ABSTRACT
We present the case of a 66 year old gentleman with trigeminal schwannoma whose only presenting feature was a single gelastic seizure. This is the first case report of pathological laughter in trigeminal schwannoma in the absence of other trigeminal, brainstem, cerebellar or other cranial nerve dysfunction.
Subject(s)
Cranial Nerve Neoplasms , Laughter , Neurilemmoma , Aged , Brain Stem , Cranial Nerve Neoplasms/diagnosis , Cranial Nerve Neoplasms/diagnostic imaging , Humans , Male , Neurilemmoma/diagnosis , Neurilemmoma/diagnostic imaging , Seizures/etiologyABSTRACT
BACKGROUND: The Neurology and Neurosurgery Interest Group (NANSIG) neurosurgical skills workshop is novel in teaching neurosurgical skills solely to medical students and foundation trainees in the UK. The aim is to offer an affordable option for a high-fidelity simulation course enabling students to learn and practise specific neurosurgical skills in a safe, supervised environment. METHODS: A 10-delegate cohort was quantitatively assessed at the NANSIG neurosurgical skills workshop. Two assessors used a novel modified Objective Structured Assessment of Technical Skills (mOSATS) assessment tool, comprising 5 domains ranked according to a 5-point scale to rate delegates' ability to create a burr hole. Qualitative data from previous workshops were collected, consisting of open-ended, closed-ended and 5-point Likert scale responses to pre- and post-workshop questionnaires. Data were analysed using SPSS® software. RESULTS: Delegates scored a mean total of 62.1% (21.75/35) and 85.1% (29.8/35) in pre- and post-workshop assessments respectively revealing a statistically significant improvement. Regarding percentage of improvement, no significant difference was shown amongst candidates when comparing the number of neurosurgical cases observed and/or assisted in the past. There was no significant difference in the overall rating between the last two workshops (4.89 and 4.8 out of 5, respectively). One hundred percent of the attendees reported feeling more confident in assisting in theatre after the last two workshops. CONCLUSION: We show that a simulation workshop cannot only objectively quantify the improvement of surgical skill acquisition but can also be beneficial regardless of the extent of prior experience.
Subject(s)
Clinical Competence , Neurosurgery/education , Simulation Training/standards , Cohort Studies , Educational Measurement , Humans , Neurosurgeons , Neurosurgical Procedures/education , Students, Medical , Trephining/educationABSTRACT
The Neurology and Neurosurgery Interest Group (NANSIG), the student arm of the Society of British Neurological Surgeons (SBNS), organised a neurosurgical skills workshop in January 2017 following evidence of high demand among medical students and foundation trainees. The workshop involved ten delegates and five neurosurgical trainees with one senior consultant. Modules covering head positioning, burr holes, ventricular access, and flaps were included. This 'Introduction to Neurosurgery' skills workshop demonstrated significantly improved knowledge and confidence of delegates with attending and assisting in theatre in the future.
Subject(s)
Clinical Competence , Neurosurgery/education , Societies, Medical , Students, Medical , Educational Measurement , Humans , Neurosurgeons/education , Neurosurgical Procedures , United KingdomABSTRACT
BACKGROUND: We report our experience with the minimally invasive supraorbital approach to aneurysms of the ipsilateral anterior cerebral circulation. METHODS: A prospective review of all patients who underwent operations to clip aneurysms in Newcastle between 1993 and 2002. RESULTS: Fifty-six aneurysms were clipped via minicraniotomy in 47 patients. Six patients presented with acute subarachnoid hemorrhage (SAH), 40 patients were admitted for elective clipping, and 1 patient presented with an SAH, had the responsible aneurysm clipped and was readmitted later for elective clipping of a further aneurysm. Bilateral supraorbital craniotomies were performed in 3 patients. In 6 patients, multiple aneurysms were clipped via a single craniotomy. All aneurysms were well visualized with the microscope. Endoscopic assistance was not found necessary. All were successfully clipped. Two aneurysms ruptured while being clipped. There was no direct mortality from surgery. One patient died later from a separate posterior circulation aneurysm. One patient had a significant long-term deficit but remained independent, and 1 had 3 seizures over the 12 months after surgery. This represents a 4% morbidity at 1 year. CONCLUSION: Selected anterior cerebral circulation aneurysms can be clipped with low morbidity, using an ipsilateral minicraniotomy preserving the orbital rim, and without using an endoscope. The types of aneurysm selection criteria and operative equipment used are described.
