We report a pair of fluorinated, redox-active copper complexes for potential use as (19)F MRI contrast agents for detecting cellular hypoxia. Trifluorinated Cu(II) ATSM-F3 displays the appropriate redox potential for selective accumulation in hypoxic cells and a completely quenched (19)F NMR signal that is "turned on" following reduction to Cu(I). Incubation of cancer cells with CuATSM-F3 resulted in a selective detection of (19)F signal in cells grown under hypoxic conditions.

F magnetic resonance imaging (MRI), an emerging modality in biomedical imaging, has shown promise for in vitro and in vivo preclinical studies. Here we present a series of fluorinated Cu(II)ATSM derivatives for potential use as F magnetic resonance agents for sensing cellular hypoxia. The synthesized complexes feature a hypoxia-targeting Cu coordination core, nine equivalent fluorine atoms connected via a variable-length poly(ethylene glycol) linker. Introduction of the fluorine moiety maintains the planar coordination geometry of the Cu center, while the linker length modulates the Cu reduction potential, F NMR relaxation properties, and lipophilicity. In particular, theF NMR relaxation properties were quantitatively evaluated by the Solomon-Bloembergen model, revealing a regular pattern of relaxation enhancement tuned by the distance between Cu and F atoms. Finally, the potential utility of these complexes for sensing reductive environments was demonstrated using both F MR phantom imaging andF NMR, including experiments in intact live cells.

BACKGROUND Myeloid sarcoma is a rare malignant hematopoietic neoplasm that arises at extramedullary sites. Although myeloid sarcoma may involve any organ, central nervous system (CNS) involvement is exceptionally rare. To date, few case reports and case series have described CNS myeloid sarcoma, the majority of which include peripheral disease. OBSERVATIONS The authors present an illustrative case of an adult male with acute myeloid leukemia (AML) in remission relapsing with an isolated, diffuse myeloid sarcoma of the cerebellum. Magnetic resonance imaging showed posterior fossa crowding and diffuse enhancement within the cerebellar white matter without an apparent mass lesion. The patient required ventriculostomy due to obstructive hydrocephalus and ultimately suboccipital craniectomy with duraplasty due to posterior fossa compression. An open cerebellar biopsy revealed myeloid sarcoma. Peripheral studies did not meet the criteria for recurrent AML. The patient subsequently received high-dose systemic chemotherapy and has responded well to treatment. LESSONS Myeloid sarcoma may be a neurosurgical lesion because it has the potential to cause mass effect with obstructive hydrocephalus requiring emergent cerebrospinal fluid diversion and possible decompression. The authors report a rare case of isolated recurrence of AML in the form of diffuse CNS myeloid sarcoma and describe the role of neurosurgery in its diagnosis and treatment.

Stroke is a leading cause of morbidity and mortality worldwide. The increasing prevalence of acute ischemic stroke treatment has stimulated many areas of active research and contributions to literature, particularly advancements in surgical management. The aim of this chapter is to provide a comprehensive review of the indications for surgical intervention in the treatment of ischemic stroke. Specifically, the evidence surrounding the indications for mechanical thrombectomy, ventriculostomy and decompressive craniectomy is discussed. Decompressive craniectomy is further divided into individual sections on hemicraniectomy and suboccipital craniectomy. Furthermore, mechanical thrombectomy is analyzed with consideration for the plethora of recent data on perfusion imaging.

Surgical site infection (SSI) is a significant source of increased cost and morbidity among patients undergoing elective neurosurgical operations. Although much research has focused on the impact of various patient and surgical factors on SSI, studies examining the role of unintended surgical glove contamination (SGC) on SSI are unavailable.METHODS: Patients undergoing elective neurosurgical operations were prospectively collected over 1 year in this prospective quality improvement project. At the conclusion of the key portion of the operation, just prior to the start of closure, the gloves of the attending, resident, and scrub tech were swabbed using standard culture swabs and sent for aerobic and anaerobic culture. Preoperative antibiotics, choice of skin preparation, length of operation, and type of wound dressing were also recorded. Any wound infection or breakdown during follow up was recorded.RESULTS: Ninety-seven patients (36 spine and 56 cranial, and 5 "other" operations) were included for analysis. Overall incidence of SSI was 4.12%. SGC incidence was 10.3%, with the majority of positive cultures (60%) found on the scrub tech's gloves. None of the patients in which SGC was identified went on to develop SSI.CONCLUSION: The incidence of SGC in our cohort was over 10%. SGC identified at the time of closure did not correlate with development of SSI. SSI does not appear to result from wound contamination prior to closure.