Citations

Introduction Although osteosarcoma represents the most common primary malignant bone tumor in children, they comprise only 0.2% of all cancers. Osteosarcoma frequently involves long bones; however, 8% of osteosarcomas involve the skull or mandible. Osteosarcoma is generally categorized based on location within the bone (central, surface, or extraskeletal) and histological grade (high-grade or low-grade). Osteoblastic osteosarcoma is a central, high-grade subtype and may be difficult to diagnose; it may present similarly to osteoblastoma, another rare, but benign, type of osteoblastic bone tumor. In this report, we present a rare case of osteoblastic osteosarcoma involving the temporal-occipital skull. Study design Case report and systematic review. Setting Tertiary referral center. Results A 21-year-old male presented for assessment of a mass appearing over his left mastoid region, first noticed within the previous 12 months. He experienced growth of the lesion and pain that increased when pressure was applied to the mass. Results from fine needle aspiration and CT-guided core biopsy were positive for osteosarcoma, osteoblastic-type. Magnetic resonance imaging of the brain and skull base revealed the mass to be 2.8 cm in maximal diameter. Given a somewhat favorable location, the tumor could be completely excised en bloc with negative margins, and the patient subsequently received adjuvant chemotherapy. The patient is doing well at last follow-up 10 months after surgery, with no evidence of recurrence to date. Conclusion The temporal bone is an uncommon location for a primary osteosarcoma, and there are numerous conditions that could present in a similar manner. This case highlights this rare occurrence of osteoblastic osteosarcoma of the temporal bone without previous exposure to radiation. There are a limited number of similar cases in the literature, and our report serves to bring awareness to this potential diagnosis and considerations related to treatment.

Objective To assess Advanced Bionics (AB) HiRes Ultra and Ultra 3D initial version (V1) cochlear implant electrode failures over time at four large cochlear implant programs. Study Design Retrospective cohort. Setting Four tertiary referral centers. Patients Patients receiving AB HiRes Ultra and Ultra 3D initial version (V1) devices as of December 31, 2022. Main Outcome Measures Failure rate, revision surgery, speech recognition scores. Results Over a span of 7 years, 205 (42.6%) of 483 implanted V1 devices have failed. Device failure rate varied across institutions from 32 to 67%. Of the 205 detected failures, 163 (79%) have undergone revision surgery, with 94% of revisions being performed with Advanced Bionics devices. Average time from implantation to diagnosis of device failure was 2.7 ± 1.2 years. Most patients (89.8%) with available testing were matched or exceeded their best prefailure speech performance after implant revision. After revision, patients had an average CNC score improvement of 24.7 percentage points over their most recent pre-revision scores and demonstrated average datalogging of 12.7 ± 4.1 h/d at most recent evaluation. Conclusions Comparison of patients across multiple high-volume implant centers confirms the presence of ongoing device failures. There is variability across institutions in the rate of revision surgery once a patient is diagnosed with a V1 device failure, as well as in the rate of device failure detection. Inter-institutional variability in failure rates may be explained by the variation in the routine use of electrical field imaging. Reimplantation with a new device typically results in a return to prefailure peak performance. Professional Practice Gap & Educational Need To our knowledge, a comparison of AB HiRes (V1) device failures across multiple institutions has not been conducted. Learning Objective To identify device failure rate across multiple institutions with different testing protocols. Desired Result Providers will have an improved understanding of the trajectory of device failures for HiRes (V1) devices over time. Level of Evidence Level IV—Historical cohort or case-controlled studies. Indicate IRB or IACUC IRB #230017; IRB #22-000183; IRB #STU-032018-085; IRB #H-49479.

Objective To examine comfort (C) and threshold (T) levels in adult cochlear implant (CI) recipients over the first 18 months postactivation. Study Design Retrospective review of longitudinal CI programming data. Setting Tertiary academic center. Patients A total of 480 CIs among 428 adult CI recipients. Interventions Cochlear implantation with Cochlear Ltd. devices with subsequent programming to behavioral standards using Custom Sound® fitting software. Main Outcome Measures Charge levels needed to achieve C and T levels were measured longitudinally using Custom Sound®, from time of activation to a minimum of 6 and a maximum of 18 months postactivation. Charge (nC) levels were calculated as the product of pulse width (μs) and current amplitude (μA) to standardize among implant models. Changes in C and T charge levels over time were evaluated using repeated-measures analysis of variance. Results When considering the entire electrode, the largest increases were seen at 1 month postactivation, and C and T charge levels did not increase significantly after 6 and 12 months, respectively. These findings were consistent across patient age at implantation and sex. When considering proximal electrodes only, C and T levels did not increase significantly after 6 months. In distal electrodes only, C levels did not increase significantly after 6 months, but T levels continued to demonstrate small, but statistically significant increases up to 18 months postactivation. Conclusions Across the entire electrode, we observed the largest changes in C and T charge levels at 1 month postactivation. Small increases in C and T levels continued out to 6 and 12 months, respectively, but may be of limited clinical significance. The stability of programming levels over time may support selective de-escalation of CI follow-up after the initial postactivation period, but, given small yet persistent increases with time, most notably in the distal electrodes, alternatives for follow-up or remote programming may still be encouraged.

Background/Objectives: Scaphoid fractures are notorious for a high rate of nonunion, resulting in chronic pain and impaired wrist function. The decision for surgical intervention often involves extensive imaging and prolonged conservative management, leading to delays in definitive treatment. The effectiveness of such treatment remains a subject of ongoing clinical debate, with no universally accepted predictive tool for surgical success. The objective of this study was to train a deep learning algorithm to reliably identify cases of nonunion with a high probability of subsequent union following operative revision. Methods: This study utilized a comprehensive database of 346 patients diagnosed with scaphoid nonunions, with preoperative and postoperative X-rays available for analysis. A classical logistic regression for clinical parameters was used, as well as a TensorFlow deep learning algorithm on X-rays. The latter was developed and applied to these imaging datasets to predict the likelihood of surgical success based solely on the preoperative anteroposterior (AP) X-ray view. The model was trained and validated over six epochs to optimize its predictive accuracy. Results: The logistic regression yielded an accuracy of 66.3% in predicting the surgical outcome based on patient parameters. The deep learning model demonstrated remarkable predictive accuracy, achieving a success rate of 93.6%, suggesting its potential as a reliable tool for guiding clinical decision-making in scaphoid nonunion management. Conclusions: The findings of this study indicate that the preoperative AP X-ray of a scaphoid nonunion provides sufficient information to predict the likelihood of surgical success when analyzed using our deep learning model. This approach has the potential to streamline decision-making and reduce reliance on extensive imaging and prolonged conservative treatment.

Kidney transplantation remains the gold standard for managing end-stage kidney disease, providing superior survival and quality-of-life outcomes compared to dialysis. Despite the ongoing gap between organ availability and demand, it is inevitable that kidney transplantation will continue to grow. This is owed to broader organ sharing, increased comfort of transplant programs with marginal kidney utilization, and the expansion of paired exchange among living donor kidneys. The evolution of kidney transplantation could not have been possible without the availability of effective immunosuppressive regimens that prevent rejection and maintain graft function. Mycophenolic acid and calcineurin inhibitors continue to serve as the foundation of modern maintenance immunosuppression. While these agents have markedly reduced acute rejection rates, their long-term efficacy in graft survival remains suboptimal. Alternative immunosuppressive therapies, including belatacept and mammalian target of rapamycin inhibitors, have demonstrated potential benefits. However, concerns regarding an increased risk of rejection have limited their widespread adoption as primary treatment options. In addition to ongoing efforts to refine steroid- and calcineurin inhibitor-sparing strategies, the identification of practical and quantifiable biomarkers for predicting long-term graft survival remains a critical objective. This review evaluates contemporary immunosuppressive protocols, highlights existing challenges, and explores future directions for optimizing long-term transplant outcomes.

BACKGROUND Tumor-to-tumor metastasis (TTM) is an exceptionally rare phenomenon. To date, only 12 cases of the metastasis of clear cell renal cell carcinoma (ccRCC) to a meningioma have been reported in the literature. The authors present a unique case of TTM involving ccRCC metastasizing to a meningioma in a patient with a history of both primary cancers. OBSERVATIONS A 58-year-old male with a history of 2 primary cancers developed a biphasic tumor diagnosed as TTM of ccRCC to meningioma. The patient initially presented with left lower-extremity (LLE) weakness and underwent subtotal resection of his meningioma. Postsurgical imaging revealed rapid tumor progression, for which the patient completed adjuvant radiotherapy. Concurrently, the patient developed hematuria and was diagnosed with ccRCC. Subsequent recurrent LLE weakness and intracranial tumor progression prompted re-resection, revealing a TTM. LESSONS In patients with a history of multiple cancers who present with recurrent intracranial disease progression radiographically and/or clinically, it is worth considering TTM in the differential diagnosis to facilitate multidisciplinary workup, management, and treatment. https://thejns.org/doi/10.3171/CASE24670

Limited scalability and restricted affordability impede the equitable deployment of curative models of care despite advances achieved with regenerative medicine therapeutics. Mitigating the risk of widening health disparities mandates actions that would improve the availability and accessibility of new classes of biotherapeutics. Namely, the use of Smart Manufacturing empowered by artificial intelligence to increase therapeutic production capacity while reducing cost is an emerging strategy central to the future of the regenerative care economy. Establishing an efficient and effective biomanufacturing ecosystem is essential to building regenerative pipelines into broadly available regenerative therapeutics options. This ecosystem must provide not only necessary cell environment controls and computer process power, but also the sensing technologies to feed critical process parameters to the algorithms in real-time. Here we outline key elements that are in development to support Smart Biomanufacturing, such as machine learning, advanced analytics, digital twins, and modular cytocentric production. The aim of integrating these technologies is to drive down costs, improve access to new regenerative medicine therapeutics, address regulatory science expectations, and in doing so, improve health equity.

Abstract Gallium-68-DOTA-Tyr3-Octreotate (Ga-68-DOTATATE) positron emission tomography/computed tomography (PET/CT) has recently been shown to have utility for the localization of phosphaturic mesenchymal tumors (PMT) that cause tumor-induced osteomalacia (TIO), a rare renal phosphate-wasting disorder. The aim of this study was to evaluate the accuracy of Ga-68-DOTATATE PET/CT in localizing PMTs causing TIO and to compare its performance with other functional imaging modalities. Prospective recruitment and retrospective chart review of 30 patients with suspected TIO and evaluation with Ga-68-DOTATATE PET/CT between 2017 and 2023 were conducted at a tertiary medical center. True positive (TP) lesions were defined by histological confirmation of PMT. There were 22 TP lesions identified among 18 patients, with a mean SUVmax of 16.8 (±10.9). Sensitivity, specificity, and accuracy of Ga-68-DOTATATE PET/CT were 85.7%, 77.8%, and 83.3% on patient-based analysis, and 84.6%, 56.3%, and 73.8% on lesion-based analysis. Lesions such as subacute fractures, parathyroid adenomas, thymus uptake, vertebral hemangiomas, bone enchondromas, liver hemangiomas, and avascular necrosis were some of the pitfalls in interpretation. Ga-68-DOTATATE PET/CT led to a significant impact on clinical management in 24 (80%) of patients. The presence of DOTATATE-avid fractures was significantly associated with a localizing scan on univariable (OR 15.0, 95% CI 2.80-110, p = .001) and multivariable analysis (OR 9.45, 95% CI 1.33-98.4, p = .003). Ga-68-DOTATATE PET/CT has good accuracy for the localization of TIO, with superior sensitivity compared to F-18-FDG PET/CT. This significantly impacted clinical treatment decisions. Although DOTATATE-avid fractures may be a source of false positives, they may also indicate a higher probability of a localizing study.