Background/Objectives: Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive malignancies with a challenging prognosis, especially for patients with Neurofibromatosis type 1 (NF1). Their low incidence necessitates comprehensive studies to investigate the survival outcome. Methods: We conducted a systematic review and meta-analysis, including data from 16 studies and 4265 patients, to explore surgical outcomes and survival rates, focusing on time-related outcomes, including overall survival (OS), progression-free survival (PFS), and recurrence rate. Results: The analysis revealed that the OS rate was 86% [95% CI: 75–97%] at 1 year, decreasing to 60% [95% CI: 45–75%] at 3 years, and further declining to 47% [95% CI: 35–58%] by 5 years. For PFS, the 1-year rate was 61% [95% CI: 25–98%], which remained similar at 62% [95% CI: 35–89%] for 3 and 5 years. In NF1-associated MPNSTs, the 1-year OS was relatively high at 93% [95% CI: 83–100%], but it dropped to 68% [95% CI: 53–84%] at 3 years and further to 50% [95% CI: 31–68%] at 5 years. Additionally, the hazard ratio indicated a 38% lower survival rate in NF1 patients than those with sporadic MPNSTs when data were presented in the same study. Recurrence rates were high, with 56% of patients experiencing a relapse, primarily as local recurrences (70.6%). Mortality was significant, with over 50% of patients dying within an average follow-up period of 33.45 months. Conclusions: MPNSTs, particularly in NF1 patients, are associated with poor prognosis and high recurrence rates. These results underline the necessity of targeted therapeutic strategies and improved programs for screening, mainly through a multidisciplinary approach to optimize management.

OBJECTIVE: Schwannomatosis is a rare genetic predisposition to develop multiple nonintradermal schwannomas affecting the spine and peripheral nerves, excluding vestibular schwannomas. Schwannomatosis-associated schwannomas can present with pain or motor deficits, prompting resection. In this study, the authors reported the clinical characteristics, surgical interventions, and postoperative outcomes of patients with schwannomatosis-related schwannomas treated with resection. METHODS: This was a retrospective cohort study of adult patients with schwannomatosis who had undergone resection of a symptomatic peripheral or spinal schwannoma at the authors’ institution from September 2003 to June 2023. Data were extracted from electronic health records and provider notes. RESULTS: A cohort of 85 patients (57.6% women) had a mean follow-up of 68.4 ± 58.2 months after surgery. The mean age at the time of surgery was 44.6 ± 16.5 years. Pain was the most common presenting symptom (94.1%), followed by motor weakness (36.4%) and sensory deficits (32.9%). Just under two-thirds of the patients (64.7%) had undergone prior surgery for schwannoma, 20 (36.4%) of whom had a prior resection in the same exact location. Gross-total resection (GTR) was achieved in 88.2% of cases and en bloc resection in 69.4%. There were significant improvements in pain, motor weakness, and sensory deficits at the last postoperative follow-up visit. There was local tumor recurrence in 14 patients (16.5%), and the overall mortality rate was 4.7%. Univariate and multivariate analyses identified GTR as the strongest predictor of a decreased risk of local recurrence (HR 0.09, 95% CI 0.02−0.48, p = 0.005). CONCLUSIONS: Patients with schwannomatosis commonly presented with neurological symptoms of pain, sensory deficits, or motor weakness associated with their schwannomas. Resection significantly improved their preoperative symptoms, and GTR was associated with a decreased risk of local recurrence.

BACKGROUND AND OBJECTIVES: Understanding sport-related concussion (SRC) mechanisms can aid in prevention and treatment. Concussions in basketball have received relatively less attention compared with collision sports. In a cohort of concussed high school basketball players, this pilot study sought to (1) describe the mechanisms of how concussions occur in basketball and (2) assess the relationship between mechanisms and acute symptomatology and recovery time. METHODS: A retrospective cohort, pilot study examined concussed adolescent athletes (aged 14-18 years) treated at a sports concussion center from 11/2017 to 04/2022. The primary independent variable was mechanism of injury, categorized into (1) contact (head-to-head, head-to-body, head-to-ball, head-to-ground), (2) player (offensive play, defensive play, both), and (3) awareness mechanisms (aware, unaware). The outcomes included acute symptom severity, time to return-to-learn, symptom resolution, and return-to-play. Associations between mechanisms and outcomes were analyzed using one-way analysis of variance, independent t-tests, multivariable linear regressions, and Cox regression. RESULTS: Of 105 basketball players (16.2 ± 1.4 years; 50.5% male), head-to-ground contact (n = 44/105; 41.9%) was most common. Taking-a-charge (n = 12/53; 22.6%) was the most frequent player mechanism, with similar rates for offensive (n = 24/53; 45.3%) and defensive (n = 23/53; 43.4%) plays. Most were aware of impending collision (n = 37/46; 80.4%). Head-to-body concussions were associated with higher initial symptoms severity scores when compared with head-to-head (β = 0.33, P = .003) and head-to-ground (β = 0.23, P = .050) contacts. Player and awareness mechanisms were not significant predictors of outcome measures. Only higher initial symptom scores were associated with a longer time to return-to-learn, symptom resolution, and return-to-play. CONCLUSION: In this pilot study of concussed high school basketball players, head-to-ground was the most common concussion mechanism, with similar rates during offensive and defensive plays. Although head-to-body contact increased acute symptoms, other mechanisms did not predict recovery time. Given the limited information on concussions in basketball, the preliminary results of this pilot study may help inform larger studies on basketball SRC mechanisms.

BACKGROUND AND OBJECTIVES: Brachial plexus tumors represent a challenge for neurosurgeons because of complex anatomy, risks during surgery, and limited evidence-based guidance in managing these rare tumors. We aim to investigate the clinical characteristics, complications, and neurological outcomes of surgical resection of benign brachial plexus tumors. METHODS: We reviewed the medical records of patients diagnosed with benign brachial plexus tumors at (Johns Hopkins Medical Institutes) from July 2014 to April 2023. Of 123 screened patients, those who had surgical resection for benign brachial plexus tumors were identified. RESULTS: A total of 56 patients were included. Their mean (SD) age was 46.79 years (14.67), and 60.7% were women. The most common initial presentations were palpable mass (82.1%) and pain (66.1%). Sensory and motor deficits were reported in 27 (48.2%) and 12 patients (21.4%), respectively. Gross total resection was achieved in 53 patients (94.6%), and en bloc approach was performed in 39 patients (69.6%). Three patients developed postoperative complications, including hematoma, wound infection, and persistent sinus tachycardia, with no recorded deaths nor significant neurological deficits. With a mean follow-up of 38.08 (39.93) months after the surgery, 35 patients (94.6%) reported improvements in their preoperative pain, and 20 patients (54.1%) had total pain relief. Among those with preoperative neurological deficits, the recovery from sensory deficits was documented in 18 patients (66.7%), with better outcomes observed with preoperative dysesthesias rather than paresthesias, and the motor strength recovery rate was 83.3%. Two patients developed new sensory deficits, whereas no new motor deficits were reported. Tumor recurrence was reported in 1 patient (1.8%). CONCLUSION: Brachial plexus tumors can be cured surgically by gross total resection with favorable outcomes, minimal complications, and low incidence of recurrence.

Objective: To (1) retrospectively apply the updated American Congress of Rehabilitation Medicine (ACRM) mild traumatic brain injury (mTBI) criteria to a cohort of high school athletes previously diagnosed with sport-related concussion (SRC) using prior clinical definitions, and (2) compare demographics, medical history, and recovery outcomes between those who met the full mTBI criteria versus those classified as suspected mTBI. Setting: Outpatient Specialty Concussion Clinic. Participants: In total, 181 concussed athletes aged 14 to 18 years were presented to clinic within 72 hours of injury. All were diagnosed with SRC by a certified athletic trainer or physician using the Concussion in Sport Group definition, which defines SRC as any traumatic blow to the head/body causing neurologic symptoms. Design: Retrospective cohort study. Main Measures: Participants were classified as having a full or suspected mTBI based on the ACRM 2023 criteria. Full mTBIs required: (1) a plausible mechanism and either (2a) a clinical sign (eg, amnesia, loss of consciousness), or (2b) at least 2 symptoms plus a clinical examination finding. Suspected mTBIs had a plausible mechanism and at least 2 symptoms or at least 2 examination findings. Groups were compared across demographics, medical history, and recovery metrics (return-to-learn, symptom resolution, return-to-play). Results: Of the 181 patients (mean age 16.3 ± 1.3 years; 35.9% female), 114 (63.0%) met the definition for a full mTBI, whereas 67 (37.0%) had a suspected mTBI. Significant differences included higher rates of family migraine history (24.8% vs 7.7%, P = .019) and on-field evaluations (50.4% vs 38.5%, P < .001) in the full group. No significant differences in return-to-learn (median [Mdn]: 4.0 vs 3.0), symptom resolution (Mdn: 11.0 vs 12.5), or return-to-play (Mdn: 15.0 vs 14.5) were noted ( P > .05). Conclusion: Among high school athletes with SRC, most met the updated full ACRM mTBI criteria, with the rest meeting the suspected mTBI criteria. Results suggest high sensitivity for the ACRM definition for diverse concussion presentations.

The current study sought to: 1) characterize the demographic and fight specific details of Ultimate Fighting Championship (UFC) athletes who experience two consecutive knockout (KO) or technical knockout (TKO) losses, and 2) identify predictors associated with two consecutive KO or TKO losses using publicly available data. A retrospective cohort study examined UFC fighters who sustained at least one KO/TKO loss between 01/2015-12/2023 (with at least one subsequent fight) using publicly available fight records and third-party sources. Fighters were binarized into: 1) One Knockout group or 2) Two Consecutive Knockouts group. Demographics and fight-specific details from the initial KO/TKO loss were compared using t-tests and chi-squared tests. A multivariable logistic regression identified predictors of two consecutive KO/TKO losses using variables including age, sex, prior knockout history, weight, total head strikes absorbed, and knockout type. Among 705 UFC athletes who sustained a knockout (age: mean = 31.1; 89.9% male), 77.3% sustained a single KO/TKO loss and 22.7% sustained two consecutive losses. Fighters with two consecutive knockouts were older (31.8 ± 3.9 vs. 31.0 ± 4.0; t = -2.288, p = .022) and more likely to be male (94.4% vs. 88.6%; χ² = 4.5, p = .034). They fought at a heavier weight class (175.9 ± 41.8 lbs vs. 168.8 ± 39.4 lbs; t = -1.991, p = .047). In the logistic regression, prior knockout history was the only independent predictor (OR = 1.13, p = .019, 95% CI = 1.020-1.246). Among UFC athletes during this 8-year period, 23% sustained two knockout losses in a row. Predictors of two consecutive knockouts were older age, male sex, heavier weight class, and prior KO history, with prior KO history the only independent predictor. Recognizing prior knockout exposure as a key risk factor may help coaches and sports medicine physicians identify fighters at greater vulnerability for subsequent knockouts. Identifying high-risk fighters through knockout history may inform return-to-competition and medical clearance decisions.