In March 2020, C.T., a kind, bright, and friendly young woman underwent surgery for a midline tumor involving her septum pellucidum and extending down into her fornices bilaterally. Following tumor diagnosis and surgery, C.T. experienced significant memory deficits: C.T.'s family reported that she could remember things throughout the day, but when she woke up in the morning or following a nap, she would expect to be in the hospital, forgetting all the information that she had learned before sleep. The current study aimed to empirically validate C.T.'s pattern of memory loss and explore its neurological underpinnings. On two successive days, C.T. and age-matched controls watched an episode of a TV show and took a nap or stayed awake before completing a memory test. Although C.T. performed numerically worse than controls in both conditions, sleep profoundly exacerbated her memory impairment, such that she could not recall any details following a nap. This effect was replicated in a second testing session. In high-resolution MRI scans, we observed evidence of the trans-callosal surgical approach's impact on the mid-anterior corpus callosum, showed that C.T. had perturbed white matter particularly in the right fornix column, and demonstrated that C.T.'s hippocampal volumes did not differ from controls. These findings suggest that the fornix is important for processing episodic memories during sleep. As a key output pathway of the hippocampus, the fornix may ensure that specific memories are replayed during sleep, maintain the balance of sleep stages, or allow for the retrieval of memories following sleep.

BACKGROUND It is crucial to develop effective and accessible interventions to improve cognitive sequelae in children treated for brain tumours (CTBT), as their impact on functional outcomes is significant. Instructor-led exercise training in a hospital setting is safe, feasible and efficacious to promote cognitive improvements in patients, however, most receive their post-treatment rehabilitative care in the community. eHealth is well positioned to support the delivery of community interventions. OBJECTIVE We aimed to i) develop a website that provides educational resources/tools for health and fitness professionals (HFP) to deliver exercise training to CTBT in the community with the goal of improving cognitive outcomes and ii) assess the website’s usability by community HFP. It was hypothesized that the website would be rated as learnable, clear, satisfactory and efficient to train on and deliver exercise training to CTBT in the community. METHODS A scoping review of academic literature, and publicly and commercially available eHealth resources was conducted. The scoping review determined the state of eHealth resources to support exercise training for CTBT and identify knowledge and resource gaps. Three focus groups were conducted with HFP with expertise serving cancer survivors in hospital (n=5) and community (n=8) settings to identify user needs and preferences. Content analysis identified themes. Gaps identified in the scoping review and themes from focus groups informed content that was integrated into the website build. Usability by community HFP (n=4) was assessed using a questionnaire (multiple choice, Likert-type, and open-ended questions). Descriptive statistics inferred elements of the website deemed sufficiently learnable, clear, satisfactory and efficient, and aspects with issues requiring modification. The mode of each multiple choice and Likert-type response was calculated to determine the value that appeared most often. Open ended responses identified issues. RESULTS The scoping review revealed a lack of eHealth resources to support exercise training to improve cognitive sequelae in CTBT and education for professionals to deliver training. Six themes were identified in the focus groups: instructor experience, instructor training, training on the intervention, venue considerations/suitability, exercise session planning and feedback. HFP reported the website to be sufficiently learnable, clear, satisfactory and efficient. Two minor issues were reported and addressed: a desire for discussion of appropriate language when instructing and correspondence between website activities and visual tools. CONCLUSIONS The development and usability testing of the website marks one of the first eHealth resources to increase accessibility of interventions typically delivered in a hospital setting to improve cognitive sequelae in CTBT. It also provides professionals the necessary education/tools for delivery in the community and provision of exercise intervention designed to improve cognitive outcomes. This website would afford an increase in the number of patients with access to interventions that promote cognitive improvement and ultimately enhance quality of life.

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