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My name is in print again! This time it’s a paper in the British Journal of Neurosurgery ‘Is referral to neuro-oncology safe?’ that has been trundling along for a few years and has finally seen the light of day. Definitely an advert for persistence! I have to give credit to Rob Corns for making the final adjustments and getting us over the line. I’m sorry it’s not open access, I’ll come to that at the end. First a little summary and discussion.

The paper deals with something far removed from my current work, but nonetheless interesting. Nowadays when you have a brain tumour your scans and information are sent along to a multidisciplinary team meeting of experts in brain tumours. Definitely a good thing. But is there a downside? Well, it could take longer to get things sorted (we found it doesn’t) and if you have got something worse than a brain tumour that needs urgent attention there might be unacceptable delay, eg if you have a brain abscess.

Answering this second question is more tricky. The people who were sent along to an MDT with an undiagnosed abscess definitely waited longer. Fortunately none of them came to harm. BUT no one with an abscess who had an MRI scan went undiagnosed. The audit population was from the cross-over between pre- and post-MDT times. Only a few years ago, but MRI use is now much more accessible. I remember as a house officer having to sell my left kidney to a radiology consultant to get an MRI that 4 consultants had thought essential and urgent. Perhaps I’ve been working in larger hospitals since, but my impression is that people tend to get MRI scans more frequently, often before CT scans if a brain tumour is suspected.

So, the bottom line is: get an MRI and refer to the MDT.

How many people will read this paper? No neurologists, that’s for sure. No one in Cambridge – the British Journal of Neurosurgery is not included on the University’s subscription list. This highlights the problem of closed access. It’ll give all of us an extra publication which may come in handy. But will it generate much debate or convince the waverers not to rely on just a CT? If it does, it’ll be a few neurosurgeons and not many other people. I hope I’m wrong…

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