Treatments of tenosynovial giant cell tumours of the temperomandibular joint: a report of three cases and a review of literature.

Tenosynovial giant cell tumours (TGCTs) are benign lesions affecting synovial joints. The classified subtypes are localized and diffuse. They seldom occur in the temporomandibular joint (TMJ). The aim of this study is to report on three new cases and to review the literature. One patient had surgical debulking with adjuvant external beam radiation therapy (EBRT). After 1year of follow-up, no evidence of disease was presented. The second patient was misdiagnosed and treated with denosumab. Debulking with adjuvant EBRT followed. Ten months postoperatively, no disease progression was seen. The third patient received systemic nilotinib and remained stable for over 5years. The literature review included 106 cases of which 95 had diffuse subtype. Most patients, had surgical excision. Thirteen (14%) patients received adjuvant EBRT. Eleven (14%) recurrences were identified. After 1-, 5- and 10 years of follow-up, an overall progression-free survival (PFS) of 99% (95% confidence interval (CI) 0.96-1), 80% (95% CI 0.68-0.94), 67% (95% CI 0.51-0.90) was calculated, respectively. Treatments for diffuse-TGCT-TMJ should be individualized depending on age, severity of symptoms, extent of disease and progression, expected mutilation of surgical interference, and current systemic treatment options. In stable disease a 'wait and see' policy, is a viable option. Additional treatments should be reserved for symptomatic, irresectable tumours or residual disease after surgical treatment with persistent complaints.

Segmental overlap: foot drop in S1 radiculopathy.

Knowledge of segmental innervation of skeletal muscles is essential for diagnosing lumbar radiculopathy. Myotomes and dermatomes are traditionally thought to be innervated by a single spinal segment, but experimental studies have shown that this pattern of segmental innervation allows considerable overlap. This implies that muscles (or dermatomes) are innervated not only by axons of one spinal segment, but also partially by axons of adjacent spinal levels. We describe a patient in whom overlap in segmental innervation complicated adequate diagnosis of a recurrent lumbar hernia. Further, we present an outline of electrophysiological and anatomical studies on segmental innervation.

[The treatment of brain metastases]. / De behandeling van hersenmetastasen.

Patients with cancer have a 15 to 30% risk of developing symptomatic brain metastases. The prognosis is extremely poor then: the median survival period is less than one year. Treatment strategies aim to guarantee an optimal quality of life. Curative treatment can only be given in just a few unique cases. Besides the previous standard treatment of whole-brain radiotherapy, the efficacy of other treatment modalities as surgery, radiosurgery, and systemic chemotherapy has been demonstrated to have additional value for certain indications. Important factors that play a role in the decision to give a specific treatment are the age and performance status of the patient, the number of brain metastases and their location, the systemic tumour activity, and the radiosensitivity and chemosensitivity of the primary tumour. A multidisciplinary approach is necessary to guarantee an optimal treatment plan.