Publications by authors named "Donald MacArthur"

Article Synopsis
  • Diffusion-weighted imaging (DWI) is a method used in brain tumor surgeries with intraoperative MRI, but traditional techniques like echo planar imaging (EPI-DWI) can suffer from image distortions and artifacts.
  • This study compares EPI-DWI and a less distorted technique known as turbo spin echo DWI (TSE-DWI) to see which one radiologists prefer during surgery.
  • Results indicate that TSE-DWI performs equally or better than EPI-DWI in terms of image quality, particularly in reducing distortions and artifacts, making it a better option for intraoperative imaging.
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  • - This study examines thirteen rare cases of primary cerebellar glioblastoma (cGB) surgically treated between 2005 and 2022, highlighting the challenges in diagnosing this uncommon type of brain tumor.
  • - All patients (3 female, 10 male, median age 56) had MRI scans showing ring enhancement, with surgical treatments varying from craniectomy to biopsy, and four requiring CSF diversion.
  • - The researchers propose that cGB's rarity in the cerebellum may be linked to its distance from germinal regions and lower activity of local neural stem cells, contributing to the limited understanding of this tumor type.
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Purpose: Neurosurgery training in the UK has undergone significant changes over the past few years, including the new competency-based curriculum and a reduction of elective operating due to the pandemic. We conducted a comprehensive survey to assess UK neurosurgical trainees' experiences and perceptions to develop targeted action plans.

Methods: An online anonymised survey was developed and distributed amongst the BNTA mailing list.

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  • In 1932, Harvey Cushing linked peptic ulcers to increased intracranial pressure due to vagal overactivity, but the current review suggests that the causes may be more complex than originally thought.
  • Clinical evidence shows only slight increases in gastric acid in head-injured patients, and increased vagal tone is not common among those with severe brain injuries.
  • The narrative proposes a new hypothesis that neurogenic peptic ulcers may stem from changes in the gut microbiome and gastrointestinal inflammation rather than just vagal mechanisms.
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Extracellular vesicles (EVs) have emerged as pivotal mediators of communication in the tumour microenvironment. More specifically, nanosized extracellular vesicles termed exosomes have been shown to contribute to the establishment of a premetastatic niche. Here, we sought to determine what role exosomes play in medulloblastoma (MB) progression and elucidate the underlying mechanisms.

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Purpose: The aim of the project was to evaluate intra-CSF etoposide administration in a palliative setting for children and young people with relapsed/refractory central nervous system (CNS) tumours, with the primary endpoints being overall survival and progression-free survival time. A safety endpoint was to assess the side effect profile and complications of intra-CSF etoposide.

Methods: Thirty-five patients under the age of 30 years (median age: 5.

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  • * Out of 25 patients enrolled, 20% showed some form of response after three cycles, with a one-year progression-free survival (PFS) of 24% and overall survival (OS) of 56%.
  • * Although etoposide demonstrated some activity, the study emphasizes the urgent need for new treatment options due to the overall poor prognosis and significant toxicity observed in patients.
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  • The SIOP Ependymoma I trial evaluated treatment strategies and survival rates for non-metastatic intracranial ependymoma in children aged 3-21, focusing on event-free and overall survival over a 12-year follow-up.
  • Out of 74 participants, those who achieved gross total resection (GTR) had significantly better event-free survival (EFS), while specific genetic markers like 1q gain and hTERT expression correlated with worse outcomes.
  • The study concluded that GTR leads to improved results, while the response rate of subtotally resected cases to chemotherapy exceeded expectations, urging for better patient stratification and review processes.
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Background: Medulloblastoma, ependymoma, and pilocytic astrocytoma are common pediatric posterior fossa tumors. These tumors show overlapping characteristics on conventional MRI scans, making diagnosis difficult.

Purpose: To investigate whether apparent diffusion coefficient (ADC) values differ between tumor types and to identify optimum cut-off values to accurately classify the tumors using different performance metrics.

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Psychrobacter piechaudii is a recently described species of Gram-negative bacteria in the Moraxellaceae family. No cases of human infection due to this species have been described before. We report the case of an ex-premature infant girl with hydrocephalus secondary to intraventricular haemorrhage who underwent multiple cerebrospinal fluid (CSF) shunt operations.

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Article Synopsis
  • - Terson Syndrome (TS) involves bleeding inside the eye, usually linked to brain bleeding, particularly from subarachnoid hemorrhage, and its causes are still debated among scientists.
  • - Earlier theories suggested that high intracranial pressure damages the optic nerve or allows blood to reach the eye, but retinal vessels are not likely the source of the blood.
  • - The review introduces a new idea that blood from the brain's subarachnoid space can flow back into the eye through a network called the glymphatic system, especially when intracranial pressure rises, providing a fresh perspective on TS.
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A case of infantile hemispheric high grade glioma in a five-month-old boy is presented. Striking images of a 'beaten copper pot' skull were concerning at first, but with a successful surgical and oncological plan he is well three years later, displaying only minor signs of developmental delay.

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We describe an unusual cause of cranial dural thickening in an elderly female with a chronic meningeal inflammatory process. A 70-year-old ethnically Chinese, Singaporean female presented with a history of chronic daily headache with no other meningeal signs. Serial MRI brains showed progressive pachymeningeal and leptomeningeal enhancement in the left frontal region with underlying vasogenic oedema, similar appearances in the right frontal region to a lesser extent, and persistent inflammatory changes in her bilateral paranasal sinuses.

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We present the case of a 65 year old gentleman who underwent craniotomy and debulking of a left temporal glioblastoma multiforme (GBM). Post-operatively he received chemotherapy and radiotherapy with good response demonstrated on interval MRI scans. At 17 months post-diagnosis and in the absence of clinical or radiological recurrence, he presented with respiratory distress.

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Article Synopsis
  • Giant intracranial aneurysms in children are very uncommon.
  • A case study is presented, detailing the appearance of the aneurysm through angiography.
  • Successful treatment was achieved using a flow diverter stent.
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  • Researchers aimed to create a pre-operative risk scoring system to predict post-operative cerebellar mutism syndrome (CMS) in pediatric patients undergoing surgery for posterior fossa tumors.
  • The study analyzed data from 89 patients, identifying significant factors like MRI findings and age, leading to a model with 88.8% accuracy in predicting CMS risk.
  • The developed model categorizes patients into low, intermediate, or high-risk groups, which may help tailor surgical treatment strategies in the future.
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We present the case of a 58 year old lady with a large middle cranial fossa meningioma (5 cm × 4 cm in maximal dimensions) which has considerably regressed without any treatment during seven years of follow up. While the tumour had remained radiologically static for the first three years, scans from year five post-diagnosis onwards have shown shrinkage of the meningioma from a calculated volume of 36 cm to 11.2 cm.

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We present the case of a 15 year old boy who developed transient lower motor neuron facial weakness on two separate occasions shortly after ventriculoperitoneal shunt insertion. Both episodes, each of which occurred on the ipsilateral side to shunt insertion, were transient, self-limiting and were managed medically with a course of oral steroids. We believe this is the first reported case of Bell's palsy after this type of surgery in a child.

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Article Synopsis
  • The purpose of the study is to standardize how surgical resection status and imaging reviews are conducted for young children with ependymoma in the upcoming SIOP Ependymoma II trial.
  • The research involved independent imaging reviews of 89 patients from a prior trial, assessing factors like residual disease location and the need for additional surgeries.
  • The results showed that while 46% of patients actually had further surgery, the review panel would have recommended early second-look surgery for 68%, leading to the development of a 5-point staging system for more consistent evaluation of surgical outcomes.
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Article Synopsis
  • Depressed skull fractures from golf balls are uncommon injuries.
  • A case study is presented involving a 16-year-old patient who suffered from this type of fracture.
  • The study includes a 3D CT reconstruction to show the injury's characteristics.
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The first Workshop on Drug Delivery in Paediatric Brain Tumours was hosted in London by the charity Children with Cancer UK. The goals of the workshop were to break down the barriers to treating central nervous system (CNS) tumours in children, leading to new collaborations and further innovations in this under-represented and emotive field. These barriers include the physical delivery challenges presented by the blood-brain barrier, the underpinning reasons for the intractability of CNS cancers, and the practical difficulties of delivering cancer treatment to the brains of children.

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  • Polymer-based drug delivery systems using PLGA/PEG microparticles show promise for targeting cancer cells in brain tissue following surgical resection.
  • The study confirmed non-toxicity and structural integrity of these microparticles during radiotherapy and demonstrated sustained release of drugs like trichostatin A, etoposide, and methotrexate over weeks.
  • Overall, this delivery system presents a novel method for administering chemotherapy directly in the brain, potentially enhancing treatment outcomes for malignant tumors.
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Introduction: Physiologically relevant pre-clinical ex vivo models recapitulating CNS tumor micro-environmental complexity will aid development of biologically-targeted agents. We present comprehensive characterization of tumor aggregates generated using the 3D Rotary Cell Culture System (RCCS).

Methods: CNS cancer cell lines were grown in conventional 2D cultures and the RCCS and comparison with a cohort of 53 pediatric high grade gliomas conducted by genome wide gene expression and microRNA arrays, coupled with immunohistochemistry, ex vivo magnetic resonance spectroscopy and drug sensitivity evaluation using the histone deacetylase inhibitor, Vorinostat.

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Article Synopsis
  • Pediatric high-grade glioma (pHGG) has a poor prognosis, with a median survival of just 15 months after diagnosis, and research is shifting towards anti-angiogenic treatments.
  • A study of 150 pHGG cases revealed that the vascular marker CD105 is strongly linked to worse outcomes, and 13 genes related to vascularity were identified through gene expression analysis.
  • The findings suggest that targeting angiogenesis, particularly through CD105, could be an effective therapeutic approach for improving pHGG treatment.
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