DNA Hypermethylation Inhibits the CD82 Metastasis Suppressor Gene in Gastric Cancer.

BACKGROUND/AIM: Gastric cancer, with its high global incidence and mortality rates, poses a significant challenge due to the rapid decline in patient survival upon metastasis. Understanding and combating metastasis are crucial in improving outcomes. The metastasis suppressor gene CD82 has demonstrated efficacy in inhibiting metastasis across various carcinomas but is frequently down-regulated. However, its role and regulatory mechanisms in gastric cancer remain elusive. MATERIALS AND METHODS: Utilizing public data, we assessed patient survival in relation to CD82 expression. CD82 expression in gastric cancer cell lines was evaluated via western blotting, and its impact on cell mobility was assessed through wound healing and Transwell assays. The demethylation of CD82 was induced using 5-aza-deoxycytidine, while methylation levels were detected via methylation-specific PCR. RESULTS: Low CD82 expression correlated with poor prognosis in patients, and down-regulation and over-expression of CD82 significantly affected cell mobility. Treatment with 5-aza-deoxycytidine restored CD82 expression in low-expressing cell lines, highlighting its methylation-dependent regulation. CONCLUSION: CD82 serves as a pivotal regulator of cell mobility in gastric cancer by suppressing metastasis. Its expression is attenuated in gastric cancer cells through promoter hypermethylation.

3D-Continuous Nanoporous Covalent Framework Membrane Nanoreactors with Quantitatively Loaded Ultrafine Pd Nanocatalysts.

The confinement effect of catalytic nanoreactors containing metal catalysts within nanometer-sized volumes has attracted significant attention for their potential to enhance reaction rate and selectivity. Nevertheless, unregulated catalyst loading, aggregation, leaching, and limited reusability remain obstacles to achieving an efficient nanoreactor. A robust and durable catalytic membrane nanoreactor prepared by incorporating palladium nanocatalysts within a 3D-continuous nanoporous covalent framework membrane is presented. The reduction of palladium precursor occurs on the pore surface within 3D nanochannels, producing ultrafine palladium nanoparticles (Pd NPs) with their number density adjustable by varying metal precursor concentrations. The precise catalyst loading enables controlling the catalytic activity of the reactor while preventing excess metal usage. The facile preparation of Pd NP-loaded free-standing membrane materials allows hydrodechlorination in both batch and continuous flow modes. In batch mode, the catalytic activity is proportional to the loaded Pd amount and membrane area, while the membrane retains its activity upon repeated use. In continuous mode, the conversion remains above 95% for over 100 h, with the reactant solution passing through a single 50 µm-thick Pd-loaded membrane. The efficient nanoporous film-type catalytic nanoreactor may find applications in catalytic reactions for small chemical devices as well as in conventional chemistry and processes.

Efficacy of tocilizumab in patients with moderate-to-severe corticosteroid-resistant thyroid eye disease: a prospective study.

PURPOSE: To evaluate the clinical outcomes of intravenous tocilizumab (TCZ) injection in patients with moderate-to-severe active thyroid eye disease (TED). METHODS: Patients with active and moderate-to-severe TED who did not respond to conventional therapies were treated with TCZ from June 2019 to January 2021. The medical records of the patients were evaluated before the treatment. We analyzed patient demographics, including the duration of Graves' disease and TED, and assessed subjective symptoms, such as diplopia and ocular movement, clinical activity score (CAS), modified NOSPECS score, and exophthalmos before treatment and at 4, 8, 12, and 16 weeks after the first drug injection. Blood tests, including TSH Rc Ab and TS Ab, were performed before treatment and 24 weeks after the first injection. And orbital computed tomography (CT) was performed and Barrett's Index was calculated at baseline and after completion of all injections. RESULTS: Nineteen completed the scheduled treatment. There were no significant side effects, other than herpes zoster in one case and headache and dermatitis in another. Clinical symptoms before and 16 weeks after the treatment showed mean CAS decreased by 2.4 points, mean modified NOSPECS score decreased by 3.7 points, and mean exophthalmos decreased by 0.4 mm. Diplopia and extraocular muscle limitation improved in ten and remained stationary in five of the 15 patients, who presented with extraocular motility abnormalities. Six of 11 patients who underwent orbit CT showed improvement in muscle size. The mean TSH Rc Ab decreased by 7.5 IU/L and TS-Ab decreased by 162.9%. CONCLUSION: TCZ can treat active moderate-to-severe TED, showing high drug compliance and reasonable response to inflammation and extraocular motility abnormality.

Cervical Myelopathy Due to Epidural Hematoma at the Cervicomedullary Junction Associated With Ventriculoperitoneal Shunt Overdrainage: A Case Report.

We present a case of cervical myelopathy caused by epidural hematoma formation due to chronic cerebrospinal fluid overdrainage. A 55-year-old man who underwent ventriculoperitoneal (V-P) shunt surgery for normal pressure hydrocephalus presented with progressive weakness of both the upper and lower extremities. Magnetic resonance imaging (MRI) revealed compressive myelopathy at the cervicomedullary junction at the C1-C2 level caused by epidural hematoma formation due to intracranial hypotension (IH) caused by a complication of V-P shunt. He underwent decompressive laminectomy and hematoma removal at C1-C2 and replacement of the V-P shunt valve. Follow-up cervical spine MRI showed an improved state of severe central spinal stenosis at the C1-C2 level and an improved state of compression-related cord signal intensity change in the spinal cord. After surgical intervention and intensive rehabilitation, the patient showed clinical improvement. If cervical myelopathy is suspected in patients with a shunt, cord compression due to venous engorgement or hematoma caused by over-shunting and IH should be considered.

Early response to intravenous methylprednisolone therapy for restrictive myopathy in patients with thyroid eye disease.

PURPOSE: To report the therapeutic efficacy of intravenous methylprednisolone (IVMP) in patients with restrictive myopathy caused by thyroid eye disease (TED). METHODS: The present prospective uncontrolled study comprised 28 patients with TED and restrictive myopathy who presented with diplopia that had developed within 6 months before their visit. All patients were treated with IVMP for 12 weeks. Deviation angle, limitation of extraocular muscle (EOM) movement, binocular single vision score, Hess score, clinical activity score (CAS), modified NOSPECS score, exophthalmometric value, and the size of EOMs on computed tomography were evaluated. The patients were divided into two groups: those whose deviation angle had decreased or remained unchanged 6 months after treatment (group 1; n = 17) and those whose deviation angle had increased in that time (group 2; n = 11). RESULTS: The mean CAS of the whole cohort significantly decreased from baseline to 1 month and 3 months after treatment (P = 0.03 and P = 0.02, respectively). The mean deviation angle significantly increased from baseline to 1, 3, and 6 months (P = 0.01, P < 0.01, and P < 0.01, respectively). The deviation angle decreased in 10 (36%), remained constant in seven (25%), and increased in 11 (39%) of the 28 patients. When groups 1 and 2 were compared, no single variable was identified as a cause of deviation angle deterioration (P > 0.05). CONCLUSIONS: When treating patients with TED who have restrictive myopathy, physicians should be aware that some patients show worsening of the strabismus angle despite inflammation control with IVMP therapy. Uncontrolled fibrosis can result in motility deterioration.

Template-Free Preparation of a Mesopore-Rich Hierarchically Porous Carbon Monolith from a Thermally Rearrangeable Polyurea Network.

A mesopore-rich, hierarchically porous carbon monolith was prepared by carbonizing a polyisocyanurate network derived by thermal rearrangement of a polyurea network. The initial polyurea network was synthesized by the cross-linking polymerization of tetrakis(4-aminophenyl)methane (TAPM) and hexamethylene diisocyanate (HDI) in the sol-forming condition, followed by precipitation into nanoparticulate solids in a nonsolvent. The powder was molded into a shape and then heated at 200-400 °C to obtain the porous carbon precursor composed of the rearranged network. The thermolysis of urea bonds to amine and isocyanate groups, the subsequent cyclization of isocyanates to isocyanurates, and the vaporization of volatiles caused sintering of the nanoparticles into a monolithic network with micro-, meso-, and macropores. The rearranged network was carbonized to obtain a carbon monolith. It was found that the rearranged network, with a high isocyanurate ratio, led to a porous carbon with a high mesopore ratio. The electrical conductivity of the resulting carbon monoliths exhibited a rapid response to carbon dioxide adsorption, indicating efficient gas transport through the hierarchical pore structure.

Flash Bottom-Up Arc Synthesis of Nanocarbons as a Universal Route for Fabricating Single-Atom Electrocatalysts.

Despite considerable development in the field of single-atom catalysts (SACs) on carbon-based materials, the reported strategies for synthesizing SACs generally rely on top-down approaches, which hinder achieving both simple and universal synthesis routes that are simultaneously applicable to various metals and nanocarbons. Here, a universal strategy for fabricating nanocarbon based-SACs using a flash bottom-up arc discharge method to mitigate these issues is reported. The ionization of elements and their recombination process during arc discharge allows the simultaneous incorporation of single metal atoms (Mn, Fe, Co, Ni, and Pt) into the crystalline carbon lattice during the formation of carbon nanohorns (CNHs) and N-doped arc graphene. The coordination environment around the Co atoms of Co1 /CNH can be modulated by a mild post-treatment with NH3 . As a result, Co1 /CNH exhibits good oxygen reduction reaction activity, showing a 1.92 times higher kinetic current density value than the commercial Pt/C catalyst in alkaline media. In a single cell experiment, Co1 /CNH exhibits the highest maximum power density of 472 mW cm-2 compared to previously reported nonprecious metal-based SACs.

Rearranged Copolyurea Networks for Selective Carbon Dioxide Adsorption at Room Temperature.

Copolyurea networks (co-UNs) were synthesized via crosslinking polymerization of a mixture of tetrakis(4-aminophenyl)methane (TAPM) and melamine with hexamethylene diisocyanate (HDI) using the organic sol-gel polymerization method. The subsequent thermal treatment of between 200 and 400 °C induced the sintering of the powdery polyurea networks to form porous frameworks via urea bond rearrangement and the removal of volatile hexamethylene moieties. Incorporating melamine into the networks resulted in a higher nitrogen content and micropore ratio, whereas the overall porosity decreased with the melamine composition. The rearranged network composed of the tetraamine/melamine units in an 80:20 ratio showed the highest carbon dioxide adsorption quantity at room temperature. The results show that optimizing the chemical structure and porosity of polyurea-based networks can lead to carbon dioxide adsorbents working at elevated temperatures.

Clinical characteristics and treatment outcomes of diffuse large B-cell lymphoma involving the eye and ocular adnexa in East Asia.

PURPOSE: To investigate the clinical features and outcomes of diffuse large B-cell lymphoma (DLBCL) involving the eye and ocular adnexa in an East Asian population and emphasize the importance of prompt biopsy and treatment in unusually progressive ocular adnexal DLBCL for better visual outcomes. METHODS: Retrospective case series of 38 patients diagnosed with DLBCL involving the eye and ocular adnexa between 1995 and 2018 at a single tertiary institution. RESULTS: There were 38 patients (22 men, 16 women), 22 (57.9%) of which had ocular adnexal lymphoma (OAL) and 16 (42.1%), vitreoretinal lymphoma (VRL). The OAL group showed higher rates of unilateral involvement (p = 0.01) and localized disease presentation (p = 0.01). Thirteen (59.1%) of 22 OAL patients were primary diseases and 9 (40.9%) were secondary. Between primary and secondary OAL groups, there was no statistical difference in clinical characteristics such as age, gender and laterality (p = 0.47, p = 0.19 and p = 0.66, respectively). All secondary OAL cases were either disseminated or relapsed by definition and only two cases (15%) of primary OAL showed disseminated presentation (p < 0.01). Six (37.3%) of 22 OAL patients showed a rapid decrease in visual acuity within 15 days and the visual recovery was irreversible in 3 of them. CONCLUSION: OA-DLBCL has a grave prognosis and its visual outcomes largely depend on the timing of diagnosis and treatment. When a high-grade lymphoma is suspected, prompt biopsy and treatment should be performed to ensure optimal visual, clinical and survival outcomes.

Decreased Maximal Tongue Protrusion Length May Predict the Presence of Dysphagia in Stroke Patients.

OBJECTIVE: To investigate the relationship between maximal tongue protrusion length (MTPL) and dysphagia in post-stroke patients. METHODS: Free tongue length (FTL) was measured using the quick tongue-tie assessment tool and MTPL was measured using a transparent plastic ruler in 47 post-stroke patients. The MTPL-to-FTL (RMF) ratio was calculated. Swallowing function in all patients was evaluated via videofluoroscopic swallowing study (VFSS), PenetrationAspiration Scale (PAS), Functional Oral Intake Scale (FOIS), and Videofluoroscopic Dysphagia Scale (VDS). RESULTS: The MTPL and RMF values were significantly higher in the non-aspirator group than in the aspirator group (MTPL, p=0.0049; RMF, p<0.001). MTPL and RMF showed significant correlations with PAS, FOIS and VDS scores. The cut-off value in RMF for the prediction of aspiration was 1.56, with a sensitivity of 84% and a specificity of 86%. CONCLUSION: There is a relationship between MTPL and dysphagia in post-stroke patients. MTPL and RMF can be useful for detecting aspiration in post-stroke patients.

Orbital decompressive effect of endoscopic transorbital surgery for sphenoorbital meningioma.

PURPOSE: This study was aimed at evaluating the orbital decompressive effect of endoscopic transorbital approach (TOA) in the management of sphenoorbital meningioma involving the orbit. METHODS: Patients treated with TOA for this tumor from December 2016 to December 2019 were included, and the data were reviewed. Pre- and postoperative clinical and imaging findings were compared with a volumetric study. RESULTS: Eighteen patients (two men and 16 women) were included. Lateral wall hyperostosis (13 patients), extraconal tumor infiltration (18 patients), intraconal tumor infiltration (seven patients), and superior and lateral rectus encasement (nine patients) were found. Intraconal tumor infiltration in the posterior orbit affected compressive optic neuropathy (CON) more often than other tumor manifestations. The orbital soft tissue volume decreased to 91.18% ± 8.19% compared to that in the contralateral side preoperatively. The postoperative volume increased to 113.73% ± 12.92% compared to the preoperative volume. The average values of LogMAR visual acuity and visual field index score of ten patients with CON improved from 0.80 to 0.42 and 48.9 to 65.9%, respectively. All 17 patients with proptosis showed improvement after surgery. There were no significant complications associated with the surgery. Additional treatment, including gamma knife surgery, was applied to 12 cases for the remaining tumor. CONCLUSION: This minimally invasive surgical debulking procedure was successful in treating sphenoorbital meningioma without significant adverse events. Lateral orbital wall decompression and limited intraorbital tumor resection were effective for compressive orbitopathy from the tumor.

Lagophthalmos after congenital ptosis surgery: comparison between maximal levator resection and frontalis sling operation.

BACKGROUND/OBJECTIVES: To compare postoperative lagophthalmos after maximal levator resection (MLR) and frontalis suspension (FS) in congenital ptosis patients with poor levator function (LF). METHODS: A cross-sectional study was performed to compare postoperative outcomes in patients with preoperative LF ≤ 4 mm who had undergone MLR or FS at a single tertiary institution, and who had visited the outpatient clinic between February 2017 and August 2018. Main outcome measures were as follows: (1) Preoperative LF and margin reflex distance 1 (MRD1), (2) Postoperative MRD1, lagophthalmos and grade of superficial punctate keratopathy (SPK). RESULTS: Our study comprised 152 eyelids of 122 patients. There were 71 eyelids in the MLR group and 81 eyelids in the FS group. The MLR group had comparable mean postoperative MRD1 (2.8 ± 0.8 mm) to the FS with autogenous fascia lata (AFL) group (3.0 ± 0.7 mm), while the FS with preserved fascia lata (PFL) group had the lowest mean postoperative MRD1 (2.2 ± 1.0 mm). The PFL group had significantly less lagophthalmos (0.6 ± 1.0 mm) than the AFL (1.9 ± 1.4 mm) and maximal levator resection (1.9 ± 1.7 mm) groups. In the MLR group, there was no significant difference in postoperative surgical measurements between the LF 0-2 mm group and LF 2.5-4 mm group in terms of exposure keratopathy, degree of lagophthalmos and MRD1. CONCLUSION: MLR is an effective alternative to FS in congenital ptosis patients with poor levator function, with the risk of postoperative lagophthalmos related to postoperative MRD1 rather than preoperative LF.

Pilosebaceous Malignant Transformation of Dermoid Cyst in the Orbit.

Dermoid cysts may occur in the orbit, most commonly in the superolateral area. Malignant transformation of such lesions has been previously reported; however, most turn out to be squamous cell carcinoma. The authors' patient initially presented with mild proptosis and limitation in extraocular movements. Preliminary biopsy showed whitish amorphous material and abundant hairs filling the thin-walled cyst, consistent with dermoid cyst. The patient underwent tumor resection via lateral orbitotomy with bone window and transorbital endoscopic approach for the dural involvement. Final biopsy showed dermoid cyst with pilosebaceous malignant transformation showing p53 expression and 30% of Ki-67 index. Adjuvant radiotherapy was performed. To the best of the authors' knowledge, this is the first reported case of this type. Despite its rarity, there should always be a high index of suspicion and complete work-up for an accurate diagnosis.

Use of Meshed Acellular Dermal Allograft as a Lining Material After Orbital Exenteration.

PURPOSE: To evaluate the surgical outcome and safety of acellular human dermal allograft as a new lining material to the exposed orbit after exenteration. METHODS: Retrospective case series of patients who underwent orbital exenteration followed by reconstruction with meshed-type acellular dermal allograft from 2009 to 2018 in a single tertiary institution. RESULTS: There were 14 eyes (2 right, 12 left) of 14 patients (6 men, 8 women). Mean age at operation was 69.1 ± 16.5 years. Indication for surgery was malignancy in all patients. One patient underwent subtotal exenteration, while the rest underwent total exenteration. SureDerm Meshed was used in 12 patients, AlloDerm Meshed in 1, and CGDerm Meshed in 1. Mean follow-up period was 12.1 months. Full or nearly full epithelialization occurred in 10 of 14 patients (71.4%) at 1 month and 9 of 12 patients (75.0%) at 3 months. There was delayed epithelialization in 3 patients due to poor wound care (n = 1), adjuvant radiotherapy (n = 1), and adjuvant radiotherapy followed by cerebrospinal fluid leak (n = 1). CONCLUSIONS: Meshed acellular human dermal allograft showed good success in reconstruction after orbital exenteration and may be considered as an alternative lining material to split-thickness skin graft after orbital exenteration.

Quantitative stiffness of the median nerve, flexor tendons, and flexor retinaculum in the carpal tunnel measured with acoustic radiation force impulse elastography in various wrist and finger positions.

Despite the high prevalence and clinical importance of soft-tissue disorders, objective methods for evaluation of the biomechanical properties of soft tissues are lacking. This study aimed to quantitatively evaluate stiffness, an important biomechanical characteristic of soft tissue, using acoustic radiation force impulse (ARFI) elastography. The shear wave velocity (SWV, m/s) values of soft tissue structures within the carpal tunnel (CT) were measured in various combinations of wrist and finger positions.Twenty-six healthy adults were enrolled in this study. We measured the cross-sectional area of the median nerve (MN) and the SWV values of several structures within the CT at the CT inlet level. Measurement of SWV of the MN, flexor digitorum superficialis (FDS), flexor digitorum profundus (FDP), and transverse carpal ligament (TCL) were conducted in six wrist/finger motion combinations.When the wrist and fingers were in neutral positions (position A), the mean SWV was lowest for the MN (mean ±â€Šstandard deviation, 2.3 ±â€Š0.5 m/s), followed by the FDS (2.9 ±â€Š0.2), FDP (3.2 ±â€Š0.3), and TCL (3.3 ±â€Š0.4). The SWV was significantly different among the six different wrist/finger positions for all structures (P < .001). However, the MN cross-sectional area was not significantly different (P = .527). The SWV values for the MN, FDS, and FDP increased significantly as the wrist/finger positions the stress on the tendons increased (from position B to F) compared with a neutral position, while the SWV of the TCL was significantly higher for in all positions compared with neutral, except for wrist neutral, finger extension. The SWV values for the MN, FDS, and TCL gradually increased as stress increased.The intra-CT structures are under increased stress during wrist and finger motions than when the hand is in a neutral position. We have used ARFI elastography to gain insight into the pathophysiology of CTS.

Facile Synthesis of Robust and Pore-Size-Tunable Nanoporous Covalent Framework Membrane by Simultaneous Gelation and Phase Separation of Covalent Network/Poly(methyl methacrylate) Mixture.

We report a facile route toward the preparation of organic-solvent-resistant and three-dimensionally continuous nanoporous covalent framework membrane. The membrane was prepared from the blend of linear poly(methyl methacrylate) and the cross-linked polyurea-based organic network, followed by selective removal of the linear polymer part. The pore morphologies, porosity, and solvent permeation properties of the membrane could be simply modified by the initial composition of the poly(methyl methacrylate) added to a sol of the organic network. The pore was three-dimensionally continuous with pore size ranging from 5 nm to tens of nanometers. Despite the broad pore size distribution, ultrafiltration of sub-10 nm solutes was realized with a molecular size cutoff near 5 nm thanks to the bicontinuous pore structure of the membrane. The nanoporous structure exhibited long-term resistance to organic solvents as well as thermal stability and mechanical strength. The separation performance remained unchanged in organic-rich medium for a prolonged time. Our strategy provides a synthetic route to a structurally robust, three-dimensionally continuous nanoporous polymeric membrane for potential application that necessitates the use of organic solvent.

Synthesis and Thermoelectric Properties of Selenium Nanoparticles Coated with PEDOT:PSS.

We synthesized a hybrid nanocomposite comprised of selenium nanoparticles coated with a thin layer of a conductive polymer, poly(3,4-ethylenedioxythiophene), and studied its thermoelectric properties. The conductive polymer layer on the surface of nanoparticles in the composites formed a percolating network running between the stacked nanoparticles, exhibiting an electrical conductivity close to or higher than that of pure polymer. The thermoelectric power factor of the resulting composite was higher than that of individual polymer or selenium nanoparticles. We further increased the electrical conductivity of the composite by thermal annealing, thereby improving the power factor to 15 µW/cmK2 which is nine times higher than that of the polymer.

Optimal Ultrasonographic Measurements for Diagnosing Carpal Tunnel Syndrome in Patients With Diabetic Sensorimotor Polyneuropathy: A Case-Control Study.

OBJECTIVE: To investigate the optimal sonographic method for diagnosing carpal tunnel syndrome (CTS) in patients with diabetic sensorimotor polyneuropathy (DSP). METHODS: A total of 190 participants were divided into four groups based on DSP history and electrodiagnostic results of CTS. The absolute parameters were measured at baseline and the relative values were calculated: maximal cross-sectional area (CSA) of the median nerve throughout the carpal tunnel (Mmax), median nerve CSA at the forearm level (Mf), ulnar nerve CSA at the pisiform level (Upi), difference between Mmax and Mf (∆MM), and difference between Mmax and Upi (∆MU). Then, the optimal ultrasonographic parameters for diagnosing CTS, according to the presence of DSP, using absolute and relative cutoff values were analyzed. RESULTS: Median and ulnar nerve CSAs were significantly larger in the DSP group than in the control group. In the DSP participants, the mean Mmax, ∆MM, and ∆MU values were significantly larger in patients with both DSP and CTS than in patients with DSP only. The Mmax thresholds of 9.5 mm2 in the control group and 11.5 mm2 in the DSP group showed the greatest sensitivity and specificity for diagnosing CTS. The ∆MM thresholds of 2.5 mm2 and ∆MU thresholds of 4.5 mm2 had the greatest sensitivity and specificity in both the DSP and control groups. CONCLUSION: Measurement of Mmax, ∆MM and ∆MU is an optimal ultrasonographic evaluation method for diagnosing CTS in patients with DSP.

Orbital apex venous cavernous malformation with optic neuropathy: treatment with multisession gamma knife radiosurgery.

PURPOSE: To evaluate the efficacy and safety of multisession gamma knife radiosurgery (GKRS) for orbital apex venous cavernous malformation causing optic neuropathy. METHODS: Retrospective cohort study in a single tertiary institution from January 2007 to December 2016 on patients who underwent multisession GKRS for orbital apex venous cavernous malformations causing optic neuropathy. RESULTS: There were 12 patients included in our study. The mean age was 40.2±14.5 years, and men comprised 66.7% (n=8). Decrease in visual acuity (83.3%) was the most common symptom at presentation. The mean clinical follow-up was 28.5 months. Ten (83.3%) of the 12 patients had improvement in best corrected visual acuity. Of the 10 patients with pre-existing relative afferent pupillary defect (RAPD), 6 (60%) had complete resolution of RAPD. Of the 12 patients with visual field defect, 7 (58.3%) had complete resolution, 3 (25%) had partial improvement, while 2 (16.7%) remained unchanged due to optic atrophy from long-standing compressive optic neuropathy. Mean proptosis reduced from 2.3±1.7 mm pre-GKRS to 0.5±1.3 mm post-GKRS (p=0.005). Tumour shrinkage was observed in all patients. The mean tumour volume at the time of GKRS was 3104 mm3 (range 221-8500 mm3), which reduced to 658 mm3 (range 120-3350 mm3) at last follow-up. None of the patients experienced GKRS-related ocular morbidity during the follow-up period. CONCLUSION: Multisession GKRS has shown to be an effective and safe option for the treatment of orbital apex venous cavernous malformations causing optic neuropathy, with significant improvement in ophthalmic outcomes and reduction in tumour volume.