Theophylline, a drug efficient to increase intracranial pressure. Case report and review of literature.

Introduction: Limited information is available regarding the direct effect of drugs prescribed to elevate intracranial pressure (ICP) in contrast to the abundance of evidence in support of medication utilized to lower ICP. Theophylline is a methylxanthine derivate used in the treatment of respiratory diseases with only a few randomized control trials or case reports describing pain improvement in low CSF pressure states or spontaneous intracranial hypotension (SIH). We present the case of a recorded increase in intracranial pressure under theophylline. Case report: A 23-year-old female with a complex history of hydrocephalus and syringomyelia was experiencing debilitating symptoms due to refractory intracranial hypotension. Medical management with oral theophylline was attempted for a period of three months. Intracranial pressure measurements were obtained via the telemetric pressure sensor reservoir (Miethke®, M.scio®) incorporated in the patient's ventriculoperitoneal shunt system. Results: A significant increase in intracranial pressure was recorded at therapeutic drug levels. Conclusion: This is the first report of an increase in intracranial pressure under oral theophylline medication.

Women in leadership positions in European neurosurgery - Have we broken the glass ceiling?

Introduction: The proportion of male neurosurgeons has historically been higher than of women, although at least equal numbers of women have been entering European medical schools. The Diversity Committee (DC) of the European Association of Neurosurgical Societies (EANS) was founded recently to address this phenomenon. Research question: In this cross-sectional study, we aimed to characterize the status quo of female leadership by assessing the proportion of women heading European neurosurgical departments. Material and methods: European neurosurgical departments were retrieved from the EANS repository. The gender of all department chairs was determined via departmental websites or by personal contact. The proportion of females was stratified by region and by type of hospital (university versus non-university). Results: A total of 41 (4.3%) female department chairs were identified in 961 neurosurgery departments in 41 European countries. Two thirds (68.3%) of European countries do not have a female neurosurgery chair. The highest proportion of female chairs was found in Northern Europe (11.1%), owing to four female chairs in a relatively small number of departments (n = 36). The proportions were considerably smaller in Western Europe (n = 17/312 (5.5%)), Southern Europe (n = 14/353 (4.0%)) and Central and Eastern Europe (n = 6/260 (2.3%)) (p = 0.06). The distribution of female chairs in university (n = 19 (46.3%)) versus non-university departments (n = 22 (53.7%)) was even. Discussion and Conclusion: There is a significant gender imbalance with 4% of all European neurosurgery departments headed by women. The DC intends to develop strategies to support equal chances and normalize the presence of female leaders in European neurosurgery.

Safety and efficacy of brain biopsy: Results from a single institution retrospective cohort study.

Introduction: Brain biopsy provides important histopathological diagnostic information for patients with new intracranial lesions. Although a minimally invasive technique, previous studies report an associated morbidity and mortality between 0.6% and 6.8%. We sought to characterise the risk linked to this procedure, and to establish the feasibility of instigating a day-case brain biopsy pathway at our institution. Materials and methods: This single-centre retrospective case series study included neuronavigation guided mini craniotomy and frameless stereotactic brain biopsies carried out between April 2019 and December 2021. Exclusion criteria were interventions performed for non-neoplastic lesions. Demographic data, clinical and radiological presentation, type of biopsy, histology and complications in the post-operative period were recorded. Results: Data from 196 patients with a mean age of 58.7 years (SD+/-14.4 years) was analysed. 79% (n=155) were frameless stereotactic biopsies and 21% (n=41) neuronavigation guided mini craniotomy biopsies. Complications resulting in acute intracerebral haemorrhage and death, or new persistent neurological deficits were observed in 2% of patients (n=4; 2 frameless stereotactic; 2 open). Less severe complications or transient symptoms were noted in 2.5% of cases (n=5). 8 patients had minor haemorrhages in the biopsy tract with no clinical ramifications. Biopsy was non-diagnostic in 2.5% (n=5) of cases. Two cases were subsequently identified as lymphoma. Other reasons included insufficient sampling, necrotic tissue, and target error. Discussion and conclusion: This study demonstrates that brain biopsy is a procedure with an acceptably low rate of severe complications and mortality, in line with previously published literature. This supports the development of day-case pathway allowing improved patient flow, reducing the risk of iatrogenic complications associated with hospital stay, such as infection and thrombosis.

Novel telemetric pressure monitoring in lumbar theca.

Introduction: There is no previous literature on the use of telemetric sensors (telesensor) in the lumbar theca. We aim to provide novel data on telemetric pressure monitoring of the lumbar theca via lumboperitoneal shunts. Research question: Primary outcome is telemetric sensor malfunction of lumboperitoneal shunt. The secondary outcome is post-operative complications. Materials and methods: A single centre retrospective case series of patients with telemetric sensor in LP shunt system, between 2015 and 2021, consisting of 5 patients. Review of indications for use, duration of function of telemetric sensor and associated complications. Results: There was no procedural complications of LP shunt insertion with telemetric sensor. The patient with highest body weight patient had retraction of distal tubing which required distal resiting 3 times. Four out of five patients had no complications. In all cases, telemetric sensor functioned satisfactorily with no dysfunction. The duration of documentation was 1-40 months. Pressure readings were satisfactorily carried out in variety of positions. Discussion and conclusion: This is the first report of telemetric sensor use in the lumbar theca. It can provide a valuable way of measuring cerebrospinal fluid pressures, particularly in patients avoiding cranial surgery. More research is indicated to assess what pressure values would mean clinically.