Day 1 :
Keynote Forum
Alberto de Bellis
Founder & President: Maria Rosaria Maglione Foundation onlus, Italy
Keynote: Delivery of Nerve Growth Factor via Nasal Spray & CNS Therapy: State of the Art
Biography:
Dr. Alberto de Bellis, Neurosurgeon, is the Founder and Chairman of Maria Rosaria Maglione Foundation onlus, non-profit organization for Neuroscience based in Naples-Italy. The MRM Foundation runs in honor of the founder’s mother, Maria Rosaria Maglione, who suffered from Frontotemporal Dementia. The activity of the MRM foundation is mainly aimed at research and health care for neurodegenerative diseases, brain tumors and spinal cord injury and in support of partner foundations operating in Kenya-Africa, such as the Gallmann Memorial Foundation and the African Neurological Diseases Research Foundation. Dr. de Bellis' work focuses on the management and surgery of brain tumors, spinal surgery, management and surgery of traumatic brain injuries and spinal cord injuries. The main research activities of the MRM foundation are focused on the study of the Nerve Growth Factor and its possible neurotherapeutic applications.
Abstract:
Nerve growth factor (NGF) is the Founding Member of the neurotrophins family of proteins, known for playing a critical protective role in the development and survival of sympathetic, sensory and basal forebrain cholinergic neurons in mammals, including humans. NGF has a neuroprotective action in Alzheimer’s and Parkinson’s disease, as showed by several studies in animal models and humans. NGF can be delivered to the CNS via nasal route and has a neuroprotective action in case of neurodegenerative diseases and brain injury. Furthermore, recent studies have shown an active link between the nasal pathway and the spinal cord in the delivery of NGF to the CNS, thus demonstrating the neuroprotective ability of NGF to support injured neurons in a mouse model of spinal cord injury. Intranasal delivery of NGF has so far been sufficiently investigated in animal models and only recently in humans, as demonstrated in a recent study on long-term intranasal administration of NGF in two patients affected by Frontotemporal Dementia associated with corticobasal syndrome (FTD/CBS) and in another study on intranasal administration of NGF in a Brain Injury. These studies demonstrated the neuroprotective role of NGF administered nasally. Intranasal administration is the most effective and non-invasive way to deliver NGF to the CNS. These neuroprotective properties of NGF make it a strong candidate for the future treatment of neurodegenerative diseases and other pathologies of CNS (brain injury, spinal cord injury, ischemic damage) when administered via nasal route. NGF would not be able to cure the FTD/CBS but these observations support the hypothesis that NGF slows down the usual decline of the disease. However, these studies reinforce the concept that neurotrophins are able to reach and protect the CNS via nasal route and open the way for new lines of research. Hence, these findings suggest the ability of NGF to protect CNS neurons when administered via nasal spray.
Keynote Forum
Terri Nicole Sawyer
Utah Valley University, USA
Keynote: The missing drug for neuropsychiatric patients: Radical compassion
Biography:
Terri Nicole Sawyer spent the first 17 years of her career practicing with one of the most vulnerable populations of children, adolescent foster youth. Her passion for helping young people transition from foster care into adulthood pushed her to research why transitions for foster youth are so difficult and sometimes deadly. She raised her bioloogical children into adulthood and felt like her education needed to be continual. She has received her Doctorate in Scoial Work the same year her youngest child graduated from high school. Now she teaches part-time at Utah Valley University and has a large private practice that speicalizes in transitions such as divorce and death of spouses, anxiety, depression, polyamorous and open relationships, and transitions during faith crisis.
Abstract:
Radical compassion is the state of mind that propels a human to not only have empathy for someone else, but to have a change deep within oneself to bring forth a mighty force for good for the other person. While empathy (considered a step towards radical compassion) has taken the world by storm and everyone from life coaches to the psychiatrists in the helping profession have reported they understand and sometimes try emulate empathy, the ideas of radical compassion towards a patient or a client seems to be unattainable for most practitioners. Warnings about radical compassion have been spoken and the ideas of how burnout can effect those with radical compassion seem to be shared by some helping professions. What if radical compassion could be the missing drug for neuropsychiatric patients? What if the intense emotion of radical compassion from people who prescribe or recommend medication has a true effect on the progress that neuropsychiatric patients experience because the patient feels understood, validated, and connected to the practitioner? Is radical compassion sustainable for practitioners? What are the prices to be paid?
- Neurosurgery conference
Location: Holiday Inn Lisbon Continental
Session Introduction
Shahid Khan
James Cook University Hospital, UK
Title: Microvascular Decompression: Incidence and Prevention of Post-operative CSF Leakage in a Consecutive Series of 134 Patients
Time : 14:15-14:45
Biography:
Mr Nath is a neurosurgery consultant at James Cook University Hospital in Middlesbrough, with a special interest in acoustic neuroma, skull base and vascular sugery, trigeminal neuralgia and cervical disc replacement. Summary of training:
Mb ChB Liverpool 1974
FRCS Edinburgh 180
Ghorka Dakshin Bahu (King of Nepal’s Birthday Honours list 2002)
FRCS England adeundem 2008
Royal College of Surgeons:
Interview Representative
Regional Adviser in Neurosurrgery
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Intercollegiate Neurosurgical Examiner |
Abstract:
Objective: The aim of this study is to share our experience of an effective dural repair technique, which we have utilised to minimise the incidence of postoperative CSF leakage in patients undergoing microvascular decompression (MVD) for Trigeminal Neuralgia and Hemifacial Spasm.
Methods: Between 1987 and 2018, 134 patients had microvascular decompression, mainly for Trigeminal Neuralgia and Hemifacial Spasm in our unit. All our patients having posterior fossa MVD using the technique described by Janetta, had an apparently watertight repair of the dura at the end of the operation. We describe our technique using Duraguard ® and Histacryl® glue. The post-operative outcome of the duraplasty was assessed retrospectively by case note review.
Results: Of 134 patients, 129 (96.2%) had no post-operative CSF leakage. Only 5 (3.7%) of the patients experienced post-operative CSF leakage.(3 from the wound, 2 from the nose)
Conclusion: We conclude that dural repair using the described technique utilising a dural substitute (Duraguard) and Histacryl glue is safe and effective in preventing post operative CSF leak following MVD.
Keyword: CSF leak, Duraplasty, Microvascular Decompression(MVD).
Sandra Sungailaite
The James Cook University Hospital, UK
Title: The outcome of the patients with chronic subdural hematoma referred to a major trauma centre and review of non-operative management
Biography:
Sandra Sungailaite completed her medical degree at the Lithuanian University of Health Sciences, Lithuania. Currently, she works as a specialty doctor in Neurosurgery Department, James Cook University Hospital, Middlesbrough, United Kingdom. Sandra has an interest in teaching and is pursuing a degree in medical education, along with her work in neurosurgery and a degree in Surgical Sciences. Mr Anil Varma is a senior neurosurgery consultant at James Cook University Hospital in Middlesbrough, with a special interest in neuro-oncology and endoscopic pituitary surgery. He is an author and co-author of many publications and research in his area of interest.
Abstract:
Objective: The main objective of this study is to review the outcome of chronic subdural hematomas (CSDH) and patients’ characteristics in a cohort referred to a major tertiary trauma centre.
Design: Retrospective audit.
Subjects: Patients with CSDH referred to the trauma centre of North East in the UK between April 2019 and January 2020.
Methods: A retrospective analysis of 88 patients presented over a nine-month period of 2019 to a tertiary centre in the UK with CSDH. We reviewed the referral database collecting data on patients’ age, GCS, presenting symptoms, anticoagulation status and the management outcome. We analyse the radiological findings and clinical outcome of the patients in the different treatment groups.
Results: The results indicated that 88 patients with CSDH were identified during the study period. Twenty (20%) underwent surgery immediately. Forty-eight (55%) were managed conservatively, and 20 (20%) were managed medically with dexamethasone. Subsequently, one of the patients managed conservatively, and one with dexamethasone underwent surgery. Forty-four (54%) out of 88 patients were on various forms of anticoagulation.
Conclusions: This study confirms that operative management was deemed suitable for a small portion of patients referred with CSDH. Medical management with dexamethasone is an option for the patients for whom surgery is not warranted or when a patient is unfit for surgery with good outcome.
Jin Eun
The catholic university of Korea, South Korea
Title: Hyperacute bilateral thalamic infarction not presented on initial diffusion weighted magnetic resonance imaging: A case report
Time : 15:15-15:45
Biography:
Jin Eun has completed MD at the age of 25 years from Eunji medical University. She trained neurosurgery at the Catholic University of Korea. She is the clinical instructor of the department of neurosurgery, Eunpyeong St.Mary’s hospital
Abstract:
In patients with hyperacute infarctions, there are situations in which initial diffusion-weighted magnetic resonance imaging (DW MRI) fails to explain the patient's neurological status. In the present case, the patient visited the emergency room about 15 minutes after the onset of symptoms and his initial neurological status was not explained by DW MRI. We injected intravenous tissue plasminogen activator on the basis of non-enhanced brain computed tomography. However, the degree of neurological improvement was insignificant and follow up DW MRI showed multiple acute infarctions in the pons, midbrain, and bilateral thalamus. A rare case of acute bilateral thalamic infarction, this article summarizes initial management and clinical outcome.
Sheng Yuan Kan
University of Edinburgh Medical School, UK
Title: Systematic Review of Clinicopathological Correlations in Logopenic Progressive Aphasia
Time : 15:45-16:15
Biography:
Sheng Yuan is a final year undergraduate medical student from the University of Edinburgh. He is previously an events coordinator and currently the treasurer for the Edinburgh University Neurological Society. He is interested in neurology/neurosurgery/neuroscience research and very keen to discuss ideas with other like-minded people.
Abstract:
Systematic Review of Clinicopathological Correlations in Logopenic Progressive Aphasia: Logopenic aphasia (lvPPA) is characterised by impaired word-retrieval and sentence repetition. It is usually associated with AD pathology, but other pathologies have been reported. The objectives of this study was to estimate the prevalence of different neuropathology in autopsied lvPPA cases and evaluate the performance of new criteria in predicting Alzheimer’s Disease (AD) pathology in lvPPA patients. In this systematic review, we developed search strategies to identify studies which reported clinical cases of lvPPA and neuropathology investigation results. The included studies were analysed for reporting quality, demographics, clinical criteria and pathological diagnosis. Out of 2459 articles screened, 35 studies reported 200 lvPPA patients in total. Reporting quality were good for clinical criteria (100%) and neuropathology (91.4%), moderate for gender, age at onset and duration (60%) and poor for ethnicity (5.7%). The neuropathology findings in lvPPA are 74% AD, 20% Frontotemporal Lobar Degeneration (FTLD-TDP=14%, FTLD-Tau=6%), 2% Dementia with Lewy Bodies (DLB), 2% Creutzfeldt-Jakob disease (CJD) and 2% others. The positive predictive value of new criteria is 9% higher, but not statistically significant (p>0.05). This study confirmed the prevalence of different neuropathologies among lvPPA patients, with AD pathology being the most prevalent. We also showed that more studies are published using the new criteria and suggested the importance of multimodal diagnostic approach due to the low positive predictive value (77%) of the consensus clinical criteria.
Luke Hale
UCL Institute of Surgical and Interventional Science, UK
Title: Voxel printing of Neuroimaging
Biography:
Dr. Luke Hale is a doctor and multi-disciplinary designer working in London, UK. He is currently working as an emergency medicine doctor in East London and is a visiting researcher at the UCL Institute of Surgical and Interventional Science and the Royal National Orthopaedic Hospital
Abstract:
3D printing is becoming a widespread and useful technology in medicine with applications in simulation, teaching, surgical planning and patient-specific prostheses. Typically, in order to 3D print neuroimaging data, anatomical areas of interest must first be identified on individual 2D slices, then isolated (either manually or via thresholding), and then converted to a 3D mesh. This time-consuming ‘segmentation’ typically requires commercial software and, in forming this 3D mesh, the rest of the scan data is lost and reduced to a binary representation i.e. either outside or inside the anatomical area of interest. Furthermore, the size of structures may be over or underestimated. Voxels (volume pixels) represent a value on a 3-dimensional regular grid, with 3D printing outputting these values to a 3D printed model. Voxel printing can obviate the need for segmentation and 3D mesh generation, with effectively lossless printing of whole neuroimaging datasets. Here, 7T MRI brain images were converted to bitmap images and printed on a Stratasys 760M printer at the printer's native resolution. SimpleITK, an open source library for imaging analysis, was used to interpolate between imaging slices to achieve the required 800dpi slice resolution; a Floyd-Steinberg dithering algorithm was used to convert images to two pixel values representing clear and opaque resin. The resulting printed model has preservation of the delicate cerebral vasculature and differentiation between grey / white matter (see images below). Voxel printing of neuroimaging therefore offers exciting possibilities with more accurate visualisation of complex neurological structures.
Sultan A Alsaif
King Abdullah International Medical Research Center, Saudi Arabia
Title: Stroke Mimics: Clinical Characteristics and Outcome
Biography:
King Abdullah International Medical Research Center, Saudi Arabia
Abstract:
Background:
Stroke mimics (SM) can be difficult to distinguish from real stroke. Misdiagnosis of stroke leads to unnecessary tests, harmful intervention, and increased cost. We aimed to study the prevalence and nature of SMs among Saudi patients who came to the emergency department with sudden neurological deficit and suspected stroke.
Methods:
We retrospectively reviewed records of all patients with suspected stroke admitted to the stroke unit at King Abdulaziz Medical City, Riyadh, Saudi Arabia from February 2016 to July 2018. We compared SM to real strokes. Logistic regression analysis was conducted to identify the potential predictors of SMs. This study was approved by local institutional review board.
Results:
Of the 1,063 patients, 131 (12.3%) had SM. The most common causes were peripheral vestibular disorder (27.4%) followed by psychogenic causes (24.4%). Stroke mimics were more common among younger individuals and women, and individuals with SM were less likely to have arterial hypertension, diabetes, and to be smokers. At discharge, individuals with SM were more likely to be independent at discharge, had milder deficits, and shorter hospital stays. Predictors of SM were young age, female gender, mild deficit at presentation, and good functional status prior to stroke.
Conclusion:
Stroke mimics are common among suspected strokes. Practicing physicians should consider potential diagnostic errors, particularly in the hyperacute phase of stroke.