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PurposeThe majority of spinal meningiomas are grade I tumors, as defined by World Health Organization (WHO) classification making atypical (grade II) or anaplastic (grade III) tumors extremely rare lesions to encounter in clinical practice. Here, we present our institutional experience of management of grade II and III spinal meningiomas.MethodsFollowing IRB approval, we queried all available institutional electronic medical records for patients undergoing surgical resection of pathology-proven spinal meningiomas, with further review of patients with grade II and III. Variables of interest included age, sex, histological type, tumor size, symptoms at baseline, treatment characteristics, symptom resolution at the last follow-up, recurrence, NF-2 status, concurrent intracranial meningioma, and mortality. Kaplan Meier curves were constructed to study time to progression/recurrence.ResultsA total of 188 patients undergoing surgical resection of spinal meningioma between 1988 and 2018 were identified. Among those, 172 (91.5%) patients had grade I meningioma and 16 (8.5%) patients had high grade meningiomas [grade II (15) and III (1)]. Over a median (IQR) follow-up of 8.0 years (5.1–13.0), mortality and recurrence rates were 18.8% (n = 3) and 47.1% (n = 8), respectively. In univariate analysis, adjuvant radiotherapy and thoracic segment involvement were associated with lower rates of recurrence while male sex was associated with a higher rate of recurrence.ConclusionsResults showed variations in clinical outcomes for patients with high grade spinal meningiomas, especially the recurrence. Adjuvant radiotherapy and thoracic segment involvement was associated with lower rates of recurrence while recurrence ocurred at a higher rate in males.

Per- and polyfluoroalkyl substances (PFAS) are pollutants that have demonstrated a high level of environmental persistence and are very difficult to remediate. As the body of literature on their environmental effects has increased, so has regulatory and research scrutiny. The widespread usage of PFAS in industrial applications and consumer products, complicated by their environmental release, mobility, fate, and transport, have resulted in multiple exposure routes for humans. Furthermore, low screening levels and stringent regulatory standards that vary by state introduce considerable uncertainty and potential costs in the environmental management of PFAS. The recalcitrant nature of PFAS render their removal difficult, but existing and emerging technologies can be leveraged to destroy or sequester PFAS in a variety of environmental matrices. Additionally, new research on PFAS remediation technologies has emerged to address the efficiency, costs, and other shortcomings of existing remediation methods. Further research on the impact of field parameters such as secondary water quality effects, the presence of co-contaminants and emerging PFAS, reaction mechanisms, defluorination yields, and the decomposition products of treatment technologies is needed to fully evaluate these emerging technologies, and industry attention should focus on treatment train approaches to improve efficiency and reduce the cost of treatment.

Abstract BACKGROUND: Embolization of spinal dural arteriovenous fistulae (SDVAFs) has emerged as an alternative to surgery. However, surgical disconnection is a simple and effective procedure. OBJECTIVE: To review results and complications of surgical treatment of 154 consecutive SDAVFs. METHODS: The records of 154 consecutive patients with SDAVFs were retrospectively reviewed. RESULTS: There were 120 males and 34 females (male/female ratio 3.5:1, mean age 63.6 years). The SDAVFs were located at the thoracic level in 92 patients and at the lumbar and sacral spine levels in 45 and 15 patients, respectively. The most common presenting symptoms were motor dysfunction (65 patients), sensory loss (31 patients), and paresthesias without sensory loss (13 patients). The mean interval from symptom onset to definitive diagnosis was 24.7 months (median 12 months). Surgery resulted in complete exclusion of the fistula at first attempt in 146 patients (95%). There were no deaths or major neurological complications related to the surgery. Six percent of patients experienced subjective or objective worsening of preoperative symptoms and signs by the time of discharge that persisted at follow-up. Other surgical complications consisted of wound infection in 2 patients and deep venous thrombosis in 3. Eight patients were lost to follow-up; 141 patients (96.6%) experienced improvement (120 patients, 82.2%) or stability (21 patients, 14.4%) of motor function at last follow-up compared with their preoperative status. Other symptoms such as numbness, sphincter dysfunction, and dysesthesias/neuropathic pain improved in 51.5%, 45%, and 32.6%, respectively. CONCLUSION: Surgical obliteration of SDAVFs is safe and very effective. Prognosis of motor function is favorable after surgical treatment.

To investigate the prognostic importance of an identified putative underlying risk factor in patients undergoing surgery for intractable temporal lobe epilepsy (TLE). A retrospective study of 400 consecutive patients who underwent TLE surgery between December 21, 1987, and September 11, 1996, was performed. Demographic characteristics, history of remote symptomatic neurologic disease, preoperative evaluation, and postoperative outcome data were extracted. Individuals without any risk factors were considered controls. Magnetic resonance imaging findings were used to identify mesial temporal sclerosis (MTS) before surgery. Seizure outcome was classified by a modified Engel classification. Two hundred eighty-one patients had a potential underlying etiology, and 143 patients had more than 1 risk factor. One hundred nineteen patients had no evidence of a putative symptomatic neurologic illness. There was a statistically significant association (P<.05) between the presence of MTS and a favorable operative outcome (odds ratio, 4.28; 95% CI, 2.67-6.87). A history of remote symptomatic neurologic disease was not of prognostic importance unless associated with the development of MTS. These results indicate that the preoperative identification of MTS by neuroimaging is the most important predictor of a favorable operative outcome in patients with TLE. These findings may be useful in the identification and counseling of potential candidates for epilepsy surgery.

The use of antibiotic-coated external ventricular catheters has been controversial among practitioners; although several papers have documented decreased adherence of microbes to catheters treated with antibiotics, there is no universally accepted practice standard for the use of coated catheters for the prevention of clinical infection. In this paper, we review the in vivo and in vitro evidence for antibiotic-coated catheters.

PFASs, or per- and polyfluoroalkyl substances, comprise a diverse group of synthetic chemicals known for their widespread use, persistence, and potential environmental and health risks. The sonolytic treatment of PFASs is one of the technologies with the ability to complete destruction without harmful byproducts. This study aims to provide a theoretical explanation for the sonolytic treatment of PFAS. Combining insights from molecular dynamics simulations with experimental data, the influence of chain length and functional headgroups on the PFAS destruction mechanism was investigated. The findings revealed that the impact on functional head groups and chain length on PFAS degradation via sonolysis treatment is complex and multifaceted. The preliminary degradation step is attributed to be headgroup cleavage, while differences in degradation rates between perfluorocarboxylic acids (PFCAs) and perfluorosulfonic acids (PFSAs) are primarily influenced by adsorption at the air–water interface of micro/nanobubbles created by ultrasound and dictated by compound hydrophobicity characteristics. Moreover, longer-chain PFAS compounds tend to degrade faster than shorter-chain counterparts due to their enhanced hydrophobic characteristics, facilitating adsorption and subsequent mineralization. The sonolytic environment significantly influences PFAS degradation, with aqueous sonolysis proving the most effective compared to dry pyrolysis or thermal combustion, highlighting the importance of considering environmental factors in remediation strategies. These insights provide valuable guidance for designing effective PFAS remediation strategies, emphasizing the need to consider molecular structure and environmental conditions. Further research and technological innovation are essential for developing sustainable approaches to mitigate PFAS pollution’s adverse impacts on human health and the environment.

To assess presentation, imaging, treatment, and outcome of patients with myelopathy due to a dural arteriovenous fistula (DAVF). This retrospective review identified 94 patients with DAVF surgically treated at our institution between June 1985 and December 1999. The mean ages of the 75 men and 19 women were 62.6 years and 63.0 years, respectively (range, 31–83 years). Magnetic resonance imaging was performed in 87 patients, computed tomography–myelography was performed in 37 patients, and spinal angiography was performed in all patients. Initial examination findings were retrospectively adjusted to a modified Aminoff-Logue myelopathy scale. Of the 94 patients, 47 presented with symptoms that worsened with erect posture or Valsalva maneuver. As myelopathy progressed, patients’ symptoms increased, and 6 patients had paraplegia at presentation. The mean time from symptom onset to diagnosis was 23 months (range, 2–120 months). Magnetic resonance imaging confirmed the diagnosis in 86 patients; computed to-mography–myelography was needed to confirm the fistula in 1 patient. Spinal angiography detected the fistula in all patients. Surgical obliteration of the DAVF was successful in 93 patients; in 1 patient surgery failed because the DAVF was not localized, but acrylic endovascular embolization was successful. No patient experienced permanent morbidity or mortality. Of the 94 patients, 93 improved postoperatively 1 or 2 levels based on a modified Aminoff-Logue scale. Older patients with severe long-term deficits had poor outcomes. The diagnosis of a DAVF seems to be delayed considerably because DAVF is not included in the differential diagnosis of myelopathy and because of clinicians’ unfamiliarity with suggestive or revealing findings on diagnostic imaging. Neurodiagnostic imaging confirms the diagnosis, and spinal angiography localizes the fistula. Surgical intradural disconnection of the DAVF clinically reverses the pathophysiology. Additionally, surgical treatment is associated with low short-term morbidity, no permanent morbidity, and no mortality. If the diagnosis is made early and treatment initiated in such patients, they generally do well.

Purpose To interrogate the association of tumor-associated syrinxes with postoperative neurological and oncological outcomes in patients surgically treated for WHO grade 2 spinal ependymomas. Methods Adults treated for primary spinal intramedullary ependymomas between 2000 and 2020 were identified and data were gathered on preoperative neurological exam, radiographic characteristics, operative details, and postoperative neurological outcome. Neurological status was graded on the modified McCormick Scale (MMS). Neurological worsening immediately postoperatively and at last follow-up were defined by ≥ 1 MMS grade deterioration. Decision-tree analyses were also performed to identify independent predictors of new neurological deficits. Results Seventy patients were identified; mean age 45.4 ± 12.7; 60% male. Forty-eight patients (68.6%) had tumor-associated syrinxes, were more common among males (68.8%) and cervical lesions (68.8 vs. 31.8%; P = 0.005). Postoperatively patients with syrinxes had better MMS (P = 0.035) and were less likely to require a gait aid (39.6 vs. 81.8; P = 0.002). This latter difference persisted to last follow-up (22.9 vs. 59.1%; P = 0.006). On decision-tree analysis the strongest predictors of long-term neurological worsening were advanced age (≥ 63 years) and worse baseline neurological function. Worsened neurological status in the immediate postoperative period was best predicted by thoracic localization, the presence of a hemosiderin cap, and longer craniocaudal extension. Conclusion For spinal ependymomas, tumor-associated syrinxes may portend decreased risk for immediate postoperative neurologic deficits but do not predict long-term neurological outcomes (MMS) or odds of successful gross total resection. Thoracic localization appears to best predict new immediate postoperative deficits, and worse baseline neurological function and advanced age best predict long-term deficits.

Abstract BACKGROUND: Medically intractable epilepsy involving drop attacks can be difficult to manage and negatively affect quality of life. Most studies investigating the effect of corpus callosotomy (CC) on seizures have been limited, focusing on the pediatric population or drop seizures alone, with little attention to other factors influencing seizure outcome. OBJECTIVE: To assess seizure outcomes after CC in adults and children. METHODS: Retrospective analysis was performed on all patients who underwent CC (anterior two thirds, 1- or 2-stage complete) at our institution between 1990 and 2011. Change in frequency after CC was assessed for drop seizures and other seizure types. Multiple factors were evaluated for impact on seizure outcome. RESULTS: Fifty patients met inclusion criteria. The median age was 1.5 years at seizure onset and 17 years at time of surgery. Anterior two-thirds CC was performed in 28 patients, 1-stage complete in 17, and 2-stage complete in 5. All 3 groups experienced a significant decrease in drop seizures (P < .001, P < .001, and P = .020, respectively), with 40% experiencing complete resolution, and 64% dropping at least 1 frequency category. Other seizure types significantly decreased in anterior two-thirds CC and 1-stage complete (P = .0035, P = .001, respectively). Younger age at surgery correlated with better seizure outcomes (P = .043). CONCLUSION: CC for medically refractory generalizing epilepsy is effective for both drop seizures and other seizure types. CC should be considered soon after a patient has been deemed medically refractory because earlier age at surgery results in lower risk and better outcome.

Intracranial subdural grid monitoring is a useful diagnostic technique for surgical localization in patients with intractable partial epilepsy. The rationale for the present study was to assess the morbidity of intracranial recordings and the surgical outcomes. We retrospectively reviewed the clinical data for 189 unique patients undergoing 198 intracranial subdural grid monitoring sessions between 1996 and 2004 at a tertiary epilepsy center. The mean age of patients undergoing monitoring was 28 +/- 14 years. An average of 63 +/- 23 electrodes were inserted. The mean duration of monitoring was 8 +/- 4 days. Localization of an epileptogenic zone occurred in 156 sessions (79%) resulting in 136 resections (69%). There were 13 major complications (6.6%), including five infections and six hematomas. Three patients (1.5%) developed permanent deficits related to implantation. Sixty-two (47%) of 136 patients undergoing resection were seizure-free after resection. An additional 38 patients (28%) had a significant reduction in seizures. The mean follow-up was 51 +/- 30 months. The duration of monitoring, bone flap replacement, number of electrodes, and perioperative corticosteroids were not associated with infection or complication. Subdural grid monitoring for identification an epileptogenic focus is high yield, revealing a focus in 79% of monitoring sessions. Complications rarely result in permanent morbidity (1.5%). Surgical outcome indicated that 74% of patients experienced a favorable reduction in seizure tendency.