Peadiatric Brain Tumours

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Brain tumours are a swelling within the brain caused by a collection of cells that grow abnormally due to an incapability of the body being able to moderate cell growth and division. Due to the restricted space within the skull, brain tumours can be very problematic. Although more rare, there are still around 400 paediatric brain tumours diagnosed in the UK each year.

 There are many different types of paediatric brain tumours. These can be either non-cancerous (benign) or cancerous (malignant).

Symptoms of paediatric brain tumours can be very diverse and depend on the location, size and growth of the tumour. These can include:

-   Sickness, especially in the morning.

-   Visual disturbances

-   Seizures

-   Headaches

-   Behavioural changes

-   Abnormal eye movements

-   Balance issues

-   Excessive thirst leading to increased urination

From ages 0-4, the most likely symptoms are visual disturbances and cranial pressure leading to nausea and vomiting whilst beyond this age, the most highly reported symptom is a continuous headache. Due to vague indicators and a child’s reduced ability to communicate these symptoms, diagnosing a paediatric brain tumour can take time. However, this delay can impact the treatment options available and therefore the prognosis, making it important to identify warning signs early on.

Diagnosing paediatric brain tumours is best done through a neurologist. There are many different methods to determine whether a child has a brain humour. However, the most popular ones are an MRI scan, X-ray or CT scan.

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Following diagnosis, there is a variety of options for treatment, including…

Surgery
During the operation, a doctor will try to extract as much of the tumour mass as possible. Surgery can also be used to remove small portions of the tumour for testing (biopsy). It’s also possible to install a device which can help alleviate symptoms, such as a shunt.

Radiotherapy

Using high energy radiation, the aim of radiotherapy is to eliminate cancer cells. Radiation is popular if it’s deemed the tumour cannot be operated on. It’s also used to remove any remaining tumour cells following surgery. As healthy cells are damaged during radiotherapy, side effects such as fatigue, hair loss and nausea are common. The process has been around for over 100 years.

Chemotherapy

Mostly used for fast growing brain tumours, chemotherapy uses drugs to combat cancer cells. There are several types of drugs depending on the type and stage of the tumour. These drugs are sometimes used in different combinations. Chemotherapy can be used alongside other treatments, such as surgery and radiotherapy. Some side effects can be anaemia, fever and hair loss.

Recovery

Complete recuperation of health from paediatric brain tumours can be possible. A variety of therapy options can also aid recovery, such as physiotherapy, occupational therapy and speech therapy.

Brain tumours for children and their loved ones are a traumatic experience. However, thanks to advances in modern medicine and science, more children than ever are fully recovering.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.

10 interesting facts about London Neurosurgery Partnership

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1.     LNP was originally founded by Mr Sanj Bassi. After practising for 15 years in the NHS, Sanj decided to take a leap and form a partnership of 11 neurosurgeons in the private sector and call it London Neurosurgery Partnership. In 2008 Sanj sought 10 surgeons from King’s College Hospital as they all worked there together on an NHS basis and still work there together on the NHS to this day! They are all great friends inside and outside work and often get together to play a spot of cricket or go for some dinner. As LNP is a partnership there is no competition or divide and they all work closely and in-sync with each other, that’s what makes them so unique! 

2.     Interesting fact about Professor Ashkan: At age 5 Professor Ashkan learned how doctors could relieve pain and suffering from a family friend who was then a trainee doctor and it defined his whole life and it is what made him become a neurosurgeon. Alongside his medical degree he also has a music degree and diploma and LOVES playing, listening and dancing to all music! 

3.     After 8 years of success with LNP the partners felt it was the right time to take a new direction and in 2016, London Neuroscience Academy was born. As you may already know LNA prides itself on delivering the best educational courses for continuing professional development with CPD awarded classes and world-renowned international speakers. LNP often speak at these events which are held almost every month, it’s a great opportunity for GP’s and all health professionals to get up-close and personal with the LNP team and really pick their brains! 

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4.     Even though you hear a lot about the surgeons at LNP you don’t necessarily hear about their medical secretaries. They have secretaries in various locations like Spire, Blackheath and The Shard but also at their practice base in Harley Street. Practice manager Mary has been working with Sanj Bassi since before LNP was ever formed and actually played a part in getting it off the ground. Some of our secretaries have been PA’s to the same surgeons for years and could run their clinics in their sleep! It’s really quite special what these women do on a daily basis and are a massive part of the practice. LNP are continually thankful and to show this, every year they host a fantastic summer and Christmas party where all the PA’s and surgeons get together for some fun and team bonding. Did someone say gin o’clock!

5.     Mr Christos Tolias served for two years as a Medical Officer in the Greek Air Force (1990-1992). He was also awarded an Action Research Fellowship in 1996 which was presented to him by its patron Prince Philip in a ceremony at Buckingham Palace! And that’s not all – it’s all pretty cool that he also writes poetry.

6.     The surgeons at London Neurosurgery Partnership have over 315 years’ worth of experience between them!  

7.     LNP are expanding and growing across London and Kent, they also are looking to increase consulting numbers in the near future. Watch This Space!

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8.     Mr Ranj Bhangoo is a secret pastry chef, so secret we have never even tried one of his cakes! Another interesting fact is when he was at medical school, he co-founded a Classical Music Society that has gone on to become the largest festival of Indian Classical Music outside of India! It is held annually at Southbank.

9.     Throughout Richard Selway’s career he has been asked to speak at many events, news articles and publications but the most memorable time is when he appeared on Richard and Judy as an expert to discuss the female orgasm!

10.  Finally, you may find it interesting (we did!) to know that the surgeons at LNP have roots all the round the world from America to Iran to India and Denmark! Combined they can speak a total of 10 different languages, of which you can find on each consultant bio! 

An image-guided brain biopsy

Mr Ranjeev Bhangoo explains what happens during an image-guided brain biopsy.

Here at LNP it’s common for us to perform a brain biopsy for patients who have a lesion on the brain. A biopsy is performed by removing a small sample of tissue and sending it to a lab where it can be determined exactly what type of lesion it is and therefore how it can be treated. 

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Undergoing an MRI scan is a fantastic and innovative way of producing clear-cut images of the brain and spinal cord in specific sequences. This will be able to initially pick up a lesion protruding on the brain and supply layered images.

The patient will be asleep during the procedure which means the they will not be able to feel a thing. There are different types of brain biopsies and the surgeon will be able to decipher which one is best for the patients’ lesion.

  • a biopsy as part of the operation to remove the tumour

  • image-guided biopsy

  • an open biopsy

  • a neuroendoscopy

Open biopsy: Some lesions can lay near the surface of the skull, using image-guidance a small incision will be made in the skull and a piece of the tissue  is take to be examined under the microscope.

Image-guided Biopsy: A small hole will be made and a small needle will be guided in to the tumour to take a sample.

Neuroendoscopy: A endoscope will be used to take tissue from in or around the ventricles of the brain. The ventricles are fluid-filled spaces in the brain.

Robotic technology for brain tumour biopsy – ROSA Robot

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 We currently use a new type of robotic surgery called ROSA Robot, it is a highly specialised stereotatic technique and is used for lesions that are in a sensitive part of the brain. ROSA has a robotic arm that reproduces the movements of a human arm but without the ‘tremor’ a human hand may give and can perform precise surgical gestures. The robot will follow the exact instruction from the controlling surgeon and will be about to provide high-definition 3D images of the surgical site on a screen in the theatre

It provides increased safety and precision for the patients and is a lot less invasive, hosting a quicker recovery time and reduced risk of infection and pain.

Once a small piece of the lesion has been removed, the sample will be taken to the labs where it will be put under a microscope. As mentioned, this will tell us exactly what this is and how we can treat it going forward.

The patient will be called back in for a consultation with the surgeon so he/she can check the wound is healing ok and go through the biopsy results, this will happen 5-7 days after the procedure. The surgeon will then discuss the treatment options in the MDT in collaboration with the oncologists and radiotherapists in order to determine the ideal treatment which may include a combination of surgery, chemotherapy, radiotherapy, immunotherapy or entering into a trial. 

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.

Sacroiliac Joint Pain

What are sacroiliac (SI) joints?

You have two sacroiliac bones in the lower part of your spine, one on the left and one on the right. They are located directly below your lumbar spine and connect to your pelvis. The SI joints do not need to move like the other parts of your spine as their job is to support and provide stability to the weight of your upper body.

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What are the causes of sacroiliac joint dysfunction?

Your SI joints are covered in a protective layer called cartilage and when this wears down, usually caused by ageing, it can cause the bones to rub on each other which can cause degenerative arthritis.

Pregnancy can also cause SI joint dysfunction; this is because the body is relaxing the muscles and joints ready for childbirth. Increased movement and changes of the joints will result in extra stress on those SI joints and can cause pain.

SI joint pain can occur when there are changes in the ligaments, this means if they become too loose or even too tight it can become painful and inflamed. Changes like a fall or injury, surgery, ageing, altered walking pattern and other medical conditions can all become factors in SI joint dysfunction.

What are the symptoms?

 SI joint pain starts in the lower back, it will then radiate down to your hips, legs, buttocks and thighs. The pain is usually felt on one side and will worsen during physical activities like walking, running, climbing stars or standing for long periods of time. The pain can feel sharp and a dull-like ache, you may also experience a tingling or numbness sensation.

 Diagnosis

During a consultation, a full medical history will be taken as well as a physical examination which will entail testing your reflexes and applying pressure to your joints to find a pain source.

An MRI scan, CT or X-ray will be performed to view detailed images of the SI joints and surrounding bones, this will ultimately confirm the diagnosis of SI joint dysfunction.

If imaging does not confirm a diagnosis then a injection containing corticosteroid and local anaesthetic will be placed at the SI joint. This will numb the area, if the pain continues after the injection then it would be unlikely that the SI joints are the source of your pain.

 

Treatments

It is always best to start with non-surgical treatment like physical therapy and stretching. Some anti-inflammatory medications may also be able to help such as ibuprofen, naproxen, creams, patches and salves

Steroid injections are a good way to target the pain without surgical intervention. They can reduce the swelling and inflammation but they are only temporary and may need repeating.  Nerve blocks are also useful in delivering an electrical current to stop the nerve fibres from sending pain signals to the brain.

Surgery will be a last option which can involve a fusion of the SI joints where titanium plates and screws are placed with the joints and fused together and promote bone growth which will stop all movement from the SI joints and stop the pain. If you would like to know more about fusion surgery please click here.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.

Talk to me about Tarlov cysts.

Talk to me about Tarlov cysts.  

What are they?

Tarlov cysts are sacs filled with cerebrospinal fluid that are found in the spinal cord. They commonly affect the nerve roots in the sacrum. The exact cause for these cysts is unknown and can typically cause no symptoms and are found when undergoing diagnostic investigations for other health conditions.

Generally, the larger the cyst grows the more likely you are to experience symptoms as the cyst will be compressing the nerve root. This can cause pain when sitting, standing, walking and laying down. The pain may feel sharp and sudden or burning, usually at the lower back and hip area and it may start to radiate down towards the buttocks and legs. The symptoms associated with Tarlov cysts are:

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Pain from the affected area by the cysts

Weakness and numbness

Incontinence

Sexual dysfunction

Constipation

Headaches due to CSF pressure

Difficulty walking and sitting for period

General pain and deterioration  

Tarlov cysts can easily mimic other conditions and sometimes this can make it difficult to diagnose, especially if the doctor has not come across this type of cyst before. The best form of diagnosis is having an MRI scan as this will take real-time images of the spine in a specific sequence and will be able to show any cysts protruding the nerves and spinal cord.

If a Tarlov cyst is not causing any symptoms and is small in size then the best option will be to watch and wait, it is not always necessary to begin surgical intervention if the patient is not in pain or at risk. Simple monitoring will be used to check the state of cyst and to see if it is growing in size, it will also give the patient an opportunity to speak with the doctor if any symptoms have arisen since the diagnosis.

Medications like NSAIDS can be prescribed to control any inflammation or irritation affecting the nerve root. A TENS machine or electrical nerve stimulation are also used to help pain.

Draining or shunting the cyst is a treatment option to relieve pressure that has been affecting the nerve roots but there is still a chance of recurrence. Injecting the Tarlov cyst at its source with fibrin glue will help with pain and symptoms it is causing. Fibrin glue can also be used to seal or close the cyst and prevent it from filling back up again.

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Treatment and surgical routes all depend on how symptomatic the patient is, the size of the cyst and whether it is responding to conservative methods well. For some, the above treatment will work wonders and a patient will feel relief and less symptomatic almost immediately and some may not respond well at all.

 Surgical options may vary and the doctor will choose a treatment route specifically tailored to the patient.  

Drainage of Tarlov cyst is a surgical option where the cyst can be drained and removed from the spine. This option usually comes in to effect when more conservative treatments have not worked and the cyst is reoccurring.

If you have a Tarlov cyst and would like to discuss your options in more detail then please do not hesitate to contact our office for a non-obligatory consultation.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.

Vagus Nerve Stimulation (VNS)

What is VNS?

 Vagus nerve stimulation is a type of neuromodulation. The aim of the treatment is to help children above the age of 4 and adults control their epilepsy. The neurostimulator is surgically implanted in to the chest with a wire connecting to the left vagus nerve. The vagus nerve is the 10th cranial nerve and runs from the brainstem right down towards the abdomen. The stimulator uses pulses of electricity that sends signals to your brain to ultimately prevent or lessen seizures. Having regular pulses of electricity sent to the brain can help people who are not aware seizures are going to happen or if they occur at night. VNS will not help patients who have non-epileptic seizures, this is because it is not associated with electrical activity in the brain.

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This treatment is extremely helpful for patients that have not achieved control on anti-seizure medication and other techniques. Vagus nerve stimulation is also helpful to patients suffering from depression and have not responded to anti-depressant medication and other treatments such as counselling.

There are different models of VNS and your consultant will point you in the direction of the correct one for you.

VNS insertion

As with all surgical procedures there are common risks and side effects attached to this procedure:

 Risks

  • Infection

  • Difficulty swallowing

  • Pain in the location where the cut was made

  • Loss of speech


Side effects

  •  Hoarseness and voice changes

  • Headache

  • Difficulty swallowing and throat pain

  • Shortness of breath

  • Sleep apnea or insomnia

  • Tinging of the skin  

Some people may get no side effects whatsoever, but if you do experience any of the above then it should be tolerable and get better over time. If it is affecting your day to day activities then consult your doctor.

Before your procedure it is important for you to be fully informed of all the pros and cons and your consultant will go through, in detail exactly what will happen and answer any questions you may have. Remember, no question is a silly question and your doctor will want you to have all the information possible to process.

You will be advised on what medications to stop prior to surgery and when to fast, which is usually 6-8 hours before.

Patients can be awake or asleep during surgery, the area will be numbed with local anaesthetic if awake.

Two incisions will be made, one in your chest or armpit and the other on the left side of the neck. The VNS will be implanted on the left side of your chest and a wire is guided under your skin from your chest and attached to the left vagus nerve where the neck incision was made.

After surgery you will be offered a follow up consultation where the doctor will turn on the VNS and test the frequency and duration correct for you, it will then be able to deliver electrical pulses to your vagus nerve. The VNS is not able to detect an impending seizure but your doctor would have set on and off cycles tailored to you. There is also a hand held magnet for people who can feel seizures about to happen or know their triggers and are about to initiate stimulation themselves. The magnet can also turn off the VNS.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition

Facet Joint Syndrome

Facet joint syndrome is caused by the degenerative changes in your spine. Your spine is made up of 33 individual bones that provides support for your body and the facet joints sit in-between the vertebrae of your spine. The facet joints provide mobility and strength to your spine and help limit movement.

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 Facet joints are synovial joints that sit in synovial fluid and are lined with cartilage. They are protected by a joint capsule that work and slide together providing mobility to your back.  Degenerative changes in your spine can sometimes cause your facet joints to become strained from wear and tear. The joint capsules that protect the facet joints can thin and the cartilage inside that is usually smooth will become harder and irregular. Facet joint syndrome can be described as an arthritis like pain as the joints become irritated and inflamed where they are unable to move together smoothly.

Symptoms can be triggered by an injury or pressure on the spinal cord. Pain signals will be sent from the medial branch nerves to your brain that the facet joint is irritated and therefore may react in spasms.  

Symptoms of facet joint syndrome do include:

  • Loss of spinal flexibility

  • Discomfort when leaning backwards, forwards or sideways

  • Radiation of pain into other parts of the spinal cord, neck, shoulders, arms, legs and fingers.

  • Tenderness of the back

  • Aching of the back

  • Pain when standing or sitting for a period of time

Degeneration basically means aging of the joints and as we get older our bones and joints do too, which causes wear and tear. Other possible causes can include obesity, posture and day to day repetitive activities like sitting for long periods. Both men and women can get facet joint syndrome but it usually occurs in people 40+ when the bones start to degenerate and ultimately rub together and become irritated.

If a patient is experiencing symptoms of possible facet joint syndrome then a trip to your doctor will be necessary. Your doctor will go through your medical history and symptoms then perform a physical examination like testing your reflexes, muscle tone and sensory function. Imaging is always a very good option when trying to diagnose a condition a doctor can not physically see. Studies like MRI, CT, and X-ray will be able to take pictures of your spinal cord and pin-point the irritated facet joints and any other problem affecting the spine.

There are a couple treatments available for facet joint syndrome and this doesn’t mean surgical intervention.

Simple solutions like self-care is sometimes the best way to start if your symptoms are not extremely painful or chronic. Correcting poor posture, exercise and better management and being mindful of your back are all effective ways of improving your back pain.

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Physiotherapists are specially trained in understanding how the body works and work hard to provide patients with effective care in the best way. They help you gain strength with exercises and show you techniques on how to walk, lift and stand properly.

Medications are also beneficial for patients with inflamed facets or who are suffering with muscle spasms. Anti-inflammatory medication and creams are just some of the options.

 Steroid joint injections are probably the most effective and quickest form of pain relief for patient suffering from a lot of pain on a daily basis. It is a minimally invasive procedure that injects corticosteroid and numbing agent in to the irritated joint. The steroid injection reduces swelling and irritation from the facet joints. Pain relief can begin straight away and can last from days to years and if the pain returns then the injections can be repeated.

Radiofrequency ablation is a treatment an x-ray guided electrical current is used to produce heat to burn areas of nerve tissue that sends pain signals to the brain, ultimately reducing the pain. It is minimally invasive and helps patients suffering from chronic pain like facet joint syndrome.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition


Children with Trigonocephaly

Mr Sanj Bassi one of our leading paediatric neurosurgeons explains to us what trigonocephaly is.

Trigonocephaly also known as metopic craniosynostosis is a condition where the baby’s skull has fused together before birth. This causes a triangular shape or ridge to the forehead. The skull is not a single bone and is actually made up of several bony plates. In between those plates are sutures. These sutures gradually get closer together and stick as the child gets older. Premature fusing of the sutures is called craniosynostosis.

This condition is present at birth but it can sometimes take some time to be more prominent.  There are other similar conditions related to craniosynostosis that can be confused with trigonocephaly so it is very important to get a correct diagnosis.

The cause for trigonocephaly is not yet known, but possibilities could include genetics, types of medication the mother takes while pregnant and the position of the baby in the womb.

The signs and symptoms vary from baby to baby because each case is different and severity can widen.

Here are some signs of Trigonocephaly:

  •  A ridge across the forehead

  • A triangular shape to the top of the head with a pointed shaped forehead. This can make the eyes closer together.

  • Difficulties with vision and developmental milestones.

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Because trigonocephaly is very visible and prominent it is not always necessary to get perform further tests to get a diagnosis. Monitoring scans such as X-rays and MRI can be used to see how the skull grows over time.

Sometimes treatment may not even be necessary if the trigonocephaly is mild and is not causing the baby any developmental or physical issues.

A multidisciplinary team of doctors will discuss each case in detail and decide on a dedicated treatment plan specifically tailored to the individual. The multidisciplinary team will include a neurosurgeon, craniofacial surgeons, ophthalmologists, speech and language therapists and more if needed.

Surgical intervention will be needed to correct the facial and skull deformities. As stated, each case is very different but surgery is usually best performed in the baby’s first year. This is because the bone is still soft so it makes it easier to manoeuvre. As the child gets older the surgery will become more complex and may have to be performed more than once.

Your surgeon will explain the best possible way to treat your child and make sure they receive the best possible outcome. You will be told the risks, complications and benefits for the treatment and able to ask as many questions as you like.

It can be extremely scary for a parent when a child goes for surgery even when in specialist hands. It is important that you talk to your doctor about your worries and are very well informed.

The types of surgery offered for patients with trigonocephaly do include endoscopic surgery and reconstructive surgery.

If your child has trigonocephaly and you would like to discuss the diagnosis and treatment options further, please do not hesitate to contact our specialist paediatric neurosurgeons, myself and Mr Christopher Chandler on +44 (0) 207 034 8709

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition


Radiofrequency ablation for pain

Radiofrequency ablation (RFA) is a minimally invasive procedure performed to reduce pain. An x-ray guided electrical current is used to produce heat to burn areas of nerve tissue that sends pain signals to the brain, ultimately reducing pain.

This type of treatment is usually performed on patients suffering from chronic pain in their spine and other parts of the body. It can help relieve the pain of arthritis and neck, pelvic, back and peripheral nerve pain.

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Is it safe?

RFA is a safe procedure and has minimal risks. It is an effective and for some, a life changing procedure that has few complications and the benefits far outweigh the risks. Here are some of the possible risks:

  • Infection

  • Numbness

  • Neuritis

  • Bleeding

  • Neuroma

Your consultant will discuss the risks with you in detail before the procedure and will inform you of all the risks, complications and benefits of RFA.

 Preparing for the procedure  

Your consultant will give you a guide on how to prepare of the procedure. Here are a few tips:

You must be very clear with your doctor what medication you are on as some can cause complications and anaesthetic effectiveness during the procedure. You will be directed on which medications you will need to adjust for the procedure.

Do not eat six hours before the procedure. Drinking water is fine.  

Bring comfy clothes and someone with you to help you home after the procedure. You should not drive for at least 24 hours after the procedure.

What happens during radiofrequency ablation?

Your doctor will once again go through the procedure with you beforehand and ask you to sign consent forms 

You will be taken to theatres and local anaesthetic will be applied to numb the area where you are experiencing pain. A low dose of sedative may be used but you will be awake during the procedure but you will not feel any pain.

During the procedure a thin needle is guided by x-ray towards the area of pain. A microelectrode is passed through the needle towards the targeted nerve tissue. The microelectrode will burn off the nerve tissue that transmits the pain and destroys the signal. The procedure can take up to 45 minutes or longer if there are more areas of pain to cover.

 After the procedure you will be taken to a ward to recover. Some observations may take place and you will be able to walk after the anaesthetic has worn off. You will be able to go home the same day, but you must not drive. A follow-up consultation will be made for you to review the procedure and your symptoms.

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How long does the pain relief last?

 The pain relief can be different for each person because it depends on the location and how bad the pain is. Usually it will last from 9 months onwards, sometimes it can be years. It is effective in 70% of people and the treatment can be repeated is need be.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition


What is a Chordoma?

Mr Nicholas Thomas explains what a chordoma is and the types of treatment available.

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A chordoma is a rare type of cancerous tumour that grows within the skull base and spine. Usually, chordomas are diagnosed in people over 50, although it can affect any one. According to the Chordoma Foundation, just one in one million people per year are diagnosed with this tumour.

Chordomas start in the notochord which helps the development of a growing baby when it is still inside the womb. Only a small amount of notochord cells is left once the bones of the spine have grown. It is those cells that can turn in to chordoma. 

This type of cancer can occur anywhere along the spine but in 50 percent of cases the chordoma is usually found in the sacrum.

Symptoms

The symptoms for this type of tumour do depend on where it is growing and what parts of the body it is affecting. Here are some symptoms a patient may experience if the tumour is growing in the spine:

  • Pain and numbness

  • Radiating back pain to other parts of the body

  • Difficulty walking, feeling unsteady or off balance

  • Bladder and bowel changes or problems

  • Worsening back pain at night

Symptoms if the tumour is in the skull:

  • Headache

  • Facial pain, tingling or numbness

  • Hearing changes

  • Feeling dizzy or unsteady

  • Double vision

  • Changes in hearing

There is no exact cause of chordoma known, research in to this is taking place but so far there are no known environmental or lifestyle causes for this cancer. There have been only a small handful of causes where members of the same family have been affected but it is extremely rare for chordoma to run in families.

 Diagnosis

It is important when diagnosing this chordoma that it is with a specialist consultant neurosurgeon, neurologist or team that has had experience with this cancer before. This is because chordoma is easily mistaken for other types of cancer like a schwannoma or other spine or skull-based tumours.

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After a consultation discussing in detail your medical history and current signs and symptoms, the best way to diagnose a chordoma is through an MRI scan. A T2 weighted MRI scan will have a specific sequence where it will be able pick up detailed images of your skull and spine and is able to locate this cancer. The MRI scan will be able to see the tumour, tissue surrounding, how it is being affected and further issues. A CT scan can be held in addition to an MRI scan if there is need for clarification.

Depending on where the tumour is, for a true definitive diagnosis, a biopsy will take place where the tissue will be placed under a microscope and examined by a pathologist.

Treatment

 Your treatment will depend on three important aspects:

  1. Age

  2. General health

  3. Size and position of your tumour

Sometimes just observation may be needed if the tumour is slow growing and not compressing or causing any harm to the surrounding tissue. The consultant may want to watch and wait if it is small. During this time, regular scans and reviews will be necessary.

Surgery is an option to completely remove or debulk the cancer from the spine or skull. Sometimes the tumour can only be part removed as the risk of further damage outweighs the risk of remaining tumour. Other treatments are available if surgery the chordoma is inoperable or if the surgeon was not able remove the whole tumour, such as radiotherapy.

Radiotherapy is a type of therapy where beams of radiation are directed to destroy the cancer. Chemotherapy is also another type of treatment that kills cancer cells and can be used for patients with chordoma. All treatment will come with side effects, risks, benefits and complications and it is important that the patient completely understands what is happening and why every step of the way.

If you have a chordoma or are worried about your symptoms and would like a consultation please do not hesitate to contact us.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition

Glossopharyngeal neuralgia

 What is glossopharyngeal neuralgia and what are the causes?

 Glossopharyngeal neuralgia (GPN) is an extreme stabbing, burning or electric shock type of intense pain in the tongue, throat, ear, and tonsils. The attacks can last from a few seconds up to a couple of minutes. The pain is connected to the ninth cranial nerve which is also called the glossopharyngeal nerve. This nerve is connected to the brainstem at the upper medulla and travels through the back of the throat, tongue, tonsil and ear, hence why such intense pain is felt in these areas.

GPN usually affects people over the age of 50. Often, the cause for GPN is unknown and diagnosed as irritation. This is because abnormalities may occur where the nerve signal is disrupted and causes abnormal signals to pass through the nerve which ultimately causes pain. Other possible causes may be a tumour or infection in the mouth area which affects the glossopharyngeal nerve. Blood vessels or growths compressing the nerve and sometimes multiple sclerosis are also causes.

Symptoms and triggers  

The symptoms of GPN is extremely intense pain in the ear, tonsil area, back of the tongue and nose and usually only one side of the throat. It is intermittent and sporadic, as mentioned it can last from a few seconds up to a couple minutes. It can also get more frequent and painful over time. Some people describe the pain as the worst pain they have ever experienced. Sometimes people who experience this pain are able to notice certain triggers that bring on the pain. This is an extremely helpful way to help manage the pain by avoiding the triggers. Some of the triggers may be:

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  • Chewing

  • Swallowing

  • Talking

  • Yawning

  • Laughing

  • Coughing

  • Sneezing

 

Diagnosis and treatment

 To diagnose GPN a doctor will begin by going through your medical history and current symptoms you are experiencing. A physical examination may also take place where a cotton tipped swab will touch the back of your throat. This is performed to see you experience any pain, if there is pain then some local anaesthetic will be applied and the doctor will try again, if the anaesthetic works and you cannot feel the pain then it is likely you have GPN.

Other ways of diagnosing glossopharyngeal neuralgia is by performing an MRI or sometimes a CT scan.

To treat GPN your doctor may want to try a conservative route first of call. Anti-convalescent drugs like carbamazepine, oxcarbazepine, gabapentin, or phenytoin may be prescribed to see if they help neutralise the pain.

A microvascular decompression is an option for more permanent relief, but usually a last resort if other methods have not worked.

A microvascular decompression is performed to stop the compression between the blood vessel and the nerve root. This is done by placing a sponge between them. Firstly a craniotomy will be performed by making a small incision behind the ear and drilling a 1-inch opening in the occipital bone. The dura is exposed which is a protective sheet or covering of the brain. The dura is moved to expose the brain. Once the glossopharyngeal nerve is found, a Teflon sponge is permanently placed in-between the glossopharyngeal nerve and blood vessel to stop the compression. The dura is then closed with sutures and a small titanium plate will cover the skull opening with small screws in place, this is because the bone from the skull is not replaced. The skin is then sutured together and dressing is placed.

You will spend a couple of days in hospital recovering and will be assessed by your surgeon and nurses before discharge. Recovery will take a couple of weeks but this can be in the comfort of your own home. A follow-up appointment will be made to check your wound and see if the surgery has worked.

 This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.

Subarachnoid Haemorrhage

Overview

A subarachnoid haemorrhage is a bleed in the brain.  More specifically bleeding within the subarachnoid space. It is where the cerebrospinal fluid (CSF) protects and cushions your brain to prevent injury. Haemorrhages are usually caused by a burst blood vessel (brain aneurysm)

This type of haemorrhages does tend to occur to people who smoke, have high blood pressure, drink excessive alcohol, are around the ages of 40-70 or have suffered a severe head injury.

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Symptoms

 Subarachnoid haemorrhages are sudden and severe, which is why it is important to know possible risk factors such as immense physical effort, straining and even coughing. Here are some symptoms below that you will need to look out for:

  • Headache – some people describe this as the worst they have ever experienced.

  • Stiff neck

  • Feeling and being sick

  • Double or blurred vision

  • Sensitivity to light

  • Stroke like symptoms – slurred speech and weakness

  • Loss of consciousness

 Please be aware that a subarachnoid haemorrhage is a medical emergency and you must call 999.

Diagnosis and treatment

To confirm a diagnosis of a subarachnoid haemorrhage a CT scan will need to be performed. This will be able to create detailed 3D images of your brain and check for bleeding. Other tests are available such as MRI scanning and a lumbar puncture, this will be able to check for blood in the cerebrospinal fluid.

Once a cause and location of the brain haemorrhage has been identified it can then be treated. This needs to be done rapidly to reduce the chance of brain damage and to save your life. Medications and pain relief can be effective in relieving the headache pain and to prevent seizures and vomiting, depending on the haemorrhage, some just need close monitoring and may not even need surgery.

Treatment does depend on how the subarachnoid haemorrhage is caused. The bleeding needs to be identified and then treated promptly as pressure will build up in the brain that can lead to detrimental effects like coma.

The two types of surgery for a haemorrhage are clipping or coiling.

Clipping

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Firstly, the surgeon performs a craniotomy by accessing your brain by removing a small piece of bone to access the brain. The aneurysm will be located and a small clip made of titanium is inserted to fit around the neck of the aneurysm and close it shut. This will ultimately isolated and prevent blood from leaking in to the spaces around the brain. The aneurysm will be permanently closed and will not be able to grow any bigger or leak in to the brain.

Coiling

A catheter which is basically a thing tube is inserted into another part of your body, like your leg. The catheter will make its way through the blood vessels to reach the aneurysm. Once reached, small titanium coils are passed through the catheter and into and aneurysm until it is filled up. This is to prevent any blood going in to the aneurysm and allows normal blood flow. This is more of a minimally invasive procedure than clipping and has a faster recovery time.

After either of these surgical procedures you will be transferred to ITU for close monitoring. Your surgeon will have gone through what happens after the surgery and how recovery will go, it will also be explained again after you have woken up. You may need to spend quite some time in hospital to recover properly but this will be to prevent another aneurysm or complications.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.


Cluster headaches

Cluster headaches are described as excruciating attacks of pain on one side of the head. These often occur around the eye. Although cluster headaches are rare their symptoms are fierce and debilitating.

Who gets cluster headaches?

Anyone can get a cluster headache but they are more common in men and usually start during 30’s or 40’s and can be recurrent.  

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What are the symptoms?

Cluster headaches occur suddenly without any warning. The pain is usually a very sharp, severe burning or piercing type pain on the side of the head. Often this is around the temple and eye, sometimes spreading into the face. Cluster headaches happen in repeated attacks, usually on the same side of the head.

The headache pain is often accompanied with one or two of the following:

·      Red and watery eye

·      Blocked or running nostril

·      Sweaty face

·      Swelling or drooping of the eyelid

·      Smaller pupil in one eye

Why do we get cluster headaches?

Perhaps the most frustrating part of cluster headaches is that the exact cause isn’t clear. There is a link with a part of the brain called the hypothalamus. This is a small region of the brain responsible for hormone regulation and maintaining body temperature. There may be a genetic link as cluster headaches do tend to run in families.

How often do cluster headaches happen?

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They usually occur daily during a bout or attack. These bouts can last 4-12 weeks before settling down. During the bout the headache often happens at the same time each day. There can symptom-free periods lasting months or years but the headaches do often return and often at the same sort of times of year.  

Do you need to seek medical advice?

If you think you are experiencing a cluster headache you should see a doctor. You may then be referred to a specialist such as a neurosurgeon or neurologist. They may perform further tests like blood tests or a brain scan to rule out other conditions. Usually with cluster headaches the scan looks normal.

Are there triggers for cluster headaches?

Sometimes cluster headaches can be brought on by triggers such as alcohol, smoking and strong smells (perfume, petrol etc). It is suggested that avoiding the triggers can help prevent cluster headaches.

There are treatment options available for cluster headaches (we will be covering these in a future blog so watch this space!).

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.

Neck pain – your questions answered!

We asked Mr David Bell, one of London Neurosurgery Partnership’s complex spine experts, to explain a bit about neck pain, why we get it, what causes it and how to help.

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Neck pain is very common among individuals of all ages. It can be linked to the simple straining of neck muscles from hunching over a computer, moving awkwardly or as a result of conditions such as osteoarthritis. Less commonly, neck pain can be a symptom of an underlying problem.

What are the symptoms of neck pain?

  • Pain that becomes worse when the head is in one position for a long time such as driving or working at a computer.

  • Muscle stiffness and sometimes spasms.

  • Limited range of movement (especially side to side or up and down).

  • Headache.

When should you seek medical advice?

Usually, neck pain improves within a couple of weeks with at home treatment. If it doesn’t improve then it is always a good idea to see your doctor.

You should always seek medical advice if neck pain is:

  • As a result of a trauma – like a trip, fall or car accident.

  • Very severe.

  • Persistent for over a few days/a week without relief.

  • Spreads down your arms or legs.

  • Is accompanied by weakness, tingling or numbness.

So what actually causes neck pain?

The neck supports the weight of the head (which isn’t that light!) yet is flexible to allow movement which makes it susceptible to conditions which can cause pain, including:

  • Muscle strains: Over use of the muscles such as poor posture at a computer or sitting awkwardly for a while can strain neck muscles.

  • Joint wear and tear: Just like the rest of the spine and other joints in the body, the joints in the neck can wear down over time. When this happens it can contribute to neck pain.

  • Nerve compression: Disc bulges (called herniations) or little bony spurs can press down on and compress the nerves which branch out from the spinal cord to the arms. This can lead to neck pain, tingling, numbness and weakness.

  • Injuries: Trauma, such as trips, falls, car accidents and other actions which result in rapid jerking of the neck can result in soft tissue (muscles, tendons and ligaments) in the neck being strained which can contribute to neck pain.

  • Diseases: Much less frequently, diseases such as meningitis, cancer or arthritis can be the underlying cause of neck pain.

Can you prevent neck pain?

Given that most neck pain is associated with poor posture and/or wear and tear there are some simple life style changes which can help prevent some neck pain:

  • Improve posture when standing and sitting.

  • Take frequent breaks to get up and move around.

  • Adjust desk and screen height so the screen is at eye level.

  • Quit smoking!

  • Sleep in a good position.

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What are the treatment options?

Mostly neck pain will cure itself over a couple of weeks. Alternate hot and cold on your neck may help relieve the pain alongside over the counter pain relievers. If it persists your doctor may prescribe some stronger pain relief. Physical therapies can often help persistent neck pain.

If these do not work and your neck pain continues over several weeks into months your doctor may suggest steroid injections. These involve injecting corticosteroid near the nerve roots and into the facet joints to help relieve pain.

If the pain is really persistent the specialist consultant may recommend decompression surgery as a very last resort. This might be recommended for neck pain resulting from a compressed nerve. The aim of surgery would be to release the pressure on the nerve root. 

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.

 

 

What is a colloid cyst

Mr Christopher Chandler explains to us what actually is a colloid cyst.

Overview

 A colloid cyst is a benign brain tumour, which means it’s non-cancerous. They do not spread but will slowly grow in size. Colloid cysts are small fluid-filled sacs located in or around the lateral and third ventricle of the brain. Because of it’s location in the ventricles, a colloid cyst can sometimes cause a blockage of cerebral spinal fluid (CSF). CSF is located in the ventricles where is protects and cushions the brain and spinal cord, if the flow of CSF is interrupted it can cause a person to develop hydrocephalus (excess CSF in the brain) as the colloid cyst is disrupting the body’s natural circulation of fluid. 

There is no defining cause why a colloid cyst develops but it is thought to be present from foetal development. They do tend to grow as a person grows in to an adult as it is rare to find a colloid cyst in a child.

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 Symptoms

Colloid cysts are usually diagnosed through incidental findings. This means that it was found almost by accident, maybe when a patient was having a scan for a different reason like headaches. This is because they do not often present with symptoms as they are slow growing, the brain has time to get used to it being there.

 A colloid cyst will start to cause symptoms when it begins to block the CSF flow the circulate the brain and spine. This will lead to hydrocephalus. Symptoms of this will include headaches and sometimes vomiting, visual disturbances, memory problems and in extreme cases loss of consciousness and coma.

Diagnosis

 If your doctor suspects your symptoms are being causes by something in the brain then they will investigate by asking the patient to have an MRI scan. This scan is will used specific sequences to capture images of the brain and spinal cord. They are able to identify colloid cysts. This is the quickest way to diagnose a colloid cyst. A doctor is able to see the imaging immediately after the scan is performed.  

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Treatment

Treatment for a colloid cyst will differ from person to person as it all depends on the age of the patient, location, size and severity of the cyst and if it is causing CSF blockage.

If a colloid cyst is found to be causing no symptoms or hydrocephalus, is small and is not affecting the patient’s life then a doctor may recommend a watch and wait technique. This means there is not a good enough reason to operate on the patient as its not affecting the brain. The doctor will be able to monitor the cyst with MRI scanning annually. If the cyst is growing in size and the patient starts to present with symptoms then surgical removal may be an option. If not, then the monitoring will continue.

If the cyst is interrupting the natural CSF flow of the brain and causing hydrocephalus then surgical intervention will be necessary. This will be in the form of an endoscopic craniotomy – a minimally invasive technique. The cyst will be carefully drained and then resected from the brain. If the hydrocephalus does not resolve then a shunt device will need to be inserted to drain the excess fluid from the brain.

 This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.  


 

Lumbar decompression surgery

Mr Irfan Malik is an expert in all thing’s spine related, so we have asked him what a lumbar spine decompression actually is and how it’s performed.

 It can be a scary situation if you have been told that spinal surgery is needed, any surgery for that matter can be nerve-racking. We hope this will help you put your mind at ease as we walk you through the what, where, why and hows.

Lumbar spine surgery would be recommended for patients who are suffering from chronic spinal stenosis, sciatica or a slipped disc, spinal injuries and fractures and even cancer if it is pressing on the spinal cord. These are just come of the common conditions are accompanied with symptoms such as weakness, numbness and pain in arms or legs, or difficulty walking and completing daily activities due to intense pain. Surgery will also be an option for people who have tried more conservative treatments like physical therapy or medications without any improvement.

Lumbar spine decompression is a surgical procedure performed to free up compressed nerves in the spinal cord. The surgeon will do this by making an incision in the lumbar spine, under X-ray control, appropriate nerves and tissues will be removed to take pressure off of the affected area. Once your surgeon is happy with the decompression and your nerves have been freed up, the muscles that were moved will be stitched back in to position and the incision will be closed.

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Depending on your individual condition there may be different procedures that need to be performed while having the operation. There are several types of decompressive surgery and you will be informed well in advance if you need any of these:

  • Laminectomy – Removal of the entire lamina that is putting pressure on the spinal cord.

  • Laminotomy – Part removal of lamina to relieve pressure on the spinal cord.

  • Foraminotomy – removal of the bone that is around the neural foramen.

  • Laminaplasty – Performed in the neck, the laminae is cut to create more space in the spinal cord.

  • Discectomy – Removing a bulging or slipped disc to release pressure of the spinal nerves.

Postoperatively, you will be placed back on a ward with close neuro observations for 24 hours. You will be able to mobilise as soon as possible. A physical therapist will visit you and your consultant before you are discharged. You may even need to have a MRI or X-ray before leaving the hospital just to check the surgery was a success. A follow up consultation will be made for 6-8 weeks’ time, during that time you will be following a guide on how to keep active after surgery which will includes the do’s and don’ts of daily activities. You will be discharged if there are no red flags in your follow up consultation.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.  

 

 

 

Epilepsy - The Basics

Mr Richard Selway is one of our leading epilepsy surgeons here at LNP. He is going to give us a rundown of what epilepsy is and how seizures affect us. Epilepsy is a very common neurological disorder which affects every 1 in 100 people in the UK. When a person is having an epileptic seizure it causes abnormal electrical activity in the brain which interrupts the way our brain normally works. Our brains cells are constantly sending electrical signals and messages to each other and throughout our body, so when an epileptic seizure is happening this can cause normal processes to be interrupted and can make a person jerk, become stiff and even be unaware of seizure they are experiencing.

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Symptoms

 Epilepsy can cause a range of symptoms and varies from person to person. Here are some of the possible symptoms you may be experiencing:

  • Uncontrollable jolting or jerking, and shaking

  • Collapsing

  • Staring blankly

  • Loss of consciousness

  • Sensation of tingling or unusual sensations when an epileptic fit is about to begin.

The main symptom of epilepsy is a seizure but there are a whole host of different types of seizures. To find out more about them visit the NHS website here.

 Causes of epilepsy

In most cases of epilepsy there is no clear identifiable cause. Sometimes it can be due to family genes and you could have inherited it. Other possible causes are associated with damage to the brain like a brain tumour, stroke, head injury, substance abuse or infection.

 Generalised seizures

There are six types of generalised seizures that would help to be familiar with.

Tonic clonic seizures: There are two phases to this seizure as both sides of the brain are affected. In the tonic phase the person will be unconscious, muscles will become stiff and can cause a person to fall to the floor. Tongue biting in common and so are sounds of crying or groaning. Following the clonic phase, jerking of the limbs may take effect as well as loss of control of bladder and bowel function. This seizure can take between 1-3 minutes.

 Tonic seizures: When a tonic seizure take effect a person’s limbs will go stiff and arms will raise upwards. They will fall hard to the floor if they are standing and it is common for them to fall backwards. There is no jerking or moving of the limbs and the person is completely unconscious during this time and the seizure will usually last for 60 seconds.

Atonic seizures: Also known as a drop seizure, a person will lose all motor function and their muscles will go limp. This will cause them to fall to the floor, bang their head and result in other possible injuries. They are very brief and last just a couple of seconds.

 Absence seizures: Previously called a Petit mal seizure, this type will result in a person unconsciously being in a daydreaming episode. They will stare in to space and look like they are not listening, they may blink and have slight jerking movements. This seizure can begin in childhood and can sometimes be missed as it could be put down to a child not listening when really, they have no control over what is happening.

Myoclonic seizures: Myoclonic are short seconds long seizures and sometimes unnoticeable. They cause short symptoms of muscle movement and jerking. They can be very mild or strong which may cause a person to fall over but they remain conscious during this seizure.

Clonic seizures: Clonic seizures have repeated and rhythmic symptoms of jerking and limb movement. The person is unaware they are doing it and will last from 10 seconds up to 2 minutes.

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Treatments for epilepsy

There are various types of management and treatment methods for epilepsy. There are medications called anti-epileptic drugs that help prevent or control seizures from happening. Other types of treatment can be Vagus nerve stimulation VNS and Deep brain stimulation DBS. Obviously surgical intervention will be considered for serious and life-affecting types and causes of epilepsy.

 Surgery for epilepsy is not taken lightly and various tests will be carried out prior, like EEG, brain scans and memory/ability testing. All of this will feed information about a person epilepsy to us so we can give the best possible outcome of management for the patient.

If you are or know someone who is suffering with epilepsy, child or adult and need more information then please do not hesitate to get in-touch for an in-depth consultation discussing the type of epilepsy associated with you.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition. 


Back Pain

Mr Nicholas Thomas gives us the low-down on back pain and what we can be doing to help it:

Back pain is extremely common in people of all ages. Normally it will resolve itself within a couple of weeks or months but patients can also experience life-long symptoms of back pain. It can be felt anywhere in the back and can occur for various different reasons.

 There are many different ways to relieve and treat back pain but to also reduce it from coming back.

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  • Staying fit and healthy

  • Improving your posture

  • Knowing your limit and not performing over-strenuous activities

  • Being active and stretching your back and body. This can be done by walking, running, stretching, swimming, yoga, Pilates and much more.

  • Taking anti-inflammatory painkillers like paracetamol and ibuprofen

  • Using heat or cooling compressors to the area of pain

  • Using a supportive mattress

 If none of the above have worked and you are still experiencing pain and it is worsening and starting to affect your day to day activities then it may be worth a visit to your GP as there could be an underlying issue. Your GP will examine you, talk through your medical history and see if other ways of therapy could help. You may even be asked to have a scan like an X-ray or MRI to check if anything is causing the back pain specifically.  

The causes of back pain obviously differ but they are also very non-specific. It can be due to strain or injury, an accident or simply not being active enough. But there can be medical reasons like a slipped disc or even sciatica. These symptoms will be accompanied by more than just back pain, for example you may be experiencing tingling, weakness, numbness and pain radiating to the arms or legs.

It is important to seek urgent medical advice if you are experiencing these symptoms:

  •  Numbness or tingling around your genitals or buttock area

  • Bladder or bowel incontinence

  • High temperature

  • Chest pain

  • Swelling or deformity in the back

  • If you have been in a serious accident

  • If your back pain is not improving or getting significantly worse

We see patients will all types of back pain related problems and conditions. Even though back pain is common, there can be underlying issues that you may not be aware of. If your back pain and its symptoms are getting in the way of life and not resolving then it is important to get a second opinion. Contact us to book an appointment and get the diagnosis and help you need.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition. 


Spinal Cord Stimulation (SCS)

Mr Richard Gullan explains to us what Spinal Cord Stimulation is and how it is surgically inserted.

Overview

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A spinal cord stimulator is a device that is surgically implanted under the skin in your spine near the vertebrae with wires leading to the epidural space. SCS is a type of therapy to help deliver mild electrical pulses to mask the pain before it has time to reach the brain. The wires of the SCS are attached to the spines nerve fibres and when turned on, it stimulates those nerves where the pain is and blocks the pain signal from reaching the brain. 

A SCS does not erase the pain from your body, it is simple a deterrent. Each person will have a completely different experience from this type of therapy because of the different levels of pain they are experiencing and also how the body reacts to such stimulation. The goal is for the stimulator to reduce pain up to 70% but that can be more or less for each person. A patient may experience a tingling sensation due to the SCS working, it is not painful but some patients may find it unpleasant. 

 There are several different types of SCS and your consultant will help you choose the right one for you and the pain you are experiencing. All SCS have batteries that help create the electrical pulses, a hand-held remote that can turn on and off and also a lead wire that delivers electrical currents.Candidates

Candidates can vary but they all have one thing in common which is chronic pain. Steps are taken for each person before they are offered an SCS. They will need to have a full medical history check, see if medication can help with pain or physiotherapy and even surgery.

Candidates may benefit from SCS if:

  • Conservative and surgical solution has failed

  • More surgery will not be beneficial

  • Chronic neck and/or back pain

  • Chronic leg and/or arm pain

  • Complex pain syndrome

  • Arachnoiditis

  • Angina

  • Peripheral vascular disease

  • Multiple Sclerosis

The true goal is for the patient to be able to live a better standard of like and perform daily activities without being in chronic pain. Medication may still need to be taken but it will be reduced.

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SCS insertion

There will be a trial for SCS initially to see if it will actually reduce the pain but also to determine if the patient is still ok to go ahead after the trial.

During the surgery the patient will be under sedation and will lie on their stomach. X-ray is used to locate the area and the electrode wires are inserted in to the spine and lower near the buttock is where the generator will sit. A laminotomy is performed in the spinal cord to make space for the wires and then secured in to the epidural space.

A test stimulation will be performed during surgery which the patient has to be awake for. This is to determine if it is working and to help the surgeon change the settings or reposition if necessary. Once this has been established then the patient will again be sedated and the generator will be implanted in to the buttock. A lead wire will run from the generator and attached to the electrode wire. Once all is in place then sutures are used to close the skin and the patient will be taken to the ward to recover.

There will be restrictions in place as the patient recovers and your surgeon will talk you through those. Mostly is it about looking after yourself and the wound sites, so no strenuous activities or bending and twisting. It is also recommended not to smoke or intake nicotine products as they prevent bone healing.  

Some of the risks do include:

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  • Epidural haemorrhage, hematoma, infection, spinal cord compression, and/or paralysis (can be caused by placing a lead in the epidural space during a surgical procedure)

  • Battery failure and/or battery leakage

  • Cerebrospinal fluid leak

  • Persistent pain at the electrode or stimulator site

  • Lead migration, which can result in changes in stimulation and reduction in pain relief

  • Generator migration and/or local skin erosion

  • Paralysis, weakness, clumsiness, numbness, or pain below the level of implantation

The patient will be sent home with instructions on how to use the stimulator but of course everything will have already been explained to them. The consultant will provide follow up and check up consultations to see how the patient is getting on.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition. 

London Neuroscience Academy - Neuromonitoring & Mapping International Course 2018

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The London Neuromonitoring and Mapping International Course was held on the 23rd and 24th of November 2018. It was London Neuroscience Academy’s third time running this two day course and it was a success. It provides the attendees with a unique approach whereby both the neurophysiologist and the neurosurgeon deliver the teaching side-by-side giving a realistic environment and extensive knowledge into the daily workings of the operating theatre. 

The first day (Basic Course) provided delegates with knowledge on the principles of intraoperative neuromonitoring and brain and spinal cord mapping. The neurophysiological principles and the clinical interpretation of MEPs, SSEPs, D-WAVES, VEPs, EEG and EcoG was analysed. Principles and techniques of direct electrical stimulation for brain and spinal cord mapping will be discussed. The setup for intraoperative neuromonitoring was be shown and hands-on demonstrations with the intraoperative neuromonitoring equipment was most definitely available. Anaesthetic considerations for intraoperative neuromonitoring was also discussed. 


The second day (Advanced Course) demonstrated how to perform intraoperative neuromonitoring and direct mapping in Spine Surgery, Brainstem Surgery and Brain Surgery. Each section included the anatomy, the physiology and the pathophysiology and the different intraoperative neuromonitoring techniques necessary to tailor neurophysiological strategies to each patient. Case studies showed and hands-on demonstration on different intraoperative neuromonitoring equipment will be available. 

The advanced course also covered cortical and sub-cortical brain mapping techniques for motor, language and higher order functions and their correlation with the extra-operative mapping with Transmagnetic Stimulation.

London Neuroscience Academy are certain that the social opportunities in London and the highly educational content of the course will make your experience unforgettable and truly worthwhile.