Emergency surgical decompression and long-term survival of glioblastoma presenting in coma in old age: case report and review of prognostic factors.

We present a case demonstrating that older age does not exclude long-term survival with glioblastoma. This is a malignant neoplasm with a median life expectancy of 14 months in patients treated with radical intent. Survival is dependent on several independent and interacting prognostic factors of which advancing age is a negative factor. We present a septuagenarian with a 3.5-year survival following aggressive management. The potential to improve glioblastoma survival in an elderly population by examination of additional prognostic factors and identifying biomarkers warrants further research.

Usefulness of Royal College of Surgeons of England operation note guidelines to neurosurgical practice: a closed loop audit.

In the UK, doctors are instructed to keep accurate and clear medical records. This helps to ensure patient safety and is a professional expectation from the General Medical Council (GMC). However, operation note documentation is often reported to be sub-optimal despite general guidelines from the Royal College of Surgeons of England (RCSeng) existing. These guidelines have sub-domains, e.g. estimated blood loss, which can inform the understanding of an intra-operative complication to help guide post-operative management. We conducted a closed loop audit of operative notes against these guidelines to ascertain if neurosurgeons in our department thought them applicable to neurosurgical practice. The first cycle was conducted retrospectively and the second cycle prospectively each conducted over a four-week period. In between each cycle the results were presented to the department: firstly, as an oral presentation and secondly as posters displayed in relevant clinical areas. Furthermore, the knowledge of operative note guidelines and their perceived importance by registrars were ascertained through a questionnaire. This highlighted that RCSeng sub-domains missing from operation notes scored lowest in terms of importance, and one sub-domain that remained recorded less frequently in both cycles was estimated blood loss. This reflects closed loop audits in general, plastic and orthopaedic surgery. Clearly, a generic guideline cannot be completely applicable to neurosurgical practice. This then begs the question if such a guideline is useful at all. Or should guidelines be specialty specific, as is the case in orthopaedic surgery, to improve compliance to a guideline more reflective of neurosurgical practice.