Fourth ventricle tumors in children: complications and influence of surgical approach

OBJECTIVES: The goal of this study was to characterize the complications and morbidity related to the surgical management of pediatric fourth ventricle tumors. / METHODS: All patients referred to the authors’ institution with posterior fossa tumors from 2002 to 2018 inclusive were screened to include only true fourth ventricle tumors. Preoperative imaging and clinical notes were reviewed to extract data on presenting symptoms; surgical episodes, techniques, and adjuncts; tumor histology; and postoperative complications. / RESULTS: Three hundred fifty-four children with posterior fossa tumors were treated during the study period; of these, 185 tumors were in the fourth ventricle, and 167 fourth ventricle tumors with full data sets were included in this analysis. One hundred patients were male (mean age ± SD, 5.98 ± 4.12 years). The most common presenting symptom was vomiting (63.5%). The most common tumor types, in order, were medulloblastoma (94 cases) > pilocytic astrocytoma (30 cases) > ependymoma (30 cases) > choroid plexus neoplasms (5 cases) > atypical teratoid/rhabdoid tumor (4 cases), with 4 miscellaneous lesions. Of the 67.1% of patients who presented with hydrocephalus, 45.5% had an external ventricular drain inserted (66.7% of these prior to tumor surgery, 56.9% frontal); these patients were more likely to undergo ventriculoperitoneal shunt (VPS) placement at a later date (p = 0.00673). Twenty-two had an endoscopic third ventriculostomy, of whom 8 later underwent VPS placement. Overall, 19.7% of patients had a VPS sited during treatment. Across the whole series, the transvermian approach was more frequent than the telovelar approach (64.1% vs 33.0%); however, the telovelar approach was significantly more common in the latter half of the series (p < 0.001). Gross-total resection was achieved in 70.7%. The most common postoperative deficit was cerebellar mutism syndrome (CMS; 28.7%), followed by new weakness (24.0%), cranial neuropathy (18.0%), and new gait abnormality/ataxia (12.6%). Use of intraoperative ultrasonography significantly reduced the incidence of CMS (p = 0.0365). There was no significant difference in the rate of CMS between telovelar or transvermian approaches (p = 0.745), and multivariate logistic regression modeling did not reveal any statistically significant relationships between CMS and surgical approach. / CONCLUSIONS: Surgical management of pediatric fourth ventricle tumors continues to evolve, and resection is increasingly performed through the telovelar route. CMS is enduringly the major postoperative complication in this patient population

Latent Disentanglement in Mesh Variational Autoencoders Improves the Diagnosis of Craniofacial Syndromes and Aids Surgical Planning

The use of deep learning to undertake shape analysis of the complexities of the human head holds great promise. However, there have traditionally been a number of barriers to accurate modelling, especially when operating on both a global and local level. In this work, we will discuss the application of the Swap Disentangled Variational Autoencoder (SD-VAE) with relevance to Crouzon, Apert and Muenke syndromes. Although syndrome classification is performed on the entire mesh, it is also possible, for the first time, to analyse the influence of each region of the head on the syndromic phenotype. By manipulating specific parameters of the generative model, and producing procedure-specific new shapes, it is also possible to simulate the outcome of a range of craniofacial surgical procedures. This opens new avenues to advance diagnosis, aids surgical planning and allows for the objective evaluation of surgical outcomes

Fourth ventricle tumors in children: complications and influence of surgical approach

OBJECTIVES: The goal of this study was to characterize the complications and morbidity related to the surgical management of pediatric fourth ventricle tumors. / METHODS: All patients referred to the authors’ institution with posterior fossa tumors from 2002 to 2018 inclusive were screened to include only true fourth ventricle tumors. Preoperative imaging and clinical notes were reviewed to extract data on presenting symptoms; surgical episodes, techniques, and adjuncts; tumor histology; and postoperative complications. / RESULTS: Three hundred fifty-four children with posterior fossa tumors were treated during the study period; of these, 185 tumors were in the fourth ventricle, and 167 fourth ventricle tumors with full data sets were included in this analysis. One hundred patients were male (mean age ± SD, 5.98 ± 4.12 years). The most common presenting symptom was vomiting (63.5%). The most common tumor types, in order, were medulloblastoma (94 cases) > pilocytic astrocytoma (30 cases) > ependymoma (30 cases) > choroid plexus neoplasms (5 cases) > atypical teratoid/rhabdoid tumor (4 cases), with 4 miscellaneous lesions. Of the 67.1% of patients who presented with hydrocephalus, 45.5% had an external ventricular drain inserted (66.7% of these prior to tumor surgery, 56.9% frontal); these patients were more likely to undergo ventriculoperitoneal shunt (VPS) placement at a later date (p = 0.00673). Twenty-two had an endoscopic third ventriculostomy, of whom 8 later underwent VPS placement. Overall, 19.7% of patients had a VPS sited during treatment. Across the whole series, the transvermian approach was more frequent than the telovelar approach (64.1% vs 33.0%); however, the telovelar approach was significantly more common in the latter half of the series (p < 0.001). Gross-total resection was achieved in 70.7%. The most common postoperative deficit was cerebellar mutism syndrome (CMS; 28.7%), followed by new weakness (24.0%), cranial neuropathy (18.0%), and new gait abnormality/ataxia (12.6%). Use of intraoperative ultrasonography significantly reduced the incidence of CMS (p = 0.0365). There was no significant difference in the rate of CMS between telovelar or transvermian approaches (p = 0.745), and multivariate logistic regression modeling did not reveal any statistically significant relationships between CMS and surgical approach. / CONCLUSIONS: Surgical management of pediatric fourth ventricle tumors continues to evolve, and resection is increasingly performed through the telovelar route. CMS is enduringly the major postoperative complication in this patient population

Evaluation of surface integrity after high energy machining with EDM, Laser Beam Machining and Abrasive Water Jet Machining of Alloy 718

Development of future aero engine components based on new design strategies utilising topological optimisation and additive manufacturing has in the past years become a reality. This allows for designs that involve geometries of "free form" surfaces and material combinations that could be difficult to machine using conventional milling. Hence, alternative manufacturing routes using non-conventional high energy methods are interesting to explore. In this investigation, the three high energy machining methods abrasive water jet machining (AWJM), electrical discharge machining (EDM) and laser beam machining (LBM) have been compared in terms of surface integrity to the reference, a ball nosed end milled surface. The results showed great influence on the surface integrity from the different machining methods. It was concluded that AWJM resulted in the highest quality regarding surface integrity properties with compressive residual stresses in the surface region and a low surface roughness with texture from the abrasive erosion. Further, it was shown that EDM resulted in shallow tensile residual stresses in the surface and an isotropic surface texture with higher surface roughness. However, even though both methods could be considered as possible alternatives to conventional milling they require post processing. The reason is that the surfaces need to be cleaned from either abrasive medium from AWJM or recast layer from EDM. It was further concluded that LBM should not be considered as an alternative in this case due to the deep detrimental impact from the machining process.KeywordsFirst Online: 05 October 2018</p

Isotopic signatures for the assessment of snow water resources in the Moroccan high Atlas mountains: contribution to surface and groundwater recharge

International audienceTo characterize snow isotopic signatures, monitoring of snowmelt was carried out at two sites (Oukaimden and Ifni) in the Moroccan High Atlas Mountains. For the Oukaimden site, samples of snow were taken by two methods to compare sampling techniques: (1) coring with a polyvinyl chloride (PVC) tube and (2) passive capillary sampling (PCS) installed at the snow/soil interface. The analyses show variable isotope contents, ranging from −14.7 to −2.5 ‰ for oxygen-18 and from −116 to −28.2 ‰ for deuterium. The most depleted values are observed in March 2013 at high elevation (3229 m asl). The majority of snow core samples display fractionation by sublimation, whereas those collected by the PCS sampling method are close to the Global Meteoric Water Line. The isotopic signature is comparable for snow, surface water and groundwater samples, indicating that snowmelt plays an important role in recharging aquifers, lakes, and rivers on the southern and northern sides of the Atlas Mountains. Recharge by snowmelt allows the dilution of salinity in adjacent aquifers. Characterization of the stable isotopic composition of snow obtained from snow cores is limited in comparison with the PCS method, which provides realistic compositions of the melt water contribution to water resources in this semi-arid area

Advances in water treatment technologies for removal of polycyclic aromatic hydrocarbons: Existing concepts, emerging trends, and future prospects

In the last two decades, environmental experts have focused on the development of several biological, chemical, physical, and thermal methods/technologies for remediation of PAH-polluted water. Some of the findings have been applied to field-scale treatment, while others have remained as prototypes and semi-pilot studies. Existing treatment options include extraction, chemical oxidation, bioremediation, photocatalytic degradation, and adsorption (employing adsorbents such as biomass derivatives, geosorbents, zeolites, mesoporous silica, polymers, nanocomposites, and graphene-based materials). Electrokinetic remediation, advanced phytoremediation, green nanoremediation, enhanced remediation using biocatalysts, and integrated approaches are still at the developmental stage and hold great potential. Water is an essential component of the ecosystem and highly susceptible to PAH contamination due to crude oil exploration and spillage, and improper municipal and industrial waste management, yet comprehensive reviews on PAH remediation are only available for contaminated soils, despite the several treatment methods developed for the remediation of PAH-polluted water. This review seeks to provide a comprehensive overview of existing and emerging methods/technologies, in order to bridge information gaps toward ensuring a green and sustainable remedial approach for PAH-contaminated aqueous systems.University of Pretoriahttps://onlinelibrary.wiley.com/journal/155475312021-08-01hj2021Chemistr