Multimaterial 3D printing preoperative planning for frontoethmoidal meningoencephalocele surgery.

INTRODUCTION: Surgical correction of frontoethmoidal meningoencephalocele, although rare, is still challenging to neurosurgeons and plastic reconstructive surgeons. It is fundamental to establish reliable and safe surgical techniques. The twenty-first century has brought great advances in medical technology, and the 3D models can mimic the correct tridimensional anatomical relation of a tissue organ or body part. They allow both tactile and spatial understanding of the lesion and organ involved. The 3D printing technology allows the preparation for specific surgery ahead of time, planning the surgical approach and developing plans to deal with uncommon and high-risk intraoperative scenarios. CASE PRESENTATION: The present report describes a case of frontoethmoidal encephalocele, (nasofrontal subtype) of a 19-month-old girl, whose surgical correction was planned using 3D printing modeling. CONCLUSION: The 3D model allowed a detailed discussion of the aspects of the surgical approach by having tissues of different consistencies and resistances, and also predicting with millimetric precision the bilateral orbitotomy measurements. Moreover, it was a fundamental and valuable factor in the multidisciplinary preoperative discussion. This approach allowed reducing the time of surgery, accurately planning the location of the osteotomies and precontouring the osteosynthesis material. 3D models can be very helpful tools in planning complex craniofacial operative procedures.

Fatores de prognóstico favorável em pacientes com glioblastoma / Favorable prognostic factors in patients with glioblastoma

O objetivo deste trabalho foi identificar, os fatores que contribuem para o prognóstico favorável em pacientes com glioblastoma, de modo a fornecer dados que possam auxiliar no manejo desses pacientes. Trata-se de uma revisão sistemática da literatura científica, dos últimos nove anos, nas bases de dados PubMed e Web of Science, utilizando os descritores "glioblastoma and prognostic factors". Aplicados os critérios de inclusão e exclusão, foram selecionados 23 artigos, os quais foram utilizados no desenvolvimento do trabalho. As variáveis mais estudadas foram idade, Karnofsky Perfomance Scale pré-operatório tratamento cirúrgico, terapia adjuvante, extensão da doença, alterações genéticas e moleculares. Fatores clínicos, genéticos, aspectos do tumor e tratamento mostraram ser importantes para o melhor prognóstico desses pacientes. Dentre esses, apresentam maiores chances de melhoria os mais jovens, com bom estado de performance inicial Karnofsky Performance Scale pré-operatório, tumor único, unilateral, tratado com cirurgia de ressecção extensa e radioterapia e quimioterapia adjuvantes (inclusive se for idoso), e panorama genético molecular favorável (aumento da expressão de N-myc downstream-regulated gene-1 em glioma em comparação com os tecidos normais do cérebro; hipermetilação do gene O6-metilguanina-metiltransferase; mutação Isocitrate Dehydrogenase-1 e ausência de expressão de Single-Stranded Deoxyribonucleic Acid-Binding Protein-2.

This review aims to identify protective factors that contribute to a favorable prognosis in patients with glioblastoma, and thereby provide data to best manage these patients. This is a systematic review of scientific articles published in the last nine years indexed in the databases PubMed and Web of Science, using the keywords "glioblastoma and prognostic factors". Twenty-three articles met the inclusion criteria for the review. The most studied variables were age, preoperative Karnofsky Performance Scale, surgical treatment, adjuvant therapy, extent of disease, and molecular/genetic changes. Tumor clinical, genetic, and treatment aspects proved to be important for a better prognosis. Patients with the best prognosis are young, have the best preoperative Karnofsky Performance Scale, have a single unilateral tumor, are treated with surgical resection, radiotherapy, and chemotherapy (even older people); and have favorable molecular/genetic features (high N-myc downstream-regulated gene-1 expression in glioma compared with normal brain tissues; hypermethylation of O6-metilguaninametiltransferase gene; Isocitrate Dehydrogenase-1 mutation; and absence of SingleStranded Deoxyribonucleic Acid-Binding Protein-2 expression).