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Paraspinal lumbar schwannomas are primarily located outside of the spinal canal with minimal extension into the neural foramen. Approaching these tumors through a traditional posterior approach can be challenging given their lateral location to the spine and is likely to require extensive bony removal and potential destabilization of the spine. Alternatives approaches have been identified that may circumvent the need for extensive bony removal.To examine the use of the paramedian Wiltse approach for giant extraspinal tumors and compare the approach with other nonposterior approaches.We present 2 cases in which the paramedian Wiltse approach is used to effectively approach large paraspinal schwannomas and achieve complete tumor resection without destabilization of the spine.The paramedian Wiltse approach along with expandable retractors systems were able to achieve complete resection of the giant paraspinal schwannomas. Neural preservation was able to be achieved in one case which was facilitated by the exposure achieved through the posterior paramedian corridor that allowed for visualization of the proximal and distal ends of the tumor.The paramedian Wiltse approach is an ideal approach to target large extraspinal schwannomas for complete resection and potential neural preservation without the need for destabilization of the spine.

PURPOSE: Unique challenges exist in the utilization of telemedicine for neurological and surgical specialties. We examined the differences in patient satisfaction for telemedicine versus in-person visits within a Neuro-Oncology Program to assess whether there was a difference between surgical and medical specialties. We also examined the potential cost savings benefits of utilizing telemedicine. METHODS: 1189 Press Ganey surveys in the Department of Neuro-Oncology (982 in-person and 207 telemedicine) by surgical and medical neuro-oncology patients between 04/01/2020 and 06/30/2021 were reviewed. Survey results were divided into 4 categories (Access, Provider, Technology (telemedicine only), and Overall Satisfaction). Results were analyzed for the impact of telemedicine versus in-person visits, and gender, age, insurance, and specialty. Cost savings were calculated based on potential travel distance and lost productivity. RESULTS: Survey results from telemedicine visits demonstrated that patients with private insurance returned higher scores in the Provider (p=0.0089), Technology (p=0.00187), and Overall (p=0.00382) categories. Surgical visits returned higher scores for Access (p=0.0015), Technology (p=0.0002), and Overall (p=0.0019). When comparing telemedicine to in-person scores, in-person scored higher in Provider (p=0.0092) for all patients, while in-person scored higher in Access (p=0.0252) amongst surgical patients. Cost analysis revealed that telemedicine allowed patients to save an average of 3.7 to 4.8 hours per visit time and a potential loss of productivity of up to $223.27 ±171.41. CONCLUSIONS: Telemedicine yields equivalent patient satisfaction when employed in surgical as compared to medical Neuro-Oncology patients with the potential to lessen the financial and time burden on neuro-oncology patients.

Unique challenges exist in the utilization of telemedicine for neurological and surgical specialties. We examined the differences in patient satisfaction for telemedicine versus in-person visits within a Neuro-Oncology Program to assess whether there was a difference between surgical and medical specialties. We also examined the potential cost savings benefits of utilizing telemedicine.1189 Press Ganey surveys in the Department of Neuro-Oncology (982 in-person and 207 telemedicine) by surgical and medical neuro-oncology patients between 04/01/2020 and 06/30/2021 were reviewed. Survey results were divided into 4 categories (Access, Provider, Technology (telemedicine only), and Overall Satisfaction). Results were analyzed for the impact of telemedicine versus in-person visits, and gender, age, insurance, and specialty. Cost savings were calculated based on potential travel distance and lost productivity.Survey results from telemedicine visits demonstrated that patients with private insurance returned higher scores in the Provider (p = 0.0089), Technology (p = 0.00187), and Overall (p = 0.00382) categories. Surgical patients returned higher scores for Access (p = 0.0015), Technology (p = 0.0002), and Overall (p = 0.0019). When comparing telemedicine to in-person scores, in-person scored higher in Provider (p = 0.0092) for all patients, while in-person scored higher in Access (p = 0.0252) amongst surgical patients. Cost analysis revealed that telemedicine allowed patients to save an average of 4.1 to 5.6 h per visit time and a potential cost savings of up to $223.3 ± 171.4.Telemedicine yields equivalent patient satisfaction when employed in surgical as compared to medical Neuro-Oncology patients with the potential to lessen the financial and time burden on neuro-oncology patients.

During the pandemic, government policies such as social distancing and telework have impacted trust and working or social exchange relationships in the workplace. The behavior of leaders is critical for good leadership, employees’ trust, and social exchange relationships. Therefore, the main objective of this study was to assess the associations among authentic leadership, trust, and social exchange relationships under the influence of leader behavior. A regression-based approach was used to test the moderating and mediating effects. The results show that authentic leadership positively impacts trust and social exchange relationships, whereas trust directly affects social exchange relationships. During COVID-19, leader behaviors with ability, ethics, and positive relationships have had a positive impact on the association between authentic leadership, trust, and social exchange relationships. Additionally, trust positively mediates authentic leadership and social exchange relationships. The findings of this paper suggest that authentic leadership promotes trust and high-quality social exchange relationships. Moreover, based on leader behaviors during COVID-19, the ability to manage change effectively, boost employees’ work motivation, provide support, and take appropriate action is essential for authentic leadership to increase trust and foster a positive working relationship based on social exchange. Finally, regarding social exchange theory, high-quality leader behaviors and the leader–follower relationships drive positive associations among variables. These results will help organizational management teams to find methods to improve their organizational working relationships. The implication is that the abilities, ethics, and supportive and positive relationship behaviors of leaders are essential for effective management to improve leadership, trust, and social exchange relationships. Leaders should have the ability to manage work and people, even with teleworkers. Therefore, leader behaviors are important to maintain organizational sustainability. Further discussion on theoretical and practical implications is provided in the section.

Background Leptomeningeal disease (LMD) occurs as a late complication of several human cancers and has no rationally designed treatment options. A major barrier to developing effective therapies for LMD is the lack of cell-based or preclinical models that recapitulate human disease. Here, we describe the development of in vitro and in vivo cultures of patient-derived cerebrospinal fluid circulating tumor cells (PD-CSF-CTCs) from patients with melanoma as a preclinical model to identify exploitable vulnerabilities in melanoma LMD. Methods CSF-CTCs were collected from melanoma patients with melanoma-derived LMD and cultured ex vivo using human meningeal cell-conditioned media. Using immunoassays and RNA-sequencing analyses of PD-CSF-CTCs, molecular signaling pathways were examined and new therapeutic targets were tested for efficacy in PD-CSF-CTCs preclinical models. Results PD-CSF-CTCs were successfully established both in vitro and in vivo. Global RNA analyses of PD-CSF-CTCs revealed several therapeutically tractable targets. These studies complimented our prior proteomic studies highlighting IGF1 signaling as a potential target in LMD. As a proof of concept, combining treatment of ceritinib and trametinib in vitro and in vivo demonstrated synergistic antitumor activity in PD-CSF-CTCs and BRAF inhibitor-resistant melanoma cells. Conclusions This study demonstrates that CSF-CTCs can be grown in vitro and in vivo from some melanoma patients with LMD and used as preclinical models. These models retained melanoma expression patterns and had signaling pathways that are therapeutically targetable. These novel models/reagents may be useful in developing rationally designed treatments for LMD.

Background Leptomeningeal disease (LMD) is a devastating complication of systemic malignancy, of which there is an unclear etiology. The aim of this study is to determine if surgical or anatomic factors can predict LMD in patients with metastatic melanoma. Methods A retrospective chart review was performed of 1162 patients treated at single institution for melanoma brain metastases (MBM). Patients with fewer than 3 months follow-up or lacking appropriate imaging were excluded. Demographic information, surgical, and anatomic data were collected. Results Eight hundred and twenty-seven patients were included in the final review. On multivariate analysis for the entire cohort, female gender, dural-based and intraventricular metastasis, and tumor bordering CSF spaces were associated with increased risk of LMD. Surgical resection was not significant for risk of LMD. On multivariate analysis of patients who have undergone surgical resection of a metastatic tumor, dural-based and intraventricular metastasis, ventricular entry during surgery, and metastasis in the infratentorial space were associated with increased risk of LMD. On multivariate analysis of patients who did not undergo surgery, chemotherapy after initial diagnosis and metastasis bordering CSF spaces were associated with increased risk of LMD. Conclusion In a single-institution cohort of MBM, we found that surgical resection alone did not result in an increased risk of LMD. Anatomical factors such as dural-based and intraventricular metastasis were significant for developing LMD, as well as entry into a CSF space during surgical resection. These data suggest a strong correlation between anatomic location and tumor cell seeding in relation to the development of LMD.

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In context of the recent COVID-19 pandemic, smart hospitals’ contributions to pre-medical, remote diagnosis, and social distancing has been further vetted. Smart hospital management evolves with new technology and knowledge management, which needs an evaluation system to prioritize its associated criteria and sub-criteria. The global effect of the COVID-19 pandemic further necessitates a comprehensive research of smart hospital management. This paper will utilize Analytical Hierarchy Process (AHP) within Multiple Criteria Decision Making (MCDM) to establish a smart hospital evaluation system with evaluation criteria and sub-criteria, which were then further prioritized and mapped to BIM-related alternatives to inform asset information management (AIM) practices. This context of this study included the expert opinions of six professionals in the smart hospital field and collected 113 responses from hospital-related personnel. The results indicated that functionalities connected to end users are critical, in particular IoT’s Network Core Functionalities, AI’s Deep Learning and CPS’s Special Network Technologies. Furthermore, BIM’s capability to contribute to the lifecycle management of assets can relate and contribute to the asset-intensive physical criteria of smart hospitals, in particular IoT, service technology innovations and their sub-criteria.

Employees are important assets of an organization. Therefore, the employee engagement in teamwork is extremely vital for long-term organizational development. Good managers need excellent leadership skills. However, as the COVID-19 pandemic rapidly spreads around the world, many countries implemented strategies to avoid infection, such as working from home, isolation of infected people from others, and 14 days of self-quarantine. These strategies impact the trust, communal relationships, and social exchange relationships among organizational employees. However, communal and social exchange relationships are necessary for organizational leadership, and they are considered as the basis of social networks. The trust, communal relationships, social exchange relationships, and leadership in an organization are an interesting issue, particularly in the COVID-19 time, since the role of leaders is very crucial for maintaining organizational sustainability. The main objective of this study is to investigate the impact of COVID-19 on leadership in organizations based on trust, communal relationships, and social exchange relationships. The study employed correlation analysis to explore the interrelationships between variables. The 220 samples collected consisted of basic, middle, and high managers of organizations. The findings show that COVID-19 impacted organizational leadership. COVID-19 (F1) and (F2) factors integrated with each variable: (1) trust, (2) communal relationships, and (3) social exchange relationships created a stronger relationship between trust and leadership, communal relationships and leadership, and also social exchange relationship and leadership in organizations. On the contrary, Covid-19 (F3) factors integrated with each variable: (1) trust, (2) communal relationships, and (3) social exchange relationships decreased a relationship between trust and leadership, communal relationships and leadership, and also social exchange relationships and leadership in organizations. These results can help CEOs in organizations to perceive what factors have a positive impact or a negative impact on leadership in organizations in order to improve their leadership skills, even post COVID-19. The managerial implications are that (1) leaders need good communication skills to share true information with empathy and optimism and (2) leaders need to be thoughtful and capable to handle change in uncertain situations ethically.

Percutaneous vertebroplasty and kyphoplasty have been proven to be very safe techniques for treatment patients with osteoporotic vertebral fractures, malignant spinal lesions, multiple myeloma, and vertebral hemangiomas. These minimally invasive techniques also could be helpful for traumatic fractures, pain related to vertebral osteonecrosis (Kummel disease), Paget disease, Langerhans cell histiocytosis, osteogenesis imperfecta, spinal pseudarthrosis, fractures, and painful Schmorl nodes. Overall, the augmentation techniques are associated with a very low risk of serious complications. This chapter reviews the possible complications of percutaneous vertebral augmentation techniques in contrast to unwanted reactions that develop during or after procedures and are not related to diagnostic or procedural issues and incidents, asymptomatic events that occur during the procedure and have little or no clinical significance.

The management of metastatic disease to the spine is often complex and requires an integrated approach with input from an interdisciplinary cancer team. Vertebroplasty and kyphoplasty are considered very effective procedures for achieving pain control and preventing further vertebral body collapse resulting in kyphotic deformities and thecal sac compression. In this chapter, we discuss the pathogenesis of osseous metastases, pathophysiology of pain related to secondary spinal neoplasms, and clinically relevant features of spinal metastases secondary to different primary tumors. The most important imaging characteristics of the metastatic disease to the spine are discussed. Also, we outline the general concept of percutaneous vertebral augmentation for malignant spinal lesions.