A 3D printing custom-made mask model was tested in terms of feasibility and accuracy for frameless neuronavigation during retrosigmoid approach.
A virtual 3D model of a cadaveric injected head was ...obtained from a high-resolution Computed Tomography (CT) scan and 3D Printed (3DP). The course of the transverse and sigmoid sinus was marked. A transparent custommade 3DP mask model was created as a cast of 3D model. The area of the lateral sinuses was grooved to allow the surgeon to use the mask as a template to draw the course of the sinuses on the patient skull. A right retrosigmoid approach was performed on formalin-fixed injected cadaveric head. Inion and other conventional landmarks were used to mark the course of the sinuses. 3DP mask was used to re-mark the course of the sinuses. The mismatch between the landmarks-based and 3DP mask-based track was assumed as a measure of the accuracy of the 3DP mask model.
3DP mask model resulted precise, feasible, easy and fast to use. A perfect interlocking with the retrosigmoid area was noted. Mismatch between the landmarks-based and 3DP mask-based track was of 4 and 6 mm for transverse and sigmoid sinus, respectively.
3DP custom-made mask model is feasible, easily reproducible and reliable for the implementation of a frameless neuronavigation during retrosigmoid approach. Its accuracy is greater than that of the bone landmark neuronavigation. In selected cases, 3DP mask can be a valid option to image-guided optical or electromagnetic tracking systems.
3D Printing, Neuronavigation, Retrosigmoid Approach, Sigmoid Sinus, Transverse Sinus.
Abstract
OBJECTIVE
Ganglioglioma is a primary central nervous system low-grade tumor composed of mixed populations of glial and neuroepithelial elements.
METHODS
The authors report a case of ...ganglioglioma in a patient affected by Peutz-Jeghers syndrome, an autosomal dominant disease with varying expressions and incomplete penetrance responsible for an increased risk of gastrointestinal and other malignant tumor forms.
RESULTS
The polymerase chain reaction products of exon 6 of STK11/LKB1 showed an abnormal pattern in the single-strand conformation polymorphism analysis. Further sequencing analysis of the exon 6 identified a deletion of T and an insertion of AC at nucleotide 821 causing a shift of the reading frame. The same mutation was found in the patient's peripheral blood. The ribonucleic acid analysis on the ganglioglioma cells revealed an out-of-frame STK11 isoform, characterized by an exon 4 skipping, which resulted in nonsense mediated decay sensitive.
CONCLUSION
This report details the molecular genetic analysis of a ganglioglioma that allowed the identification of a new mutation.
In the last 20 years, there have been advances in techniques and instrumentation for intracranial aneurysm exposure and obliteration 94. However, it seems that 32% of the patients, who underwent ...surgery, suffer a fatal outcome or some form of sequelae 20. Primary brain damage due to subarachnoid haemorrhage (SAH) and to a vasospasm, is the major cause of mortality and morbidity; but surgery-related complications constitute 14% of the morbidity 20. Indeed, the surgical therapy of cerebral aneurysms carries several risks related to manipulation, accidental or intentional blood vessels clipping, or bleeding due to premature aneurysm rupture, suggesting room for improvement in surgical procedures.
Today, electrophysiological monitoring with somatosensory and motor evoked potential (SSEP and MEP) recording, and electroencephalographic (EEG) monitoring, are frequently used in aneurysm surgery, and they are the standard techniques used in level assessing of cerebroprotective anaesthesia and monitoring ischemia during surgical manoeuvres.
In this chapter, we report our experience in using neurophysiopathological monitoring during aneurysm surgery with particular reference at the evoked potential and EEG changes in response to surgical and anaesthetic variables; we also give technical advice and discuss clinical applications. However, to prove intraoperative usefulness, these techniques require a dedicated knowledge, both technical and pathophysiological. .
Background
Cytomegalovirus (CMV) is the major and most common opportunistic infection complicating lung transplant (LTX). The aim of this study was to analyse the epidemiological aspects of CMV ...infection in lung transplant patients subject to a pre-emptive anti-CMV approach and to study the impact of this infection on lung transplant outcome, in terms of onset of chronic lung allograft dysfunction (CLAD).
Methods
This single-centre retrospective study enrolled 87 LTX patients (median age 55.81 years; 41 females, 23 single LTX, 64 bilateral LTX). All patients were managed with a pre-emptive anti-CMV approach. The incidences of the first episode of CMV infection, 1, 3, 6 and 12 months after LTX, were 12.64%, 44.26%, 50.77% and 56.14%. A median interval of 41 days elapsed between LTX and the first episode of CMV infection. The median blood load of CMV-DNA at diagnosis was 20,385 cp/ml; in 67.64% of cases, it was also the peak value. Patients who had at least one episode had shorter CLAD-free survival. Patients who had three or more episodes of CMV infection had the worst outcome.
Results
CMV infection was confirmed to be a common event in lung transplant patients, particularly in the first three months after transplant. It had a negative impact on transplant outcome, being a major risk factor for CLAD. The hypothesis that lower viral replication thresholds may increase the risk of CLAD is interesting and deserves further investigation.
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