accessing-subdural-space-rodent-spinal-cord-for-treatment

Accessing the Subdural Space of the Rodent Spinal Cord for Treatment Delivery

Treating spinal cord diseases or injuries is challenging, in part, due to difficulties in developing effective treatments that can be directly applied to ...

Auckland City Hospital

New Zealand has one of the highest rates of melanoma in the world. In up to 10% of cases, the disease is metastatic at diagnosis. Cerebral metastatic involvement carries a particularly poor prognosis. 110 patients were included in the analysis. A retrospective consecutive series of patients treated surgically at Auckland City Hospital were studied, with parameters of demographics, tumour characteristics, surgery, pathology, systemic therapy and survival analysed. Mean age was 59.9 years (range 22-81 years). Median survival from date of surgery was 8.1 months (95% CI 6.9-9.4 months). Of the 58 patients tested for BRAF mutation, 28 were positive, similar to previously published data. This conferred a better prognosis with median overall survival of 12.3 months (95% CI 7.2-17.3 months) compared to 7.8 months (95% CI 5.6-10 months) for those who were negative (p < 0.05). Survival correlated positively with extent of surgical resection. Both BRAF positive status and targeted and/or immunotherapy were significant predictors of improved survival. In this cohort, radiation therapy did not show a statistically significant improvement in overall survival. Survival from resection of cerebral metastases from melanoma is improving. Survival benefit is conferred by BRAF mutation, solitary metastasis and gross total resection of lesion.

Metastatic melanoma: Surgical treatment of brain metastases - Analysis of 110 patients.

Dural venous sinus thrombosis is an uncommon, but significant sequela that may occur after resection of a cerebellopontine angle lesion. The natural history and management of this pathology has not been sufficiently studied.

Dural venous sinus thrombosis after cerebellopontine angle surgery: Should it be treated?

Glioblastoma (GBM) is a malignant cerebral neoplasm carrying poor prognosis. The importance of extent of resection (EoR) in GBM patient outcomes has been argued in the literature. Previous studies included tumors in eloquent regions of the brain. This confounds the role of EoR by including patients with intrinsically worse outcomes but will be over-represented in the reduced EoR category. In a homogenous group of patients in whom GTR was considered achievable, we investigated the effect of increasing EoR on survival. A retrospective review of 51 patients was undertaken. Quantitative, volumetric analysis of pre-operative and post-operative magnetic resonance image was compared with corresponding clinical details. The primary outcome measured was post-operative overall survival. Median overall survival was 18.3 months for GTR patients compared to 11.6 months for non-GTR (p = 0.025). Median pre-operative contrast-enhancing tumor volume for GTR patients was 54.7 cm and 24.9 cm for non-GTR. Post-operative median residual tumor volume was 1.1 cm in the non-GTR cohort. In multivariate analyses, GTR (HR [95% CI] = 0.973 [0.954-0.994], p = 0.00559) and increasing EoR (HR [95% CI] = 0.964 [0.944-0.985], p = 0.000665) remained predictors of survival. Centile dichotomization of EoR revealed 74% (HR [95% CI] = 0.351 [0.128-0.958], p = 0.0409) as the lowest threshold conferring statistically significant survival benefit. Where technically feasible, both GTR and EoR remained as independent prognostic factors for survival. GTR remains the gold standard for surgical treatment of GBM in patients, 74% being the minimum EoR required to confer survival benefit.

Extent of resection affects prognosis for patients with glioblastoma in non-eloquent regions.

We report a case of nail gun-related penetrating brain injury, puncturing through the anterior third of superior sagittal sinus, which remained patent and was associated with an arteriovenous (AV) shunt revealed on catheter angiogram.

Article	Year
Metastatic melanoma: Surgical treatment of brain metastases - Analysis of 110 patients. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia\| PubMed ID: 31956087	2020
Dural venous sinus thrombosis after cerebellopontine angle surgery: Should it be treated? Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia\| PubMed ID: 32173152	2020
Extent of resection affects prognosis for patients with glioblastoma in non-eloquent regions. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia\| PubMed ID: 33099354	2020
Nailed Through Superior Sagittal Sinus: A Case Report and Surgical Considerations. Operative neurosurgery (Hagerstown, Md.)\| PubMed ID: 36701558	2023
Spinal intradural electrodes: opportunities, challenges and translation to the clinic. Neural regeneration research\| PubMed ID: 37721274	2024
Advances in Surgery for Metastatic Disease of the Spine: An Update for Oncologists. Global spine journal\| PubMed ID: 39069655	2024

Chien Kow

Biography

JoVE Journal Publications

Other Publications