Long-term treatment outcomes of patients with primary optic nerve sheath meningioma treated with stereotactic radiotherapy.

We analysed the long-term outcomes of patients with primary optic nerve sheath meningioma (ONSM) treated with stereotactic radiotherapy (SRT). 26 patients with primary ONSM were treated with SRT between 2004 and 2013 at a single institution. SRT was delivered with image guidance to a median dose of 50.4 Gy in 28 fractions. 4 patients had prior surgical debulking. At a median radiological follow-up of 68 months, the MRI based tumour control was 100%. Visual acuity improved in 10 (38.4%), remained stable in 10 (38.4%) and was reduced in 6 (23.1%) patients following treatment. Stable or improved vision post-treatment was seen in 92.3% of patients with good pre-treatment vision (best corrected visual acuity 6/18 or better), compared to only 61.5% of patients with poor pre-treatment vision (best corrected visual acuity 6/24 or worse). Overall, the treatment was well tolerated with no Grade 2 or greater acute toxicity. Minimal other ophthalmic complications were seen with only one patient developing late onset Grade 3 radiation retinopathy.

Fatal ischemic stroke complicating acute multifocal placoid pigment epitheliopathy: histopathological findings.

A previously healthy 29-year-old man was admitted to a tertiary referral center with acute left hemiparesis followed shortly by de novo convulsive status epilepticus. This was in the context of a 2-month history of flu-like symptoms, severe headaches, and retinopathy recently diagnosed as acute multifocal placoid pigment epitheliopathy. Neuroimaging demonstrated bilateral, multiple territory cerebral infarction. Despite intravenous methylprednisolone and craniotomy for the management of raised intracranial pressure, the patient deteriorated and died 14 days later. At autopsy, multiple infarcts of varying ages within a 10-day period were seen in association with a segmental giant cell vasculopathy of meningeal arteries.

Does pregnancy increase the need for revisional surgery after laparoscopic adjustable gastric banding?

BACKGROUND: Over 80% of laparoscopic adjustable gastric banding (LAGB) patients are women, and approximately half of these are of reproductive age; therefore, pregnancy post-LAGB is common. It is not known if pregnancy increases the need for revisional procedures. We compare the incidence of revisions in two matched cohorts of LAGB patients, with or without subsequent pregnancy. METHODS: From September 1994 to May 2009, 5,467 patients underwent LAGB at the Centre for Bariatric Surgery, Australia. Women with births post-LAGB were matched to controls, with a "matched follow-up date" calculated equivalent to pregnancy. Rates of primary and overall revisions for band-related (erosions and proximal pouch dilatations) and port/tubing complications were compared for cases and controls at 2 and 3 years post-pregnancy. RESULTS: One hundred eighty-nine women had ≥1 pregnancies post-LAGB, including 137 with follow-up at 2 years and 104 at 3 years post-pregnancy. There was no significant difference in band or port/tubing revisions between groups at either time point: 16.8% vs 10.5% (p = 0.13) and 23.9% vs 14.6% (p = 0.09) for primary band revisions, and 5.8% vs 5.3% (p = 0.84) and 10.5% vs 6.6% (p = 0.35) for primary port/tubing revisions at 2 and 3 years, respectively. Percentage excess weight loss (%EWL) 3 years post-pregnancy was similar (47.9% vs 47.7%). Pregnancy LAGB management was not found to affect revisions; however, less time between LAGB and pregnancy was associated with a higher rate of primary band revisions (p = 0.03). CONCLUSION: These data suggest that pregnancy post-LAGB does not affect revision rate or %EWL; however, a shorter time between LAGB operation and pregnancy may predispose to band revisions.