To compare the accuracy of three volumetric methods in the radiological assessment of meningiomas: linear (ABC/2), planimetric, and multiparametric machine learning-based semiautomated voxel-based morphometry (VBM), and to investigate the relevance of tumor shape in volumetric error. MethodsRetrospective imaging database analysis at the authors' institutions. We included patients with a con rmed diagnosis of meningioma and a volumetric acquired cranial magnetic resonance imaging.After tumor segmentation, images underwent automated computation of shape properties such as sphericity, roundness, atness, and elongation. ResultsSixty-nine patients (85 tumors) were included. Tumor volumes were signi cantly different using linear (13.82 cm³ [range: 0.13-163.74 cm³]), planimetric (11.66 cm³ [range: 0.17-196.2 cm³]) and VBM methods (10.24 cm³ [range: 0.17-190.32 cm³]) (p < 0.001). Median volume and percentage errors between the planimetric and linear methods and the VBM method were 1.08 cm³ and 11.61%, and 0.23 cm³ and 5.5%, respectively. Planimetry and linear methods overestimated the actual volume in 79% and 63% of the patients, respectively. Correlation studies showed excellent reliability and volumetric agreement between manual-and computer-based methods. Larger and atter tumors had greater accuracy on planimetry, whereas less rounded tumors contributed negatively to the accuracy of the linear method. ConclusionSemiautomated VBM volumetry for meningiomas is not in uenced by tumor shape properties, whereas planimetry and linear methods tend to overestimate tumor volume. Furthermore, it is necessary to consider tumor roundness prior to linear measurement so as to choose the most appropriate method for each patient on an individual basis. methods. VBM could replace manually-based volumetric assessment in the future, especially for research purposes, and could have a complementary role for clinical purposes.

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BACKGROUND: Persistent cerebrospinal fluid (CSF) egress after durotomy in posterior thoracic or lumbar spine surgery may cause devastating complications. Persistent CSF leaks may require reoperation, which confers additional cost and morbidity. OBJECTIVE: To evaluate the efficacy of our subfascial epidural drainage protocol in the setting of durotomy to prevent reoperation. METHODS: A retrospective cohort study of drained and undrained cohorts was completed to identify factors associated with reoperation for persistent CSF leak-related symptoms. The efficacy and safety of this 7-day subfascial epidural drainage protocol was assessed by comparing reoperation incidence, perioperative complications, rehabilitation necessity, and readmissions. RESULTS: In total, 156 patients underwent subfascial epidural drainage, and 14 were not drained. Subfascial drainage for up to 7 days was associated with a significantly lower incidence of reoperation than no drainage (3.3% vs 14%, respectively; P = .03). Perioperative complication incidence was similar between cohorts (12.8% vs 21.4%, respectively; P = .37), and length of stay was unchanged regardless of drainage (median 7 days). Subfascial drainage conferred a nearly 2-fold relative risk reduction in inpatient rehabilitation requirement (RR 0.55) and 3-fold relative risk reduction in 30-day (RR 0.31) and 90-day readmission (RR 0.36). Factors associated with reoperation among drained patients included drainage longer than 7 days, tobacco use, age younger than 50 years, and longer segment operations. Revision spine surgery was associated with reoperation among undrained patients. CONCLUSION: When followed after durotomy, our subfascial epidural drainage protocol results in fewer reoperations than in an undrained cohort without prohibitive cost and no added morbidity.

Hypothesis: Immunotherapies hold great promise for treatment of highly resistant cancers, such as glioblastoma (GBM). We hypothesized that high powered imaging can be effectively combined to quantitatively assess the therapeutic efficacy of human derived natural killer (hNK) cells in an orthoptic xenografted mouse model of GBM. Methods: Tumor take (TT) was established via fluorescence. Mice in the treatment (n=5) and control (n=4) groups were given IV hNK cells and physiological saline, respectively. MRI and PET scans were performed four and six weeks after tumor implantation. Histological slices were taken at time of death. Software analysis of tumor volume, standardized uptake value (SUV), and tumor-to-brain ratio (TBR) was conducted via Qimage and Indica Labs - HALO. Results: Mean growth rates are as follows: T1 volume (mL) – 4.1 in the control group vs 2.3 in treatment. T2 volume (mL) – 6.0 in control vs 2.7 in treatment. PET volume (mL) – 3.1 in control vs 2.1 in treatment, SUV (g/mL) – 5.4 in control vs 3.0 in treatment. Two-tailed t-test analysis showed statistical significance (p < 0.01) in T1 volume data. Conclusion and Potential Impact: Treatment group mice showed a trend in reduction in growth rate of tumor volume and SUV compared to control, with a correlated lower histology TBR, suggesting effective in vivo assessment of hNK therapeutic efficacy in the mouse model of GBM via MR/PET imaging. Future trials should provide a larger population size to increase reliability, precision and power.