Abstract Journal Neurosurgery

Journal Neurosurgery NS005 A SURVEY OF NEUROSURGICAL MANAGEMENT AND PROGNOSTICATION OF TRAUMATIC BRAIN INJURY FOLLOWING THE RESCUEICP TRIAL AARON CHESTER, GORDON PURDIE, ELIZABETH DENNETT AND ANDREW PARKER UNIVERSITY OF OTAGO WELLINGTON, WELLINGTON, NEW ZEALAND Purpose: Decompressive craniectomy remains controversial because of uncertainty regarding its benefit to patients; this study aimed to explore current practice following the RESCUEicp Trial, an important study in the evolving literature on decompressive craniectomies. Methodology: Fifty-eight neurosurgeons in New Zealand, Australia, Nepal and the USA completed a survey consisting of two case scenarios and several multi-choice questions exploring their surgical management and prognostication of traumatic brain injuries following the RESCUEicp Trial. Results: One in ten neurosurgeons (n = 6, 10.3%) were no longer performing decompressive craniectomies for TBI following the RESCUEicp Trial and two fifths (n = 23, 39.7%) were less enthusiastic. Most neurosurgeons would not operate in the face of severe disability (n = 46, 79.3%) or vegetative state/death (n = 57, 98.3%). There was significant variability in the neurosurgeons’ prognostic estimates, which were generally more optimistic than the CRASH prognostic model. Those with more pessimistic prognostic estimates and those who use decision support tools were more likely to decline decompressive surgery to the two case scenarios. Conclusions: RESCUEicp had a notable impact on neurosurgeons and their management of TBI. Although there remains no clear clinical consensus on the contraindications for decompressive craniectomy, most neurosurgeons would not operate if severe disability or vegetative state (the rates of which are increased by such surgery) seemed likely. Whilst unreliable, prognostic estimates still have an impact on clinical decision making and neurosurgical management. Wider use of decision support tools should be considered. NS006 MULTIMODALITY TREATMENT OF INTRACRANIAL ARTERIOVENOUS MALFORMATIONS IN SOUTH ISLAND, NEW ZEALAND SUDIPTO PAL, FRANCES NICHOLSON, RONALD BOET, ANDREW LAING, WAYNE COLLECUTT, ANTHONY LIM AND KERRY HITOS Christchurch Hospital, Christchurch, New Zealand Purpose and Methodology: We present a retrospective review of the experience of a single centre using the treatment approach of favouring surgical resection, and utilizing embolization (often in a staged, multi-procedure fashion) for more complex lesions, however the goal of treatment remains obliteration of nidus for cure. Results: A total of 40 patients treated over a 10 year period (2004–2014) are analysed here. Nine patients were managed surgically and complete resection was achieved in all cases with nil mortalities. Embolization was utilized in 31 patients (mean age 40), of which 45% presented with headache, 39% with seizures, 10% with a headache only, and 6% with a deficit. None were found incidentally. The Spetzler-Martin grade 1 cases accounted for 10% of the cohort, 23% were grade II, 42% grade III, 23% grade IV and 3% grade V. A single aneurysm was present in 42% of cases, and multiple in 13%. All cases were embolized using Onyx and the average volume used was 6.4 ml (range 0.2-24 ml, SD 6.2 ml). The nidus was obliterated in 9.6% of cases with a morbidity rate of 6.5% and mortality rate of 3%. There were no cases of recanalization. Of the 15 cases referred to radiosurgery, 8 were cured. The total overall cure rate was 50%. Conclusion: Our approach to intracranial AVM management can lead to excellent overall rates of cure with satisfactory morbidity and mortality rates compared to international literature. NS007 LAPAROSCOPIC VENTRICULOPERITONEAL SHUNT INSERTION IS SAFE AND EFFECTIVE WHEN PERFORMED BY NEUROSURGEONS ALONE ROSALIND L. JEFFREE AND MICHAEL J. COLDITZ Royal Brisbane Hospital, QLD Background and Purpose: Benefits of laparoscopic insertion of the peritoneal end of a ventriculo-peritoneal (VP) shunt by general surgeons have been reported. We present an audit of VP shunt insertion at RBWH, where shunts are often inserted laparoscopically by members of the neurosurgical team without general surgeons. Methods: After ethics exemption, shunt operations from 2013 to 2019 were extracted from the operation theatre database (ORMIS) by ICD10 code and text word search. Results: Over 5 years, 161 laparoscopic shunt procedures were performed: 115 by the neurosurgical team, 33 by doctors from the acute surgical unit (ASU), and 13 combined. Four cases were converted to open procedures & in three the ASU was called when difficulties were encountered. In the same time, 84 open procedures were performed: 77 by the neurosurgical team, 6 by the ASU, 1 combined & 2 where the ASU was called due to problems. Procedure time was similar for laparoscopic (85 34 minutes) and open (92 32 minutes, P = 0.1) operations. Use of stereotaxy was associated with ~15 minutes longer surgery (P = 0.016). Sixty-seven repeat operations were performed on 45 patients, 41/161 (25%) following laparoscopic surgery and 26/84 (30%) after open surgery (Chi squared = 0.83, P = 0.36). Conclusions: VP shunts can be safely inserted laparoscopically by members of the neurosurgical team achieving benefits of laparoscopic shunt insertion without the complexities of coordinating two surgical teams. Laparoscopic shunt insertion should be included in neurosurgical training and as an option on consent and registry data forms.