Stephanie Du Four

Background: Spinal cord stimulation (SCS) is a well‐established treatment for chronic neuropathic and ischaemic pain. Although patient‐reported outcomes have increasingly gained recognition, the impact of SCS on informal caregivers—an equally important consideration—remains underexplored. This study aims to address this gap by evaluating multidimensional outcomes following SCS, with a particular focus on the burden experienced by informal caregivers over a one‐year period. Methods: A prospective cohort study was conducted involving 35 patient‐caregiver dyads treated with SCS between January and December 2021 at AZ Delta and Jan Yperman Hospital. Inclusion required the availability of a spousal or offspring caregiver. Patients and caregivers were evaluated preoperatively and at 3, 6 and 12 months postoperatively using validated instruments including the Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), EuroQuality of Life‐5 Dimensions (EQ5D), Zarit Burden Index (ZBI), Modified Caregiver Strain Index (MCSI) and Relation Quality Indexes (RQI). Results: Patients reported significant reductions in leg and back pain ( p < 0.001), leading to decreased disability ( p < 0.001) and improved quality of life ( p < 0.05) during follow‐up. However, no significant changes were observed in caregiver burden or in the quality of the patient‐caregiver relationship. Conclusions: While patients reported significantly lower pain and better quality of life following SCS, these benefits do not extend to reducing caregiver burden or strengthening the patient‐caregiver relationship. A holistic treatment approach that actively involves caregivers may be necessary to optimise outcomes for both patients and caregivers. Further research with a larger cohort is required. Significance Statement: This prospective cohort study is the first to analyze the patient‐caregiver dyad in chronic pain patients treated with SCS. Although SCS effectively reduces pain and improves the quality of life of patients, these benefits do not extend to reducing caregiver burden or enhancing the patient‐caregiver relationship. We argue that a more holistic approach, including caregiver involvement in the treatment process, may be necessary to improve outcomes for both patients and caregivers.

IntroductionSagittal imbalance significantly impacts outcomes in adult degenerative spine conditions. Lumbar lordosis (LL) restoration is essential for spinopelvic alignment. Posterior or posterolateral fusions using hypo-lordotic implants can exacerbate spinopelvic imbalance by increasing the already existing hypo-lordosis. This study examines the impact of L5-S1 anterior lumbar interbody fusion (ALIF) on sagittal alignment in patients with adjacent segment disease following prior posterior or posterolateral lumbar fusions. MethodsThis retrospective study included 17 patients with a history of lumbar fusions, treated with L5-S1 ALIF at AZ Delta Hospital between 2019 and 2024. Pre-operative and post-operative radiographs were assessed for (proximal and distal) LL and sagittal balance parameters. Changes in alignment were analyzed with paired samples t-tests after verification of normal distribution. ResultsPre-operative LL averaged at 43.7∘ (95% CI [36.1–51.3]) and improved significantly to 50.1∘ (95% CI [43.5–56.7] p < 0.05) post-operatively, primarily due to an increase of distal LL from 25.5∘ to 35.2∘ (p < 0.001). The pelvic incidence–lumbar lordosis (PI-LL) mismatch decreased significantly from 39.0∘ to 18.9∘ (p < 0.05), while the sagittal vertical axis (SVA) reduced non-significantly from 97.3 mm to 86.7 mm. DiscussionL5-S1 ALIF has the potential to effectively restore LL and reduce PI-LL mismatch in patients with degenerative spine conditions and a history of lumbar hypo-lordotic fusions. Study limitations include a small sample size, missing full-spine radiographic data in a subset of patients and lack of long-term follow-up. These limitations underscore the need for validation through larger, prospective studies with standardized imaging and clinical follow-up. ConclusionThis study highlights the efficacy of L5-S1 ALIF in restoring lumbar curvature, reducing PI-LL mismatch and improving sagittal alignment in patients with a history of lumbar fusions. Despite the challenges of fixed hypo-lordosis resulting from previous hypo-lordotic lumbar fusions, our findings demonstrate that L5-S1 ALIF can significantly increase LL and reduce forward trunk inclination. Future studies involving larger patient cohorts and extended follow-up are warranted to validate these findings and evaluate their long-term clinical implications.

Although pituitary adenomas (PAs) account for 15% of intracranial tumors, pituitary carcinomas (PCs) are a rare entity. Most commonly, PCs evolve from aggressive PAs invading the surrounding structures and eventually leading to metastatic lesions. Due to the low incidence, the diagnosis and treatment remains challenging. We report a case series of five patients with pituitary carcinoma (PC) treated in our center. At first diagnosis 3 patients had an ACTH-producing adenoma, 1 a prolactinoma and 1 a double secreting adenoma (GH and prolactin). The mean time interval from initial diagnosis to diagnosis of PC was 10.7 years (range 5-20 years). All patients underwent multiple surgical resections and radiotherapy. Four patients were treated with temozolomide for metastatic disease. One patient with concomitant radiochemotherapy for local recurrence. Temozolomide led to a stable disease in 2 patients. One patient had a progressive disease after 9 cycles of temozolomide. In absence of standard treatment, immunotherapy was initiated, resulting in a stable disease.We report five cases of PCs. Three patients obtained a stable disease after tailored multidisciplinary treatment. Additionally, one patient was treated with immunotherapy, opening a new treatment option in PCs. Overall, PCs are rare intracranial neoplasms occurring several years after the initial diagnosis of aggressive PAs. Currently, the absence of predictive factors for an aggressive clinical course, provokes a challenging management.

Introduction: Up to 60% of patients with metastatic melanoma develop melanoma brain metastasis ( MBM ) during the course of their disease. Surgery, radiosurgery ( SRS ), stereotactic radiotherapy ( SRT ), and whole‐brain radiation therapy ( WBRT ) or combinations of these are commonly used local treatment modalities. Inhibitory monoclonal antibodies against the CTLA ‐4 and PD ‐1 immune checkpoint receptors significantly improved the survival of metastatic melanoma patients, including patients with MBM . This prolonged survival, and potentially also the immunostimulatory mechanisms, may expose patients to a higher risk for long‐term complications such as focal postradiation necrosis of the brain ( RNB ). Methods: We analyzed the incidence of pseudotumoral RNB in a single institution cohort of 142 melanoma patients that were prospectively followed after starting treatment with pembrolizumab in an expanded access program. Results: Of the 142 patients, 43 (30.7%) patients had MBM at initiation pembrolizumab. Of these, 31 (72.1%) were treated with SRS , 8 (18.6%) with WBRT while 4 (9.3%) had no prior local therapy. Of patients treated with RT , 28 (71.1%) received RT before the initiation of pembrolizumab. 5 (12.8%) patients developed a new symptomatic pseudotumoral lesion at a median time of 11.15 months (range 8‐46) after the RT . In all patients, the diagnosis of RNB was radiologically confirmed. The RNB was treated with corticosteroids in two patients, bevacizumab in two patients, and surgery in three symptomatic patients. The diagnosis was histologically confirmed in the patients treated with surgery. Conclusion: Melanoma patients with MBM treated with radiosurgery and showing a beneficial response to pembrolizumab are at risk for late RNB . In case of suspected isolated progression at the site of a previously irradiated MBM , the diagnosis of RNB should be considered.

Tick borne encephalitis (TBE) is an infectious zoonotic disease caused by an RNA virus that is endemic to Central and Eastern Europe, Russia, and large parts of Asia. The tick borne encephalitis virus (TBEV) is transmitted through the saliva of infected ticks and infected goat milk. In the vast majority of cases, an infection with TBEV has a subclinical course. However, in some cases, it leads to neurological symptoms due to meningitis, meningoencephalitis, meningoencephalomyelitis, or meningoencephaloradiculitis. Here, we present the first case of meningoencephaloradiculitis in Belgium.

Four cases previously treated with ipilimumab with a total of six histologically confirmed symptomatic lesions of RNB without any sign of active tumour following stereotactic irradiation of MBM are reported. These lesions were all originally thought to be disease recurrence. In two cases, ipilimumab was given prior to SRT; in the other two ipilimumab was given after SRT. The average time from first ipilimumab to RNB was 15 months. The average time from SRT to RNB was 11 months. The average time from first diagnosis of MBM to last follow-up was 20 months at which time three patients were still alive, one with no evidence of disease. These cases represent approximately three percent of the total cases of melanoma and ten percent of those cases treated with ipilimumab irradiated in our respective centres collectively. We report this to highlight this new problem so that others may have a high index of suspicion, allowing, if clinically warranted, aggressive surgical salvage, possibly resulting in increased survival. Further studies prospectively collecting data to understand the denominator of this problem are needed to determine whether this problem is just the result of longer survival or whether there is some synergy between these two modalities that are increasingly being used together.