Intraoperative feedback: A survey of surgical trainees' perspective.

INTRODUCTION: Intraoperative feedback can be associated with improved surgical performance. Quality feedback can reduce the time required by trainees to achieve proficiency in psychomotor skills. Operative training time has become increasingly limited, and it has become imperative to use surgical training time effectively. AIM: In this survey, we assessed trainees' perspectives of intraoperative feedback. We included several aspects of feedback including its occurrence, quality, and potential barriers. METHODS: All surgical trainees in a single centre were invited to complete an electronic questionnaire. Participants were anonymised. We summarised data using descriptive statistics. RESULTS: Most trainees (85%) reported they had the opportunity to share their training goals with trainers. Just under three-quarters of trainees felt they always or sometimes got timely feedback. Only half of the trainees were signposted to feedback and 23% felt feedback was not part of their department's culture. Half of the trainees did not always feel comfortable asking for feedback from their trainers stating their reasons as fear of criticism, lack of time and competing clinical commitments. CONCLUSION: There is no denying the importance of feedback on operative performance, however, this survey shows that many of the pillars of quality feedback are poorly adhered to.

An unusual case of a grade I meningioma with perineural spread.

A 39-year-old lady with worsening intermittent diplopia and headaches was diagnosed with a WHO Grade I Meningothelial Meningioma with highly unusual perineural spread on imaging, making this the first reported case of this behaviour. Complete surgical resection was deemed too great a risk and the patient remains under observation. The process of perineural spread is not restricted to more aggressive brain tumours.

A case of aneurysmal subarchnoid haemorrhage and superficial siderosis complicated by prospagnosia, simultagnosia and alexia without agraphia.

A 42-year-old lady presented with acute aneurysmal subarachnoid haemorrhage and developed difficulty recognising faces (prosopagnosia), inability to process visual information in busy environments (simultagnosia) and difficulty to read (alexia). She was subsequently found to have superficial siderosis on MRI.

Functional herniated choroid plexus in brain parenchyma following VP shunt removal.

We report a 4-year-old male who presented with a blocked ventriculoperitoneal (VP) shunt inserted post excision of a WHO Grade 1 cerebellar pilocytic astrocytoma complicated post-operatively by pseudo meningocoele formation. Imaging revealed choroid plexus that had herniated along the shunt tract. Subsequent MRI showed development of cystic changes around the tract. The ectopic choroid plexus was still in continuity with the ventricular ependyma and was producing CSF in the left parietal lobe.

Demographics of Cauda Equina Syndrome: A Population-Based Incidence Study.

INTRODUCTION: Cauda equina syndrome (CES) has significant medical, social, and legal consequences. Understanding the number of people presenting with CES and their demographic features is essential for planning healthcare services to ensure timely and appropriate management. We aimed to establish the incidence of CES in a single country and stratify incidence by age, gender, and socioeconomic status. As no consensus clinical definition of CES exists, we compared incidence using different diagnostic criteria. METHODS: All patients presenting with radiological compression of the cauda equina due to degenerative disc disease and clinical CES requiring emergency surgical decompression during a 1-year period were identified at all centres performing emergency spinal surgery across Scotland. Initial patient identification occurred during the emergency hospital admission, and case ascertainment was checked using ICD-10 diagnostic coding. Clinical information was reviewed, and incidence rates for all demographic and clinical groups were calculated. RESULTS: We identified 149 patients with CES in 1 year from a total population of 5.4 million, giving a crude incidence of 2.7 (95% CI: 2.3-3.2) per 100,000 per year. CES occurred more commonly in females and in the 30-49 years age range, with an incidence per year of 7.2 (95% CI: 4.7-10.6) per 100,000 females age 30-39. There was no association between CES and socioeconomic status. CES requiring catheterization had an incidence of 1.1 (95% CI: 0.8-1.5) per 100,000 adults per year. The use of ICD-10 codes alone to identify cases gave much higher incidence rates, but was inaccurate, with 55% (117/211) of patients with a new ICD-10 code for CES found not to have CES on clinical notes review. CONCLUSION: CES occurred more commonly in females and in those between 30 and 49 years and had no association with socioeconomic status. The incidence of CES in Scotland is at least four times higher than previous European estimates of 0.3-0.6 per 100,000 population per year. Incidence varies with clinical diagnostic criteria. To enable comparison of rates of CES across populations, we recommend using standardized clinical and radiological criteria and standardization for population structure.

Choroid plexus and CSF: an updated review.

In this article, we review the available literature about the functions of the choroid plexus (ChP), including its basic role in cerebrospinal fluid (CSF) secretion, renewal and absorption. We discuss more recently described, lesser-known functions of the ChP, such as its role in circadian rhythm regulation, chemical and immune surveillance and functional implications of ChP disruption, as occurs in neurodegenerative disorders.