Awake craniotomy for high-grade gliomas - a prospective cohort study in a UK tertiary-centre.

Background: Studies from the UK reporting on awake craniotomy (AC) include a heterogenous group of patients which limit the evaluation of the true impact of AC in high-grade glioma (HGG) patients. This study aims to report solely the experience and outcomes of AC for HGG surgery from our centre.

Methods: A prospective review of all patients who underwent AC for HGG from 2013 to 2019 were performed.

A 3D star shot to determine the gantry, collimator, and couch axes positions.

A linear accelerator has three independent axes that are nominally intersecting at the isocenter. Modern treatment techniques require the coincidence of these axes to lie within a 1-mm diameter sphere. A solution to verify this requirement is to wrap a film on a cylindrical surface, align the cylinder to the linac's isocenter and gantry axis, and take multiple exposures of slits, rotating either the gantry, collimator, or couch between exposures.

Cerebral protothecosis mimicking high-grade glioma.

is a common, indolent alga that seldom causes central nervous system infections in humans. We report the first UK case of cerebral protothecosis in an immunocompetent 56-year-old woman who presented with a 5-month history of intermittent fatigue followed by a 2-week history of symptoms, including right arm and leg weakness, a loss of fine motor coordination, worsening gait, right facial tingling, diplopia and a metallic oral taste. MRI scans revealed a multifocal abnormality suggestive of high-grade glioma.

A quality assurance tool for daily checks of the gamma knife high definition motion management system.

Purpose: This note describes the performance of a quality assurance (QA) tool built for daily checks of the Gamma Knife's high definition motion management (HDMM) system.

Methods: The tool is a three-dimensional (3D)-printed platform with a raised corner in the center. A reflector post is placed at the corner and the HDMM tool is zeroed to this position.

Measuring Workload with Paired Detectors.

Linear accelerator workloads for each available photon energy are important quantities to know for radiation safety considerations, and presented is a technique to measure the workload using paired detectors. The signals from the two detectors can give sufficient information to separate the signal contributions from 6 and 18 MV photon fields and, combined with a signal-per-monitor-unit calibration factor, yields the number of monitor units delivered for each energy. CR-39 NTD is a neutron detector chosen for its ability to discriminate between 6 MV and 18 MV radiation fields.

Calibrating TrueBeam jaws by considering collimator walkout to improve the dose uniformity at abutting field junctions.

Jaw positions on a linear accelerator are calibrated to have accurate field size values over the range of jaw positions and to have excellent junctions when matching fields. It is sufficient to have field size accuracy on the order of a millimeter for most clinical applications but good junctions require submillimeter precision and accuracy in the jaw positioning. Presented is a method to measure collimator walkout with the MV imager and a mathematical model to determine an optimal origin for calibrating jaws on the TrueBeam accelerator.

Predictors of Epileptic Seizures and Ability to Work in Supratentorial Cavernous Angioma Located Within Eloquent Brain Areas.

Background: The postoperative outcomes and the predictors of seizure control are poorly studied for supratentorial cavernous angiomas (CA) within or close to the eloquent brain area.

Objective: To assess the predictors of preoperative seizure control, postoperative seizure control, and postoperative ability to work, and the safety of the surgery.

Methods: Multicenter international retrospective cohort analysis of adult patients benefitting from a functional-based surgical resection with intraoperative functional brain mapping for a supratentorial CA within or close to eloquent brain areas.

Evaluation of a national neurosurgical formative examination: the UK experience.

Introduction: Formative assessment is a key component in medical education and that it is a helpful process for all involved. Until recently there was no national formative examination for neurosurgical trainees. The Neurosurgery Annual in Training Examination (NAiTE) is an annual online, formative assessment that was introduced in 2014.

Solitary calvarial haemangioma presenting as metastatic renal cell carcinoma.

Renal cell carcinoma is the most common renal tumour in adult that often metastasises to the lung, liver or bone. Head and neck lesions are uncommon with no early warning signs and presents with overt metastases at primary presentation in 25%-30% of reported cases. The incidence of haemangiomas that suggest malignancy are similar to that of bone metastasis.

Intravenous delivery of oncolytic reovirus to brain tumor patients immunologically primes for subsequent checkpoint blockade.

Immune checkpoint inhibitors, including those targeting programmed cell death protein 1 (PD-1), are reshaping cancer therapeutic strategies. Evidence suggests, however, that tumor response and patient survival are determined by tumor programmed death ligand 1 (PD-L1) expression. We hypothesized that preconditioning of the tumor immune microenvironment using targeted, virus-mediated interferon (IFN) stimulation would up-regulate tumor PD-L1 protein expression and increase cytotoxic T cell infiltration, improving the efficacy of subsequent checkpoint blockade.

Assessing Health Implications of the Potential Radiation Exposure in the Community During Pregnancy: A Case Study.

The unintentional radiation exposure can have significant implications. We present a case of a 30-year-old pregnant female who was exposed to a potentially radioactive rock for over a one week period during her 13 week of pregnancy. After an arduous process of obtaining activity measurements, the most conservative estimate of dose, the female was exposed to, was found to fall within the permissible limits.

Prognostic factors for survival in adult patients with recurrent glioblastoma: a decision-tree-based model.

We assessed prognostic factors in relation to OS from progression in recurrent glioblastomas. Retrospective multicentric study enrolling 407 (training set) and 370 (external validation set) adult patients with a recurrent supratentorial glioblastoma treated by surgical resection and standard combined chemoradiotherapy as first-line treatment. Four complementary multivariate prognostic models were evaluated: Cox proportional hazards regression modeling, single-tree recursive partitioning, random survival forest, conditional random forest.

Presentation and management of lateral sinus thrombosis following posterior fossa surgery.

OBJECTIVE There are no guidelines for the management of postoperative lateral sinus thrombosis following posterior fossa surgery. Introducing treatment-dose anticoagulant therapy during the immediate postoperative period increases the risk of intracranial bleeding. This study assessed the incidence of and risk factors associated with postoperative lateral sinus thrombosis and the complications related to thrombosis and/or anticoagulation.

Pion effects in flattening filter-free radiation beams.

Flattening filter-free radiation beams have higher dose rates that significantly increase the ion recombination rate in an ion chamber's volume and lower the signal read by the chamber-electrometer pair. The ion collection efficiency correction (P(ion)) accounts for the loss of signal and subsequently changes dosimetric quantities when applied. We seek to characterize the changes to the percent depth dose, tissue maximum ratio, relative dose factor, absolute dose calibration, off-axis ratio, and the field width.

Long-term results of carmustine wafer implantation for newly diagnosed glioblastomas: a controlled propensity-matched analysis of a French multicenter cohort.

Background: The standard of care for newly diagnosed glioblastoma is maximal safe surgical resection, followed by chemoradiation therapy. We assessed carmustine wafer implantation efficacy and safety when used in combination with standard care.

Methods: Included were adult patients with (n = 354, implantation group) and without (n = 433, standard group) carmustine wafer implantation during first surgical resection followed by chemoradiation standard protocol.

5-aminolevulinic acid guidance during awake craniotomy to maximise extent of safe resection of glioblastoma multiforme.

Overall survival for patients with glioblastoma multiforme (GBM) has been consistently shown to improve when the surgeon achieves a gross total resection of the tumour. It has also been demonstrated that surgical adjuncts such as 5-aminolevulinic acid (5-ALA) fluorescence--which delineates malignant tumour tissue--normal brain tissue margin seen using violet-blue excitation under an operating microscope--helps achieve this. We describe the case of a patient with recurrent left frontal GBM encroaching on Broca's area (eloquent brain).

Resection of olfactory groove meningioma - a review of complications and prognostic factors.

Introduction: High complication rates have been cited following olfactory groove meningioma (OGM) resection but data are lacking on attendant risk factors. We aimed to review the complications following OGM resection and identify prognostic factors.

Methods: A retrospective review was performed on 34 consecutive patients who underwent primary OGM resection at a single London institution between March 2008 and February 2013.

The death of Henry II, King of France (1519-1559). From myth to medical and historical fact.

On 30 June 1559, Henry II, King of France, was mortally wounded in the head by a lance during a jousting match. Despite the best efforts of his physicians, Ambroise Paré and Andreas Vesalius, King Henry died 11 days later. This article, based on previously unpublished evidence, aims at examining the historical account of his death against modern medical practice to establish the probable cause of the king's death.

Transient cauda equina syndrome: a subtle but sinister sign.

A 54-year-old man presented with symptoms of cauda equina syndrome, which spontaneously resolved. Initial MRI did not show any compression of the cauda equine; however, an unusual pattern of epidural fat lead to further investigation and ultimately the diagnosis.

Transient obscuration of vision.

A previously well 13-year-old girl presented with a 4-month history of progressively worsening headache and visual disturbance. At fourth presentation, examination showed bilateral papilloedema and a left homonymous hemianopia. CT and MRI scans revealed a tumour obstructing the third ventricle with consequent hydrocephalus.

Prevalence of recurrence and retreatment of ruptured intracranial aneurysms treated with endovascular coil occlusion.

Object: Endovascular coiling is a common treatment for ruptured intracranial aneurysms. However, concerns have been raised over the durability of this treatment. The aim of this study was to establish the rate of recurrence and retreatment of coiled aneurysms treated in our unit.

A three-isocenter jagged-junction IMRT approach for craniospinal irradiation without beam edge matching for field junctions.

Purpose: Traditionally craniospinal irradiation treats the central nervous system using two or three adjacent field sets. We propose a technique using a three-isocenter intensity-modulated radiotherapy (IMRT) plan (jagged-junction IMRT) which overcomes problems associated with field junctions and beam edge matching and improves planning and treatment setup efficiencies with homogenous target dose distribution.

Methods And Materials: Treatments for 3 patients with a prescription of 36 Gy in 20 fractions were retrospectively planned with jagged-junction IMRT and compared to conventional treatment plans.