Photo-Stacking Technique for Neuroanatomical High-Definition Photography and 3-Dimensional Modeling.

BACKGROUND: Three-dimensional (3D) neuroanatomical knowledge is vital in neurosurgery. Technological advances improved 3D anatomical perception, but they are usually expensive and not widely available. The aim of the present study was to provide a detailed description of the photo-stacking technique for high-resolution neuroanatomical photography and 3D modeling. METHODS: The photo-stacking technique was described in a step-by-step approach. The time for image acquisition, file conversion, processing, and final production was measured using 2 processing methods. The total number and file size of images are presented. Measures of central tendency and dispersion report the measured values. RESULTS: Ten models were used in both methods achieving 20 models with high-definition images. The mean number of acquired images was 40.6 (14-67), image acquisition time 51.50 ± 18.8 s, file conversion time 250 ± 134.6 s, processing time 50.46 ± 21.46 s and 41.97 ± 20.84 s, and 3D reconstruction time was 4.29 ± 0.74 s and 3.89 ± 0.60 s for methods B and C, respectively. The mean file size of RAW files is 1010 ± 452 megabyte (MB) and 101.06 ± 38.09 MB for Joint Photographic Experts Group files after conversion. The mean size of the final image means size is 71.9 ± 0.126 MB, and the mean file size of the 3D model means is 37.4 ± 0.516 MB for both methods. The total equipment used was less expensive than other reported systems. CONCLUSIONS: The photo-stacking technique is a simple and inexpensive method to create 3D models and high-definition images that could prove valuable in neuroanatomy training.

Current Approach of Functioning Head and Neck Paragangliomas: Case Report of a Young Patient with Multiple Asynchronous Tumors.

Introduction. Pheochromocytomas (Pheo) and paragangliomas (PGL) are rare neuroendocrine tumors arising from chromaffin cells of the adrenal medulla and from the extra-adrenal autonomic paraganglia, respectively. Only 1-3% of head and neck PGL (HNPGL) show elevated catecholamines, and at least 30% of Pheo and PGL (PCPG) are associated with genetic syndromes caused by germline mutations in tumor suppressor genes and proto-oncogenes. Clinical Case. A 33-year-old man with a past medical history of resection of an abdominal PGL at the age of eleven underwent a CT scan after a mild traumatic brain injury revealing an incidental brain tumor. The diagnosis of a functioning PGL was made, and further testing was undertaken with a PET-CT with 68Ga-DOTATATE, SPECT-CT 131-MIBG, and genetic testing. Discussion and Conclusion. The usual clinical presentation of functioning PCPG includes paroxistic hypertension, headache, and diaphoresis, sometimes with a suggestive family history in 30-40% of cases. Only 20% of PGL are located in head and neck, of which only 1-3% will show elevated catecholamines. Metastatic disease is present in up to 50% of cases, usually associated with a hereditary germline mutation. However, different phenotypes can be observed depending on such germline mutations. Genetic testing is important in patients with PCPG since 31% will present a germline mutation. In this particular patient, an SDHB gene mutation was revealed, which can drastically influence the follow-up plan and the genetic counsel offered. A multidisciplinary approach is mandatory for every patient presenting with PCPG.SDHB gene mutation was revealed, which can drastically influence the follow-up plan and the genetic counsel offered. A multidisciplinary approach is mandatory for every patient presenting with PCPG.

Treatment of craniopharyngioma in adults: systematic analysis of a 25-year experience.

BACKGROUND AND AIMS: Craniopharyngioma is a rare and mostly benign epithelial tumor of the central nervous system, mostly affecting children. Considering that most of the published series of craniopharyngioma are based on pediatric populations, studies in adults gain importance based mainly on the reduced number of cases and the possible differences emerging from a mostly different histological type. We undertook this study to establish the pattern of presentation, morphological features and specific characteristics of craniopharyngioma in an adult Mexican population, as well as discussing the long-term outcome and how it may be influenced by surgical, anatomic and clinical factors. METHODS: A total of 153 adult patients (16 years or older) underwent transcranial and transsphenoidal surgery between January 1985 and December 2009, all with histological confirmation of craniopharyngioma. Hypothalamic involvement, surgical complications, rate of tumor resection and endocrinological outcome were evaluated. RESULTS: Seventy nine males (51.6%) and 74 females (48.4%) were included. Mean age at diagnosis was 32.4 years (range: 16-77 years). Mean initial tumor volume was 28.44 mL (range: 0.18-100.44 mL). Partial or complete hypothalamic involvement (Samii Grades III, IV and V) was found in 90.2%. The overall rate of new endocrinopathies was 37.25% after surgery (95% CI = 33.9-41.2). CONCLUSIONS: Gross total removal of craniopharyngiomas with large hypothalamic involvement was related to poor neuroendocrine outcome in adults. Partial removal should be indicated, associated with adjuvant therapy, in order to improve postoperative neuroendocrine status.

Efecto del tratamiento quirúrgico de los adenomas de la hipófisis sobre la función visual / Results of surgical treatment of pituitary adenomas with compression of optic pathway

Uno de los síntomas más importantes producidos por el crecimiento de los tumores de la hipófisis es la afección de las vías ópticas. El diagnóstico temprano y la descompresión dependerá el resultado terapéutico. Se analizan 49 casos tratados quirúrgicamente por vía transcraneal y transesfenoidal, y el efecto del tratamiento en la función visual; así como, la necesidad de seguimiento de estos tumores.

Evaluación funcional del músculo temporal en el abordaje pterional / Funtional evaluation of temporal muscle in the pterional approach

La craneotomía pterional es uno de los abordajes más comunes dentro de la neurocirugía, tienen inconvenientes tales como la sección del músculo temporal que ocasiona defectos estéticos importantes. Se realizó un estudio comparativo para evaluar las técnicas de disección del músculo temporal en el abordaje pterional y definir cuál es la que presenta menor lesión al músculo, así como a la rama frontotemporal del nervio facial. Las tres técnicas evaluadas fueron: I. La sección muscular transversal, II. Disección subfacial, y III. Craneotomía osteoplástica. En todos los pacientes se valoró un procedimiento quirúrgico unilateral, con evolución neurológica favorable y participación voluntaria. Se encontraron los mejores resultados cosméticos para el grupo 2, con un hundimiento de la fosa temporal de 1.08 mm contra 2.6 mm para los del grupo 1 (p=0.0020) y 2 mm para el grupo 3 ( p=0.033). En ningún caso hubo datos clínicos de lesión a la rama frontotemporal del nervio facial. La electromiografía tuvo pocos cambios en el grupo 2. Se concluyó que el abordaje subfacial tiene los mejores resultados estéticos y funcionales, es una técnica que ofrece un adecuado corredor quirúrgico sin que la disección y reparación de la fascia del músculo temporal modificaran de manera significativa el tiempo quirúrgico.