Microsurgical Fenestration of Intracranial Arachnoid Cysts: Volumetric Analysis and Clinical Outcome.

INTRODUCTION: There is paucity of data regarding change in arachnoid cyst (AC) volume following surgery. This study aimed at investigating the clinical outcome of ACs and applying 2 volumetric methods for determination of their volume change post microsurgical fenestration. METHODS: Twenty-one ACs in 20 patients that underwent microsurgical fenestration were analyzed using 2 volumetric methods; the modified McDonald equation and the picture archiving and communication (PAC) system-based method. Patients were followed up for 23 ± 40.3 months. RESULTS: The majority of the patients (13 or 65%) were children. Preoperative symptoms in children were mainly seizures and less commonly headache. Of the 20 patients, 12 (60%) had complete resolution of their preoperative symptoms with 8 (40.0%) showing partial improvement. Volumetric studies showed a mean reduction in AC size of 73.7% in children and 64.4% in adults using the PAC system versus 67.9% in children and 70.5% in adults using the modified McDonald equation method. There was no correlation between the percentage decrease in AC volume post surgery and degree of symptom improvement (49.2 ± 34.3% in patients with complete vs. 60.9 ± 40.3% in patients with only partial resolution of symptoms, p = 0.57). DISCUSSION/CONCLUSION: Microsurgical fenestration is an effective approach for ACs with an excellent clinical outcome apparent in the complete or partial improvement of symptoms in all patients. Volumetric estimates of ACs and their change following surgery are feasible using the modified McDonald or PAC system methods. However, there is no correlation between the percentage decrease in AC volume after surgery and degree of clinical improvement.

Incidental finding of an aberrant left pulmonary artery, an aberrant right subclavian artery, and a tracheal bronchus in an adult woman with a meningioma and a history of medulloblastoma.

The aberrant left pulmonary artery and the aberrant right subclavian artery are rare congenital vascular anomalies, and the tracheal bronchus is a rare congenital respiratory anomaly. A 33-year-old female patient, with a history of desmoplastic medulloblastoma, was surgically treated at our hospital for a meningioma. On the second postoperative day, the patient complained of shortness of breath and chest pain. Contrast-enhanced multislice computed tomography was negative for pulmonary embolism, but incidentally revealed all three congenital anomalies. In our report, we detail this exceedingly rare case.

Promising new treatments for pancreatic cancer in the era of targeted and immune therapies.

Pancreatic ductal adenocarcinoma (PDAC) is the fourth leading cause of cancer mortality among men and women in the United States. Its incidence has been on the rise, with a projected two-fold increase by 2030. PDAC carries a poor prognosis due to a lack of effective screening tools, limited understanding of pathophysiology, and ineffective treatment modalities. Recently, there has been a revolution in the world of oncology with the advent of novel treatments to combat this disease. However, the 5-year survival of PDAC remains unchanged at a dismal 8%. The aim of this review is to bring together several studies and identify various recent modalities that have been promising in treating PDAC.

Interrater and intrarater agreement and reliability of ratings made using the Zaidi-Dayal and Richards-Jabbour scales for the shape of the foramen magnum.

Anatomists and radiologists use the Zaidi-Dayal and Richards-Jabbour scales to study the shape of the foramen magnum. Our aim is to measure the interrater and intrarater agreement and reliability of ratings made using the two scales. We invited 16 radiology residents to attend two sessions, four weeks apart. During each session, we asked the residents to classify the shape of the foramen magnum in 35 images using both scales. We used Fleiss' κ to measure interrater reliability and Cohen's κ to measure intrarater reliability. The interrater reliability of ratings made using the Zaidi-Dayal scale was 0.34 (0.26-0.46) for session one and 0.30 (0.24-0.39) for session two, and the intrarater reliability was 0.39 (0.34-0.44). The interrater reliability of ratings made using the Richards-Jabbour scale was 0.14 (0.10-0.19) for session one and 0.12 (0.09-0.17) for session two, and the intrarater reliability was 0.11 (0.07-0.15). In conclusion, the interrater and intrarater agreement and reliability of ratings made using the Zaidi-Dayal and Richards-Jabbour scales are inadequate. We recommend an objective method by Zdilla et al. to researchers interested in studying the shape of the foramen magnum.