No abstract

Introduction Stereotactic mesencephalotomy is an ablative procedure which lesions the pain pathways (spinothalamic and trigeminothalamic tracts) at the midbrain level to treat medically refractory, nociceptive, contralateral pain. Sparsely reported in contemporary English language literature, this operation is at risk of being lost from the modern-day neurosurgical practice. Methods We present a case report and brief review of the literature on stereotactic mesencephalotomy. A 17-year-old girl with cervical cord glioblastoma and medically refractory unilateral head and neck pain was treated with contralateral stereotactic mesencephalotomy. The lesion was placed at the level of the inferior colliculus, half way between the lateral edge of the aqueduct and lateral border of the midbrain. Results The patient had no head and neck pain immediately after the procedure and remained pain-free for the remainder of her life (five months). She was weaned off her pre-operative narcotics and was able to leave hospital, meeting her palliative care goals. Conclusions Cancer-related unilateral head and neck nociceptive pain in the palliative care setting can be successfully treated with stereotactic mesencephalotomy. We believe that stereotactic mesencephalotomy is the treatment of choice for a small number of patients typified by our case. The authors make a plea to the palliative care and neurosurgical communities to rediscover this operation.

Shunt series (SS) X-rays are often performed as additional routine initial investigations for suspected ventriculo-peritoneal shunt dysfunction, despite low diagnostic utility and radiological implications. We reviewed such referrals at our neurosurgical unit and found an 8.3% sensitivity rate for SS; consistent with current evidence. SS should not be performed routinely.

Trainees found that Neurosurgery provided a generalised exposure not a specialised one. Ninety-two per cent felt Neurosurgery had provided sufficient educational opportunities to achieve their required competencies. Importantly, all trainees managed to achieve their core generic competencies. F1 placements in Neurosurgery are highly beneficial to both trainee and service. The placement provides more than sufficient educational opportunities to help meet mandatory training requirements. F1 doctors also augment the number of junior doctors supporting the neurosurgical service.