstract":"<div><p><span>Spinal injuries are common, ranging from minor ligamentous injury or </span>spinous process<span><span> fracture to fractures of the vertebral body and posterior elements and ligamentous injury, resulting in injury to the spinal cord. Understanding the </span>epidemiology<span>, anatomy, biomechanics and classification of spinal injuries is important. The aim of this article is to describe the aetiology of fractures, investigations to aid the diagnosis and management options available and different factors that influence the management.</span></span></p></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 8","pages":"Pages 621-627"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141708709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Francesca Soldá, Cornel Tancu, Neil Kitchen, Naomi Fersht
{"title":"Neurosurgical applications of radiotherapy","authors":"Francesca Soldá, Cornel Tancu, Neil Kitchen, Naomi Fersht","doi":"10.1016/j.mpsur.2024.05.012","DOIUrl":"10.1016/j.mpsur.2024.05.012","url":null,"abstract":"<div><p><span>The term ‘radiosurgery’ (RS) indicates a high precision localized technique of irradiation used as an alternative to surgical excision in patients with malignant or benign conditions, both in the brain and in the body. Brain RS has been historically identified with ‘stereotactic radiotherapy’. The term refers to the long-established neurosurgical technique of localizing the position of a lesion in the brain by using a system of external 3D co-ordinates coupled with rigid head immobilization device (often fixed to the skull). A high dose of radiation is delivered to the target stereotactically identified and a safe and accurate treatment is achieved, minimizing the dose of radiation to the surrounding brain. While for some techniques the traditional stereotactic localization has been replaced by the integration of modern imaging with non-invasive accurate immobilization, the term ‘stereotactic’ is still maintained in the clinical practice. Over the past 30 years, the implementation of powerful diagnostic imaging devices and of new </span>radiotherapy<span> equipment has contributed to the large diffusion of brain RS. RS plays an important role in the management of brain tumours, vascular and functional brain lesions and the expertise of the multidisciplinary treating team (clinical oncologists, neurosurgeons, neuro-radiologists and medical physics) contributes to the treatment success rate.</span></p></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 8","pages":"Pages 590-598"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141714222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adam J Wells, Edoardo Viaroli, Peter JA Hutchinson
{"title":"The management of traumatic brain injury","authors":"Adam J Wells, Edoardo Viaroli, Peter JA Hutchinson","doi":"10.1016/j.mpsur.2024.05.004","DOIUrl":"10.1016/j.mpsur.2024.05.004","url":null,"abstract":"<div><p><span>Traumatic brain injury<span><span> (TBI) remains a significant global problem with an increasing socioeconomic impact. Increasing knowledge of the pathophysiology<span> of TBI has led to a systematic multidisciplinary approach towards management aiming to protect the brain from secondary injury. Early management starting from the scene of injury, to intensive care and surgical settings is paramount to achieve this purpose. TBI includes a large spectrum of diseases, therefore identifying the correct pathology on imaging is fundamental to define the appropriate next steps of management. Computed tomography (CT) imaging to date remains the gold standard for initial radiological assessment. Intracranial and </span></span>cerebral perfusion pressure<span><span> targeted therapies are still the minimum requirement in most of modern </span>intensive care units worldwide. </span></span></span>Decompressive craniectomy<span><span><span> is a fundamental technique to control medically refractory intracranial hypertension and reduce mortality; however, its burden in terms of outcomes remains a controversial topic requiring further debate. There is emerging evidence that TBI is a chronic illness, with increased incidence of cognitive and behavioural deficits, </span>neurodegenerative disease such as </span>seizures and epilepsy, and an increased mortality that extends well beyond the initial TBI stage. Ongoing research into novel biomarkers, the application of artificial intelligence (AI) and an increasing global effort may yield future therapeutic strategies to improve clinical outcomes.</span></p></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 8","pages":"Pages 543-552"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141952177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Management of cerebrospinal fluid disorders","authors":"Jonathan R. Ellenbogen, Conor Mallucci","doi":"10.1016/j.mpsur.2024.05.008","DOIUrl":"10.1016/j.mpsur.2024.05.008","url":null,"abstract":"<div><p>Cerebrospinal fluid (CSF) disorders generally result in an excess volume of CSF within the neuraxis and an increase in intracranial pressure, defined as hydrocephalus. The treatment of hydrocephalus remains surgical today with the aim of CSF diversion, but the best technique and the best assessment of adequacy of treatment remains undecided in many cases. While shunt insertion remains the mainstay of treatment, neuroendoscopic interventions such as endoscopic third ventriculostomy (ETV) have proven successful for specific pathological conditions. Improved understanding of CSF dynamics and hydrocephalus pathophysiology together with technological advances in neuroimaging, neuronavigation and shunt hardware is leading to a more bespoke, patient-specific approach to this complex and multifactorial pathological entity. In this article we discuss the basics of our current understanding in CSF physiology, the presenting signs and symptoms of hydrocephalus and the modalities best employed to diagnose it. We also discuss treatment modalities and the tailored approach required for specific CSF disorders.</p></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 8","pages":"Pages 580-589"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141952179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"An overview of the nervous system","authors":"Peter J. Bazira","doi":"10.1016/j.mpsur.2024.05.013","DOIUrl":"10.1016/j.mpsur.2024.05.013","url":null,"abstract":"<div><p><span>The nervous system is divided topographically into two parts: the </span>central nervous system<span> and the peripheral nervous system<span>. From a functional perspective, however, the two systems are intimately connected and function in an integrated and coordinated manner. The central nervous system comprises the brain and spinal cord, while the peripheral nervous system is made up of the cranial and peripheral nerves and associated neurological structures. This article presents a broad and general overview of the structure and organization of the nervous system emphasizing several important functional features.</span></span></p></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 8","pages":"Pages 525-535"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141952196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Tumours of the central nervous system","authors":"Paul M. Brennan","doi":"10.1016/j.mpsur.2024.05.007","DOIUrl":"10.1016/j.mpsur.2024.05.007","url":null,"abstract":"<div><p>Surgery plays a key role in the management of brain tumours. The prognosis for patients following many brain tumour diagnoses is poor, but without the input of the surgical team, the outcomes would be bleaker. Innovations in understanding of the molecular biology of brain tumours may identify new targets for future therapies, but surgery is likely to retain a role in reducing the bulk of the tumour mass and in tissue diagnosis. In this article, we will examine recent updates in understanding of brain tumour biology and the implications for management. We will look at the latest research on brain tumour diagnosis, and then focus on management of the three most common brain tumours – glioma<span>, meningiomas and cerebral metastases. We examine the surgical approach and adjuncts that should be employed to optimize patient outcomes.</span></p></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 8","pages":"Pages 553-560"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141952174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Management of malignant spinal cord compression","authors":"Surya Gandham, Simon Clark, Marcus DeMatas","doi":"10.1016/j.mpsur.2024.05.011","DOIUrl":"10.1016/j.mpsur.2024.05.011","url":null,"abstract":"<div><p>Metastatic cord compression is one of the most serious complications of cancer. It is an emergency that requires rapid decision making involving several specialities, given the risk of permanent spinal cord injury<span>. Patients may present with various clinical signs such as pain and neurological dysfunction with interventions aiming to improve both of these. Diagnosis is made through detailed history and examination followed by specific radiological investigations. The standard of care in most cases is rapid initiation of corticosteroids in combination with either surgical decompression in case of an operable candidate, followed by radiation therapy or radiotherapy alone. This process has recently been improved by the use of decision frameworks such as NOMS (neurologic, oncologic, mechanical, and systemic), to help clinicians direct treatment. This article represents an overview of the pathogenesis, investigations and management of metastatic cord compression. It references up-to-date national guidance and evidence-based protocols which should inform both surgical and nonsurgical clinicians.</span></p></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 8","pages":"Pages 604-614"},"PeriodicalIF":0.0,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141952181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Major incidents: an overview","authors":"Ian Nesbitt","doi":"10.1016/j.mpsur.2024.03.012","DOIUrl":"10.1016/j.mpsur.2024.03.012","url":null,"abstract":"<div><p>This piece aims to give a brief overview of some of the systemic considerations when managing a major incident which will be explored in greater detail in other articles in this issue.</p></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 7","pages":"Pages 453-455"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140766989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Major incident pre-hospital care","authors":"Natalie Lonsdale, R. Jonathan Howes","doi":"10.1016/j.mpsur.2024.03.016","DOIUrl":"https://doi.org/10.1016/j.mpsur.2024.03.016","url":null,"abstract":"<div><p>Major incidents are rare, but when they happen, they have the potential for devastating consequences. The pre-hospital management of major incidents follows the JESIP principles and focuses on the key concepts of command and control, safety and communication, followed by assessment and casualty management including the hierarchy of triage, treatment and transportation. An understanding of these processes is important knowledge for hospital staff.</p></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 7","pages":"Pages 471-478"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141478511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Trauma resuscitation and the damage control approach","authors":"Sarah Fadden","doi":"10.1016/j.mpsur.2024.04.005","DOIUrl":"https://doi.org/10.1016/j.mpsur.2024.04.005","url":null,"abstract":"<div><p>Trauma is a leading cause of morbidity and mortality worldwide. Developments in trauma care, from point of wounding to rehabilitation, have often been led and driven by military medical experiences in recent conflicts. Trauma mechanisms are manifold, affecting an omnifarious patient population indiscriminately, and potentially resulting in significant multisystem dysfunction or damage, sometimes permanently. The horizontal approach to trauma resuscitation, whereby a patient is assessed and treated by multiple specialists to prioritize management of life-threatening issues swiftly and concurrently, was exploited to good effect by clinicians at Camp Bastion in Afghanistan. This tactic is just one element of the dynamic and synchronous teamwork that this complex and challenging area of clinical practice demands. Similarly, the damage control approach deploys medical and surgical treatment strategies in parallel, balancing therapies in pursuit of physiological equipoise, aiming to reduce mortality and accepting the risk of morbidity. Damage control therapy embodies bold, yet nuanced, clinical care.</p></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 7","pages":"Pages 479-486"},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141480182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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