A hybrid simulation model for pre-operative planning of transsphenoidal encephalocele.

Congenital transsphenoidal encephalocele (CTE) surgical correction is a challenging procedure. Although rare, this anomaly, characterized with neural herniation elements, including the pituitary gland or optic pathway through the sphenoid bone with anatomical alteration, can be presented in many different ways and should be individually analyzed. Significant advances in medical technology and the 3D models may simulate the complex anatomical relations of the human body. Nowadays, medical education relies on the availability of standardized materials that can reliably emulate human anatomy. Therefore, realistic anatomical models have become an alternative for cadavers or animal specimens. In this technical note, the authors present a new technique to create personalized models that combine 3D printing, molding, and casting to create an anatomically and tactilely realistic model based on magnetic resonance and computerized tomography images. Produced from different silicon types, the model recreated the anatomic alterations precisely, allowing a multidisciplinary team to determine the adequate surgical approach for this patient. We describe a case of congenital transsphenoidal encephalocele of a 3-year-old boy, whose surgical correction was planned using a hybrid model. The technical description of the model is given in detail. This new hybrid model allowed a detailed discussion of the surgical approach aspects by having tissues of different consistencies and resistances and a very high prediction rate. This approach may allow a reduction in surgery time and possible complications after operative procedures.

Closure of Skull Base Defects after Endonasal Endoscopic Resection of Planum Sphenoidale and Tuberculum Sellae Meningiomas.

BACKGROUND: The expanded endoscopic endonasal transplanum transtuberculum approach allows tumor removal by minimally invasive procedures. A large dural and bone defect is created during the surgical procedure, increasing the risk of postoperative cerebrospinal fluid (CSF) leakage. OBJECTIVE: The aim of this study is to describe a surgical technique and complications observed in patients undergoing endonasal resection of planum sphenoidale and/or tuberculum sellae meningiomas. METHODS: A retrospective analysis was performed of patients with planum sphenoidale and/or tuberculum sellae meningiomas after expanded endoscopic endonasal resection between June 2013 and August 2018, in which autologous grafts, fascia lata inlay, and nasoseptal flap onlay were used for closure of skull base defects. RESULTS: Ten patients were included in the analysis. No cases of postoperative CSF leakages or meningitis were reported, whereas two patients evolved with postoperative infectious complications (fungal ball in right frontal sinus and brain abscess). The skull base defect created for resection measured, on average, 3.58 cm2. CONCLUSION: Our experience suggests that closure of skull base defects using combined fascia lata inlay and nasoseptal flap onlay is effective for preventing postoperative CSF leakage in resection of planum sphenoidale and/or tuberculum sellae meningiomas, and offers high reproducibility due to its low cost.

Successful osimertinib rechallenge following drug-induced pneumonitis after previous anti-PDL1 exposure.

Osimertinib is a first-line treatment option for patients with metastatic non-small cell lung cancer (NSCLC) harbouring EGFR mutations. Pneumonitis is a severe adverse event (AE) related to osimertinib treatment which appears to be more frequent when associated with concurrent or previous anti-PD(L)1 exposure. Data regarding the efficacy and safety of osimertinib rechallenge, especially in the setting of central nervous system (CNS) metastases, are scarce. We herein describe a case of a 53-year-old patient with metastatic EGFR-mutated NSCLC, who developed pneumonitis after osimertinib treatment and was successfully rechallenged with 40 mg daily osimertinib, with CNS response. This dose reduction strategy may be an option for selected patients with brain metastases after tyrosine kinase inhibitors-induced AEs.

Cystic brain metastases in ALK-rearranged non-small cell lung cancer.

The central nervous system (CNS) is a common site of disease progression in patients with non-small-cell lung cancer (NSCLC) with anaplastic lymphoma kinase (ALK)-rearrangement treated with crizotinib. Cystic brain metastases (CBM) have been recently identified as one possible variant of this disease. An illustrative case report is presented along with a literature review performed in order to track relevant papers about CBM in ALK-rearranged NSCLC, including possible pathophysiology, differential diagnosis and treatment options for this condition. Three case reports have been published describing six ALK-rearranged NSCLC patients presenting with CBM, all of which were under treatment with crizotinib by the time of CBM diagnosis. Treatment with CNS-penetrating tyrosine kinase inhibitors (TKIs) resulted in CNS disease control in three of the six cases reported either as single therapy or in combination with radiation therapy (RT). Investigation of differential diagnoses of CBM might be necessary, which include inflammatory and demyelinating disorders, primary brain tumours and infectious diseases, especially neurocysticercosis that might mimic CBM images. Treatment options include RT, CNS-penetrating TKIs and invasive procedures, such as stereotactic drainage. Thus, CBM are associated with ALK-rearranged NSCLC, particularly in patients who use crizotinib and should prompt investigation of differential diagnosis. CNS-penetrating TKIs are effective in the control of solid brain metastases and also seem to be active in CBM as single therapy or in combination with RT.

Postsurgical imaging of the oral cavity and oropharynx: what radiologists need to know.

The oral cavity and oropharynx are common locations of neoplastic lesions; neoplasms at these sites are often treated with surgery. The goal of this surgical treatment is to achieve tumor control while preserving, whenever possible, the function of local structures. The procedure used depends largely on the location and extension of the tumor and the disease stage. Follow-up evaluation of patients is done with computed tomography (CT) and magnetic resonance (MR) imaging. The ability to interpret characteristic features at CT and MR imaging is particularly important because normal anatomic structures are altered in specific patterns according to the distinct surgical technique applied. Anatomic changes resulting from the most commonly performed procedures (eg, glossectomy, pelvectomy, and mandibulectomy) will be presented with CT and MR images, multiplanar reconstructions, and schematic illustrations. Understanding of postsurgical CT and MR imaging findings is important to avoid misinterpretation and confusion. Familiarity with the typical postsurgical imaging appearance of the oral cavity and oropharynx is crucial for differentiating normal postsurgical changes from persistent or recurrent disease and for diagnosis of associated second primary malignancies. Knowledge of postsurgical findings is essential for analysis of the oral cavity and oropharynx and allows early diagnosis of tumor recurrence or typical complications after surgical reconstruction.

Lipomyelocele with osseous dysraphic hamartoma in a child: a case report.

Lipomyelocele is a well-known vertebral malformation that affects intraspinal and extraspinal tissues and compartments. However, other tissues can be associated with the lipomatous component, such as well-developed bones in unusual sites. This association is consistent with dysraphic hamartoma, one of the rarest malformations of the vertebral canal closure. We describe an 8-year-old girl without neurological deficit with a voluminous lipomyelocele associated with a well-developed flat bone articulated to the left iliac wing. We reviewed the role of magnetic resonance and computed tomography with tridimensional reconstruction in this rare form of spinal dysraphism and described the imaging features.