World Neurosurg
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This study explores the integration of chimeric antigen receptor T-cell (CAR-T) therapy with convection-enhanced delivery (CED) as a novel approach for treating diffuse intrinsic pontine glioma, a highly aggressive pediatric brain tumor with limited treatment options. Preliminary clinical results indicate that CED improves CAR-T cell distribution within the tumor microenvironment, leading to promising antitumor responses. ⋯ Ongoing research is essential to optimize these strategies and address ethical considerations surrounding patient safety and equitable access to innovative therapies. The aim is to assess the safety, efficacy, and distribution of CAR T cells delivered directly to the tumor site via CED, thereby enhancing therapeutic outcomes while minimizing systemic side effects.
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Failure to rescue (FTR) is defined as mortality within 30 days following a major complication. While FTR has been studied in various brain tumor resections, its predictors in malignant brain tumor resection (mBTR) remain unexplored. This study aims to identify FTR predictors in mBTR resection patients using a frailty-driven model. ⋯ Preoperative RAI-measured frailty, alongside non-elective surgery and major postoperative complications were significant predictors of FTR in mBTR patients. Identifying mBTR patients at risk for FTR using frailty strata may aid in preoperative neurosurgical risk stratification to optimize patients prior to surgery.
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Burr holes can lead to cranial defects that result in cosmetic and functional issues. Effective reconstruction of these burr holes is crucial for improving patient outcomes, yet there is no consensus on the optimal techniques and materials. This systematic review critically evaluates the efficacy and safety of various materials used in neurosurgical practice for burr hole reconstruction. ⋯ Burr hole reconstruction is essential for enhancing esthetic outcomes and patient satisfaction post-trephination. Autologous bone grafts, particularly cortical grafts, demonstrate superior integration, while synthetic materials offer viable alternatives with low complication rates. Future research should focus on long-term outcomes and the implementation of standardized, objective evaluation methods.
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Alcohol use disorder carries major effects shown to limit social support, increase recovery times, and lead to a higher incidence of surgical complications. This retrospective cohort study investigated the influence of AUD on perioperative outcomes and adverse events after spinal fusions in the largest sample size to date and spanning 11 years. ⋯ We found that AUD carries a significantly negative influence over perioperative outcomes and adverse events after spinal fusion in a large database population.