The Manufacturing of 3D Printed models for the Neurotraumatological Education of Military Surgeons.

INTRODUCTION: When deployed abroad, military surgeons frequently have to deal with casualties involving head trauma. The emergency treatments, as well as craniotomies, are often performed by non-neurosurgeons qualified with basic neurotraumatological skills. Previous neurotrauma courses for education of non-neurosurgeons in Germany teach surgical emergency skills but do not include the training of skills needed to successfully utilize imaging in surgical planning, which is of importance for the safety and success of the treatment. To overcome these limitations, 3D printed models of neurotrauma cases were fabricated for application in the training of non-neurosurgeons. MATERIALS AND METHODS: Five models of actual neurotrauma cases from our neurosurgical department were segmented from CT scans and 3D printed using multi-part fused deposition modeling. Model quality was assessed with respect to the representation of pre-defined anatomical landmarks. The models were then fixed to a wooden mount with a central light source and covered by a latex mask for skin simulation. Surgical planning by means of craniometric measurements on the basis of available CT scans of the corresponding patients was then applied to the model. RESULTS: The 3D printed models precisely represented the cranium, the lesion, and anatomical landmarks, which are taken into consideration during surgical planning. Surface covering with washable latex masks ensured sufficient masking of the now non-noticeable lesion within the semi-translucent skull. Surgical planning was performed using washable marker drawings. When lighted, the otherwise non-visible lesion within the semi-translucent 3D printed craniums became visible and facilitated immediate success control for the course participants. CONCLUSION: The presented method provided a way to fabricate precise 3D models of neurotrauma cases, which are suitable to teach the application of medical imaging in surgical planning. For further benefit analysis, the application of the presented education tool needs to be investigated within a neurotrauma course.

ioCT-guided percutaneous radiofrequency ablation for trigeminal neuralgia: how I do it.

BACKGROUND: Percutaneous trigeminal nerve rhizotomy is usually performed by free-handed puncture of the foramen ovale under radiographic control with the patient kept semiconscious. The procedure has thus been reported to be highly uncomfortable for both the patient and surgeon. To our knowledge, this is the first description of a technique that includes precise navigated, CT-guided puncture of the foramen with the patient in general anesthesia and confirmation of needle placement by intraoperative CT. METHOD: Radiofrequency ablation of the trigeminal nerve was guided by intraoperative CT navigation with neuromonitoring of trigeminal nerve function. The patient was kept under general anesthesia during the procedure. CONCLUSION: CT-guided percutaneous trigeminal nerve rhizotomy is a safe and efficient treatment strategy for the management of trigeminal neuralgia without the need of the patient being in a semiconscious state.

Hypertrophic pachymeningoencephalitis associated with temporal giant cell arteritis.

We report the rare case of an 80-year-old male patient with hypertrophic pachymeningoencephalitis that may be associated with temporal arteritis. The patient presented to our neurological department with a 2-week history of latent paresis and ataxia affecting his right hand. He had been diagnosed with temporal arteritis 12 years earlier. Brain MRI showed an enhancement of the left-sided frontoparietal meninges with oedema of the adjacent tissue of the precentral and postcentral cortex. A leptomeningeal biopsy was performed. An autoimmune-mediated immunoglobulin G4-associated hypertrophic pachymeningoencephalitis was diagnosed. The patient received a high-dose corticosteroid therapy and his symptoms gradually improved. Our results suggest that hypertrophic pachymeningoencephalitis may occur as a complication of giant cell arteritis and may cause central neurological deficits by cerebral perifocal oedema.

Assessment of rhabdoid brain tumor by F-18 FDG PET, C-11 methionine PET and MRI.

A 28-year-old man with headache, nausea, and decreased vision had a left parieto-occipital tumor demonstrated by MRI. Postradical resection and histology showed a solid mass containing rhabdoid cells, 10% positive for Ki-67. After completing chemotherapy and radiotherapy treatment, follow-up MRI revealed possible tumoral recurrence. Cerebral F-18 FDG PET revealed no pathologic uptake, and C-11 methionine PET showed a pathologic low uptake. These findings suggested recurrence of a mild-grade aggressiveness tumor, which was confirmed by a second neurosurgical resection.

Use of twist-drill craniostomy with drain in evacuation of chronic subdural hematomas: independent predictors of recurrence.

BACKGROUND: Recurrence rates after chronic subdural hematoma (CSDH) evacuation with any of actual techniques [twist-drill craniostomy (TDC), burr-hole craniostomy, craniotomy] range from 5% to 30%. Use of drain has improved recurrence rates when used with burr-hole craniostomy. Now, we analyze predictors of recurrence of TDC with drain. METHOD: Three hundred twelve consecutive patients with CSDH have been studied in a retrospective study. Operative technique in all patients consisted in TDC with drain. Data recorded included any associated comorbidity. Radiologic measures of the CSDH before and after the procedure were studied. Clinical evaluation included Modified Rankin Scale, Glasgow Coma Scale (GCS), and neurological deficits. Two groups were compared: recurrence group and nonrecurrence group. Follow-up was for at least 1 year. RESULTS: Twelve percent experienced recurrence. Preoperative CSDH width, preoperative midline shift, postoperative midline width, postoperative CSDH width, and residual CSDH 1 month later were significantly associated with CSDH recurrence. The logistic regression model for the multivariate analysis revealed that postoperative midline shift and postoperative neurological deficit were significantly associated with CSDH recurrence. The duration of treatment with dexamethasone was found not to be related with recurrence. Mortality before hospital discharge was 1%. Hospital stay was 2.5 days. CONCLUSIONS: TDC with drain has similar results in recurrence rates, morbidity, mortality, and outcome as other techniques as burr-hole craniostomy with drain. Preoperative and postoperative hematoma width and midline shift are independent predictors of recurrence. Brain re-expansion and time of drain maintenance are important factors related with recurrence of CSDH. Future CSDH reservoirs must avoid negative pressure and sudden pressure changes inside the whole closed drain system.