Intra-operative extracorporeal irradiation of tumour-invaded craniotomy bone flap in meningioma: a case series.

BACKGROUND: Extracorporeal irradiation of tumorous calvaria (EITC) can be performed to restore function and form of the skull after resection of bone-invasive meningioma. We sought to examine the rate of tumour recurrence and other selected outcomes in patients undergoing meningioma resection and EITC. METHODS: Retrospective single-centre study of adult patients undergoing meningioma resection and EITC between January 2015 and November 2022 at a tertiary neurosurgical centre. Patient demographics, surgery data, tumour data, use of adjuvant therapy, surgical complications, and tumour recurrences were collected. RESULTS: Eighteen patients with 11 (61%) CNS WHO grade 1, 6 (33%) grade 2, and 1 (6%) grade 3 meningiomas were included. Median follow-up was 42 months (range 3-88). Five (28%) patients had a recurrence, but none were associated with the bone flap. Two (11%) wound infections requiring explant surgery occurred. Six (33%) patients required a further operation. Two operations were for recurrences, one was for infection, one was a washout and wound exploration but no evidence of infection was found, one patient requested the removal of a small titanium implant, and one patient required a ventriculoperitoneal shunt for a persistent CSF collection. There were no cases of bone flap resorption and cosmetic outcome was not routinely recorded. CONCLUSION: EITC is feasible and fast to perform with good outcomes and cost-effectiveness compared to other reconstructive methods. We observed similar recurrence rates and lower infection rates requiring explant compared to the largest series of cranioplasty in meningioma. Cosmetic outcome is universally under-reported and should be reported in future studies.

Comparative Analysis of Lumbar Spine Vertebral Morphology Between Maori and New Zealand Europeans: A Computed Tomography Study.

BACKGROUND: Most existing studies of lumbar anatomy do not consider ethnic influence and recruit mostly white participants. Recent studies have considered other populations; however, none have assessed Maori, the indigenous people of New Zealand (NZ). A computed tomography study of vertebral body (VB) and canal dimensions was performed for lumbar vertebrae of Maori and NZ European patients to evaluate for ethnic variation. METHODS: Lumbar vertebrae from 196 patients were measured using computed tomography. After interrater and intrarater reliability analyses, a single trained examiner measured VB heights, VB lengths, segmental angle, pedicle height and width, and vertebral canal length (VCL) and vertebral canal width for each level. Canal:body ratio was calculated. Demographic data recorded included age, sex, and ethnicity. RESULTS: VCL remained relatively constant through the lumbar spine; canal width increased to a maximum of 28.2 mm at L5. Canal:body ratios and pedicle height decreased while pedicle width increased to a maximum of 16.1 mm at L5. There were few differences between Maori and NZ Europeans except at the L5 level, where VCL and canal:body ratio were larger in NZ Europeans (P < 0.05), and pedicle height, width, and VB pediculolaminar length were larger in Maori (P < 0.05). Females had generally smaller measurements and age was a positive predictor of measured values (P < 0.05). CONCLUSIONS: This study is the first to characterize lumbar anatomy in a Maori cohort. Adequately powered results demonstrated few differences between Maori and NZ Europeans. Isolated differences observed at L5 may be due to sacropelvic differences, which represent an area for further investigation. LEVEL OF EVIDENCE: 3. CLINICAL RELEVANCE: Diagnosis, surgical planning, ethnic differences.

Retrospective evaluation of prognostic factors in metastatic spine disease: serum albumin and primary tumour type are key.

BACKGROUND: Treatment decisions for metastatic spine disease are complex and depend on prognosis. Four prognostic systems in use are the Oswestry Risk Index, modified Bauer score (MBS), van der Linden score and New England Spinal Metastasis Score (NESMS). We aimed to determine the performance of these scoring systems in a New Zealand cohort of patients and develop a prognostic score specific to this demographic. METHODS: A retrospective review of a patient cohort from 2009 to 2016 was undertaken. Scores and individual scoring items were evaluated with univariate and multivariate analyses. Significant items were used to design a simple, population-specific objective scoring system, which was then tested. RESULTS: A total of 106 patients receiving either surgery and radiotherapy (65) or radiotherapy alone (41) were included. Mean post-treatment survival time was 13.7 months. All scoring systems were significantly correlated with survival and had similar concordances. The MBS had the largest coefficient of determination (Cox and Snell's R2 = 0.18), followed by the NESMS (R2 = 0.14). On multivariate analysis, the lung cancer (MBS) and serum albumin (NESMS) items were significant. A modified Oswestry Risk Index primary tumour item and NESMS serum albumin outperformed the MBS (R2 = 0.20), providing the basis for a prognostic scoring tool specific to our demographic. CONCLUSION: Based on serum albumin and primary tumour type, we propose the 'Metastatic Spine Risk Index' as a simple and objective tool, specific to our population for predicting survival, which can be used in conjunction with other clinical information when considering treatment options.

AAV Targeting of Glial Cell Types in the Central and Peripheral Nervous System and Relevance to Human Gene Therapy.

Different glial cell types are found throughout the central (CNS) and peripheral nervous system (PNS), where they have important functions. These cell types are also involved in nervous system pathology, playing roles in neurodegenerative disease and following trauma in the brain and spinal cord (astrocytes, microglia, oligodendrocytes), nerve degeneration and development of pain in peripheral nerves (Schwann cells, satellite cells), retinal diseases (Müller glia) and gut dysbiosis (enteric glia). These cell type have all been proposed as potential targets for treating these conditions. One approach to target these cell types is the use of gene therapy to modify gene expression. Adeno-associated virus (AAV) vectors have been shown to be safe and effective in targeting cells in the nervous system and have been used in a number of clinical trials. To date, a number of studies have tested the use of different AAV serotypes and cell-specific promoters to increase glial cell tropism and expression. However, true glial-cell specific targeting for a particular glial cell type remains elusive. This review provides an overview of research into developing glial specific gene therapy and discusses some of the issues that still need to be addressed to make glial cell gene therapy a clinical reality.

Comparison of higher order wavefront aberrations with four aberrometers.

Purpose: To evaluate the agreement of selected higher order aberration measurements between aberrometers based on three different wavefront technologies. Methods: Twenty-three eyes of 23 participants were compared between Zywave, OPD-Scan III, and iDesign aberrometers, for total ocular aberrations. Participants were between 19 and 69 years of age, and exclusion criteria were previous ocular surgery or trauma, contact lens wear within the preceding 2 weeks, and ocular or systemic disease. Corneal aberrations were compared between the OPD-Scan III and GALILEI™ G2 aberrometers. Zernike coefficients of vertical and oblique trefoil, vertical and horizontal coma, and spherical aberration were analyzed in R software. Results: In all, 276 scans were captured in total, with a male-to-female ratio of 11:12. Total ocular vertical coma [mean difference (MD) = 0.026 µm, P < 0.005], vertical trefoil (MD = 0.033 µm, P < 0.05), and spherical aberration (MD = 0.022 µm, P < 0.05) differed significantly between the iDesign and OPD-Scan III. Differences in total vertical (MD = 0.072 µm, P < 0.05) and oblique trefoil (MD = 0.058 µm, P < 0.05) were demonstrated between the Zywave and OPD-Scan III, and spherical aberration (MD = 0.030 µm, P < 0.005) between iDesign and Zywave. iDesign corneal horizontal coma (MD = 0.025 µm, P < 0.05) and spherical aberration (MD = 0.043 µm, P < 0.005) measurements were significantly different between the GALILEI™ G2 and the OPD-Scan III. Conclusion: Zywave, iDesign, and OPD-Scan III, and GALILEITM G2 and OPD-Scan III may be used interchangeably for their total ocular and corneal wavefront functions, respectively; however, care must be taken if using these devices for guiding ablation or monitoring corneal disease.

Concomitant surgical treatment of dental and valvular heart diseases.

BACKGROUND: Invasive dental procedures are often indicated before cardiac valve surgery. The purpose of this case-control study was to determine the risks and benefits of concomitant dental and thoracic surgery. METHODS: Critically ill cardiac inpatients requiring cardiac valve surgery were referred by the Department of Thoracic and Cardiovascular Surgery to our Oral Medicine consult service. Those requiring dental extractions were considered for dental treatment during the same general anesthetic as the cardiac surgery. These study patients were compared with control patients who had extractions before valve surgery in a different setting. There was no attempt to analyze the impact of this practice on the development of infective endocarditis. All patients received broad-spectrum antibiotics during dental surgery. RESULTS: Twenty-one patients had concomitant oral and cardiac valve surgery. Seventeen patients were in the control group. There were no statistically significant differences between cases and controls in demographics, length of stay, nature of the dental surgery, mean number of teeth removed, oral bleeding, or postoperative infections. One patient in the control group developed prosthetic valve endocarditis versus none in the concomitant surgery group. CONCLUSIONS: This case-control study suggests that concomitant surgical procedures for dental and valvular heart disease can be accomplished without clinically significant oral complications. Given the risk from poor oral health following cardiac valve surgery, this approach should be considered for patients who would benefit by avoiding a second general anesthetic and/or a delay in cardiac surgery, and by having their oral surgery performed in the safest environment.