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Neurenteric cyst in a split cord malformation is a rare finding. We report an adult female becoming acutely symptomatic secondary to an expanding neurenteric cyst, though previous imaging had demonstrated stability. We discuss our workup and management with surgical resection and possible etiologies of her acute decline.

Background Patients require vitamin and mineral supplementation after bariatric surgery to prevent the development of micronutrient deficiencies. Consuming oral supplements is challenging due to gastric volume restriction. A transdermal patch dosage form may provide adequate micronutrient supplementation without pill burden. The study aims to determine the percentage of patients who have two or more nutritional deficiencies one year after surgery and to determine serum nutrient concentrations and gastrointestinal symptoms over time. Methods Patients who planned to undergo bariatric surgery and preferred transdermal patches versus oral supplements were recruited during preoperative office visits. Enrolled patients were instructed to use a transdermal multivitamin patch as per the manufacturer's instructions. Serum nutrient concentrations and Gastrointestinal Symptom Response Scale scores were determined at baseline and three months, six months, and one year after surgery. Results Ninety-two participants completed the study protocol. Twenty-five participants had a full panel of study labs one year after surgery. Among these patients, 19% had two or more micronutrient deficiencies. Vitamin D was the most common deficiency followed by vitamin B6; however, median serum concentrations of both nutrients increased over time. Vitamin B1, folate, and zinc deficiencies were also observed. There were no changes in gastrointestinal symptoms. Conclusions Additional studies, including randomized controlled trials, are required to determine if the PatchMD Multivitamin Plus patch (Pilot Rd. STE. B, Las Vegas) can provide adequate supplementation of vitamins and minerals. The patch was not associated with changes in gastrointestinal symptoms.

Throughout this chapter, we will discuss the various breakthroughs in methodology associated with convection-enhanced delivery (CED). Several preclinical trials will be discussed, focusing on how they laid the groundwork for human trials, and how they have raised questions regarding the ideal parameters for CED treatment. This chapter will discuss the limited clinical trials of CED for glioblastoma (GBM), with emphasis on the only Phase III trial to date, the PRECISE trial, along with some of its shortcomings. We will briefly explore the future of CED research, and the hope that it can be used as a method for sensitizing recurrent GBM to other therapies as well.