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Richard Gullan

King's College Hospital, Clinical Neurosciences, Faculty Member

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Papers by Richard Gullan

Therapeutic strategies and challenges in the management of craniospinal tumours in pregnancy: a 10-year retrospective tertiary centre study, systematic review, and proposal of treatment algorithms

Research Square (Research Square), Dec 20, 2021

The study aims to evaluate therapeutic strategies in the management of craniospinal tumours in pr... more The study aims to evaluate therapeutic strategies in the management of craniospinal tumours in pregnant patients and the factors that in uence the management along with their in uence on maternal & foetal outcomes. Materials and Methods: A retrospective single-centre cohort study was performed at a tertiary neurosurgical referral centre. Pregnant patients referred to neuro-oncology multidisciplinary meeting (MDM) with craniospinal tumour were included. Ten-year patient data were collected from hospital records and neuro-oncology MDM outcomes. A systematic review was performed on the available literature in PubMed as per PRISMA guidelines. Results: Thirty-three patients were identi ed with a mean age of 31 years. 91%(n=30) had cranial lesions and 9% (n=3) had spinal lesions. Most of the patients had WHO Grade I/II tumours. 33.3% underwent surgery when pregnant whilst in 24.2% this was deferred until after the due date. 27.2% patients did not require surgical intervention and were followed up with serial imaging in the MDM. Left Lateral/park bench position was the preferred position for the spinal and posterior fossa lesions. Systematic review identi ed 26 eligible articles. Treatment algorithms are proposed addressing the therapeutic strategy for management of cranio-spinal tumours during pregnancy and the challenges for maternal and foetal outcomes were tabulated. Conclusions: Craniospinal tumours presenting in pregnancy are challenging. The surgical management needs to be tailored individually and as part of a multidisciplinary team approach. Maternal and foetal outcomes are to be considered during patient counselling.

Intraoperative ultrasound to aid resection of a peritorcular meningioma: a technical note

Journal of surgical case reports, Oct 1, 2021

Surgery for meningiomas involving dural venous sinuses is challenging. We describe a case of a pe... more Surgery for meningiomas involving dural venous sinuses is challenging. We describe a case of a peritorcular meningioma involving major venous sinuses, which was removed using a venous sparing approach with the aid of intraoperative ultrasound. We found ultrasound to be a useful adjunct as it enabled us to get real-time information about the location of venous structures, their function and demonstrate dynamic changes in blood f low during surgery.

Exploring the Role of Specialist Physiotherapy in Awake Craniotomy Surgery for the Neuro-Oncology Patient

Neuro-oncology, Oct 1, 2022

0.46-0.79, P=0.005) and low (HR 0.67, 95% CI 0.50-0.89, P<0.001) methylation groups had better su... more 0.46-0.79, P=0.005) and low (HR 0.67, 95% CI 0.50-0.89, P<0.001) methylation groups had better survival compared to unmethylated group. There was no evidence for interaction between MGMT methylation and completed temozolomide regimen (interaction term for low methylation P=0.097; high methylation P=0.071). This suggests no strong effect of MGMT status on survival in patients completing temozolomide regimen. In patients not completing the temozolomide regimen, higher MGMT methylation predicted better survival (interaction terms P<0.001). CONCLUSION: Quantitative MGMT methylation may provide additional prognostic value. This is important when assessing clinical and research therapies.

Impact of Tubular Retractor-Assisted Transsulcal Minimal Invasive Parafascicular Approach for Deep-Seated Lesions in Cortical Vascularization

Neuro-oncology, Oct 1, 2022

AIMS Assess the impact of tubular retractor-assisted transsulcal minimal invasive parafascicular ... more AIMS Assess the impact of tubular retractor-assisted transsulcal minimal invasive parafascicular approaches(tsMIPS) in the cortical vascularization using indocianin green angiography(ICGA) during removal of deep-seated cerebral tumours. METHOD Single-centre prospective cohort study of patients with deep-seated lesions – distance to nearest sulcus &gt; 10mm - where ICGA was performed. Zeiss FLOW800 Software was used to analyse the following variables - delay time, speed, time to peak and rise time - before and after insertion of the tubular retractor (NICO BrainPath). RESULTS 13 patients were enrolled. 60 regions-of-interest were analysed. The most common pathology was high grade glioma (69%). The average depth of tumours was 34,2mm (23– 45mm) and the time-under-retraction 166mins (45-280 mins). The most common vascular pattern before-after tubular retractor was: increase on the delay time, time to peak and rising time (present in 8 patients) and a decrease on the speed (present in 7 patients). Two patients had a mayor neurological deficit after the surgery. Both had the same flow pattern with an increase on the speed and decrease on the time to peak and rise time, the delay was indifference. CONCLUSION This is the first study assessing the impact of tubular retractor-assisted tsMIPS in cortical vascularization during deep-seated lesion resection. The most common cortical vascular pattern is: an increase on the delay time, time to peak and rising time and a decrease on the speed. The two patients who presented vascular injury shared the same pattern (increase on the speed, decrease on the time to peak and rise time, with indifference delay).

033 Audit on the diagnostic pathway of patients with glioma mimics

Journal of Neurology, Neurosurgery, and Psychiatry, Nov 14, 2019

BackgroundConditions such as primary CNS lymphoma (PCNSL) or demyelinating/inflammatory diseases ... more BackgroundConditions such as primary CNS lymphoma (PCNSL) or demyelinating/inflammatory diseases may present with similar clinical and neuroradiological features to gliomas. These ‘glioma mimics’ are commonly diagnosed with brain biopsy, but this is not always possible. We aim to optimize the contribution of less invasive investigations to the diagnostic pathway.MethodRetrospective review of the diagnostic process of glioma mimics between September to November 2018 in a tertiary Neuro–oncology unit.ResultsThe Neuro-oncology MDT gave 558 opinions excluding post –operative reviews. Twelve cases were identified as glioma mimics. 6/12 were new cases. Further investigations in five new cases took 2.5 – 11 weeks to complete. Two patients deteriorated during diagnostic workup and had expedited brain biopsies which confirmed PCNSL. One proceeded with chemotherapy and one was referred to palliative care.ConclusionDiagnostic tests prior to brain biopsy were not performed in all glioma mimic cases. This was because test results excluding brain biopsy were not available to start treatment before the patient deteriorated clinically. We anticipate that the frequency of glioma mimics will increase due to the greater use of immunomodulatory therapies. A dedicated protocol to achieve rapid diagnosis of glioma mimics is imperative to facilitate early, appropriate treatment.

Supratentorial and Infratentorial Ependymomas in Adult Population - A 10-year single institution case series

Neuro-oncology, Oct 1, 2019

We aim to demonstrate the entire range of PRMT proteins expressed in two different glioblastoma c... more We aim to demonstrate the entire range of PRMT proteins expressed in two different glioblastoma cell lines (U87MG and U251) in order to elucidate a consistency in expression of these proteins across cell lines. METHODS: Cells from 2 different glioblastoma cell lines (U87MG and U251) were cultured and lysed using standard aseptic techniques. Protein profiling was done using SDS-PAGE electrophoresis with a molecular weight marker as the reference and all primary antibodies to various PRMTs (1-10) and respective secondary antibodies. Membranes were visualised with a chemiluminescent protocol. Experiments were repeated in order to reduce bias. CONCLUSION: It was clearly seen that in both cell lines there is a strong tendency for PRMT5 expression and relative under-expresssion of PRMT 9/10. In addition, however, there are varying expressions of other PRMTs as well. We aim to further explore this to improve the strength of this correlation.

Tractography-Enhanced Biopsy of Central Core Motor Eloquent Tumours: A Simulation-Based Study

Journal of Personalized Medicine, Mar 3, 2023

This article is an open access article distributed under the terms and conditions of the Creative... more

In Reply: Altered Motor Excitability in Patients With Diffuse Gliomas Involving Motor Eloquent Areas: The Impact of Tumor Grading

Neurosurgery, Jan 11, 2021

Simultaneous Motor and Visual Intraoperative Neuromonitoring in Asleep Parietal Lobe Surgery: Dual Strip Technique

Journal of Personalized Medicine, Sep 9, 2022

This article is an open access article distributed under the terms and conditions of the Creative... more

Letter to the Editor. Multidisciplinary meetings for neuro-oncology services

Journal of Neurosurgery, Feb 1, 2021

C, et al. Earlier radiosurgery leads to better pain relief and less medication usage for trigemin... more

Neurosurgical Management of Central Nervous System Lymphoma: Lessons Learnt from a Neuro-Oncology Multidisciplinary Team Approach

Journal of Personalized Medicine, Apr 30, 2023

This article is an open access article distributed under the terms and conditions of the Creative... more

Delayed Lumbar Drop Metastases of Choroid Plexus Carcinoma in an Adult

Journal of neurological surgery, May 1, 2012

Minimally invasive approach to a deep-seated motor eloquent brain tumour: a technical note

Journal of surgical case reports, 2022

Deep-seated brain tumours represent a unique neurosurgical challenge as they are often surrounded... more Deep-seated brain tumours represent a unique neurosurgical challenge as they are often surrounded by eloquent structures. We describe a minimally invasive technique using tubular retractors and intraoperative neurophysiology monitoring for open biopsy of a deep-seated lesion surrounded by the corticospinal tract. We used preoperative functional mapping with diffusion tensor imaging tractography and navigated transcranial magnetic stimulation to identify a safe surgical corridor. We also used 5-Aminolevulinic Acid induced fluorescence to identify the lesion intraoperatively and optimize tissue samples obtained for histopathological diagnosis. We found the use of these tools improved the safety of surgery and reduced the risk of surgical morbidity.

033 Audit on the diagnostic pathway of patients with glioma mimics

Journal of Neurology, Neurosurgery & Psychiatry

BackgroundConditions such as primary CNS lymphoma (PCNSL) or demyelinating/inflammatory diseases ... more BackgroundConditions such as primary CNS lymphoma (PCNSL) or demyelinating/inflammatory diseases may present with similar clinical and neuroradiological features to gliomas. These ‘glioma mimics’ are commonly diagnosed with brain biopsy, but this is not always possible. We aim to optimize the contribution of less invasive investigations to the diagnostic pathway.MethodRetrospective review of the diagnostic process of glioma mimics between September to November 2018 in a tertiary Neuro–oncology unit.ResultsThe Neuro-oncology MDT gave 558 opinions excluding post –operative reviews. Twelve cases were identified as glioma mimics. 6/12 were new cases. Further investigations in five new cases took 2.5 – 11 weeks to complete. Two patients deteriorated during diagnostic workup and had expedited brain biopsies which confirmed PCNSL. One proceeded with chemotherapy and one was referred to palliative care.ConclusionDiagnostic tests prior to brain biopsy were not performed in all glioma mimic c...

Therapeutic Strategies and Challenges in the Management of Craniospinal Tumors in Pregnancy: A Ten-Year Retrospective Tertiary-Center Study, Systematic Review, and Proposal of Treatment Algorithms

World Neurosurgery

The study aims to evaluate therapeutic strategies in the management of craniospinal tumours in pr... more The study aims to evaluate therapeutic strategies in the management of craniospinal tumours in pregnant patients and the factors that in uence the management along with their in uence on maternal & foetal outcomes. Materials and Methods: A retrospective single-centre cohort study was performed at a tertiary neurosurgical referral centre. Pregnant patients referred to neuro-oncology multidisciplinary meeting (MDM) with craniospinal tumour were included. Ten-year patient data were collected from hospital records and neuro-oncology MDM outcomes. A systematic review was performed on the available literature in PubMed as per PRISMA guidelines. Results: Thirty-three patients were identi ed with a mean age of 31 years. 91%(n=30) had cranial lesions and 9% (n=3) had spinal lesions. Most of the patients had WHO Grade I/II tumours. 33.3% underwent surgery when pregnant whilst in 24.2% this was deferred until after the due date. 27.2% patients did not require surgical intervention and were followed up with serial imaging in the MDM. Left Lateral/park bench position was the preferred position for the spinal and posterior fossa lesions. Systematic review identi ed 26 eligible articles. Treatment algorithms are proposed addressing the therapeutic strategy for management of cranio-spinal tumours during pregnancy and the challenges for maternal and foetal outcomes were tabulated. Conclusions: Craniospinal tumours presenting in pregnancy are challenging. The surgical management needs to be tailored individually and as part of a multidisciplinary team approach. Maternal and foetal outcomes are to be considered during patient counselling.

Impact of Tubular Retractor-Assisted Transsulcal Minimal Invasive Parafascicular Approach for Deep-Seated Lesions in Cortical Vascularization

Neuro-Oncology

AIMS Assess the impact of tubular retractor-assisted transsulcal minimal invasive parafascicular ... more AIMS Assess the impact of tubular retractor-assisted transsulcal minimal invasive parafascicular approaches(tsMIPS) in the cortical vascularization using indocianin green angiography(ICGA) during removal of deep-seated cerebral tumours. METHOD Single-centre prospective cohort study of patients with deep-seated lesions – distance to nearest sulcus > 10mm - where ICGA was performed. Zeiss FLOW800 Software was used to analyse the following variables - delay time, speed, time to peak and rise time - before and after insertion of the tubular retractor (NICO BrainPath). RESULTS 13 patients were enrolled. 60 regions-of-interest were analysed. The most common pathology was high grade glioma (69%). The average depth of tumours was 34,2mm (23– 45mm) and the time-under-retraction 166mins (45-280 mins). The most common vascular pattern before-after tubular retractor was: increase on the delay time, time to peak and rising time (present in 8 patients) and a decrease on the speed (present in 7...

Exploring the Role of Specialist Physiotherapy in Awake Craniotomy Surgery for the Neuro-Oncology Patient

Neuro-Oncology

AIMS To describe the methods used to assess and monitor motor function during awake craniotomy su... more AIMS To describe the methods used to assess and monitor motor function during awake craniotomy surgery for tumour resection. METHOD A service review was carried out over 10 months. Patients with highly motor eloquent lesions – invasion of primary motor cortex or fronto-parietal connections involved in motor cognition – were included. Clinical notes were reviewed and summarised using descriptive analysis. Dexterity and grip strength were measured using 9-hole peg test and handheld dynameter pre/intra and post-operatively. Patient occupation/interests were reported to guide bespoke assessments to trial intra-operatively. RESULTS From April 2021 to January 2022, 13 patients (mean age 39.7 years, 4 female:10 male, 9 low grade:5 high grade gliomas) were included. Mean score 9-hole peg test 22.2sec pre-operatively, 30.6sec post-operatively; handheld dynameter 26.7kg pre-operatively, 18.4kg post-operatively. At discharge 5 of 7 impaired patients demonstrated motor improvement. For motor co...

Continuous Microdebrider-Based Dynamic Subcortical Motor Mapping: A Technical Advance in Tubular Retractor–Assisted Surgery

Operative Neurosurgery

Simultaneous Motor and Visual Intraoperative Neuromonitoring in Asleep Parietal Lobe Surgery: Dual Strip Technique

Background: The role played by the non-dominant parietal lobe in motor cognition, attention and s... more Background: The role played by the non-dominant parietal lobe in motor cognition, attention and spatial awareness networks has potentiated the use of awake surgery. When this is not feasible, asleep monitoring and mapping techniques should be used to achieve an onco-functional balance. Objective: This study aims to assess the feasibility of a dual-strip method to obtain direct cortical stimulation for continuous real-time cortical monitoring and subcortical mapping of motor and visual pathways simultaneously in parietal lobe tumour surgery. Methods: Single-centre prospective study between May’19-November’20 of patients with intrinsic non-dominant parietal-lobe tumours. Two subdural strips were used to simultaneously map and monitor motor and visual pathways. Results: Fifteen patients were included. With regards to motor function, a large proportion of patients had abnormal interhemispheric resting motor threshold ratio (iRMTr) (71.4%), abnormal Cortical Excitability Score (CES) (85....

Preoperative and intraoperative anatomical-functional mapping in insular glioma surgery: integrated model to improve surgical outcome

Journal of Neurosurgical Sciences, 2022

Therapeutic strategies and challenges in the management of craniospinal tumours in pregnancy: a 10-year retrospective tertiary centre study, systematic review, and proposal of treatment algorithms

Research Square (Research Square), Dec 20, 2021

The study aims to evaluate therapeutic strategies in the management of craniospinal tumours in pr... more The study aims to evaluate therapeutic strategies in the management of craniospinal tumours in pregnant patients and the factors that in uence the management along with their in uence on maternal & foetal outcomes. Materials and Methods: A retrospective single-centre cohort study was performed at a tertiary neurosurgical referral centre. Pregnant patients referred to neuro-oncology multidisciplinary meeting (MDM) with craniospinal tumour were included. Ten-year patient data were collected from hospital records and neuro-oncology MDM outcomes. A systematic review was performed on the available literature in PubMed as per PRISMA guidelines. Results: Thirty-three patients were identi ed with a mean age of 31 years. 91%(n=30) had cranial lesions and 9% (n=3) had spinal lesions. Most of the patients had WHO Grade I/II tumours. 33.3% underwent surgery when pregnant whilst in 24.2% this was deferred until after the due date. 27.2% patients did not require surgical intervention and were followed up with serial imaging in the MDM. Left Lateral/park bench position was the preferred position for the spinal and posterior fossa lesions. Systematic review identi ed 26 eligible articles. Treatment algorithms are proposed addressing the therapeutic strategy for management of cranio-spinal tumours during pregnancy and the challenges for maternal and foetal outcomes were tabulated. Conclusions: Craniospinal tumours presenting in pregnancy are challenging. The surgical management needs to be tailored individually and as part of a multidisciplinary team approach. Maternal and foetal outcomes are to be considered during patient counselling.

Intraoperative ultrasound to aid resection of a peritorcular meningioma: a technical note

Journal of surgical case reports, Oct 1, 2021

Surgery for meningiomas involving dural venous sinuses is challenging. We describe a case of a pe... more Surgery for meningiomas involving dural venous sinuses is challenging. We describe a case of a peritorcular meningioma involving major venous sinuses, which was removed using a venous sparing approach with the aid of intraoperative ultrasound. We found ultrasound to be a useful adjunct as it enabled us to get real-time information about the location of venous structures, their function and demonstrate dynamic changes in blood f low during surgery.

Exploring the Role of Specialist Physiotherapy in Awake Craniotomy Surgery for the Neuro-Oncology Patient

Neuro-oncology, Oct 1, 2022

0.46-0.79, P=0.005) and low (HR 0.67, 95% CI 0.50-0.89, P<0.001) methylation groups had better su... more 0.46-0.79, P=0.005) and low (HR 0.67, 95% CI 0.50-0.89, P<0.001) methylation groups had better survival compared to unmethylated group. There was no evidence for interaction between MGMT methylation and completed temozolomide regimen (interaction term for low methylation P=0.097; high methylation P=0.071). This suggests no strong effect of MGMT status on survival in patients completing temozolomide regimen. In patients not completing the temozolomide regimen, higher MGMT methylation predicted better survival (interaction terms P<0.001). CONCLUSION: Quantitative MGMT methylation may provide additional prognostic value. This is important when assessing clinical and research therapies.

Impact of Tubular Retractor-Assisted Transsulcal Minimal Invasive Parafascicular Approach for Deep-Seated Lesions in Cortical Vascularization

Neuro-oncology, Oct 1, 2022

AIMS Assess the impact of tubular retractor-assisted transsulcal minimal invasive parafascicular ... more AIMS Assess the impact of tubular retractor-assisted transsulcal minimal invasive parafascicular approaches(tsMIPS) in the cortical vascularization using indocianin green angiography(ICGA) during removal of deep-seated cerebral tumours. METHOD Single-centre prospective cohort study of patients with deep-seated lesions – distance to nearest sulcus &gt; 10mm - where ICGA was performed. Zeiss FLOW800 Software was used to analyse the following variables - delay time, speed, time to peak and rise time - before and after insertion of the tubular retractor (NICO BrainPath). RESULTS 13 patients were enrolled. 60 regions-of-interest were analysed. The most common pathology was high grade glioma (69%). The average depth of tumours was 34,2mm (23– 45mm) and the time-under-retraction 166mins (45-280 mins). The most common vascular pattern before-after tubular retractor was: increase on the delay time, time to peak and rising time (present in 8 patients) and a decrease on the speed (present in 7 patients). Two patients had a mayor neurological deficit after the surgery. Both had the same flow pattern with an increase on the speed and decrease on the time to peak and rise time, the delay was indifference. CONCLUSION This is the first study assessing the impact of tubular retractor-assisted tsMIPS in cortical vascularization during deep-seated lesion resection. The most common cortical vascular pattern is: an increase on the delay time, time to peak and rising time and a decrease on the speed. The two patients who presented vascular injury shared the same pattern (increase on the speed, decrease on the time to peak and rise time, with indifference delay).

033 Audit on the diagnostic pathway of patients with glioma mimics

Journal of Neurology, Neurosurgery, and Psychiatry, Nov 14, 2019

BackgroundConditions such as primary CNS lymphoma (PCNSL) or demyelinating/inflammatory diseases ... more BackgroundConditions such as primary CNS lymphoma (PCNSL) or demyelinating/inflammatory diseases may present with similar clinical and neuroradiological features to gliomas. These ‘glioma mimics’ are commonly diagnosed with brain biopsy, but this is not always possible. We aim to optimize the contribution of less invasive investigations to the diagnostic pathway.MethodRetrospective review of the diagnostic process of glioma mimics between September to November 2018 in a tertiary Neuro–oncology unit.ResultsThe Neuro-oncology MDT gave 558 opinions excluding post –operative reviews. Twelve cases were identified as glioma mimics. 6/12 were new cases. Further investigations in five new cases took 2.5 – 11 weeks to complete. Two patients deteriorated during diagnostic workup and had expedited brain biopsies which confirmed PCNSL. One proceeded with chemotherapy and one was referred to palliative care.ConclusionDiagnostic tests prior to brain biopsy were not performed in all glioma mimic cases. This was because test results excluding brain biopsy were not available to start treatment before the patient deteriorated clinically. We anticipate that the frequency of glioma mimics will increase due to the greater use of immunomodulatory therapies. A dedicated protocol to achieve rapid diagnosis of glioma mimics is imperative to facilitate early, appropriate treatment.

Supratentorial and Infratentorial Ependymomas in Adult Population - A 10-year single institution case series

Neuro-oncology, Oct 1, 2019

We aim to demonstrate the entire range of PRMT proteins expressed in two different glioblastoma c... more We aim to demonstrate the entire range of PRMT proteins expressed in two different glioblastoma cell lines (U87MG and U251) in order to elucidate a consistency in expression of these proteins across cell lines. METHODS: Cells from 2 different glioblastoma cell lines (U87MG and U251) were cultured and lysed using standard aseptic techniques. Protein profiling was done using SDS-PAGE electrophoresis with a molecular weight marker as the reference and all primary antibodies to various PRMTs (1-10) and respective secondary antibodies. Membranes were visualised with a chemiluminescent protocol. Experiments were repeated in order to reduce bias. CONCLUSION: It was clearly seen that in both cell lines there is a strong tendency for PRMT5 expression and relative under-expresssion of PRMT 9/10. In addition, however, there are varying expressions of other PRMTs as well. We aim to further explore this to improve the strength of this correlation.

Tractography-Enhanced Biopsy of Central Core Motor Eloquent Tumours: A Simulation-Based Study

Journal of Personalized Medicine, Mar 3, 2023

This article is an open access article distributed under the terms and conditions of the Creative... more

In Reply: Altered Motor Excitability in Patients With Diffuse Gliomas Involving Motor Eloquent Areas: The Impact of Tumor Grading

Neurosurgery, Jan 11, 2021

Simultaneous Motor and Visual Intraoperative Neuromonitoring in Asleep Parietal Lobe Surgery: Dual Strip Technique

Journal of Personalized Medicine, Sep 9, 2022

This article is an open access article distributed under the terms and conditions of the Creative... more

Letter to the Editor. Multidisciplinary meetings for neuro-oncology services

Journal of Neurosurgery, Feb 1, 2021

C, et al. Earlier radiosurgery leads to better pain relief and less medication usage for trigemin... more

Neurosurgical Management of Central Nervous System Lymphoma: Lessons Learnt from a Neuro-Oncology Multidisciplinary Team Approach

Journal of Personalized Medicine, Apr 30, 2023

This article is an open access article distributed under the terms and conditions of the Creative... more

Delayed Lumbar Drop Metastases of Choroid Plexus Carcinoma in an Adult

Journal of neurological surgery, May 1, 2012

Minimally invasive approach to a deep-seated motor eloquent brain tumour: a technical note

Journal of surgical case reports, 2022

Deep-seated brain tumours represent a unique neurosurgical challenge as they are often surrounded... more Deep-seated brain tumours represent a unique neurosurgical challenge as they are often surrounded by eloquent structures. We describe a minimally invasive technique using tubular retractors and intraoperative neurophysiology monitoring for open biopsy of a deep-seated lesion surrounded by the corticospinal tract. We used preoperative functional mapping with diffusion tensor imaging tractography and navigated transcranial magnetic stimulation to identify a safe surgical corridor. We also used 5-Aminolevulinic Acid induced fluorescence to identify the lesion intraoperatively and optimize tissue samples obtained for histopathological diagnosis. We found the use of these tools improved the safety of surgery and reduced the risk of surgical morbidity.

033 Audit on the diagnostic pathway of patients with glioma mimics

Journal of Neurology, Neurosurgery & Psychiatry

BackgroundConditions such as primary CNS lymphoma (PCNSL) or demyelinating/inflammatory diseases ... more BackgroundConditions such as primary CNS lymphoma (PCNSL) or demyelinating/inflammatory diseases may present with similar clinical and neuroradiological features to gliomas. These ‘glioma mimics’ are commonly diagnosed with brain biopsy, but this is not always possible. We aim to optimize the contribution of less invasive investigations to the diagnostic pathway.MethodRetrospective review of the diagnostic process of glioma mimics between September to November 2018 in a tertiary Neuro–oncology unit.ResultsThe Neuro-oncology MDT gave 558 opinions excluding post –operative reviews. Twelve cases were identified as glioma mimics. 6/12 were new cases. Further investigations in five new cases took 2.5 – 11 weeks to complete. Two patients deteriorated during diagnostic workup and had expedited brain biopsies which confirmed PCNSL. One proceeded with chemotherapy and one was referred to palliative care.ConclusionDiagnostic tests prior to brain biopsy were not performed in all glioma mimic c...

Therapeutic Strategies and Challenges in the Management of Craniospinal Tumors in Pregnancy: A Ten-Year Retrospective Tertiary-Center Study, Systematic Review, and Proposal of Treatment Algorithms

World Neurosurgery

The study aims to evaluate therapeutic strategies in the management of craniospinal tumours in pr... more The study aims to evaluate therapeutic strategies in the management of craniospinal tumours in pregnant patients and the factors that in uence the management along with their in uence on maternal & foetal outcomes. Materials and Methods: A retrospective single-centre cohort study was performed at a tertiary neurosurgical referral centre. Pregnant patients referred to neuro-oncology multidisciplinary meeting (MDM) with craniospinal tumour were included. Ten-year patient data were collected from hospital records and neuro-oncology MDM outcomes. A systematic review was performed on the available literature in PubMed as per PRISMA guidelines. Results: Thirty-three patients were identi ed with a mean age of 31 years. 91%(n=30) had cranial lesions and 9% (n=3) had spinal lesions. Most of the patients had WHO Grade I/II tumours. 33.3% underwent surgery when pregnant whilst in 24.2% this was deferred until after the due date. 27.2% patients did not require surgical intervention and were followed up with serial imaging in the MDM. Left Lateral/park bench position was the preferred position for the spinal and posterior fossa lesions. Systematic review identi ed 26 eligible articles. Treatment algorithms are proposed addressing the therapeutic strategy for management of cranio-spinal tumours during pregnancy and the challenges for maternal and foetal outcomes were tabulated. Conclusions: Craniospinal tumours presenting in pregnancy are challenging. The surgical management needs to be tailored individually and as part of a multidisciplinary team approach. Maternal and foetal outcomes are to be considered during patient counselling.

Impact of Tubular Retractor-Assisted Transsulcal Minimal Invasive Parafascicular Approach for Deep-Seated Lesions in Cortical Vascularization

Neuro-Oncology

AIMS Assess the impact of tubular retractor-assisted transsulcal minimal invasive parafascicular ... more AIMS Assess the impact of tubular retractor-assisted transsulcal minimal invasive parafascicular approaches(tsMIPS) in the cortical vascularization using indocianin green angiography(ICGA) during removal of deep-seated cerebral tumours. METHOD Single-centre prospective cohort study of patients with deep-seated lesions – distance to nearest sulcus > 10mm - where ICGA was performed. Zeiss FLOW800 Software was used to analyse the following variables - delay time, speed, time to peak and rise time - before and after insertion of the tubular retractor (NICO BrainPath). RESULTS 13 patients were enrolled. 60 regions-of-interest were analysed. The most common pathology was high grade glioma (69%). The average depth of tumours was 34,2mm (23– 45mm) and the time-under-retraction 166mins (45-280 mins). The most common vascular pattern before-after tubular retractor was: increase on the delay time, time to peak and rising time (present in 8 patients) and a decrease on the speed (present in 7...

Exploring the Role of Specialist Physiotherapy in Awake Craniotomy Surgery for the Neuro-Oncology Patient

Neuro-Oncology

AIMS To describe the methods used to assess and monitor motor function during awake craniotomy su... more AIMS To describe the methods used to assess and monitor motor function during awake craniotomy surgery for tumour resection. METHOD A service review was carried out over 10 months. Patients with highly motor eloquent lesions – invasion of primary motor cortex or fronto-parietal connections involved in motor cognition – were included. Clinical notes were reviewed and summarised using descriptive analysis. Dexterity and grip strength were measured using 9-hole peg test and handheld dynameter pre/intra and post-operatively. Patient occupation/interests were reported to guide bespoke assessments to trial intra-operatively. RESULTS From April 2021 to January 2022, 13 patients (mean age 39.7 years, 4 female:10 male, 9 low grade:5 high grade gliomas) were included. Mean score 9-hole peg test 22.2sec pre-operatively, 30.6sec post-operatively; handheld dynameter 26.7kg pre-operatively, 18.4kg post-operatively. At discharge 5 of 7 impaired patients demonstrated motor improvement. For motor co...

Continuous Microdebrider-Based Dynamic Subcortical Motor Mapping: A Technical Advance in Tubular Retractor–Assisted Surgery

Operative Neurosurgery

Simultaneous Motor and Visual Intraoperative Neuromonitoring in Asleep Parietal Lobe Surgery: Dual Strip Technique

Background: The role played by the non-dominant parietal lobe in motor cognition, attention and s... more Background: The role played by the non-dominant parietal lobe in motor cognition, attention and spatial awareness networks has potentiated the use of awake surgery. When this is not feasible, asleep monitoring and mapping techniques should be used to achieve an onco-functional balance. Objective: This study aims to assess the feasibility of a dual-strip method to obtain direct cortical stimulation for continuous real-time cortical monitoring and subcortical mapping of motor and visual pathways simultaneously in parietal lobe tumour surgery. Methods: Single-centre prospective study between May’19-November’20 of patients with intrinsic non-dominant parietal-lobe tumours. Two subdural strips were used to simultaneously map and monitor motor and visual pathways. Results: Fifteen patients were included. With regards to motor function, a large proportion of patients had abnormal interhemispheric resting motor threshold ratio (iRMTr) (71.4%), abnormal Cortical Excitability Score (CES) (85....

Preoperative and intraoperative anatomical-functional mapping in insular glioma surgery: integrated model to improve surgical outcome

Journal of Neurosurgical Sciences, 2022