A novel technique for skull base reconstruction in craniofacial fibrous dysplasia surgery using three-dimensional printing and a dental alginate mold: illustrative case.

BACKGROUND: Fibrous dysplasia is a rare and benign skeletal lesion characterized by fibrous tissue proliferation due to an abnormal osteogenesis replacing normal bone. OBSERVATIONS: An 18-year-old male with fibrous dysplasia of the left sphenoid, ethmoid, orbit, and frontal bones was managed with excision and skull base reconstruction. After complete removal of the tumor, skull base reconstruction was commenced by making a reverse temporalis flap and placing it over the opened paranasal sinuses for a robust vascularized graft, followed by an abdominal fat graft, and then a pedicled pericranal flap was added to complete the multilayer onlay graft. To recreate the skull base, a mirror image of the contralateral skull base was constructed using three-dimensional (3D) printing, and the 3D-printed model was sterilized prior to the surgery. Intraoperatively, the model was then pressed onto dental alginate gel to make a negative mold. This was used to make the definitive flap using polymethylmethacrylate. Temporoplasty was also performed using polymethylmethacrylate to fill the defect left by the temporalis graft. The patient recovered well following the procedure. LESSONS: Appropriate, personalized skull base reconstruction techniques can be successfully done with 3D printing using alternative low-cost materials and implements, especially following resection of cases like craniofacial fibrous dysplasia. https://thejns.org/doi/10.3171/CASE24262.

Extracapsular Resection of Pituitary Adenomas: A Systematic Review.

There is considerable variation in the surgical techniques for transsphenoidal excision of pituitary tumors. Recently, an extracapsular method has been developed that involves using the tumor pseudocapsule as a dissection plane to increase the extent of resection. This review assessed the outcomes of this new approach as compared with standard transsphenoidal surgery. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE/PubMed, the US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov), the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP; apps.who.int/trialsearch), and LILACS databases for relevant literature and checked reference lists of relevant articles. Randomized controlled trials and prospective and retrospective cohort studies comparing extracapsular and intracapsular resection of pituitary tumors were included in the review. Five cohort studies with 1,588 participants were included. Extracapsular resection was associated with a higher likelihood of complete excision (relative risk [RR] 1.31, 95% confidence interval [CI] 1.01-1.70, p = 0.04) and endocrinologic remission (RR 1.26, 95% CI 1.03-1.54, p = 0.02). Because there was a significant risk of bias and substantial heterogeneity, the estimates of effect may not be robust. In patients with pituitary adenomas undergoing transsphenoidal excision, extracapsular resection may be associated with higher rates of complete excision and endocrinologic remission, but the evidence is not strong. Hence, randomized controlled trials to determine the magnitude of benefit and identify an improvement in progression-free or overall survival are warranted.

Perceptions of Selected Undergraduate Medical Students in the Philippines on the Effectiveness of the Combined Use of Plastinated and Formalin-preserved Brains in Neuroanatomy Education: A Cross-sectional Study.

Background and Objective: Neuroanatomy is both terrifying to learn and problematic to teach, and the different methods of neuroanatomical education have their own strengths and weaknesses. In this cross-sectional study, we evaluated the perception of undergraduate medical students towards the combined use of plastinated and formalin-preserved brain specimen in their neuroanatomy course. Methods: A bridging program was designed for students whose medical education was interrupted by the COVID-19 pandemic in order to reinforce the knowledge and understanding of anatomy that they acquired in a virtual environment. A total of 175 first year medical students participated in this learning activity, which included seven stations in neuroanatomy spread across two hours, and covered the anatomy of the circle of Willis, brainstem, cranial nerves, spinal cord, internal cerebrum, and external cerebrum. To evaluate short-term learning, the students were asked to take a quiz containing 10 multiple-choice questions before and after the learning activity. In addition, the students also answered a survey containing 11 Likert-type questions asking about their perception of the learningactivity. Results: Following the learning activity, mean test scores increased from 4.73 (SD 1.74) to 5.32 (SD 1.52; mean difference 0.59, p = 0.008). Majority of the students (mean 81%, range 43-93%) had a neutral or positive perception of plastinated brain specimen, and on factor analysis, plastinated brain specimen were found to be both practical and useful for learning neuroanatomy. However, the participants perceived plastinated brain specimen alone to be insufficient for learning neuroanatomy, and a multimodal approach to learning neuroanatomy is ideal. Conclusion: Plastinated brain specimens were found to be an effective complement to formalin-preserved brain, and these should be used by medical schools when designing neuroanatomy learning activities for their students.

Student Evaluation of a Learning Enhancement in Anatomy Program (LEAP) during the COVID-19 Pandemic: A Retrospective Study.

Background and Objective: The pandemic acted as an accelerator for the development of online teaching formats in anatomy and histology worldwide. The authors introduce a bridging program that reinforces the knowledge and understanding of gross and correlative anatomy and histology acquired in a virtual environment in preparation for its future clinical application. The study aims to evaluate the Learning Enhancement in Anatomy Program (LEAP) conducted among first-year medical students at the College of Medicine, University of the Philippines Manila. Methods: This descriptive cross-sectional study aims to determine the initial experience of implementing a learning enhancement program and assess areas for its improvement. An internally validated questionnaire was given to students after the program to gauge students' reactions (Kirkpatrick Level 1 evaluation). Pre- and post-tests were administered to evaluate knowledge acquisition (Kirkpatrick Level 2 evaluation). Short-term behavioral peer evaluation (Kirkpatrick Level 3 evaluation) was also instituted. Results: One hundred fifty-two (152) students participated in the study. General reactions from students to the LEAP were consistently positive, with a steady majority of the students rating '5' or a 'Strongly Agree' to positive statements regarding the program. Higher ratings for more traditional teaching methods, such as cadavers, formalinized specimens, and bones, compared to virtual systems were apparent. However, inter-student variation in preference for teaching modalities was observed. All stations of the LEAP were evaluated satisfactorily, with most gross anatomy stations rated higher than histology stations. A significant increase was noted in the total post-test scores compared to pre-test scores. This improvement in test scores was observed in the anatomy and histology subcategories and in six of the seven organ system modules. Perceived behavioral outcomes were also generally positive. Conclusion: The LEAP is a worthwhile endeavor, garnering overwhelmingly positive reactions and a significant improvement in test scores. Future studies are necessary to fine-tune teaching and training in a blended learning environment.