Highlights • Virtual reality (VR) and augmented reality (AR) have great potential in neurosurgery. • Immersive VR has the potential to be used an educational tool. • AR has the added potential of use ...in the live operative field. • Further improvement of VR and AR is crucial to its integration into neurosurgery.
Background:
Gastric bands, specifically the Lap-Band, have been widely used for weight loss. However, little is known about the complications associated with abdominal contouring procedures in ...patients with Lap-Bands. This study aimed to determine the complication rates and consent processes for these procedures.
Methods:
We conducted a survey study of 300 members of the American Society of Aesthetic Plastic Surgery. Commonly performed abdominal contouring procedures included abdominal liposuction, abdominoplasty, and combined abdominoplasty with abdominal liposuction.
Results:
The overall infection rate was low (1%) and did not significantly differ between the procedural groups. Abdominoplasty and combined liposuction with abdominoplasty had significantly higher complication rates (4.7% and 10.5%, respectively) than liposuction alone (1%,
P
= 0.0004). Abdominoplasty procedures also had higher rates of port/tubing malposition (2.3%,
P
= 0.04) and system leaks (1.6%,
P
= 0.003). Approximately 59% of plastic surgeons provided written or dictated consent as part of the standard procedural consent to address the presence of the Lap-Band, whereas 8% of plastic surgeons provided a separate written or printed signed consent specifically related to the procedure in the presence of a Lap-Band.
Conclusions:
Our study supports the relative safety of aesthetic abdominal contouring procedures in patients with gastric bands but highlights the increased risk of complications in the presence of a Lap-Band. Surgeons should use careful dissection techniques to minimize complications and consider involving a bariatric surgeon, especially with abdominoplasty procedures. Surgical consent should explicitly outline the risks identified in this study to ensure that patients are fully informed.
Purpose
Glioblastoma (GBM) is the most common and malignant primary adult brain tumor. Current care includes surgical resection, radiation, and chemotherapy. Recent clinical trials for GBM have ...demonstrated extended survival using interventions such as tumor vaccines or tumor-treating fields. However, prognosis generally remains poor, with expected survival of 20 months after randomization. Chemokine-based immunotherapy utilizing CCL21 locally recruits lymphocytes and dendritic cells to enhance host antitumor response. Here, we report a preliminary study utilizing CPZ-vault nanoparticles as a vehicle to package, protect, and steadily deliver therapy to optimize CCL21 therapy in a murine flank model of GBM.
Methods
GL261 cells were subcutaneously injected into the left flank of eight-week-old female C57BL/6 mice. Mice were treated with intratumoral injections of either: (1) CCL21-packaged vault nanoparticles (CPZ-CCL21), (2) free recombinant CCL21 chemokine empty vault nanoparticles, (3) empty vault nanoparticles, or 4) PBS.
Results
The results of this study showed that CCL21-packaged vault nanoparticle injections can decrease the tumor volume in vivo. Additionally, this study showed mice injected with CCL21-packaged vault nanoparticle had the smallest average tumor volume and remained the only treatment group with a negative percent change in tumor volume.
Conclusions
This preliminary study establishes vault nanoparticles as a feasible vehicle to increase drug delivery and immune response in a flank murine model of GBM. Future animal studies involving an intracranial orthotopic tumor model are required to fully evaluate the potential for CCL21-packaged vault nanoparticles as a strategy to bypass the blood brain barrier, enhance intracranial immune activity, and improve intracranial tumor control and survival.
Highlights • Differences between systems are probe design, delivery, cooling, and wavelength. • Epilepsy is the most common indication for Visualase therapy. • Brain mass is the most common ...indication for NeuroBlate therapy. • NeuroBlate group is nearly twice as old as the Visualase group.
Purpose
Glioblastoma prognosis remains grim despite maximal, multimodal management. Recent literature has demonstrated an increase in research devoted to experimental treatments, particularly those ...relying on the foundations of active immunotherapy with promising results. We hypothesize that the utilization of bioengineered recombinant vault nanoparticles coupled with glioma-associated antigens, such as the NY-ESO-1 peptide, may be capable of stimulating native dendritic cell (DC) maturation and inducing an anti-tumor response.
Methods
Immature DCs were cultured from the bone marrow of 4–6-week-old C57BL/6 mice. The three treatment groups consisted of: (1) DC and media, (2) DC with mCherry vault, and (3) DC with NYESO and vault. DC maturity was assessed via flow cytometric evaluation of CD11c, CD86, and MHC-II. Increase in CD86 Median Fluorescence Intensity (MFI) was analyzed in the CD11c+CD86+MHC-II+ population to determine the extent of maturation
Results
Our findings suggest that CP-MVP-NY-ESO-1-INT recombinant vault nanoparticles are efficiently bioengineered with exceptional integrity, are quickly internalized by immature DCs for antigen processing, and result in DC maturation.
Conclusion
This study reports our preliminary results, which demonstrate the feasibility and progress regarding our immunotherapeutic technique utilizing NY-ESO-1 packaged vault nanoparticles to prime DCs for subsequent anti-cancer therapies.
Neurofibromatosis type 2 (NF2) is a genetic neoplastic disorder that presents with hallmark bilateral vestibular schwannomas and multiple meningiomas. Though the current standard of care for ...meningiomas includes surgery, the multiplicity of meningiomas in NF2 patients renders complete resection of all developing lesions infeasible. Stereotactic radiosurgery (SRS) may be a viable non-invasive therapeutic alternative to surgery. We describe a particularly challenging case in a 39-year-old male with over 120 lesions who underwent more than 30 surgical procedures, and review the literature. We also searched three popular databases and compared outcomes of SRS versus surgery for the treatment of multiple meningiomas in patients with NF2. A total of 50 patients (27 radiosurgical and 23 surgical) were identified. For patients treated with SRS, local tumor control was achieved in 22 patients (81.5%) and distal control was achieved in 14 patients (51.8%). No malignant inductions were observed at an average follow-up duration of 90 months. Complications in the SRS-treated cohort were reported in 9 patients (33%). Eight patients (29.6%) died due to disease progression. Six patients experienced treatment failure and required further management. For NF2 patients treated with surgery, 11 patients (48%) showed tumor recurrence and 10 patients (43.5%) died due to neurological complications. SRS may be a safe and effective alternative for NF2-associated meningiomas. Further studies are required to identify the ideal radiosurgical candidate.
Ecchordosis physaliphora (EP) is a benign notochordal remnant derived from ectopic nests found along the craniospinal axis. It typically presents asymptomatically and is diagnosed using classic ...radiologic features, particularly location, T1-hypointensity, T2-hyperintensity, and lack of enhancement following gadolinium (Gd) contrast administration. Distinguishing EP from its malignant counterpart, chordoma, is of paramount importance, given the aggressive nature of the latter. Advances in imaging and immunohistochemistry have aided in diagnosis to an extent but, to our knowledge, identification of the genetic fingerprint of EP has yet to take place. Further cytological analysis of these lesions in search of a genetic link is warranted. We propose here a set of diagnostic criteria based on features consistently cited in the literature. In this literature review, 23 case reports were identified and collated into a summary of symptomatic cases of ecchordosis physaliphora. An illustrative case report of two patients was also included.
•EMP2 is a membrane protein found to be upregulated in human cancers.•Antibodies targeting EMP2 may have implications for improving patient outcomes.•EMP2 may be the basis for future therapies ...against GBM and other cancers.
Epithelial membrane protein 2 (EMP2) is a cell surface protein that has recently emerged as an object of neuro-oncological interest due to its potential to be utilized as a biomarker and target for antibody therapies. Preclinical studies have demonstrated that EMP2 is associated with disease prognosis in a number of human cancers, including glioblastoma. The four large extracellular domains of EMP2 and its association with the extracellular matrix makes it an attractive target for future cancer therapies. Translational research suggests that EMP2 may be targeted with antibodies to improve tumor control and survival in a variety of murine models and cancer types. However, in order to translate these preclinical findings into the clinic, future research will need to focus on elucidating the role EMP2 in the normal human body by better understanding its molecular and chemical interactions. The focus of this review is to provide a comprehensive insight into current research endeavors, discuss the potential for clinically translatable applications, and predict the future directions of such research.
Abstract Objective To present an illustrative case of fourth ventricular epidermoid cyst and review the literature to identify predictors of surgical outcomes. Methods A case of fourth ventricular ...epidermoid cyst is presented and a systematic review of five popular databases was performed by independent authors. Stepwise logistic regression was performed to identify clinical predictors of outcomes. Results A 21-year-old female presented with 3 months of headaches and visual obscurations and was diagnosed with a multi-lobulated mass in the fourth ventricle. The patient underwent suboccipital craniotomy. Complete removal of the mass was achieved and the final diagnosis was consistent with an epidermoid cyst. The systematic review identified a total of 23 studies that reported 37 patients. Mean age was 42.8 years. Mean length of time between symptom onset and diagnosis was 4.43 years. Age (p = 0.049) and duration of symptoms (p < 0.001) were significantly different between patients who experienced symptom improvement and those who did not. Duration of symptom onset to diagnosis was a significant predictor of poor outcomes (OR: 1.19, 95% CI: 0.209-0.997). Conclusions Our review found that in patients with fourth ventricular epidermoid cysts, unfavorable outcomes were predicted by older age and by longer intervals from symptom onset to diagnosis. Clinicians should maintain a high index of suspicion for fourth ventricular epidermoid cysts in patients presenting with cerebellar signs and visual disturbances.
Epithelial membrane protein-2 (EMP2) expression is noted in many human cancers. We evaluated EMP2 as a biomarker in gliomas. A large tissue microarray of lower grade glioma (WHO grades II–III,
n
... = 19 patients) and glioblastoma (GBM) (WHO grade IV,
n
= 50 patients) was stained for EMP2. EMP2 expression was dichotomized to low or high expression scores and correlated with clinical data. The mean EMP2 expression was 1.68 in lower grade gliomas versus 2.20 in GBMs (
P
= 0.01). The percentage of samples with high EMP2 expression was greater in GBMs than lower grade gliomas (90.0 vs. 52.6%,
P
= 0.001). No significant difference was found between median survival among patients with GBM tumors exhibiting high EMP2 expression and survival of those with low EMP2 expression (8.38 vs. 10.98 months,
P
= 0.39). However, EMP2 expression ≥2 correlated with decreased survival (
r
= −0.39,
P
= 0.001). The EMP2 expression level also correlated with Ki-67 positivity (
r
= 0.34,
P
= 0.008). The mortality hazard ratio for GBM patients with EMP2 score of 3 or higher was 1.92 (CI 0.69–5.30). Our findings suggest that elevated EMP2 expression is associated with GBM. With other biomarkers, EMP2 may have use as a molecular target for the diagnosis and treatment of gliomas.
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