Adamantinomatous craniopharyngioma (ACP) is an uncommon and anatomically variable tumor in children. The balance between critical treatment objectives, including the pursuit of gross total surgical resection and the reduction of hypothalamic injury and tumor recurrence, remains difficult and controversial. In this retrospective observational study, we compare the management and outcome of ACP in two large paediatric neurosurgical centres to determine how variations in tumor characteristics and management influence long-term outcomes. In this retrospective observational study, consecutive children (aged ≤ 18 years) diagnosed with primary ACP between 1997 and 2023 at two tertiary paediatric neurosurgical centres (Great Ormond Street Hospital (GOSH), United Kingdom, and Universidade de São Paulo (USP), Brazil) were evaluated. Functional outcomes related to pituitary function, hypothalamic injury, cognition, and vision were analysed. Scans were independently reviewed for tumor size, characteristics, and relationship to the optic apparatus and hypothalamus. Extent of surgery was documented. 123 patients (USP = 52; GOSH = 71) were included. Mean follow-up was 10.1 ± 5.6 years at USP and 7.5 ± 4.8 years at GOSH. There were no demographic differences. Rates of growth hormone deficiency (USP = 62.5 June 29–July 2, 2024
Design of a medical implant needs to ensure the device can be positioned accurately and removed subsequently if needed. This necessitates specific design considerations for implantation. This review is an opinion paper considering how an operation to introduce an implant into a patient may affect design, focusing on development of implantable artificial muscles (IAMs). Compatibility with endoscopic ports or the Seldinger technique will help deliver treatment with shorter hospital stay and quicker recovery. This means an IAM device has to have configurations to suit both deployment and use. Replacement of the device or removal as an emergency means it must be easy to extract without damage to the patient’s tissues, using standard surgical equipment. The implant has to be compatible with processes for sterilizing medical devices. But design of the packaging of the implant is equally important, since transfer of the device from its sterile-packaged storage state to the operating table for deployment into a patient is a vulnerable process in which contamination can occur. Implant surgery is a high-risk healthcare intervention. Those developing IAMs should consider aspects relating to surgical approach, deployment, wear, fixation, avoidance of perioperative complications and subsequent removal.
Light-responsive polymers hold great promise for remote or battery-free actuation in soft robotics. Yet, current systems often suffer from limited responsiveness, processability and biocompatibility-challenges that are particularly critical for muscle restoration applications. Here, we introduce MyoHybrid, a 'dual-photoresponsive' skeletal muscle actuator combining optogenetic myofibres with a scalable, unidirectionally aligned polyurethane-azobenzene (PAzo) nanofibre scaffold. The term 'dual-photoresponsive' refers to the synergy between intrinsic PAzo photoactuation-driven by coupled photochemical and photothermal effects-and optogenetically induced myofibre contractions. This anisotropic integration enables cooperative light-driven actuation of both nanofibres and myotubes. Compared with PAzo flat solid substrate, aligned PAzo nanofibres improved unidirectional myotube fusion by 25.3% and enhanced maturation by 37.7%. Furthermore, optogenetic stimulation of the resulting myofibres led to a 60% increase in contraction velocity and force relative to glass controls. MyoHybrid established a seamless interface between synthetic nanofibres and biological myofibres, offering a programmable platform for muscle-on-chip models, biohybrid actuators and light-driven soft tissue systems. This work bridges mechanical bionics and cellular actuation, advancing next-generation soft robotics and regenerative technologies.
Surgical implants, such as joint replacements, are used for many serious conditions. Innovation continues to supply new implants, including outputs of the soft robotics revolution. However, they carry risk of complications with potentially devastating consequences. We present an opinion paper providing the reflections of two surgical technologists on present challenges to safety, efficacy and broad implementation of medical implants. We highlight lack of familiarity with implant surgery in healthcare services, with concomitant risk. First-in-human application of new implants is not sufficiently standardized and regulated. IDEAL-D is a structured framework for medical devices (Idea, Development, Exploration, Assessment, Long-term study). Once CE-marked and approved for mainstream use, there are problems with the implementation. ‘Early adopter’ surgeons and centres face cultural inertia, lack of funding support and issues around training, especially learning curves. Patient selection may not be well-defined, and complications inaccurately reported, affecting implant dissemination detrimentally. The Cumberlege report showed how harmful this can be. There is need to standardize early clinical studies. Implementation of implantable devices requires changes to whole-team training, funding and post-implementation reporting. The IDEAL-D framework represents an important step, but other system-wide changes are required if implants are to achieve their intended clinical impact.
