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Biomedical subjects

R S Maurice-Williams

Publications and source records attributed to R S Maurice-Williams.

At least 19 recordsLinked to original sources
PubMed1999

Topical antibiotics in neurosurgery: a re-evaluation of the Malis technique.

We report the effect on the neurosurgical wound infection rate of a modification of the 'Malis' technique of antibiotic prophylaxis. In this a combination of antibiotics is given in the form of both parenteral administration and wound irrigation. A series of 1173 clean neurosurgical operations was compared with a historical control of 303 operations. Both treatment and control groups were operated on by the same surgeon, using similar surgical techniques. The control group received parenteral pre- and postoperative antibiotics (flucloxacillin and ampicillin). The treatment group (where the parenteral antibiotics used was cephradine) also received wound irrigation with a solution of gentamicin and flucloxacilin. The infection rate was 0.42% in the treatment group (five patients), in the control group it was 3.96% (12 patients). The difference was highly significant (p = 0.00006). We believe that the use of wound irrigation with antibiotics should receive further study.

Ampicillin↗
PubMed1999

Extended anterior cervical decompression without fusion: a long-term follow-up study.

We report the long-term outcome in 80 patients who had undergone extended anterior cervical decompression without fusion for cervical nerve root or spinal cord compression. Follow-up ranged from 2 years 4 months to 13 years. Five patients had died from causes unrelated to the original pathology or the surgery. Of the remaining 75 patients, 66 (88%) were symptom free or clearly improved, eight (10%) were unchanged and one patient (1.5%) was worse. Sixty-eight patients (91%) were satisfied with the outcome of treatment. Nineteen patients (25%) had some degree of residual neck pain, but in none was this a major problem. Three patients had required subsequent surgery for cervical disc protrusions at levels adjacent to the first operation, while two patients had developed foraminal stenosis at the level of the surgery and had undergone foraminotomy. One patient had developed a symptomatic flexion deformity. Radiological assessment revealed bony fusion in 71%, some degree of flexion deformity in 13% and some degree of foraminal stenosis in 38%. Our results suggest that the initial good results of extended anterior cervical decompression without fusion are maintained long-term. Although a small number of patients eventually develop problems that might be avoided by an initial spacing procedure/formal fusion, these are no greater than the immediate problems associated with the harvesting and insertion of a bone graft.

Decompression, Surgical↗
PubMed1998

Cervical foraminotomy: an effective treatment for cervical spondylotic radiculopathy.

Between 1983 and 1994, posterior cervical foraminotomy as described by Frykholm was performed on 89 patients with exclusively radicular symptoms caused by cervical osteophytes. The main presenting feature was arm pain. Objective neurological signs were present in 50% of the patients. At mean postoperative follow-up of 8.6 months, 95.5% of patients reported excellent or good results, while 4.5% were not improved. No patient was rendered worse following the procedure. There were no deaths and the complication rate was 2.2%. Further surgery for recurrent root symptoms was required by 6.7% of patients. Our findings are in keeping with the good results and low complication rate of this procedure as described in other studies. Informal inquiries suggest that this procedure is not widely used, at any rate in the United Kingdom, and we present this series in order to emphasize the efficacy and safety of this procedure.

Adult↗
PubMed1998

Paired colloid cysts of the third and lateral ventricles.

We report the case of a man of aged 27 years who presented with obstructive hydrocephalus caused by a colloid cyst of the third ventricle. He was found to have an additional and larger colloid cyst lying adjacent to it, but within the lateral ventricle. The contents of the two cysts were of different consistency. We have been able to find only one previous report of more than one colloid cyst occurring in the same patient and none where one of the cysts lay within the lateral ventricle.

Adult↗
PubMed1997

Delayed surgery for ruptured intracranial aneurysms: a reappraisal.

Delayed aneurysm surgery, once standard practice, is now followed by only a minority of neurosurgeons. We analysed the outcome of such a policy in 400 consecutive patients with ruptured aneurysms treated over a 14-year period. Despite an 'open door' admissions policy, admitting all patients immediately on referral, only 56% arrived within 24 h of the ictus (69% within 72 h). Surgery was generally delayed for 8-10 days in patients in Grades 1 and 2; for higher grade patients often for longer until their condition was stable. Two-hundred-and-eighty-seven patients (72%) underwent surgery, 93% on day 8 or later (78% on day 11 or later). Outcome was assessed at 1 year. For all patients 68% were in Glasgow Outcome Scale Grade 1, while 26% had died. Of the operated patients 88% were in GOS grade 1, while 5% had died (30-day surgical mortality was 3.5%). Fifty-one patients (12.8%) rebled, 30 in the first 10 days. Rebleeding was distributed evenly in time over the first 2 weeks. Eighty-four patients experienced non-haemorrhagic deterioration (NHD) all but 3 within 10 days. NHD peaked at days 4-9. Thirty-three patients died of rebleeding and 16 of NHD, but only 12 of the patients who died from rebleeding were fit for operation at anytime and might have been considered for early surgery. Two of these patients died so soon after admission that surgery could not have been performed leaving 10 patients who might have been saved by early surgery. We review the theoretical advantages of delayed as against early surgery and conclude that it is doubtful whether the timing of surgery has any significant effect on management outcome in line with the conclusions of the Cooperative Study.

Aged↗
PubMed1996

Extended anterior cervical discectomy without fusion: a simple and sufficient operation for most cases of cervical degenerative disease.

Of 291 operations performed for cervical degenerative disease causing cord or root involvement over a 12-year period 187 have been treated by extended anterior discectomy without fusion, removing bone on either side of the posterior disc space so as to give a wide exposure of the anterior spinal and root dura. The technique has been used for 73% of the cases operated on in the last four years. Nine patients (4.8%) required an additional posterior decompression for coexisting spinal or root canal stenosis. By the first postoperative follow-up at 2-4 months 94.5% of patients showed clear neurological or functional improvement, 3% were worse and 1.5% had died (the deaths were in elderly patients with severe myelopathy and intercurrent disease). Minor treatable complications occurred in 3.2%. Only two patients (1%) complained of persistent postoperative neck pain. Patients were mobilized immediately after surgery without a collar and most left hospital within 1-4 days. A single level decompression was sufficient in 92% of patients and only one patient required more than two levels to be decompressed. In 79% of cases soft disc protrusions contributed to the compression while in 21% osteophytes alone caused the compression. We believe that this simple technique is a sufficient surgical treatment for the majority of cases of cervical degenerative disease. It does not require a fusion and avoids the specific problems and complications associated with Cloward type operations. We are engaged at present in a long-term follow up study of these patients, but to date no late problems have become apparent.

Adult↗
PubMed1994

Ossification of the posterior longitudinal ligament mimicking cord compression from a dorsal disc protrusion: a cautionary tale.

A patient with focal anterior compression of the dorsal cord at the level of the D6/7 disc was mistakenly diagnosed as a dorsal disc protrusion on the basis of CT myelography. The CT scanning had been confined to axial views at the level of the cord compression. A transthoracic exploration failed to reveal a disc protrusion and the correct diagnosis, ossification of the posterior longitudinal ligament, was only revealed by a subsequent sagittal CT scan. This case emphasizes the dangers of relying on limited axial imaging in diagnosing a spinal lesion.

Diagnostic Errors↗
PubMed1994

Ruptured intracranial aneurysms--learning from experience.

The outcome of treatment of 400 consecutive patients with ruptured intracranial aneurysms was assessed at 1 year. The patients were treated by a single surgeon over a period of 13 years. Data sheets completed as each patient was treated included a contemporary analysis of the reasons for any unsatisfactory outcome. Surgery was usually delayed for over 10 days from the last haemorrhage. Over the four successive 100-patient cohorts, in which the composition of the patient population remained unaltered, 1 year overall management mortality fell steadily from 38 to 24%. One year surgical mortality fell from 19 to 3%. The population of those operated on who were in Glasgow Outcome Score 5 at 1 year rose from 73 to 90% (from 51 to 71% for all patients). Of the 123 deaths, 89 occurred prior to operation, 24 after it. Thirty-five patients died from rebleeding prior to operation, but only eight of these occurred in patients judged fit for surgery at the time. All but one of the postoperative deaths resulted from technical problems related to the surgery. Over the successive cohorts, several factors indicated an improvement in operative efficiency, notably a fall in the proportion of cases with technical problems from 15 to 1%. We have demonstrated a steady improvement in management results, resulting largely from increasing operative experience. We do not believe that changes in overall management strategy, such as early surgery, would have any effect on overall outcome.

Adult↗
PubMed1993

Lymphocytic meningitis following insertion of a porcine dermis dural graft.

We describe a case of lymphocytic meningitis following insertion of a porcine dermis implant to repair an operative dural defect. Histology of the excised implant revealed local abscess formation with a granulomatous reaction. Oligoclonal Immunoglobulin G, part of which could be removed by absorbtion with the porcine dermis, was present in the patient's cerebrospinal fluid, and, to a less marked degree, in his serum. The cerebrospinal fluid glucose was markedly depressed. An unusual hypersensitivity reaction to the porcine implant was considered the most likely explanation for this meningitic illness. The patient went on to make a full recovery following excision of the implant.

Adult↗
PubMed1993

The scope of neurosurgery for elderly people.

Patients treated by a single neurosurgeon over a period of 17 years have been reviewed in order to assess the volume and nature of neurosurgical work performed on patients aged over 65 years. Based on this data we report: (1) The age distribution of the principal neurosurgical conditions, drawing attention to those conditions which are over- and under-represented in elderly patients. (2) A steady increase in the number of patients over 65 admitted over the last 15 years. (3) The numbers and types of neurosurgical operations carried out on elderly patients at the present time compared with 10 years ago. (4) The outcome of first-time surgery for intracranial meningiomas in 144 patients analysed by age. It is clear that a large and increasing proportion of neurosurgical work is carried out on persons over the age of 65. Age by itself appears to be no bar to a good outcome after a major neurosurgical operation provided that the surgery is elective and is not accompanied by a diffuse neurological disturbance.

Aged↗
PubMed1992

Spinal dural arteriovenous malformations--a treatable cause of progressive paraparesis in elderly people.

Spinal dural arteriovenous malformations (SDAVMs) were first described in 1977. They present with a progressive paraparesis, principally in men aged 60 years and over. They are usually dorsolumbar in situation and are thought to be acquired lesions which produce symptoms by obstructing the venous drainage of the spinal cord. There are no pathognomonic clinical features and diagnosis depends on a high level of clinical suspicion and myelography extended into the dorsal region. The condition is probably underdiagnosed and may be quite a common cause of progressive leg weakness in elderly people. Surgical treatment is relatively simple, safe, and if carried at an early stage can lead to dramatic neurological recovery. This paper reports nine cases seen over a period of 7 years. All the patients showed marked neurological improvement after surgery.

Aged↗