No abstract

A827 conducted at HUSM including all patients undergoing general surgery serially between ages 18-75 years during 6 months duration. Patients who died before or during surgery and those who failed to come for follow-up were excluded. Each patient was under constant surveillance from the date of admission until 30 days post-operatively. SSI was defined as per Centers of Disease Control (CDC), USA criteria. Patients were stratified into risk groups according to SENIC and NNIS risk scoring index. Statistical analysis was done using SPSS version 20. Results: Out of total 180 patients enrolled, 23 (12.8%) developed SSI. Abdominal procedures had highest rate of SSI (65.2% of total SSI cases). NNIS index stratified 90 (50%) patients at risk of developing post-operative infection while SENIC identified 136 (75.6%) patients at risk. For NNIS, incidence of SSI in low, medium and high risk patients was 2.2%, 16.4% and 43.5% and for SENIC index it was 4.5%, 9.6% and 24.5% respectively. 15.4% patients had SSI who were stratified at risk by SENIC while NNIS risk group had 23.3% cases of SSI. Surprisingly, sensitivity of both indexing tools came out to be 91.3% (CI: 71.9%-98.9%) which is quite good however specificity was low (26.8%, CI: 20.0%-34.4%) for SENIC and comparatively high for NNIS (56.1%, CI: 47.9%-63.9%). Receiver operating characteristic (ROC) curve for the calculated risk in SENIC and NNIS models was derived and area-under-the-curve was larger for the NNIS model (Area: 0.799, p < 0.001). ConClusions: Both NNIS and SENIC are significant risk indexes and should be utilized concurrently, however NNIS proved to be more reliable index in our settings.

Background: Lactate, a by-product of glycolysis, has been well established as a marker of poor tissue perfusion. Elevated lactate production is observed in tumor glycolysis known as the Warburg effect. We have previously shown that serum lactate correlated with brain tumor grade. In this prospective study we aimed to determine if the preoperative serum lactate correlated with preoperative MR spectroscopy and in lactate levels in the fresh frozen tissue samples. Methods: Twenty-one glioma patients (13 male, 8 female) ages 34 – 86 underwent craniotomy at a single institution by lead author. Tumor pathology revealed a Glioblastoma (n=16), grade II (oligodendroglioma n=1) and Grade III Glioma (anaplastic astrocytoma n=4). Preoperative spectroscopy was performed on 18 patients. A fellowship trained neuro-radiologist (JPC) was blinded to the serum and tissue lactate levels and graded the spectroscopy lactate levels as low or elevated. Results: There was direct correlation of spectroscopy tissue lactate levels with serum lactate levels. Pre-operative serum lactate (range 6.6- 29.9 mg/dl) was directly correlated with the fresh frozen tissue lactate levels (range 0.1 – 0.39 ug/mg; Pearson r=0.6 p = 0.0021). Conclusions: This study supports that serum lactate correlates with spectroscopy and tissue lactate levels.

Background: Although surgery is the mainstay of treatment for most pituitary adenomas, post-operative radiotherapy has been shown to be of benefit in improving tumor control and recurrence-free survival. To understand potential side effects of radiotherapy we performed a systematic review and meta-analysis to determine the efficacy and safety of post-operative radiotherapy for pituitary adenoma. Methods: A systematic review was performed according to the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. We searched PubMed, MEDLINE and Cochrane databases with no language or publication date restrictions. Outcomes included 5- and 10-year progression-free survival and adverse events rates. Results: A total of 48 studies from 1986-2016 met the inclusion criteria, with 7551 cumulative patients. The cumulative 5- and 10-year s progression-free survival rates were 90.8% (95% CI 86-94%) and 88.6% (95% CI 81-93%), respectively. The overall adverse events rate was 8% (95% CI 5-12%). All outcomes were associated with significant heterogeneity (I2 ≥ 70%). No differences in survival rates or adverse events in relation to study date, tumor pathology, radiosurgery system used or dose of radiation. Conclusions: Post-operative radiotherapy for pituitary adenomas is effective and safe. Because of the significant heterogeneity and lack of matched controls in the literature, optimum timing and dosage are still unclear. Further prospective studies are needed.

Background: Surgical managment of eloquent lesions in the brain require a multidisciplinary approach. Radiographic imaging, such as magnetic resosnance, can provide details of “normal” anatomy however are limited when lesions can distort/displace due to mass effect or neuroplasticity. Functional MRI (fMRI) has limitations due to patient dependent actions can often be limited due oncological or vascular lesions but known to still be near or involving “eloquent” cortex. Navigated transcranial magnetic stimulation (nTMS) provides the physician with the ability to accurately (~2mm error) stimulate cortex of the brain, in a clinical setting, and to understand function of areas of motor and language and incorporate this information into the surgical theatre. Methods: We will present a personal expierience of complex oncological and vascular cases to illustrate how nTMS can assist in the determination of surgical approaches and educating patients of potential morbidities. Will also review potential research opportunities that nTMS provides. Details of Phase 2 clinical trial of nTMS for improving neuro-cognitive outcomes will be discussed. Results: Case ilustrations will be provided. Preliminary results of Phase 2 clinical study will be discussed. Conclusions: Navigated TMS provides another tool in the armamentarium of neurosurgeons to better manage and approach complex and eloquent lesions in the brain.