Giant perivascular space: a rare cause of acute neurosurgical emergency.

We present a rare case of giant perivascular space in mesencephalo-thalamic region causing hydrocephalus. The patient presented insidiously over 6 months. However, the patient suddenly deteriorated in the hospital with visual symptoms, increasing headache and papilloedema, prompting urgent VP shunt and biopsy. Patient's symptoms resolved completely after decompression and he continues to remain symptom free. This patient is only the second described case of giant perivascular space with sudden deterioration of symptoms. This case report is intended to highlight this rare presentation of this cyst which can potentially suggest a more aggressive underlying lesion and prompt a biopsy which can be risky, given the proximity to perforators and normal structures, which is otherwise not necessary.

Depiction of detailed surgical anatomy and CSF flow information using a single MRI technique.

We describe a novel MRI sequence (T2 SPACE) capable of demonstrating detailed structural anatomy and functional CSF flow information simultaneously. While traditionally, a variety of sequences are utilised for this purpose, we have highlighted the advantages of this technique over traditional approaches, using example of a patient with CSF loculation in prepontine/suprasellar cistern, causing third ventricular compression and hydrocephalus. The sequence depicted the surgical anatomy by showing the web/cyst wall as well as CSF flow entering the cyst potentially causing increased pressure.

Neurosurgery activity levels in the United Kingdom and republic of Ireland during the first wave of the covid-19 pandemic - a retrospective cross-sectional cohort study.

The impact of Covid-19 on surgical patients worldwide has been substantial. In the United Kingdom (UK) and the Republic of Ireland (RoI), the first wave of the pandemic occurred in March 2020. The aims of this study were to: (1) evaluate the volume of neurosurgical operative activity levels, Covid-19 infection rate and mortality rate in April 2020 with a retrospective cross-sectional cohort study conducted across 16 UK and RoI neurosurgical centres, and (2) compare patient outcomes in a single institution in April-June 2020 with a comparative cohort in 2019. Across the UK and RoI, 818 patients were included. There were 594 emergency and 224 elective operations. The incidence rate of Covid-19 infection was 2.6% (21/818). The overall mortality rate in patients with a Covid-19 infection was 28.6% (6/21). In the single centre cohort analysis, an overall reduction in neurosurgical operative activity by 65% was observed between 2020 (n = 304) and 2019 (n = 868). The current and future impact on UK neurosurgical operative activity has implications for service delivery and neurosurgical training.