Introduction: Accidents during sporting activities are a common cause of head injury, particularly in children and young adults. Whilst most sporting head injuries are minor, there remains a proportion which is associated with high morbidity and mortality. The epidemiology of sports associated head injuries is variable based on geographical region so the aim of this study was to review the management and outcomes of sporting head injuries managed by a single neurosurgical unit in the South of England. Method: A retrospective review of the Trauma Audit and Research Network database was conducted for all patients admitted to a tertiary neurosurgical centre over a six-year period (January 2011-December 2016). Case notes were reviewed for demographics, mechanism of injury, injury severity score, intensive care admission, surgical interventions and Glasgow Outcome Score at discharge. Results: Seventy-six patients (mean age: 37.6 +/- 18.4 years, male gender n = 43; 56.6%) were eligible for inclusion in this series. Horse riding accidents were identified as the most common cause of head injury (n = 31; 40.8%). Fifteen patients (19.7%) in this series had a severe head injury (GCS 3-8 on admission). Twenty-eight (36.8%) patients required admission to an intensive care unit and 26 (34.2%) patients underwent neurosurgical intervention. At discharge, 68 (89.5%) patients had a Glasgow Outcome Score 4-5. Conclusion: The majority of patients with head injuries admitted to a neurosurgical unit can expect a good functional outcome despite the need for intensive care or neurosurgical intervention. The range of sports resulting in head injury is likely influenced by geographic location; however, further national study is required for wider comparison.

Abstract In the United Kingdom widespread adoption of day-case image-guided biopsy (DIB) for brain tumour has yet to develop. We review a decade of experience of DIB for suspected supra-tentorial brain tumour and recommend discharge criteria for patients post-operatively. 30-day complications, post-operative admissions into hospital and patient satisfaction are examined. METHODS Published protocols and procedures for DIB of brain tumours were used. Tissue samples were sent for fixed histological preparation without intraoperative neuropathological assessment. All patients undergoing an image-guided biopsy for tumour were retrospectively identified from operative logbooks (01/10/2006–30/09/2016), and information recorded from online records. Patients completed satisfaction questionnaires. RESULTS 706 image-guided biopsies for supratentorial tumour were performed of which approximately 60% were identified pre-operatively as candidates for DIB. 92% of DIB patients were successfully discharged 6 hours postoperatively. 4.5% of DIB patients were admitted directly from the day-case unit following identification of a postoperative haematoma >2 cm diameter on CT head performed at 4 hours. 3/401 DIB patients (< 1%) required surgical evacuation for the haematoma, all made a full recovery, with no delay to commencing their oncological management. A diagnostic accuracy of 98% was achieved. Overall 90% of patients were satisfied about the timing of their discharge from hospital and 92.5 % felt they had enough medical support following discharge. DISCUSSION Conscious sedation with enhanced recovery techniques, lack of intra-operative neuropathological analysis and a stream lined service with robust communication between patients, carers/families and the oncology allied medical professionals has ensured that DIB for diagnosis of tumour is safe, reliable and feasible for most patients and is not associated with increased morbidity or mortality. The procedure is well tolerated with good patient satisfaction. We recommend that patients with a good pre-operative functional baseline, requiring a supra-tentorial biopsy are offered day-case surgery in a dedicated unit specialising in this procedure.

Neurological conditions are common so a knowledge of neuroanatomy is necessary for junior doctors. Additionally, some students have a particular interest in neuroscience. However, little time is dedicated to neuroanatomy in the medical curriculum, and many students struggle with neuroanatomy. The National Undergraduate Neuroanatomy Competition (NUNC) aims to support the development of neuroanatomical knowledge among medical students and promote interest in neurosciences. Students who attended the NUNC completed a series of neuroanatomy-based examinations and a questionnaire investigating aspects of neuroanatomy teaching and resources at their home university. 387 students attended the NUNC between 2013 and 2017, of which 382 had a complete data set (response rate 98.7%). Male students significantly outperformed female students (p<0.0001) and clinical students outperformed pre-clinical students p<0.05). Best answered questions were on the spine (average score 53.9%), and the most poorly answered questions were on the vasculature (average score 44.7%). Students felt that the neuroanatomy teaching, time spent on neuroanatomy and dissection/prosection resources were all reasonable (6-7/10) at their home institution. E-learning resources were rated more poorly (5.4/10). We conclude that the NUNC gives students the opportunity to enhance their neuroanatomical knowledge and gives keen students the chance to develop their interest.

BACKGROUND:Near-peer teaching is used in anatomy education because of its benefits to the learner, teacher and faculty members. Despite the range of reports focusing on the learner, the advantages for the teacher, which are thought to include communication skills, subject knowledge and employability, are only beginning to be explored.METHOD:A questionnaire was distributed to the teachers involved in anatomy near-peer teaching at the University of Southampton and Brighton and Sussex Medical School (BSMS). This questionnaire was designed using a rating scale of 0-10 to assess teacher perspectives on their level of knowledge, teaching skills and enjoyment of teaching. Free-text responses determined the teachers' motivation and perceived benefits from the teaching.RESULTS:Twenty-eight questionnaires were gathered (54.9% response rate), including 20 from Southampton and eight from BSMS. Long-term knowledge retention and better understanding of the material were rated 8.1 and 7.9 out of 10, respectively. Eight responses were from currently practising doctors, who rated how much they now use their teaching skills as doctors as 8.9 out of 10. Of the eight doctors, seven gained points for their foundation programme applications as a direct result of near-peer teaching. The most common motivator for engaging in teaching was to improve subject matter knowledge and the most common benefit was improved communication skills. There are numerous advantages to being a near-peer teacher in medical school DISCUSSION: There are numerous advantages to being a near-peer teacher in medical school, which include knowledge improvement, transferrable professional skills and employability. These initial results support the hypothesised benefits to the teachers and provide a foundation for further longitudinal studies.

In the United Kingdom widespread adoption of day-case image-guided biopsy (DIB) for brain tumour has not occurred. To qualify for DIB patients are selected in the outpatient clinic and day-case is defined as arriving and being discharged from hospital on the same day. Published protocols and procedures for DIB of brain tumours were used (1). All Patients undergoing an image-guided biopsy for tumour were retrospectively identified from operative logbooks (October 2006 - March 2016 inclusive), and information recorded from online records or notes. In this 9.5 year study, 645 image-guided biopsies for tumour were performed. 355 (55%) cases were planned DIB of a supratentorial tumour. Histological diagnosis included high grade glioma (62%), low grade glioma (18%), lymphoma (8%), metastasis (5%), meningioma (1%), primitive neuroectodermal tumour (1%), other (2%) and no diagnosis (3%). 92% of DIB patients were successfully discharged at 6 hours postoperatively. 16/355 (4.5%) of DIB patients were directly admitted following identification of a postoperative haematoma > 2 cm diameter on CTH. 9/16 had no associated new deficit and were discharged the following day. 0.8% of patients required surgical evacuation of postoperative haematoma, however all made a full recovery. 0.3% DIB were complicated by infection. 0% experienced significant permanent neurological deficit that influenced further oncological treatment. 3% of cases were non-diagnostic on first biopsy. 1/355 CTH identified an asymptomatic extradural requiring evacuation that otherwise would have been discharged home at 6 hours post DIB. 0.8% of patients were readmitted within 48 hours of biopsy and none of our patients came to harm as a result of being a DIB. DIB surgery with close clinical and radiological surveillance is well-tolerated, safe and feasible. We advocate this concept is more widely adopted. REFERENCES: 1) Grundy P.L et al (2008) Br.J.Neurosurg (22) 360-367.