Dr Michael Stuart

All Publications

• Clipping of Intracranial Aneurysms by Neurosurgical Trainees Is Safe and Effective: A Statewide Retrospective Cohort of 614 Consecutive Cases in Queensland, Australia. Neurosurgery Stuart, M. J., Harbison, A. M., Yousif, S., James, W., Khoo, J., Jayalath, R., Pattavilakom, A., Coulthard, L. G. 2025

  Abstract

  Craniotomy and clipping of intracranial aneurysms remain some of the most technically challenging procedures in neurosurgical practice. There are no contemporary published data to describe the safety and efficacy of these procedures when performed by neurosurgical trainees. This study aims to report the outcomes of intracranial aneurysm clipping procedures performed by neurosurgical trainees.All consecutive patients undergoing microsurgical clipping of intracranial aneurysms at public hospitals in Queensland in the period from 1/1/2018 to 1/1/2024 were identified from retrospective review of operating theater databases at all adult public/teaching neurosurgical hospitals. Procedures where the primary operator was a neurosurgical trainee were included. Clinical and radiological outcomes were assessed by review of the medical records and perioperative imaging, in duplicate.Six hundred fourteen patients underwent microsurgical clipping of intracranial aneurysms in the state of Queensland during the study period, 506 of which occurred in public teaching hospitals. One hundred twelve (22%) of these procedures were performed by neurosurgical trainees as the primary operator. A total of 63/112 (56%) were unruptured. A total of 74/112 (66%) aneurysms were on the middle cerebral artery. A downgrade of ≥1 point on the modified Rankin scale (mRS) occurred in 7/63 (11.1%) unruptured and 22/74 (44.9%) ruptured cases where a trainee was the primary operator. Complete aneurysm clipping was confirmed on postoperative angiography in 106/112 (95%) cases. Comparison with cases completed by senior neurosurgeons in the same institutions showed that cases performed by trainees were shorter in duration (mean 252 vs 299 min, P < .001), less likely to be ruptured (44% vs 58%, P = .02), and less likely to suffer an mRS downgrade (6-month mRS 0-2: 87% vs 76%, P = .02).This series suggests that in appropriately selected cases and with appropriate supervision, the primary operator role in clipping of both ruptured and unruptured aneurysms can be safely performed by senior neurosurgical trainees.

  View details for DOI 10.1227/neu.0000000000003463

  View details for PubMedID 40298369

• Hydrocephalus temporisation with ventricular reservoir or trans-fontanelle ventricular taps for intraventricular haemorrhage of prematurity: A retrospective cohort study. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia Stuart, M. J., Burnett, A., Coulthard, L. G., Cunningham, P. S., Birch, P., Campbell, R. A., Harbison, A. M., Vonhoff, C. R. 2025; 136: 111225

  Abstract

  PURPOSE: Hydrocephalus following intraventricular haemorrhage of prematurity (post haemorrhagic ventricular dilation/PHVD) is one of the most common causes of paediatric hydrocephalus. There is little evidence regarding the role of trans-fontanelle ventricular taps (TFVT) as a temporising strategy in the early management of these patients. This study aimed to compare the safety and efficacy of TFVT with the use of a ventricular reservoir/access device.METHODS: A retrospective review of prospectively maintained databases was conducted, including all patients who received a diagnosis of intraventricular haemorrhage or PHVD at the two major neonatal intensive care units in the State of Queensland, Australia between 1st January 2016 to 31st December 2022. Followup data was obtained from review of statewide electronic medical records.RESULTS: The medical records of 910 low birth-weight infants with intraventricular haemorrhage were screened. Of these, 28 patients underwent placement of a ventricular reservoir and 36 underwent serial TFVT alone. There were no statistically significant differences in rates of ventriculoperitoneal shunt insertion (83% vs 75%, p=0.41). There were no significant differences in mortality or two year Paediatric modified Rankin Scale. No clinically significant intracranial haemorrhages occurred in either group. CSF leak was more common from the ventricular reservoir wound (14% vs 3%, p=0.02). There was no significant difference in the incidence of CSF infection between the cohorts (6% vs 4%, p=0.71).CONCLUSION: This study provides level III evidence to suggest that trans-fontanelle ventricular taps may have a similar safety and efficacy profile to the use of a ventricular reservoir.

  View details for DOI 10.1016/j.jocn.2025.111225

  View details for PubMedID 40188661

• The utility of routine intraoperative CSF during ventricular shunt insertion: a 10-year retrospective cohort study. Journal of neurosurgery. Pediatrics Stuart, M. J., Harbison, A. M., Ruder, T., Hackney, J., Jardim, A. J., Ma, N., Campbell, R. A., Coulthard, L. G. 2025; 35 (4): 338-344

  Abstract

  Ventricular shunt insertion is a common procedure in pediatric neurosurgical practice. In many areas of medicine there is a push toward rationalization of healthcare resources and a reduction in low-value tests or procedures. The intraoperative sampling of CSF at the time of shunt insertion is one traditional aspect of care that has not been rigorously evaluated. Additionally, the role of CSF cell counts and chemistry in predicting shunt dysfunction is often discussed but poorly studied. A recent meta-analysis found a correlation between elevated CSF protein levels and shunt failure in patients with tuberculous meningitis, but not other pathologies, which limits the generalizability of those findings to Western populations. The aims of this study were to assess the clinical utility of intraoperative CSF sampling during insertion of ventricular shunts and to describe any association of routine intraoperative CSF sample parameters with shunt failure or infection.A retrospective review of a prospectively maintained surgical database covering 10 years of consecutive cases from a quaternary Australian pediatric neurosurgical center serving a population of 5.3 million was conducted. Statewide electronic medical records were reviewed to collate data on demographics, postoperative imaging, CSF biochemistry, instances of shunt failure, shunt revisions, and mortality. Patients undergoing insertion of a new ventricular shunt were included, while all cases of shunt revision were excluded.During the study period, 1485 shunt procedures were performed, of which 427 involved the placement of a new ventriculoperitoneal shunt system. The mean patient age was 5.2 years (range premature-18 years). Of the 427 cases, 377 (88%) underwent routine CSF sampling. The most common indications for shunt revision were proximal catheter obstruction (51/173, 29%), followed by infection (29/173, 17%) and valve blockage (23/173, 13%). During the study period, 3 patients with existing intracranial hardware had overt ventriculitis identified at the time of intraoperative sampling, resulting in shunt removal. One patient with an existing ventricular reservoir had a delayed clinically significant infection identified on intraoperative cultures. Elevated CSF protein levels were associated with shunt failure during follow-up (area under the curve 0.625). The identified cutoff of 300 mg/L was significantly associated with a reduced time to shunt failure in both univariate and multivariate analyses.It may be reasonable to consider omission of routine intraoperative CSF sampling at the time of shunt insertion in patients without existing intracranial hardware. Elevated CSF protein levels are associated with a reduced time to shunt failure in a dose-dependent manner.

  View details for DOI 10.3171/2024.11.PEDS24513

  View details for PubMedID 39823592

• The risks of omitting routine postoperative imaging after insertion of new ventricular shunts in children: a 10-year retrospective cohort study. Journal of neurosurgery. Pediatrics Stuart, M. J., Harbison, A. M., Ruder, T., Hackney, J., Ma, N., Campbell, R. A., Jardim, A. J., Coulthard, L. G. 2025: 1-8

  Abstract

  Ventriculoperitoneal shunt insertion is the primary treatment for pediatric hydrocephalus and is one of the most common procedures performed in pediatric neurosurgery. However, the value of routine postoperative imaging remains controversial. Although some evidence suggests that routine postoperative imaging provides a low yield after shunt revision, its role following initial shunt insertion in children has not been reported. Additionally, the role of routine postoperative imaging as a baseline study in altering the rate of longer-term shunt revision rates remains unexplored.A retrospective review was conducted using a prospectively maintained surgical database, encompassing 10 years of consecutive cases from a quaternary pediatric neurosurgical center serving a population of 5.3 million. Statewide electronic medical records including imaging and mortality data were reviewed. Only cases involving the insertion of a new ventricular shunt system were included. Based on longstanding physician preferences, approximately half the neurosurgeons in the department did not routinely perform postoperative imaging during the study period. The primary outcomes were shunt-related mortality during the study period, shunt revision or mortality within 7 days of surgery, or hospital discharge, with time to first revision as a secondary outcome.During the study period 1485 shunt procedures were performed, of which 427 involved the placement of a new ventriculoperitoneal shunt system. The mean age of the patients was 5.2 years (range premature to 18 years). A total of 206/427 (48%) underwent routine postoperative imaging with MR or CT, and 153/427 (36%) underwent routine postoperative shunt series radiographs. During the study period, 2 abdominal radiographs identified preperitoneal placement; however, in both cases a symptomatic subcutaneous fluid collection was present (2/427, 0.5%). Postoperative CT or MR studies identified 1 case of extraventricular catheter placement and 5 cases of a kink adjacent to the valve (6/427, 1.4%), of which 4 cases were detected on routine imaging (4/427, 0.9%). No significant differences were detected between patients with or without imaging in 7-day postoperative (14 [7%] vs 8 [4%], p = 0.25) or 7-day postdischarge (2 [1%] vs 1 [< 1%], p = 0.96) rates of noninfective shunt revision, shunt-related mortality (4 [2%] vs 5 [2%], respectively, p = 0.8) or Kaplan-Meier long-term shunt survival curves (all p > 0.05).Routine postoperative imaging after pediatric shunt insertion rarely identifies clinically significant issues, and consideration could be given to its omission.

  View details for DOI 10.3171/2024.12.PEDS24496

  View details for PubMedID 40153838

• Validation of data capture in the Australasian shunt registry with a prospectively maintained institutional database. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia Stuart, M. J., Wray, A., Dexter, M., Campbell, R. A. 2025; 135: 111179

  Abstract

  The Australasian Shunt Registry was established in 2016 with the aim of providing safety and quality data in addition to enhancing capacity for research to improve health outcomes for patients with cerebrospinal fluid shunts. The Queensland Children's Hospital is the largest single contributor of paediatric patient data to the Registry and maintains an independent institutional shunt database. The aim of this study was to validate the demographic data and outcomes captured by the Registry against that institutional database.Data from the institutional database and a sample of data from the same institution held by the Australasian Shunt Registry were acquired from the period of 1 January 2017 to 1 October 2024. Patients ≤ 18 years of age undergoing placement of a new ventriculoperitoneal shunt system were included. Revision and mortality data were acquired from the Australasian Shunt Registry and Queensland statewide electronic medical records independently. Comparison was made between demographic and mortality data captured by each database. The primary outcome of time to shunt revision (shunt survival) in each sample was assessed through the generation of Kaplan-Meier curves and analysis by both Wilcoxon and log-rank tests.Over the study period the shunt registry reported a full or partial opt-out rate of 9.5 %. 344 patients were identified and included from the institutional database, and 294 patients were included from the Registry. The identified patient samples were demographically similar with a mean age of 5 years, and 44 % female in both groups. The most common aetiologies of hydrocephalus in both cohorts were congenital (28 % vs 28 %, p = 0.49), tumour (33 % vs 27 %, p = 0.08) and haemorrhage (25 % vs 18 %, p = 0.02). Mortality during followup was consistent across both samples (13 % vs 11 %, p = 0.27). Similarly, binary revision status during the followup period was similar (34 % vs 32 %, p = 0.3). Kaplan-Meier analysis of time to revision (shunt survival) estimated shunt survival to be 4.82 years (95 % CI 4.42--5.22 years) in the institutional database and 5.25 (95 % CI 4.81-5.69 years) in the Registry with no significant differences between the samples on Wilcoxon, p = 0.3 or late Log-Rank, p = 0.36 tests.The Australasian Shunt Registry appears to capture a valid sample which is representative of the demographics and clinical outcomes of patients treated at one large contributing institution. Ongoing efforts to ensure comprehensive data capture at all participating sites are justified to ensure that future findings derived from Registry data are representative of the studied population.

  View details for DOI 10.1016/j.jocn.2025.111179

  View details for PubMedID 40088759

• Synchronous intracranial arteriovenous malformation and papillary glioneuronal tumour: hypothesis or reality? Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery Stuart, M., Burnett, A., Robertson, T., Harbison, A., Coulthard, L., Campbell, R. 2024; 40 (12): 4329-4333

  Abstract

  Brain arteriovenous malformations (AVM) rarely occur with spatial and/or temporal co-localisation to intracranial neoplasms. Most prior reports describe this association with high-grade gliomas; however, reports of a co-occurrence with low grade gliomas are very rare. It is unclear whether such cases represent a true co-occurrence of separate pathologies or simply an unusually vascular phenotype of the neoplasm. Most such reports pre-date the era of molecularly defined gliomas. We present the first report of the spatial and temporal co-occurrence of an intracranial arteriovenous malformation traversing and within a papillary glioneuronal tumour, molecularly defined by the presence of SLC44A1::PRKCA fusion. This case was successfully managed by resection of both lesions adhering to the principles of AVM surgery. It is possible these exceptionally rare co-occurrences may have common underlying molecular drivers relating to the mitogen activated protein kinase (MAPK) pathway.

  View details for DOI 10.1007/s00381-024-06621-3

  View details for PubMedID 39292231

  View details for PubMedCentralID PMC11579150

• Monitoring the impact of cancer for Queenslanders: A comprehensive review of lung, pancreas, Merkel cell, and brain cancer Walpole, E., Allen, M., Burmeister, B., Sanmugarajah, J., Walker, R., Chan, B. A., Clark, J., Youlden, D., Dhanda, P., Dunn, N., Lehman, M., Bolton, A., Windsor, M., Guan, T., Nath, A., Buckley, L., Stuart, M., Coulthard, L., Green, L., Harbison, A., Kusukuntla, S., Kurth, E., Campbell, R., Woodrow, P., Gujadhur, S., Moore, J., Donoghue, V., Cossio, D. WILEY. 2024: 112

  View details for Web of Science ID 001352150600133

• Lost in Transition: the burden of brain tumors in the adolescent and young adult (AYA) population Walker, R., Buckley, L., Stuart, M., Coulthard, L., Green, L., Harbison, A., Kusukuntla, S., Kurth, E., Cossio, D., Campbell, R. A. WILEY. 2024: 114

  View details for Web of Science ID 001352150600137

• Technical note: durable resolution of hydrocephalus after ultrasound-guided percutaneous fenestration of giant suprasellar arachnoid cyst in a neonate CHILDS NERVOUS SYSTEM Stuart, M. J., Yoon, J., McEniery, J., Jardim, A. J., Vonhoff, C. 2024; 40 (12): 4279-4282

  Abstract

  Arachnoid cysts are relatively common, but rarely require intervention. While most arachnoid cysts in typical middle or posterior cranial fossa locations are seldom symptomatic, suprasellar cysts may become symptomatic due to the potential for ventricular outflow obstruction and hydrocephalus. Typical standard of care for the treatment of these lesions is endoscopic fenestration with third ventriculostomy, or the placement of ventriculoperitoneal or cystoperitoneal shunts. The surgical and anaesthetic risks of traditional interventions may be higher in the early neonatal period, including leak of cerebrospinal fluid, infection, and premature failure of ventriculostomy or shunts. This note describes a novel bedside ultrasound-guided technique to percutaneously fenestrate large suprasellar arachnoid cysts under local anaesthesia. The technique involves insertion of a 25-g spinal needle until contact with the membrane of the arachnoid cyst medially, followed by a lateral sweeping to widely incise/fenestrate the lesion into the ventricular space under continuous ultrasound visualisation. This note describes an example case which demonstrates durable radiological and clinical improvement after 2 years of follow-up. This may represent a management option to temporise, or perhaps definitively manage suprasellar arachnoid cysts in the neonatal period.

  View details for DOI 10.1007/s00381-024-06560-z

  View details for Web of Science ID 001290947900001

  View details for PubMedID 39138665

  View details for PubMedCentralID PMC11579056

• Ten-year statewide cross-sectional review of pediatric sinogenic intracranial abscess and empyema in Queensland, Australia: microbial profile before and after COVID-19 JOURNAL OF NEUROSURGERY-PEDIATRICS Stuart, M. J., Harbison, A. M., Ma, N., Campbell, R. J., Jardim, A. J., Anderson, D. S., Withers, T. K., Coulthard, L. G. 2024; 34 (5): 489-494

  Abstract

  Sinogenic intracranial infections in children, such as subdural empyema or intracranial abscess, are a rare disease process with significant associated morbidity. Recent literature has suggested that there may have been an increase in frequency of these infections following the COVID-19 pandemic, but the literature has been conflicting, perhaps related to the heterogenous management of COVID-19 lockdowns in various states and differences in data capture between methods. The collection of statewide Australian data overcomes these limitations by capturing a comprehensive sample though the public healthcare system of patients who were subject to a homogeneous statewide approach to public health policy during the COVID-19 pandemic (population 5.6 million, including 1.3 million children). The objective of this study was to present population-level data to address the question of whether the incidence of intracranial infections changed in pediatric patients before and after the COVID-19 pandemic.The authors present a retrospective 10-year statewide description of sinogenic intracranial infections in Queensland, Australia. A comparison was made between the incidence and microbiological profile before and after the onset of COVID-19 lockdowns on March 22, 2020.Forty-four pediatric intracranial infections undergoing neurosurgical intervention were identified within the review period. After exclusion of postsurgical and cardioembolic causes, 33 sinogenic intracranial infections were included (16 before and 17 after 2020, with a mean annualized incidence of 0.25 vs 0.37 cases per 100,000 children, respectively; p > 0.05). The most frequent organisms identified were Streptococcus milleri (n = 19), polymicrobial (n = 4), and S. aureus (n = 3). No significant differences in antimicrobial profile, susceptibility, parenchymal involvement, or clinical outcome were identified between the pre- and post-COVID-19 groups.No statistically significant differences in the epidemiology of pediatric intracranial infection have occurred in the state of Queensland, Australia, before and after March 22, 2020, and the COVID-19 pandemic.

  View details for DOI 10.3171/2024.6.PEDS24201

  View details for Web of Science ID 001381996100008

  View details for PubMedID 39151187

• General surgeon performed emergency craniotomies in regional Queensland hospitals: a 20-year state-wide study on patient outcomes. ANZ journal of surgery Kelly, M. L., Stuart, M., Zouki, J., Long, B., Sabat, N., Clark, C. R., Donaldson, E., Colbran, R. E. 2024; 94 (4): 585-590

  Abstract

  Traumatic brain injuries account for up to 50% of trauma related deaths and if surgical intervention is indicated, consensus suggests a maximum of 4 hours to surgical decompression. The occurrence and outcomes of craniotomies performed by non-neurosurgeons in regional Queensland hospitals have never been reported previously in the literature.A retrospective review was performed at all regional Queensland hospitals without an on-site neurosurgical service from January 2001 to December 2022 to identify patients undergoing emergency craniotomy. Data recorded included basic demographics, history of anti-coagulant use, mechanism of injury, type of haemorrhage, Glasgow Coma Score and Glasgow Outcome Scale (GOS) on discharge. Radiological parameters measured included midline shift and maximal coronal depth of haematoma. The primary aim of this study was to assess the clinical and radiological outcomes of patients who underwent a craniotomy performed by general surgeons.Over the past 20 years there have been 23 emergency decompressive procedures (one excluded) performed in regional Queensland. Preoperative imaging demonstrated 9 extradural haematomas and 13 subdural haematomas. Six of 17 transferred cases required reoperation after transfer to a neurosurgical centre. Survival was observed in 9 of 22 cases, with 'good' functional outcome (GOS ≥3) observed in 7 cases. In no cases were rurally performed burr holes effective.Qualitatively, a larger craniotomy may be associated with better clinical and radiological outcomes. Although rare occurrences, our results demonstrate that general surgeon performed craniotomies are frequently efficacious in producing radiological and/or clinical improvement and should be considered as a potentially lifesaving procedure.

  View details for DOI 10.1111/ans.18911

  View details for PubMedID 38553955

• Systematic review and meta-analysis of external ventricular drain placement accuracy and narrative review of guidance devices JOURNAL OF CLINICAL NEUROSCIENCE Stuart, M. J., Antony, J., Withers, T. K., Ng, W. 2021; 94: 140-151

  Abstract

  Insertion of external ventricular drain (EVD) is one of the most common neurosurgical procedures performed worldwide. This is generally performed freehand, on the basis of anatomical landmarks. There is significant variability in the reported accuracy of freehand placement, lacking Level I evidence. We present the first meta-analysis of freehand EVD placement accuracy and technologies or techniques to enhance accuracy.We report a systematic review of the Pubmed, Embase, and Cochrane Central databases according to MOOSE (Meta-analysis Of Observational Studies) guidelines. 37 studies were included for qualitative analysis and 19 studies (2983 cases) for quantitative analysis.There is substantial heterogeneity in the outcome measures used to report EVD placement accuracy. Of those nineteen studies reporting accuracy using the Kakarla grading system the mean rate of ideal ipsilateral frontal horn placement was 73% (standard deviation ±7%). The use of formal stereotaxic guidance is consistently reported to improve accuracy to >90%, although with variable outcome measures. However, the reported efficacy of other guidance devices or techniques is highly variable. The quality of studies directly comparing all existing non-stereotaxic devices with freehand EVD placement is poor and precludes any assertion of superiority to freehand insertion.We provide the first meta analysis of freehand placement accuracy. There is insufficient data to perform a meta-analysis of the relative efficacy of interventions to improve accuracy. Qualitative synthesis of reports of stereotaxic guidance is suggestive of higher accuracy than freehand placement.

  View details for DOI 10.1016/j.jocn.2021.10.014

  View details for Web of Science ID 000744292000020

  View details for PubMedID 34863429

• Orthogonal external ventricular drain (EVD) trajectory from burr holes sited by junior neurosurgical staff is superior to freehand placement: An in-silico model JOURNAL OF CLINICAL NEUROSCIENCE Stuart, M. J., Mehigan, B., Colbran, R. E., Withers, T. K., Ng, W. 2021; 94: 65-69

  Abstract

  External ventricular drain (EVD) or ventriculostomy placement is one of the most common neurosurgical procedures performed worldwide and is associated with complications including haemorrhage, malposition and infection. Several authors have attempted to define an ideal trajectory for placement, and scalp-mounted guidance devices have been devised to exploit the theoretical ideal orthogonal trajectory from the scalp to the lateral ventricles. However, uptake has been limited due to lack of demonstrated superiority to freehand placement. Previous modelling studies have failed to include a true-to-life sample of patients undergoing EVD insertion and excluded cases with midline shift or non-hydrocephalus indications. Further, none have attempted to model the orthogonal insertion of EVD via actual burr holes placed by junior neurosurgical staff. In our report of 58 cases of frontal EVD insertion in a low-volume Australian neurosurgical unit freehand EVD insertion resulted in acceptable placement in the ipsilateral frontal horn in 62% of cases, any ventricle in 22%, and in eloquent or non-eloquent brain in 16% of cases. The modelled orthogonal trajectory from the same burr holes, using post-procedural computed tomography scans and the S8 Stealth Station (Medtronic), resulted in superior placement; 80% in the ipsilateral frontal horn and 20% contralateral (p = 0.007). There were no significant malpositions associated with the modelled trajectories. In our series, 18% of freehand catheters required multiple placement attempts. In conclusion, our data suggests that an orthogonal trajectory may result in improved EVD positioning compared to freehand placement.

  View details for DOI 10.1016/j.jocn.2021.09.041

  View details for Web of Science ID 000744292000009

  View details for PubMedID 34863464

• Comment on: remote site haemorrhage after intracranial surgery: is it really benign? BRITISH JOURNAL OF NEUROSURGERY Stuart, M., Tsahtsarlis, A., Amato, D., Pattavilakom, A. 2016; 30 (5): 593

  View details for DOI 10.1080/02688697.2016.1218439

  View details for Web of Science ID 000383825500021

  View details for PubMedID 27601028

• A meta-analysis of chemokines in major depression PROGRESS IN NEURO-PSYCHOPHARMACOLOGY & BIOLOGICAL PSYCHIATRY Eyre, H. A., Air, T., Pradhan, A., Johnston, J., Lavretsky, H., Stuart, M. J., Baune, B. T. 2016; 68: 1-8

  Abstract

  Chemokines are increasingly recognised as playing a role in depression. Here we meta-analyse the data on concentrations of all chemokines in patients diagnosed with a major depression versus healthy controls. We included studies which utilised Diagnostic and Statistical Manual (DSM)-IV diagnostic criteria for major depression, participants free from major medical conditions, studies with healthy controls, and unstimulated measurements of chemokines. We only included chemokines which had ≥3 studies performed. Two chemokines and 15 studies in total met criteria for this meta-analysis; 8 for Monocyte Chemotactic Protein (MCP)-1/CCL2 (n=747), and 7 for Interleukin (IL)-8/CXCL8 (n=560). There were significantly higher concentrations of CCL2/MCP-1 in depressed subjects compared with control subjects - overall mean difference of 36.43pg/mL (95% CI: 2.43 to 70.42). There was significant heterogeneity across these studies (I2=98.5%). The estimates of mean difference between the control and depression groups did not remain significant when the trim-and-fill procedure was used to correct for publication bias. There was no significant difference in concentrations of IL-8/CXCL8 in depressed subjects compared with control subjects. Significant heterogeneity was found across these studies (I2=96.7%). The estimates of mean difference between the control and depression groups remained non-significant when the trim-and-fill procedure was used to correct for publication bias. This meta-analysis reports significantly heterogeneity in this field among studies. There are higher concentrations of the chemokine MCP-1/CCL2 in depressed subjects compared with control subjects, and no differences for IL-8/CXCL8. More high quality research and consistent methodologies are needed in this important area of enquiry.

  View details for DOI 10.1016/j.pnpbp.2016.02.006

  View details for Web of Science ID 000373854400001

  View details for PubMedID 26903140

  View details for PubMedCentralID PMC5536843

• Routine multidisciplinary cerebrovascular meetings do not reduce aneurysm clipping case load: a cohort study ANZ JOURNAL OF SURGERY Davis, B. W., Stuart, M. J., Jayapratap, P., Hall, B. I. 2016; 86 (7-8): 594-597

  Abstract

  Structured multidisciplinary care is an increasingly popular tool in the management of many complex disease processes; however, there is little published data regarding the effects of such a process on management of intracranial aneurysms and neurosurgical case loads. There is some resistance in the neurosurgical community to routine involvement of interventional neuroradiologists in the care of patients with intracranial aneurysms due to concerns regarding maintenance of neurosurgical case loads and training capabilities. At our tertiary Australian hospital, we have implemented a weekly multidisciplinary cerebrovascular meeting (MDCVM) facilitating routine discussion of these cases between neurosurgeons and interventional neuroradiologists.This study identified management modalities for ruptured and unruptured cerebral aneurysms diagnosed at our centre for a 2-year period before and after the implementation of MDCVM culminating in a 4-year retrospective cohort study. The pre- and post-MDCVM cohorts were well matched for demographics with 162 and 224 patients, respectively.There is no significant difference in percentage or absolute numbers of endovascular or surgical cases in the pre-MDCVM (103; 73.0% versus 38; 27.0%, respectively) or post-MDCVM cohorts (105; 79.5% versus 27; 20.5%, respectively), reflecting a maintained surgical case load after the implementation of MDCVM (P = 0.21). There were no significant differences in any confounding variables including age, sex, aneurysm size/location, Fisher or World Federation of Neurosurgical Societies (WFNS) grade.Implementation of MDCVM did not impact on active management case loads with consistent numbers and percentages for both endovascular and microsurgical management.

  View details for DOI 10.1111/ans.13386

  View details for Web of Science ID 000380690900018

  View details for PubMedID 26631218

• Remote cerebellar haemorrhage from site of craniotomy: A report of two cases BRITISH JOURNAL OF NEUROSURGERY Stuart, M., Tsahtsarlis, A., Amato, D., Pattavilakom, A. 2016; 30 (1): 101-103

  Abstract

  Remote cerebellar haemorrhage (RCH) is a rare complication of neurosurgical procedures seldom requiring intervention. We report two cases of RCH. The first unilateral RCH is asymptomatic, the other is bilateral and associated with supratentorial haemorrhage and hydrocephalus requiring intervention. We propose multiple foci of haemorrhage as an adverse prognostic marker in RCH.

  View details for DOI 10.3109/02688697.2015.1071322

  View details for Web of Science ID 000372195900022

  View details for PubMedID 26311311

• Systematic review of the neurobiological relevance of chemokines to psychiatric disorders FRONTIERS IN CELLULAR NEUROSCIENCE Stuart, M. J., Singhal, G., Baune, B. T. 2015; 9: 357

  Abstract

  Psychiatric disorders are highly prevalent and disabling conditions of increasing public health relevance. Much recent research has focused on the role of cytokines in the pathophysiology of psychiatric disorders; however, the related family of immune proteins designated chemokines has been relatively neglected. Chemokines were originally identified as having chemotactic function on immune cells; however, recent evidence has begun to elucidate novel, brain-specific functions of these proteins of relevance to the mechanisms of psychiatric disorders. A systematic review of both human and animal literature in the PubMed and Google Scholar databases was undertaken. After application of all inclusion and exclusion criteria, 157 references were remained for the review. Some early mechanistic evidence does associate select chemokines with the neurobiological processes, including neurogenesis, modulation of the neuroinflammatory response, regulation of the hypothalamus-pituitary-adrenal axis, and modulation of neurotransmitter systems. This early evidence however does not clearly demonstrate any specificity for a certain psychiatric disorder, but is primarily relevant to mechanisms which are shared across disorders. Notable exceptions include CCL11 that has recently been shown to impair hippocampal function in aging - of distinct relevance to Alzheimer's disease and depression in the elderly, and pre-natal exposure to CXCL8 that may disrupt early neurodevelopmental periods predisposing to schizophrenia. Pro-inflammatory chemokines, such as CCL2, CCL7, CCL8, CCL12, and CCL13, have been shown to drive chemotaxis of pro-inflammatory cells to the inflamed or injured CNS. Likewise, CX3CL has been implicated in promoting glial cells activation, pro-inflammatory cytokines secretion, expression of ICAM-1, and recruitment of CD4+ T-cells into the CNS during neuroinflammatory processes. With further translational research, chemokines may present novel diagnostic and/or therapeutic targets in psychiatric disorders.

  View details for DOI 10.3389/fncel.2015.00357

  View details for Web of Science ID 000361244100001

  View details for PubMedID 26441528

  View details for PubMedCentralID PMC4564736

• Clinically relevant aspects of stem cell technologies: current state of play ANZ JOURNAL OF SURGERY Stuart, M. J., Pattavilakom, A. 2015; 85 (9): 615-619

  Abstract

  The emergence of stem cell technologies and their potential applications in regenerative medicine have generated immense interest by both the lay public and clinicians. Unproven and unregulated cell-based therapies are commercially available both in Australia and internationally, and reports of patient uptake (stem cell tourism) and associated morbidity are increasingly frequent. Clinicians in all fields will require an enhanced understanding of the basic science principles and current state of play in regenerative medicine in order to effectively counsel patients regarding these therapies in the setting of both commercial ventures and clinical trials. This review aims to concisely highlight the key clinically pertinent features of these trials and briefly discuss the specific therapeutic potential, mechanism of action and risks associated with these variables.

  View details for DOI 10.1111/ans.12864

  View details for Web of Science ID 000360670000010

  View details for PubMedID 25267417

• A phase-specific neuroimmune model of clinical depression PROGRESS IN NEURO-PSYCHOPHARMACOLOGY & BIOLOGICAL PSYCHIATRY Eyre, H. A., Stuart, M. J., Baune, B. T. 2014; 54: 265-274

  Abstract

  Immune dysfunction and pro-inflammatory states in particular have been implicated in the aetiology and pathogenesis of depression. Whilst the onset of an episode and certain symptoms of depression appear well explained by this inflammatory model, the underpinnings of the episodic and progressive nature, as well as relapse and remission status in depression require attention. In this review it is suggested that additional immune factors beyond pro- and anti-inflammatory cytokines may effectively contribute to the understanding of the neurobiology of clinical depression. Considering neurobiological effects of immunomodulatory factors such as T cells, macrophages, microglia and astrocytes relevant to depression, we suggest a neuroimmune model of depression underpinned by dynamic immunomodulatory processes. This perspective paper then outlines a neuroimmune model of clinical phases of depression in an attempt to more adequately explain depression-like behaviours in pre-clinical models and the dynamic nature of depression in clinical populations. Finally, the implications for immunomodulatory treatments of depression are considered.

  View details for DOI 10.1016/j.pnpbp.2014.06.011

  View details for Web of Science ID 000341167800033

  View details for PubMedID 24999185

• Chemokines and chemokine receptors in mood disorders, schizophrenia, and cognitive impairment: A systematic review of biomarker studies NEUROSCIENCE AND BIOBEHAVIORAL REVIEWS Stuart, M. J., Baune, B. T. 2014; 42: 93-115

  Abstract

  The search for immune biomarkers in psychiatric disorders has primarily focused on pro-inflammatory cytokines. Other immune proteins including chemokines have been relatively neglected in such studies. Recent evidence has implicated chemokines in many neurobiological processes potentially relevant to psychiatric disorders, beyond their classical chemotactic functions. These may include neuromodulator effects, neurotransmitter-like effects, and direct/indirect regulation of neurogenesis. This systematic review presents the existing early evidence which supports an association of many chemokines with the psychiatric disorders: depression, bipolar disorder, schizophrenia, mild cognitive impairment and Alzheimer's disease. The non-specific association of chemokines including CXCL8 (IL-8), CCL2 (MCP-1), CCL3 (MIP-1α) and CCL5 (RANTES) with these disorders across diagnostic categories implies a generalised involvement of many chemokine systemic with psychiatric disease. Additional chemokines with great mechanistic relevance including CXCL12 (SDF-1) and CX3CL1 (fractalkine) have been rarely reported in the existing human literature and should be included in future clinical studies. The potential utility of these proteins as pathologically relevant biomarkers or therapeutic targets should be considered by future clinical and translational research.

  View details for DOI 10.1016/j.neubiorev.2014.02.001

  View details for Web of Science ID 000336464100005

  View details for PubMedID 24513303

• Knockout of CXCR5 increases the population of immature neural cells and decreases proliferation in the hippocampal dentate gyrus JOURNAL OF NEUROINFLAMMATION Stuart, M. J., Corrigan, F., Baune, B. T. 2014; 11: 31

  Abstract

  The process of neurogenesis in which new neurons are generated by proliferation and differentiation of neural stem/progenitor cells (NSCs/NPCs) has been a topic of intensive recent investigation. Investigations of the factors which regulate this process have recently begun to include immune factors including immune cells and cytokines, however the class of immune proteins designated as chemokines have been relatively neglected. Increasing evidence for novel brain-specific mechanisms of chemokines beyond their classical chemotactic functions has suggested that they may play a role in the regulation of NSC/NPC biology.We have investigated the role of the chemokine receptor CXCR5 (ligand is CXCL13) in the activity of these cells through neurobiological and behavioural analysis of CXCR5-deficient mice (CXCR5-/-). These investigations included: immunohistochemistry for the markers Ki67, nestin, doublecortin, and IBA-1, neurosphere assays, and the baseline behavioural tests: open field test and sucrose preference test.We observed a significant increase in doublecortin and nestin staining in the hippocampal dentate gyrus (P = 0.02 and P = 0.0008, respectively) of CXCR5-/- animals as compared to wild-type controls. This was accompanied by a decrease in Ki67 staining subgranular zone (P = 0.009). Behavioural correlates included a significant increase in baseline locomotor activity in an open field test (P <0.00018) and a decrease in stress reactivity in that test (P = 0.015). Deficiency in CXCR5 was not associated with alterations in hippocampal microglial density, microglial activation or systemic cytokine levels, nor with loss of NSC/NPC populations in the neurosphere assay.These findings are the first to describe a brain-specific function of CXCR5 under physiological conditions. CXCR5 reduces maintenance of immature neural cell populations and enhances proliferation of subgranular zone cells in the hippocampal dentate gyrus, however the mechanism of these effects remains unclear. Further research into the regulation of NSC/NPC activity should consider investigation of CXCR5 and other chemokines which may be relevant to the pathophysiology of psychiatric disorders including depression, anxiety and cognitive impairment/dementia.

  View details for DOI 10.1186/1742-2094-11-31

  View details for Web of Science ID 000333239600001

  View details for PubMedID 24528805

  View details for PubMedCentralID PMC3928586

• Moderators of the relationship between depression and cardiovascular disorders: a systematic review GENERAL HOSPITAL PSYCHIATRY Baune, B. T., Stuart, M., Gilmour, A., Wersching, H., Arolt, V., Berger, K. 2012; 34 (5): 478-492

  Abstract

  A bidirectional relationship between depression and cardiovascular disease (CVD) including biological mechanisms has been proposed; however, the potential role of clinical and sociodemographic moderators in this relationship remains unclear. We aim to systematically review the moderating influence of the clinical and sociodemographic variables on the observed interrelationship between depressive disorders and CVD.We systematically reviewed MEDLINE, The Cochrane Library and PsycINFO databases. After the exclusion of articles, 101 remained for this review.Several studies suggest that clinical characteristics of depression, such as severity of depression, number of episodes and duration of depression, may moderate the relationship between depression and cardiovascular disease. Consistently, various studies support a role for marital status, education and income as moderators of this relationship. Several of these studies vary in methodology, hence yielding some inconsistent results. Longitudinal and controlled studies are required to investigate the effect sizes of these moderating factors on the depression-CVD relationship.Clinical characteristics of depression and sociodemographic factors appear to be moderators in the bidirectional relationship between depression and cardiovascular disease. Further research should consider these factors in conjunction with subtypes of depression and biological markers in a comprehensive model of this interrelationship. Our findings may assist with clinical decision-making processes.

  View details for DOI 10.1016/j.genhosppsych.2012.05.013

  View details for Web of Science ID 000308511500005

  View details for PubMedID 22771109

• REVIEW OF STRATEGIES TO ENHANCE THE UPTAKE OF SEASONAL INFLUENZA VACCINATION BY AUSTRALIAN HEALTHCARE WORKERS COMMUNICABLE DISEASES INTELLIGENCE Stuart, M. J. 2012; 36 (3): E268-E276

  Abstract

  Annual vaccination of healthcare workers (HCWs) against seasonal influenza is recommended by The Australian Immunisation Handbook to prevent personal morbidity and transmission to patients. There are limited data available concerning the uptake of this vaccination by Australian healthcare workers, and few studies have investigated the determinants of this uptake. This report therefore aims to review the seasonal influenza immunisation uptake rates of Australian HCWs, the determinants of these rates, and strategies to improve them. The Cumulative Index to Nursing and Allied Health Literature, PubMed and the Cochrane Library were searched for literature published online between January 2000 and May 2011. A manual search of the grey literature was also undertaken. Studies of influenza pandemic A(H1N1) 2009 immunisation were excluded. Eleven relevant studies were identified. The published data suggests that annual seasonal influenza immunisation rates among Australian HCWs are below recommended levels (range 22%-70%). Factors contributing to the decision to be immunised demonstrate only minor variations from those identified in international samples. There is little high quality evidence to support specific strategies and interventions to increase uptake of immunisation in HCWs. Further high quality research is needed to demonstrate the efficacy of strategies and interventions on HCW immunisation uptake, particularly in Australian samples, and if conventional interventions continue to prove ineffective, policy change to mandatory seasonal influenza immunisation should be considered.

  View details for Web of Science ID 000213224500005

  View details for PubMedID 23186238

• Early career medical research in Australia: looking to the future INTERNAL MEDICINE JOURNAL Eyre, H., Stuart, M. 2012; 42 (7): 850-851

  View details for DOI 10.1111/j.1445-5994.2012.02825.x

  View details for Web of Science ID 000306514800028

  View details for PubMedID 22805696

• The relationship between subtypes of depression and cardiovascular disease: a systematic review of biological models TRANSLATIONAL PSYCHIATRY Baune, B. T., Stuart, M., Gilmour, A., Wersching, H., Heindel, W., Arolt, V., Berger, K. 2012; 2: e92

  Abstract

  A compelling association has been observed between cardiovascular disease (CVD) and depression, suggesting individuals with depression to be at significantly higher risk for CVD and CVD-related mortality. Systemic immune activation, hypothalamic-pituitary-adrenal (HPA) axis hyperactivity, arterial stiffness and endothelial dysfunction have been frequently implicated in this relationship. Although a differential epidemiological association between CVD and depression subtypes is evident, it has not been determined if this indicates subtype specific biological mechanisms. A comprehensive systematic literature search was conducted using PubMed and PsycINFO databases yielding 147 articles for this review. A complex pattern of systemic immune activation, endothelial dysfunction and HPA axis hyperactivity is suggestive of the biological relationship between CVD and depression subtypes. The findings of this review suggest that diagnostic subtypes rather than a unifying model of depression should be considered when investigating the bidirectional biological relationship between CVD and depression. The suggested model of a subtype-specific biological relationship between depression and CVDs has implications for future research and possibly for diagnostic and therapeutic processes.

  View details for DOI 10.1038/tp.2012.18

  View details for Web of Science ID 000315990800008

  View details for PubMedID 22832857

  View details for PubMedCentralID PMC3309537

• Depression and type 2 diabetes: Inflammatory mechanisms of a psychoneuroendocrine co-morbidity NEUROSCIENCE AND BIOBEHAVIORAL REVIEWS Stuart, M. J., Baune, B. T. 2012; 36 (1): 658-676

  Abstract

  Unipolar depression and diabetes mellitus each account for a significant proportion of the global burden of disease. Epidemiological literature suggests a bi-directional relationship between these two common disorders, and evidence from the molecular sciences supports a role for inflammation in the pathogenesis and pathophysiology of each disorder individually. Recent advances in understanding the neurobiology of depression have implicated dysfunction of the hypothalamus-pituitary-adrenal axis, neurotrophins, and inflammatory mediators in the development of this disorder. Similarly, dysregulated facets of both the innate and adaptive immune system have been implicated in the onset of insulin resistance and type 2 diabetes. This review draws upon an emerging body of epidemiological and mechanistic evidence to support the hypothesis that shared inflammatory mechanisms may represent a key biological link in this co-morbidity. Given the shared mechanisms of this co-morbidity, these patients may be excellent candidates for novel immune targeted pharmacotherapy.

  View details for DOI 10.1016/j.neubiorev.2011.10.001

  View details for Web of Science ID 000300458800041

  View details for PubMedID 22020230