Introduction: Primary cleft palate repair is associated with significant psychosocial burdens for patients and their families. The abundance of operations and appointments create financial and non-financial hardships for the patient and health care system alike. Therefore, the financial implications of cleft care have become an area of focus in craniofacial surgery. The purpose of this study was to evaluate the financial implications of utilization of the buccal fat pad flap (BFPF) during primary cleft palate repair. We hypothesized that utilization of the BFPF as vascularized soft tissue filler would decrease the need for secondary speech operations, therefore decreasing the financial burden of cleft care on patients and the health care system. Methods: A retrospective cohort study was performed that included 146 patients who underwent primary cleft palate repair between 1996 and 2022. Medicare.gov national average costs were utilized to establish standardized direct secondary cleft palate procedural costs, and the total direct and indirect financial cost associated with secondary speech operations was also determined. Results: It was found that usage of the BFPF resulted in a reduction of roughly $1000 in direct secondary procedural costs and a reduction of roughly $3000 in total financial secondary procedural costs for patients. Furthermore, the BFPF’s role in reducing a patient’s need for a secondary speech procedure was reaffirmed with a 15% absolute risk reduction for BFPF patients. Discussion: Overall, cleft palate patients treated with BFPF at the time of initial surgery benefited due to the decreased likelihood of requiring a secondary speech operation as this resulted in a reduction in financial and non-financial costs associated with cleft palate repair, reducing financial toxicity as a whole.

Gliomas are generally readily detected and broadly characterized using conventional MRI; however, substantial challenges remain in accurately delineating tumor extent, grading heterogeneous disease, and translating imaging findings into consistent, reproducible clinical decisions. Despite reported Dice coefficients of 0.85–0.91 for whole-tumor segmentation and classification AUC values exceeding 0.90 for glioma grading in curated datasets, most AI systems remain limited by validation design, dataset bias, and inadequate external generalizability. This narrative review synthesizes current AI applications for MRI-based glioma detection and segmentation, highlighting the evolution from radiomics-based classical machine learning approaches relying on handcrafted features to deep learning models capable of end-to-end representation learning. Commonly used MRI sequences, algorithmic paradigms, and reported performance trends are reviewed, with particular emphasis on tumor segmentation as a foundational enabling task. Key limitations that hinder clinical translation are examined, including limited dataset diversity, validation practices that inflate reported performance, domain shift across institutions, acquisition-related bias, and inadequate model interpretability. Emerging strategies to address these challenges, such as multi-institutional training, harmonization techniques, explainable AI frameworks, and workflow-integrated validation, are also discussed. While AI-based models demonstrate strong technical performance in research settings, their clinical impact will depend on rigorous external validation, transparency, and alignment with real-world neuro-oncology workflows.

Background: Metal hypersensitivity reactions are infrequently reported but clinically significant after spinal implant surgery. Clinical presentation can mimic infection or mechanical failure, making diagnosis difficult. Evidence to guide diagnosis and management is largely limited to short case series and case reports. The purpose of this study was to systematically review the clinical presentation, diagnostic methods, and outcomes of metal hypersensitivity associated with spinal implants. Methods: A systematic review was conducted of PubMed, Embase, and Scopus from inception through June 22, 2026, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Title and abstract screening, full-text review, and data extraction were performed independently by 2 reviewers with conflicts resolved by a third reviewer. Eligible studies included adult patients with suspected or confirmed metal hypersensitivity following spinal implant surgery that reported patient-level clinical outcomes. Results: Fifteen studies with a total of 19 patients met inclusion criteria (53% female, 42% male, and 5% not reported). The median patient age was 47 years (range, 19-69). Twelve procedures (63%) were fusion-based, while 7 (37%) were motion preserving, including disk arthroplasty and artificial facet replacement systems. Common clinical presentations included persistent pain, with 8 patients (42%) exhibiting dermatologic manifestations. Metal hypersensitivity was immunologically confirmed by positive patch testing and/or lymphocyte transformation testing in 11 patients (58%), while 8 (42%) were diagnosed clinically. Onset of symptoms ranged from immediately postoperatively to 15 years after implantation. Eighteen patients underwent removal or revision with clinical improvement in 14 of 16 with a reported outcome (88%). Conclusion: Metal hypersensitivity reactions following spinal implants are infrequently reported but may present either immediately or in a delayed manner with symptoms that mimic more common postoperative complications, such as infection or pseudarthrosis, or may present with dermatologic manifestations. In cases where other etiologies are ruled out, hardware removal was frequently, though not invariably, associated with clinical improvement, which was reported narratively rather than by validated outcome measures. Level of Evidence: Therapeutic Level V . See Instructions for Authors for a complete description of levels of evidence.