The invasive capabilities of glioblastoma (GBM) define the cancer’s aggressiveness, treatment resistance, and overall mortality. The tumor microenvironment influences the molecular behavior of cells, both epigenetically and genetically. Current forces being studied include properties of the extracellular matrix (ECM), such as stiffness and “sensing” capabilities. There is currently limited data on the physical forces in GBM—both relating to how they influence their environment and how their environment influences them. This review outlines the advances that have been made in the field. It is our hope that further investigation of the physical forces involved in GBM will highlight new therapeutic options and increase patient survival. A search of the PubMed database was conducted through to 23 March 2022 with the following search terms: (glioblastoma) AND (physical forces OR pressure OR shear forces OR compression OR tension OR torsion) AND (migration OR invasion). Our review yielded 11 external/applied/mechanical forces and 2 tumor microenvironment (TME) forces that affect the ability of GBM to locally migrate and invade. Both external forces and forces within the tumor microenvironment have been implicated in GBM migration, invasion, and treatment resistance. We endorse further research in this area to target the physical forces affecting the migration and invasion of GBM.

In infants born prematurely, the fragility of the germinal matrix vasculature and its lack of vessel autoregulation increase the risk of germinal matrix hemorrhage and consequent intraventricular hemorrhage (IVH). 1 The incidence of IVH in preterm infants is estimated to be 12% in infants weighing under 1500 g at birth and higher than 20% in infants weighing under 1000 g. 2 IVH grade IV represents germinal matrix hemorrhage extending into the brain parenchyma with ventricular dilation, and it is associated with a 28% risk of developing posthemorrhagic hydrocephalus. 3,4 We report the case of a 1-year-old premature female infant born at 22 weeks and 400 g with grade IV IVH shortly after birth. She developed a progressive hydrocephalus with a frontal occipital horn ratio of 0.66 before her index surgery. An endoscopic third ventriculostomy was first attempted, but it failed, so a ventriculoperitoneal shunt was placed in the patient. Distal shunt catheter malfunction due to bowel perforation required removal of the ventriculoperitoneal shunt. Afterward, the patient had 2 additional failures of a ventriculoatrial shunt placement due to thrombosis and stenosis in both the internal jugular and subclavian veins. As a result, consent was obtained from the patient's mother, and the patient underwent a direct ventriculoatrial shunt by a lower partial sternotomy. The distal end of the catheter was tunneled to the chest soft tissue over the heart and secured in the right atrial appendage. The procedure did not have any complications, and the patient was discharged on postoperative day 12.

Introduction Middle Meningeal Artery (MMA) embolization has emerged as a qualitative treatment option for subdural hematomas (SDH). Multiple studies have compared MMA embolization to other alternatives, namely surgery, and conservative treatment, with some indicating that MMA embolization was as effective and safe as the other two options. This study aimed to identify predictors of failures in SDH patients undergoing an MMA embolization. Methods We retrospectively reviewed 52 patients receiving MMA embolization for subdural hematoma management at our institution from 2020 until July 5, 2022 either as primary or adjunctive management. Patients who were under the age of 18 were excluded. Our definition of failure was any MMA embolization requiring an additional surgical procedure to evacuate the hematoma or relieve persistent symptoms. Results 52 patients with mean age of 71±14 and male gender 36 (69.2%) were reviewed. Most common presenting symptom was headache27 (51.9%) followed by gait instability22 (42.3%).35 out of 52 patients underwent MMA embolization as primary management of chronic subdural hematoma without prior surgical treatment. Six out of the 35 patients (17.1%) required a rescue surgical treatment due to increased hematoma size or recurrence of symptoms. Our early trend shows that half of the patients whose MMA embolization failed had a possible onset of SDH between 2 to 4 weeks prior the embolization. This trend is similar to Khorasanizadeh et al. description in which they concluded that late‐stage SDH was more predicated to have a failure of MMA embolization compared to early‐stage SDH (1). Of the remaining three patients, one was diagnosed with metastatic prostate cancer to the bones and kidney. This patient passed away 12 days after the procedure despite a craniotomy post‐embolization. Conclusions More clinical trials are needed to further establish MMA embolization as standard of care in the management of cSDH in a subset profile of patients with higher success rates.

ObjectivesThis report describes the use of an Everolimus-eluting stent (Xience Skypoint stent) for the treatment of medically-refractory ICAD.DesignRetrospective, case-seriesSettingIn-hospital patientsParticipantsAll patients in this report had a history of stroke secondary to ICAD. All patients failed aggressive medical treatments and had recurrence of symptoms despite anticoagulation or dual-antiplatelet therapy plus a statin. Diagnostic angiogram in each case showed severe vessel stenosis, therefore patients were recommended for intracranial artery stenting.Main outcome measuresTechnical feasibility of deploying Xience Skypoint stent for treatmet of ICAD.ResultsThe Xience Skypoint stent was safely and effectively deployed in the vertebral artery (x1) and the internal carotid artery (x2) using trans-ulnar (x1), trans-radial (x1), and trans-femoral (x1) approaches without the use of an intermediate catheter.ConclusionSecond-generation EES such as Xience Skypoint may be utilized for treatment of medically-refractory ICAD. This technical report serves as a proof of concept for further studies analysing long-term safety and efficacy of such stents for treatment of ICAD.