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COVID-19 is a global pandemic that has had an unprecedented effect on health care systems globally. The infrastructure of British neurosurgical practice has had to adapt and react to the challenges of the National Health Service (NHS) in several ways. This crisis is an opportunity for trainees to reflect on and explore alternative training opportunities. Below, we discuss the clinical and educational impact of COVIDe19, potential training opportunities during this period, and the long-term impact on training.

IntroductionThere are two main choices of anti-coagulation in cerebral venous thrombosis: Unfractionated heparin versus low molecular weight heparin. A consensus is yet to be reached regarding which agent is optimal. Therefore the aim of this systematic review and meta-analysis was to identify which agent is most effective in treating CVT.MethodsDatabases Pubmed (MEDLINE), Google Scholar and hand-picked references from papers of interest were reviewed. Studies comparing the use of low molecular weight heparin and unfractionated heparin in adult patients with a confirmed diagnosis of cerebral vein thrombosis were selected. Data was recorded for patient mortality, functional outcome and haemorrhagic complications of therapy.ResultsA total of 2761 papers were identified, 74 abstracts were screened, with 5 papers being read in full text and three studies suitable for final inclusion. A total of 179 patients were in the LMWH group and 352 patients were in the UH group. Mortality and functional outcome trended towards favouring LMWH with OR [95% CI] of 0.51 [0.23, 1.10], p = 0.09 and 0.79 [0.49, 1.26] p = 0.32 respectively. There was no difference in extra-cranial haemorrhage rates between either agent with a OR [95% CI] of 1.00 [0.29, 3.52] p = 0.99.ConclusionTrends towards improved mortality and improved functional outcomes were seen in patients treated with LMWH. No result reached statistical significance due to low numbers of studies available for inclusion. There is a need for further large scale randomized trials to definitively investigate the potential benefits of LMWH in the treatment of CVT.

Subthalamic nucleus (STN) beta-triggered adaptive deep brain stimulation (ADBS) has been shown to provide clinical improvement comparable to conventional continuous DBS (CDBS) in people with Parkinson's disease (PD) with less energy delivered to the brain and less stimulation induced side-effects. However, several questions remain unanswered. First, there is a normal physiological reduction of STN beta band power just prior to and during voluntary movement. ADBS systems will therefore reduce or cease stimulation during movement and could therefore compromise motor performance compared to CDBS. Second, beta power was smoothed and estimated over time periods of 400ms or longer in most previous ADBS studies. A shorter smoothing period could have the advantage of being more sensitive to changes in beta power which could enhance motor performance. In this study, we addressed these two questions by evaluating the effectiveness of STN beta-triggered ADBS using a standard 400ms and a shorter 200ms smoothing window during reaching movements. Results from 13 people with PD showed that STN beta-triggered ADBS is effective in improving motor performance during reaching movements as it better preserves gamma oscillation than CDBS in people with PD, and that shortening the smoothing window does not result in any additional behavioural benefit. ADBS significantly improved tremor compared with no DBS but was not as effective as CDBS. When developing ADBS systems for PD, it might not be necessary to track very fast beta dynamics; combining beta, gamma, and motor decoding might be more beneficial with additional biomarkers needed for optimal treatment of tremor.