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Annals of The Royal College of Surgeons of England (1)
Journal of Neurology, Neurosurgery, and Psychiatry (1)
Hardwidge, C (2)
Garfield, J S (1)
Goodden, JR (1)
Illis, L S (1)
Sedgwick, E M (1)
Tallis, R C (1)
Tranter, R (1)
Year of Publication
Setting the Standard – UK Neurosurgical Acoustic Neuroma Practice
Annals of The Royal College of Surgeons of England
The aim of this study was to determine how current practice in the UK and Ireland complies with the Clinical Effectiveness Guidelines for the Management of Acoustic Neuromas.
MATERIALS AND METHODS
A survey of units and consultants using a standardised questionnaire was carried out.
Fifty-six neurosurgeons treat acoustic neuromas in 33 out of 34 units. In 27 units, one or two surgeons specialise in this area. Caseload per annum per surgeon ranged from 2 to 30, median 15. Forty-one neurosurgeons (75%) work with an ENT surgeon. All surgeons use facial nerve monitoring during surgery. All neurosurgeons informed patients about stereotactic radiosurgery, tending to recommend it for medically unfit patients, and those with small tumours.
Overall, 26 units (79%) and 40 surgeons (73%) met the criteria for good surgical practice. The main reasons for non-compliance were a lack of teamwork with ENT, and insufficient caseload to maintain surgical expertise.
Acoustic neuroma; Vestibular schwannoma; Practice guidelines; Surgery; Radiosurgery
Spinal cord stimulation in peripheral vascular disease.
Tallis, R C
Illis, L S
Sedgwick, E M
Garfield, J S
Journal of Neurology, Neurosurgery, and Psychiatry
The results of ten patients with severe, intractable symptoms of arterial disease receiving spinal cord stimulation are reported. Six out of ten patients showed clinical improvement. Three of five patients with severe rest pain obtained complete or very marked relief and one of two patients with moderate rest pain in the legs obtained complete relief. The mean claudication distance in the ten patients increased from 65 to 212 metres during epidural stimulation of the spinal cord. Exercise tolerance as measured on a bicycle ergometer increased by 61%. These changes were associated with small increases in cutaneous and muscle blood flow. In those patients who responded clinically, the improvements seen were maintained as long as spinal cord stimulation was continued. There was no clinical response to transcutaneous (placebo) stimulation and four patients did not respond in any way to spinal cord stimulation. The improvements seen are unlikely to be due to either the natural history of the disease or to a placebo effect. The effect is probably due to antidromic stimulation of the central processes of the first order sensory neurons. It is suggested on the basis of animal studies that this effect may be mediated by release of prostaglandins as well as indirectly via pain relief.
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