ABSTRACT
Purpose@#. The purpose of the study was to fabricate a prototype robotic simulator for dental education, to test whether it could simulate mandibular movements, and to assess the possibility of the stimulator responding to stimuli during dental practice. @*Materials and methods@#. A virtual simulator model was developed based on segmentation of the hard tissues using cone-beam computed tomography (CBCT) data. The simulator frame was 3D printed using polylactic acid (PLA) material, and dentiforms and silicone face skin were also inserted. Servo actuators were used to control the movements of the simulator, and the simulator’s response to dental stimuli was created by pressure and water level sensors.A water level test was performed to determine the specific threshold of the water level sensor. The mandibular movements and mandibular range of motion of the simulator were tested through computer simulation and the actual model. @*Results@#. The prototype robotic simulator consisted of an operational unit, an upper body with an electric device, a head with a temporomandibular joint (TMJ) and dentiforms. The TMJ of the simulator was capable of driving two degrees of freedom, implementing rotational and translational movements. In the water level test, the specific threshold of the water level sensor was 10.35 ml. The mandibular range of motion of the simulator was 50 mm in both computer simulation and the actual model. @*Conclusion@#. Although further advancements are still required to improve its efficiency and stability, the upper-body prototype simulator has the potential to be useful in dental practice education.
ABSTRACT
We report a rare case of pericatheter abscess formation after scalp acupuncture in a 25-year-old woman who had a history of meningitis and hydrocephalus, which were treated using ventriculoperitoneal shunt placement at the age of 5 years. Prior to the current hospitalization, the patient received acupuncture therapy for a subgaleal hematoma. Clinical and laboratory examinations revealed a retained catheter and an associated abscess in the lateral neck. The abscess was immediately treated with radical debridement, washing of the cavity, and removal of the implant. Culture studies of the pus drainage yielded Staphylococcus aureus. The patient recovered well after active antibiotic treatment. Considering the increasing application of this alternative medicine modality by practitioners, careful interventions are required to minimize acupuncture-related infections and other serious complications.
ABSTRACT
Surgery for the placement of a ventriculoperitoneal shunt incurs numerous procedure-related complications. Distal dislodgment of the device from the cranial insertion site after pumping of the shunt chamber has rarely occurred and it has not been evaluated to date. Herein, we report an interesting case of a 20-year-old man who underwent shunt revision for ventricular catheter migration after a manual pumping test. We reviewed previously reported cases related to such rare conditions and described a simple method of valve fixation for preventing disconnection and migration of the proximal shunt system.
ABSTRACT
Intracranial immature teratoma is an extremely rare disease with poor prognosis and requires complicated treatment. Owing to the deep midline location of the tumor, total surgical resection of the tumor is challenging. We present our experience with a fast-growing pineal gland immature teratoma in a 4-year-old boy, who presented with obstructive hydrocephalus and abducens nerve palsy, which was treated with total surgical resection of the tumor. In addition, we aimed to determine the appropriate treatment modality for intracranial immature teratomas by reviewing the literature and investigating the prognosis.
ABSTRACT
Glioependymal cyst (GEC) is an uncommonly observed clinical entity in the posterior cranial fossa. A 36-year-old female with cystic lesion in the right cerebellum was hospitalized for evaluating headache and dizziness. Brain images showed a well-defined, ovoid mass adjacent to the fourth ventricle. After drainage and excision of the cyst, the patient became symptom free. Pathology examination disclosed low cuboidal epithelium and glial cells in the cyst wall. The radiological features, neurological manifestations, and the operations for GECs of the present localization are described in this short communication.
ABSTRACT
Glioependymal cyst (GEC) is an uncommonly observed clinical entity in the posterior cranial fossa. A 36-year-old female with cystic lesion in the right cerebellum was hospitalized for evaluating headache and dizziness. Brain images showed a well-defined, ovoid mass adjacent to the fourth ventricle. After drainage and excision of the cyst, the patient became symptom free. Pathology examination disclosed low cuboidal epithelium and glial cells in the cyst wall. The radiological features, neurological manifestations, and the operations for GECs of the present localization are described in this short communication.
ABSTRACT
Cushing syndrome (CS) is rare in pregnancy, and few cases have been reported to date. Women with untreated CS rarely become pregnant because of the ovulatory dysfunction induced by hypercortisolism. It is difficult to diagnose CS in pregnancy because of its very low incidence, the overlap between the clinical signs of hypercortisolism and the physiological changes that occur during pregnancy and the changes in hypothalamus-pituitary-adrenal axis activity that occur during pregnancy and limit the value of standard diagnostic testing. However, CS in pregnancy is associated with poor maternal and fetal outcomes; therefore, its early diagnosis and treatment are important. Here, we report two patients with CS that was not diagnosed during pregnancy, in whom maternal and fetal morbidity developed because of hypercortisolism.
ABSTRACT
The vast majority of intracranial chondromas are located in the base of the cranium. Their presentationas an intracerebral neoplasm is considered to be extremely rare. A previously healthy 45-year-old manexperienced recurrent seizure attacks over a period of 6 months. Imaging studies of the brain revealedan ovoid and calcified mass which involve the cortex in the left frontal lobe. Intraoperatively, the masshad no adhesion to the dura and arachnoid membrane. The tumor was completely removed and thefinal diagnosis was intracerebral chondroma. The patient remained free of disease over the period of18-years follow-up. This communication adds an unusual case to the literature on the chondroma thatexpressed in the form of an intra-axial space-occupying lesion in the frontal lobe.
ABSTRACT
Pineal cysts (PCs) are often encountered as incidental findings in intracranial images. The vast majorityof cysts are normally asymptomatic and clinically benign. Bleeding into the cysts, which leads to neurologicalsymptoms and signs, is considered to be quite rare. The authors illustrate a newly identifiedcomplication of PC in a 56-year-old woman who characterized by headache of sudden onset and vomiting.MRI disclosed a small hemorrhagic PC without narrowing of the cerebral aqueduct. The patientwas managed conservatively without any surgical interventions, and she remained symptom-free overa period of 15-year follow-up. The description of this case adds to the limited literature on the series inwhich nonsurgical treatments had a role in the care for patients with PC complicated by intracystichemorrhage.
ABSTRACT
Clip compression injury of oculomotor nerve (ON) is a preventable complication of aneurysm microsurgery. The author illustrates this condition in which ON was inadvertently occluded by the clip during repairing posterior communicating artery (PcoA) aneurysm. The report indicates that the surgeon should be meticulous in identifying and protecting ON at clipping stage when PcoA aneurysm prematurely bursts.
ABSTRACT
BACKGROUND: Pilocytic astrocytoma (PA) is a brain tumor that is relatively more common in children and young adults. METHODS: We retrospectively reviewed the medical records of patients with PA treated at a single center between 1988 and 2018. RESULTS: We included 31 subjects with PA. The median age at diagnosis was 13.4 years, and the median follow-up duration was 9.9 years. The total PA group had a 10-year disease-specific survival (DSS) rate of 92.6% [95% confidence interval (CI), 82.6–100] and 10-year progression-free survival (PFS) rate of 52.8% (95% CI, 32.0–73.6). In patients aged <20 years, tumors were more likely to be located in sites in which gross total tumor resection (GTR) was impossible. No statistically significant difference in 10-year DSS was found between the GTR (100%) and non-GTR (89.7%; 95% CI, 76.2–100; p=0.374) groups. However, a statistically significant difference in 10-year PFS was found between the GTR (100%) and non-GTR groups (30.7%; 95% CI, 8.6–52.8; p=0.012). In the non-GTR group, no statistically significant difference in 10-year DSS was found between the patients who received immediate additional chemotherapy and/or radiotherapy (Add-Tx group, 92.9%; 95% CI, 79.4–100) and the non-Add-Tx group (83.3%; 95% CI, 53.5–100; p=0.577). No statistically significant difference in 10-year PFS was found between the Add-Tx group (28.9%; 95% CI, 1.7–56.1) and non-Add-Tx group (33.3%; 95% CI, 0–70.9; p=0.706). CONCLUSION: The PFS of the patients with PA in our study depended only on the degree of surgical excision associated with tumor location. This study is limited by its small number of patients and retrospective nature. A multicenter and prospective study is necessary to confirm these findings.
Subject(s)
Adolescent , Child , Humans , Young Adult , Astrocytoma , Brain Neoplasms , Diagnosis , Disease-Free Survival , Drug Therapy , Follow-Up Studies , Glioma , Medical Records , Prognosis , Prospective Studies , Radiotherapy , Retrospective Studies , SurvivorsABSTRACT
The author has encountered a 67-year-old man with dural arteriovenous fistula (AVF) presenting as a non-traumatic chronic subdural hematoma (CSDH). This previously healthy patient was hospitalized due to progressive headache with subacute onset. He underwent burr-hole surgery twice for evacuating the left CSDH that was thickest at the posterior temporal area. The operative procedure and finding was not extraordinary, but subdural hematoma slowly progressed for days following the revision surgery. After investigation by super-selective external carotid angiography, a dural AVF found near the transverse-sigmoid sinus was diagnosed. Dural AVF was completely occluded with trans-arterial injecting polyvinyl alchol particles into the petrosquamosal branch of the middle meningeal artery. The patient showed a good neurological outcome with no additional intervention. Brain surgeons have to consider the possibility of dural AVF and perform cerebral angiogram if necessary when they manage the cases that have a spontaneously occurred and repeatedly recurring CSDH.
Subject(s)
Aged , Humans , Angiography , Arteriovenous Fistula , Brain , Central Nervous System Vascular Malformations , Headache , Hematoma, Subdural , Hematoma, Subdural, Chronic , Meningeal Arteries , Polyvinyls , Surgeons , Surgical Procedures, OperativeABSTRACT
No abstract available.
Subject(s)
Humans , Brain , Hemangioma, Cavernous , Neoplasm Metastasis , Thyroid Gland , Thyroid NeoplasmsABSTRACT
PURPOSE: To investigate treatment outcome and long term complication after surgery and radiotherapy (RT) for pituitary adenoma. MATERIALS AND METHODS: From 1990 to 2009, 73 patients with surgery and RT for pituitary adenoma were analyzed in this study. Median age was 51 years (range, 25 to 71 years). Median tumor size was 3 cm (range, 1 to 5 cm) with suprasellar (n = 21), cavernous sinus extension (n = 14) or both (n = 5). Hormone secreting tumor was diagnosed in 29 patients; 16 patients with prolactin, 12 patients with growth hormone, and 1 patient with adrenocorticotrophic hormone. Impairment of visual acuity or visual field was presented in 33 patients at first diagnosis. Most patients (n = 64) received RT as postoperative adjuvant setting. Median RT dose was 45 Gy (range, 45 to 59.4 Gy). RESULTS: Median follow-up duration was 8 years (range, 3 to 22 years). In secreting tumors, hormone normalization rate was 55% (16 of 29 patients). For 25 patients with evaluable visual field and visual acuity test, 21 patients (84%) showed improvement of visual disturbance after treatment. The 10-year tumor control rate for non-secreting and secreting adenoma was 100% and 58%, respectively (p < 0.001). Progression free survival rate at 10 years was 98%. Only 1 patient experienced endocrinological recurrence. Following surgery, 60% (n = 44) suffered from pituitary function deficit. Late complication associated with RT was only 1 patient, who developed cataract. CONCLUSION: Surgery and RT are very effective and safe in hormonal and tumor growth control for secreting and non-secreting pituitary adenoma.