IntroductionSurgery remains the mainstay for treatment of primary glioblastoma, followed by radiotherapy and chemotherapy. Current standard of care during surgery involves the intraoperative use of ...image-guidance and 5-aminolevulinic acid (5-ALA). There are multiple other surgical adjuncts available to the neuro-oncology surgeon. However, access to, and usage of these varies widely in UK practice, with limited evidence of their use. The aim of this trial is to investigate whether the addition of diffusion tensor imaging (DTI) and intraoperative ultrasound (iUS) to the standard of care surgery (intraoperative neuronavigation and 5-ALA) impacts on deterioration free survival (DFS).Methods and analysisThis is a two-stage, randomised control trial (RCT) consisting of an initial non-randomised cohort study based on the principles of the IDEAL (Idea, Development, Exploration, Assessment and Long-term follow-up) stage-IIb format, followed by a statistically powered randomised trial comparing the addition of DTI and iUS to the standard of care surgery. A total of 357 patients will be recruited for the RCT. The primary outcome is DFS, defined as the time to either 10-point deterioration in health-related quality of life scores from baseline, without subsequent reversal, progressive disease or death.Ethics and disseminationThe trial was registered in the Integrated Research Application System (Ref: 264482) and approved by a UK research and ethics committee (Ref: 20/LO/0840). Results will be published in a peer-reviewed journal. Further dissemination to participants, patient groups and the wider medical community will use a range of approaches to maximise impact.Trial registration numberISRCTN38834571.
Nuclear storage facilities are sites of intense radiation, and surveillance of nuclear storage containers in these facilities is largely performed through manual inspection, which leaves humans ...performing the inspection vulnerable to the radiation. Robotic surveillance solutions in nuclear storage facilities for detecting damaged nuclear storage containers offer a viable alternative to reduce human exposure to nuclear radiation.This work details the efforts made toward building such a solution through the development of a mobile robotic system (to autonomously scan container surfaces), a machine learning algorithm (to segment areas of damage on the scans), and a communication framework based on ROS2 (to integrate the two components together).The capabilities of the system were tested in a laboratory environment using an array of surgical steel containers with varying degrees of damage on them. The containers were chosen and processed to best mimic the visual characteristics of nuclear storage containers. The system was successfully able to perform four tasks autonomously: 1) obtain scans of the container surfaces, 2) perform damage estimation on the scans using machine learning (ML), 3) transmit the scans with the estimations for human operator verification and 4) retrain the ML algorithm on new data. The work establishes an end-to-end automated surveillance solution that allows the integration of multiple robotic agents, machine learning classification and human operator verification. It also provides an important resource for researchers developing algorithms for mapping and localization of mobile robots, eye-in-hand visual servo of robotic arms, and communication frameworks for integrating machine learning capabilities in robotic agents.
We present a very rare case of a metastasising pleomorphic adenoma with spinal cord compression and review the small handful of cases with central nervous system (CNS) involvement in the literature. ...This case is unusual as most other reported cases are preceded by local recurrences; also, there is only one previous case of an MPA presenting with spinal cord compression. Metastasising pleomorphic adenoma is a rare malignant salivary gland tumour which, despite "benign" histological appearances produces secondary deposits in distant sites.
INTRODUCTION: Extra-pineal supratentorial primitive neuro-ectodermal tumours (sPNETs) are considered rare in adults and little is known about their radiological appearances. The most clinically ...relevant pre-surgical differential diagnosis is glioblastoma multiforme (GBM). We present a series of patients with sPNET over a 6 year period (2008-2014), and provide an imaging update with a review of the existing literature. METHOD: Retrospective review of CT and MRI characteristics of 7 patients with histologically proven sPNETs. Comparisons were made with similarly located and histopathologically confirmed WHO Grade 4 GBMs. RESULTS: 6 of the 7 sPNETs occurred de novo. One arose within the resection bed of a WHO Grade 1 pilocytic astrocytoma. There were 4 frontal and 3 temporal lobe incidences. Mean age was 42.8yrs (range 23 - 73 yrs, median 36 yrs). On CT the solid component of the tumour was usually hyperdense. Some of the small sPNETs contained central haemorrhage, confirmed on MRI. Larger tumours were solid/cystic. On MRI the solid component of all sPNETs was T2 hypointense, showed avid enhancement and marked restricted diffusion, typical of a high grade tumour. The degree of restricted diffusion was notably greater in the sPNET group when compared to the GBM cohort. CONCLUSION: The extreme rarity of sPNETs in adults makes for difficult interpretation of existing imaging modalities. In non-histopathologically confirmed cases, imaging could be misinterpreted as high grade glioma. However, greater restricted diffusion in sPNETs may help distinguish them from GBMs. Advanced MRI techniques and correlation with spectroscopy and molecular markers will also help in the future.
INTRODUCTION: Extra-pineal supratentorial primitive neuro-ectodermal tumours (sPNETs) are considered rare in adults and little is known about their radiological appearances. The most clinically ...relevant pre-surgical differential diagnosis is glioblastoma multiforme (GBM). We present a series of patients with sPNET over a 6 year period (2008-2014), and provide an imaging update with a review of the existing literature. METHOD: Retrospective review of CT and MRI characteristics of 7 patients with histologically proven sPNETs. Comparisons were made with similarly located and histopathologically confirmed WHO Grade 4 GBMs. RESULTS: 6 of the 7 sPNETs occurred de novo. One arose within the resection bed of a WHO Grade 1 pilocytic astrocytoma. There were 4 frontal and 3 temporal lobe incidences. Mean age was 42.8yrs (range 23 - 73 yrs, median 36 yrs). On CT the solid component of the tumour was usually hyperdense. Some of the small sPNETs contained central haemorrhage, confirmed on MRI. Larger tumours were solid/cystic. On MRI the solid component of all sPNETs was T2 hypointense, showed avid enhancement and marked restricted diffusion, typical of a high grade tumour. The degree of restricted diffusion was notably greater in the sPNET group when compared to the GBM cohort. CONCLUSION: The extreme rarity of sPNETs in adults makes for difficult interpretation of existing imaging modalities. In non-histopathologically confirmed cases, imaging could be misinterpreted as high grade glioma. However, greater restricted diffusion in sPNETs may help distinguish them from GBMs. Advanced MRI techniques and correlation with spectroscopy and molecular markers will also help in the future.
INTRODUCTION: Primary CNS Lymphoma (PCNSL) in the immunocompetent population is reported as comprising 3–5% of all primary CNS neoplasms. They are considered aggressive tumours and their management ...remains controversial. We report a single centre experience of PCNSL over 7 years. METHODS: This is a retrospective cohort study of all biopsy confirmed PCNSLs between 2009 and 2016 in a busy London neurosurgical unit. Data was sourced from the lymphoma database, pathology reports, patient notes and radiology. We then reviewed their oncology treatment and outcomes. Primary endpoints were mortality, relapse and treatment complication rates. RESULTS: We had 58 patients (35 males and 23 females). 13 (22.4%) had a previous history of cancer and 10(17.2%) were immunocompromised. The rate of mortality during the seven years was 58.6% (34/58). The mean survival was 1.9 years (11 days to 7.16 years) Biopsies for tissue diagnosis had a low complication rate in our cohort (1 patient with biopsy related intracranial haematoma; 1 patient with wound breakdown). We were able to review treatment plans of 30 patients of whom 19 underwent chemotherapy and 10 had palliative radiotherapy only. 3 patients were not fit for either chemotherapy or radiotherapy. Neutropenic sepsis occurred in 26.1% (6/30) of the treated group with a similar proportion having neurological problems such as short term memory loss, seizures and hydrocephalus. 21.7% (5/30) had relapse despite treatment. CONCLUSIONS: 40% of our cohort had a history of cancer or being immunocompromised which can be attributed to the presence of activated oncogenes and failure of cell cycle repair mechanisms. A significant proportion (21.7% in our cohort) had relapse despite treatment which supports previous studies of PCNSL as an aggressive disease. It remains a disease with a high mortality and significant complications during treatment.
INTRODUCTION: Primary CNS lymphomas (PCNSLs) are a rare entity and comprise only 5% of brain tumours. Histopathologically they are primarily of B-cell phenotype. Primary CNS T-Cell Lymphomas ...(PCNSTLs) constitute <5% of all PCNSLs. Such rarity in clinical practice means there is a paucity of robust data on the long term outcomes for patients with PCNSTLs. We report our PCNSTL (or T-Cell rich PCNSLs) experience over 7 years. METHODS: We reviewed our pathology database for all PCNSLs diagnosed between 2009 and 2016. Specifically T-cell expression, Ki67 Proliferative Index (KPI) and CD expression were looked reviewed from histopathological reports. Treatment options, survival and complications were also reviewed. RESULTS: We identified a total of 58 PCNSLs of which 2 were pure T-cell lymphomas and 3 were B cell lymphomas with T cell expression (2 were ‘T-cell rich’; 1 was anaplastic). Mean age was 58.4 (44–66 years). These 5 patients comprised of 4 males and 1 female. One patient was HIV positive; and another had a previous history of lung cancer. On FLAIR MR Imaging, three patients had supratentorial bihemispheric lesions; and one patient (who is still alive) had a left cerebellar lesion. In our small sample, those with bihemispheric lesions had shorter survival times which would correlate with extent of disease dissemination within the white matter tracts. The 2 ‘T-cell rich’ samples had a KPI of 70–80%. (In the PCNSLs with T cell expression, the KPI ranged from 20% - 90% and in our group this correlated with survival).One patient whose cells demonstrated a KPI of 90% survived for only 56 days from diagnostic biopsy. Immunohistochemistry showed variable CD expression (as in previous published literature). All 5 patients had their histology dually reported by a neuropathologist and haemotopathologist. One patient was not fit enough for oncology treatment. The other 4 had chemotherapy and all had relapses or progression on treatment. Mean survival time was 275.2 days (7.56months with a range of 56–571 days). At the time of writing, 1 patient was still alive with ongoing haematology clinic review; 1 was discharged to a palliative care facility and 3 patients had died. SUMMARY: With PCNSTls or PCNSLs with T-cell expression, there seems to be an association between survival and the Ki67 proliferative index in addition to presence of bilateral supratentorial disease on MR imaging. As they are extremely rare presentations, further studies would perhaps benefit from multi-centre involvement. Their histological diagnosis (especially immunohistochemistry) remains challenging due to the heterogeneity of the cells and CD expression, and in our experience has often required multiple histology reviews.
ABSTRACT
Endoscopic transsphenoidal resection of skull base lesions has been introduced widely as an alternative to microscopic transmucosal approaches. We report the introduction of this technique ...to our unit, including the learning curve recognized for this procedure, comparing techniques in a concurrent case-control fashion. All patients operated on for sellar, suprasellar, or clival lesions were considered for endoscopic surgery, with 51 patients undergoing endoscopic surgery and 46 having microscopic surgery with the operating method determined by the availability of the ear, nose, and throat surgeon involved with the procedures. Endoscopic surgery compared favorably with microscopic surgery with respect to endocrine control, length of stay, diabetes insipidus, and cerebrospinal fluid leakage. A learning curve was found with a significant fall in complication rates between the first third and most recent third of the cohort. Endoscopic skull base surgery has superior results to microscopic approaches once the initial learning curve is overcome, but this can be done quickly and safely.
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