Citations

Abstract Background Leptomeningeal disease (LMD) remains a challenging complication of both solid tumors and hematologic malignancies, with diagnosis traditionally relying on cerebrospinal fluid (CSF) cytology, which has limited sensitivity. Circulating tumor DNA (ctDNA) analysis in CSF has emerged as a promising diagnostic and molecular profiling tool that may improve detection and guide treatment decisions. We will report real-world clinical experience using a CSF ctDNA assay (Menarini Silicon Biosystems) in routine neuro-oncology practice. Methods Retrospective analysis of over 100 CSF specimens obtained from patients with suspected or confirmed LMD will be conducted. Clinical data to be collected: patient demographics, tumor histology, indication for testing, and prior treatments. ctDNA assay results will be compared with conventional CSF cytology. Molecular alterations identified through ctDNA testing will be recorded, along with subsequent treatment decisions, including use of targeted therapies, systemic therapy modifications, radiation therapy, or intrathecal approaches. Preliminary clinical outcomes, including radiographic response, progression patterns, and survival trends, will be explored. Descriptive statistical methods will be used to summarize the findings. Results We anticipate that among analyzed specimens, ctDNA testing will provide clinically meaningful diagnostic yield across multiple tumor histologies. Concordance and discordance patterns between ctDNA results and conventional cytology will be evaluated, including cases in which ctDNA identified molecular alterations despite negative cytology. Actionable genomic findings in a subset of patients will be analyzed and presented. Early outcome observations that ctDNA-informed management may facilitate more personalized care will be reported. Conclusions CSF ctDNA analysis represents a feasible and informative adjunct to conventional cytology in the evaluation of patients with suspected LMD in real-world clinical practice. Beyond diagnostic support, molecular profiling from ctDNA may influence treatment selection and enable precision oncology approaches in this high-risk population. Prospective studies are warranted to define sensitivity, specificity, and the impact of ctDNA-guided interventions on clinical outcomes.

Abstract Background and aims A substantial proportion of large vessel strokes remain untreated worldwide due to limited access to specialized neuroendovascular care. Remote robotic neuroendovascular thrombectomy performed by expert interventionalists from a distant hub has been proposed as one solution to address these disparities. In this study, we test the feasibility of remote robotic thrombectomy in a live animal model. Methods Two live porcine experiments were conducted, involving Mayo Clinic Arizona (MCA), University Hospital Zurich (USZ), and Inselspital—Bern University Hospital (USB), Switzerland. Aspiration thrombectomy at USB was performed remotely from USZ (regional hub, 95 km; two experiments) and MCA (international hub, one experiment). Five aspiration thrombectomies were completed using a proprietary robotic magnetic navigation system consisting of a mobile magnetic field generator, a three-axis robotic advancer, controlling an 80 cm 6f sheath, a 6f aspiration catheter and a 0.035″ magnetically trackable guidewire, and a teleoperated console. The primary endpoint was the feasibility of successful clot aspiration using the robotic magnetic navigation system. Results Five out of seven thrombectomy procedures were successfully completed, achieving full clot retrieval. In the remaining two procedures, more distal clots were targeted, which could not be reached due to the limited catheter length. Magnetic navigation was successful in all cases. Image quality was excellent to acceptable. Conclusions Remote robotic thrombectomy using robotic magnetic navigation technology is technically feasible over both regional and transcontinental distances. This first-in-vivo regional and transatlantic study establishes a potential model of stroke intervention that may one day bridge access to endovascular stroke treatment. Conflict of interest Patrick Thurner and Tilman Schubert have consulting agreements with Nanoflex Robotics.

BACKGROUND AND OBJECTIVES: The artery of Davidoff and Schechter (ADS) is a dural branch of the posterior cerebral artery, supplying the falcotentorial junction. It is not commonly depicted on angiography due to its small size; thus, its visibility is usually indicative of a pathology, such as a dural arteriovenous fistula (DAVF). Recognizing the ADS as a feeder could be vital in enhancing management success, and understanding its anatomy is important for preventing complications during embolization or microsurgery. We present a scoping review of DAVFs fed by the ADS followed by an illustrative case report encountered at our institution. METHODS: An extensive literature review was conducted using PubMed, Embase, Web of Science, Scopus, and Cochrane databases. The search included the keywords: “Davidoff,” “Schechter,” “Davidoff and Schechter,” “dural branch,” “tentorial branch,” “medial branch,” and “meningeal branch,” in combination with “arteriovenous fistula,” “posterior cerebral artery,” and “superior cerebellar artery.” Only articles published in English or Spanish were included, with no restriction on publication date. Case reports and series were further screened based on best relevance. Data extraction and synthesis were performed in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. RESULTS: A total of 16 articles describing 32 cases of DAVFs supplied by the ADS were identified. The most common onset was headache (43.8%), followed by altered mental status (21.2%). Most DAVFs were classified as high grade based on Borden/Cognard scales. Transarterial embolization was the most used treatment (81.3%), achieving complete occlusion in 76.9% of cases. Among patients with complete occlusion, approximately half experienced full resolution of symptoms. In a mean follow-up of 27.4 months (IQR: 30), 2 cases reported complications due to reflux of the embolic agent. CONCLUSION: A comprehensive understanding of the ADS's angioarchitecture is essential to take full advantage of this artery's features in the treatment, mitigating potential complications and optimizing patient outcomes.