The foundation of precision immunotherapy in oncology is rooted in computational biology and patient-derived sample sequencing to enrich for and target immunogenic epitopes. Discovery of these tumor-specific epitopes through tumor sequencing has revolutionized patient outcomes in many types of cancers that were previously untreatable. However, these therapeutic successes are far from universal, especially with cancers that carry high intratumoral heterogeneity such as glioblastoma (GBM). Herein, we present the technical aspects of Mannan-BAM, TLR Ligands, Anti-CD40 Antibody (MBTA) vaccine immunotherapy, an investigational therapeutic that potentially circumvents the need for in silico tumor-neoantigen enrichment. We then review the most promising GBM vaccination strategies to contextualize the MBTA vaccine. By reviewing current evidence using translational tumor models supporting MBTA vaccination, we evaluate the underlying principles that validate its clinical applicability. Finally, we showcase the translational potential of MBTA vaccination as a potential immunotherapy in GBM, along with established surgical and immunologic cancer treatment paradigms.

Understanding physiologic and pathologic central nervous system function depends on our ability to map the entire in situ cranial vasculature and neurovascular interfaces. To accomplish this, we developed a non-invasive workflow to visualize murine cranial vasculature via polymer casting of vessels, iterative sample processing and micro-computed tomography, and automatic deformable image registration, feature extraction, and visualization. This methodology is applicable to any tissue and allows rapid exploration of normal and altered pathologic states.

BACKGROUND: Robot-assisted techniques are increasingly integrated into the field of spine surgery, with the potential benefits of increased accuracy and reduced radiation exposure. The objective of this study was to describe the technique of minimally invasive robot-assisted direct pars repair with 2 case illustrations. OBSERVATIONS: An 18-year-old male and a 42-year-old male, both with bilateral L5 spondylolysis, underwent successful minimally invasive L5 direct pars repairs with robotic assistance after conservative measures failed, and their cases are presented herein. LESSONS: A robot-assisted direct pars repair is a safe and effective technique for treating bilateral lumbar spondylolysis. The integration of robot-assisted techniques in spine surgery has the potential to improve outcomes, decrease surgical time, and reduce the amount of radiation exposure to operating room staff. https://thejns.org/doi/10.3171/CASE2415

Lumbar discectomy is an effective surgical treatment for radiculopathy due to lumbar disc herniation (LDH); however, recurrent LDH (rLDH) after discectomy may result in continued radiculopathy necessitating reoperation. This is associated with worse patient outcomes and further revision surgeries. A retrospective, single-center review was performed on a prospectively-collected database of patients who underwent MIS discectomy for treatment of LDH from 2013-2020 totaling 404 patients. Both patient-derived (age, gender, BMI, smoking, and diabetes status) and radiological (disc height index {DHI}, Modic endplate changes, and herniation subtype) risk factors were assessed. LDHs were subclassified as either protrusion, subligamentous extrusion, transligamentous extrusion, or sequestration. Patients were grouped based on incidence of recurrence and statistical analysis was performed on the previously noted variables. The recurrence of rLDH following MIS was calculated to be 12.13%. The recurrence group had a higher prevalence of any type of Modic change and thus a decreased prevalence of no Modic changes. There was an increased prevalence of subligamentous and decreased prevalence of transligamentous disc herniations in the recurrence group. Tubular lumbar discectomy has similar rates of recurrent lumbar disc herniations when compared to traditional open microdiscectomy surgery. Our data suggest that Modic endplate changes are associated with increased risk of recurrent lumbar disc herniation. The rate of comorbid diabetes mellitus was non-significantly higher in patients who experienced a reherniation. Although not statistically significant, the recurrence group showed an increased prevalence of subligamentous herniations, suggesting this herniation subtype may be associated with recurrence.