Given the complexity of these procedures, the high recurrence rate, and the likelihood of complications, methylmethacrylate is contraindicated in 1-stage cranioplasty and soft-tissue reconstruction in high-risk patients. For unfavorable local conditions (eg previous infection, radiotherapy), the surgeon can either postpone the cranioplasty until the soft-tissue reconstruction has healed, or use a nonanatomical titanium mesh alone. The soft-tissue flap should be harvested of larger dimensions than anticipated.

Ex-situ normothermic limb perfusion preserves swine limb physiology and function for at least 12 hours.

Background Recent epidemiological studies have suggested that sexual dimorphism influences treatment response and prognostic outcome in Glioblastoma (GBM). To this end, we sought to (1) identify distinct sex-specific radiomic phenotypes, from tumor sub-compartments (peri-tumoral edema, enhancing tumor, and necrotic-core) using pretreatment MRI scans, that are prognostic of overall survival (OS) in GBMs, and (2) investigate radiogenomic associations of the MRI-based phenotypes with corresponding transcriptomic data, to identify the signaling pathways that drive sex-specific tumor biology and treatment response in GBM. Methods In a retrospective setting, 313 GBM patients (male=196, female=117) were curated from multiple institutions for radiomic analysis, where 130 were used for training and independently validated on a cohort of 183 patients. For the radiogenomic analysis, 147 GBM patients (male=94, female = 53) were used, with 125 patients in training and 22 cases for independent validation. Results Cox regression models of radiomic features from Gd-T1w MRI allowed for developing more precise prognostic models, when trained separately on male and female cohorts. Our radiogenomic analysis revealed higher expression of Laws energy features that capture spots and ripples-like patterns (representative of increased heterogeneity) from the enhancing tumor region, as well as aggressive biological processes of cell adhesion, and angiogenesis to be more enriched in the ‘high-risk’ group of poor OS in the male population. In contrast, higher expressions of Laws energy features (that detect levels and edges) from the necrotic core with significant involvement of immune related signaling pathways was observed in the ‘low-risk’ group of the female population. Conclusions Sexually-dimorphic radiogenomic models could help risk-stratify GBM patients for personalized treatment decisions.

This study suggests that SP can resolve VPI in 78.4% of patients, which can be increased to 94.7% after one revision. Most failures are technique-dependent; therefore, there could be significant ground for improvement of outcomes.