Temporal and masseter muscle evaluation by MRI provides information on muscle mass and quality in acromegaly patients.

PURPOSE: The impact of GH/IGF-1 levels on skeletal muscle in acromegaly is still controversial. Temporal (TMT) and masseter muscle (MMT) thickness has been recently demonstrated as a reliable measure of muscle mass. We aimed to investigate the relationship between TMT, MMT and clinical/biochemical characteristics in patients with acromegaly. METHODS: Single center retrospective longitudinal study including 69 patients with at least one available brain/sella turcica MRI and matched clinical data. TMT, MMT, and muscle fatty infiltration (modified Goutallier score) were evaluated in all patients at baseline (first available MRI) and over time (182 MRIs analyzed). RESULTS: At baseline, both TMT and MMT were higher in males than females (p = 0.001 and p = 0.016, respectively). TMT and MMT were positively associated (ß 0.508, p < 0.001), and they were positively correlated with IGF-1 xULN (TMT, p = 0.047; MMT, p = 0.001). MMT had a positive correlation with patients' weight (p = 0.015) and height (p = 0.006). No correlation was found between TMT, MMT and the presence of hypogonadism. Considering all available MRIs, sex and IGF-1 xULN were significant determinants of TMT and MMT at multivariable analysis (female sex: ß -0.345/-0.426, p < 0.001; IGF-1 xULN: ß 0.257/0.328, p < 0.001). At longitudinal evaluation, uncontrolled patients at baseline showed a significant reduction of MMT over time (p = 0.044). Remarkable fatty infiltration was observed in 34-37% of MRIs; age was the main determinant (temporal muscle: OR 1.665; p = 0.013; masseter muscle: OR 1.793; p = 0.009). CONCLUSION: Male patients with higher IGF-1 values have thicker temporal and masseter muscles, suggesting that sex and IGF-1 have a significant impact on muscle mass in acromegaly.

Prognostic value of pretreatment temporal muscle thickness after curative surgery for oral cavity squamous cell carcinoma.

BACKGROUND: Sarcopenia is a poor prognostic factor in various diseases. Temporal muscle thickness (TMT) has been reported to be associated with sarcopenia. We investigated the prognostic value of TMT in patients with oral squamous cell carcinoma. METHODS: This study included 61 patients with oral squamous cell carcinoma. Two board-certified otolaryngologists measured TMT based on pre-treatment CT. The following sex-specific TMT cut-off values were used in accordance with previous reports: ≤ 6.3 mm in men, and ≤ 5.2 mm in women. We classified patients into normal TMT group and low TMT group according to the cutoff values. The correlation between the TMT measurements of the two readers was tested using the interclass correlation coefficient (ICC). Cox regression models were used to verify the association between TMT and prognostic factors. RESULTS: The low TMT group had a significantly lower BMI than the normal TMT group. Patients with low TMT at baseline had a significantly higher risk of death than those with normal TMT (hazard ratio 4.51; 95% confidence interval [CI] 1.49-13.61; p = 0.0076). There were no significant differences in disease-specific survival between the two groups. The correlation between the two evaluators' TMT measurements was excellent (ICC 0.988, 95% CI 0.981-0.933). CONCLUSIONS: Sex-specific TMT was associated with overall survival in patients with oral squamous cell carcinoma. TMT is easy to assess and its measurement is consistent between evaluators.

The possible relation between temporal muscle mass and glioblastoma multiforme prognosis via sarcopenia perspective.

BACKGROUND: The optimal sarcopenia measurement method in patients with a diagnosis of glioblastoma multiforme (GBM) is unknown. It has been found that temporal muscle thickness (TMT) may reflect sarcopenia and be associated with survival, but the relationship between temporal muscle area (TMA) and GBM prognosis has never been evaluated before. The primary outcome of the study was to evaluate the relationship between TMA/TMT and overall survival (OS) time in newly diagnosed GBM patients. METHODS: The data of patients who presented at the university hospital between January 2009 and January 2019 with a confirmed diagnosis of glioblastoma multiforme at the time of diagnosis were analyzed retrospectively. Temporal muscle thickness and TMA were measured retrospectively from preoperative MRIs of patients diagnosed with GBM. Due to the small number of patients and the failure to determine a cut-off value with acceptable sensitivity and specificity using ROC analysis, the median values were chosen as the cut-off value. The patients were basically divided into two according to their median TMT (6.6 mm) or TMA (452 mm2 ) values, and survival analysis was performed with the Kaplan-Meier analysis. RESULTS: The median TMT value was 6.6 mm, and the median TMA value was 452 mm2 . The median overall survival (OS) was calculated as 25.8 months in patients with TMT < 6.6 mm, and 15.8 months in patients with TMT ≥ 6.6 mm (p = 0.29). The median overall survival (OS) of patients with TMA < 452mm2 was 26.3 months, and the group with TMA ≥ 452mm2 was 14.6 months (p = 0.06). The median disease-free survival was 18.3 months (%95 CI: 13.2-23.4) in patients with TMT < 6.6mm, while mDFS was 10.9 (%95 CI: 8.0-13.8) months in patients with TMT ≥ 6.6mm (p = 0.21). The median disease-free survival was found to be 21.0 months (%95 CI: 15.8-26.1) in patients with TMA < 452 mm2 and 10.5 months (%95 CI: 7.8-13.2) in patients with TMA ≥ 452 mm2 (p = 0.018). DISCUSSION: No association could be demonstrated between TMT or TMA and OS of GBM patients. In addition, the median DFS was found to be longer in patients with low TMA. There is an unmet need to determine the optimal method of sarcopenia in GBM patients.

Correlation of reduced temporal muscle thickness and systemic muscle loss in newly diagnosed glioblastoma patients.

PURPOSE: Reduced temporal muscle thickness (TMT) has recently been postulated as a prognostic imaging marker and an objective tool to assess patients frailty in glioblastoma. Our aim is to investigate the correlation of TMT and systemic muscle loss to confirm that TMT is an adequate surrogate marker of sarcopenia in newly diagnosed glioblastoma patients. METHODS: TMT was assessed on preoperative MR-images and skeletal muscle area (SMA) was assessed at the third lumbar vertebra on preoperative abdominal CT-scans. Previous published TMT sex-specific cut-off values were used to classify patients as 'patient at risk of sarcopenia' or 'patient with normal muscle status'. Correlation between TMT and SMA was assessed using Spearman's rank correlation coefficient. RESULTS: Sixteen percent of the 245 included patients were identified as at risk of sarcopenia. The mean SMA of glioblastoma patients at risk of sarcopenia (124.3 cm2, SD 30.8 cm2) was significantly lower than the mean SMA of patients with normal muscle status (146.3 cm2, SD 31.1 cm2, P < .001). We found a moderate association between TMT and SMA in the patients with normal muscle status (Spearman's rho 0.521, P < .001), and a strong association in the patients at risk of sarcopenia (Spearman's rho 0.678, P < .001). CONCLUSION: Our results confirm the use of TMT as a surrogate marker of total body skeletal muscle mass in glioblastoma, especially in frail patients at risk of sarcopenia. TMT can be used to identify patients with muscle loss early in the disease process, which enables the implementation of adequate intervention strategies.

Temporal muscle thickness as an independent prognostic marker in glioblastoma patients-a systematic review and meta-analysis.

Glioblastoma is the most common primary malignant brain tumor in the adult population. It causes the patient to incur a great deal of malady. Even with the advances in management and the Stupp protocol in place, the prognosis remains grim. There are various parameters to evaluate patients' performance status and frailty pre-operatively, but these are mostly subjective and thus suffer from inter-observer variability. Assessment of sarcopenia serves as an objective parameter to assess the patient's performance status pre-operatively. Temporalis muscle thickness serves as a surrogate to assess sarcopenia in patients with glioblastoma. We conducted a literature review and meta-analysis to determine the prognostic implications of temporalis muscle thickness in 3283 patients with primary glioblastoma. The pooled overall survival hazard's ratio of thick versus thin TMT was 0.54. The pooled progression-free survival hazard's ratio of thick versus thin TMT was 0.38. Thus, the main finding of this study is that thicker temporal muscle is associated with better OS and PFS as compared to thinner temporal muscle. We thus conclude that TMT is a viable surrogate for predicting sarcopenia and survival in primary glioblastoma. TMT measurement is extremely easy and can be incorporated as a part of the routine neurosurgical workflow in these patients. Survival prediction will help inform treatment decisions in glioblastoma patients having poor prognosis, at the initial diagnosis itself.

Prognostic relevance of temporal muscle thickness as a marker of sarcopenia in patients with glioblastoma at diagnosis.

OBJECTIVES: Temporal muscle thickness (TMT) is a surrogate marker of sarcopenia, correlated with survival expectancy in patients suffering from brain metastases and recurrent or treated glioblastoma. We evaluated the prognostic relevance of TMT measured on brain MRIs acquired at diagnosis in patients affected by glioblastoma. METHODS: We retrospectively enrolled 51 patients in our Institution affected by methylated MGMT promoter, IDH1-2 wild-type glioblastoma, who underwent complete surgical resection and subsequent radiotherapy with concomitant and maintenance temozolomide, from January 1, 2015, to April 30, 2017. The last clinical/radiological follow-up date was set to September 3, 2019. TMT was measured bilaterally on reformatted post-contrast 3D MPRAGE images, acquired on our 3-T scanner no more than 2 days before surgery. The median, 25th, and 75th percentile TMT values were identified and population was subdivided accordingly; afterwards, statistical analyses were performed to verify the association among overall survival (OS) and TMT, sex, age, and ECOG performance status. RESULTS: In our cohort, the median OS was 20 months (range 3-51). Patients with a TMT ≥ 8.4 mm (median value) did not show a statistically significant increase in OS (Cox regression model: HR 1.34, 95% CI 0.68-2.63, p = 0.403). Similarly, patients with a TMT ≥ 9.85 mm (fourth quartile) did not differ in OS compared to those with TMT ≤ 7 mm (first quartile). The statistical analyses confirmed a significant association among TMT and sex (p = 0.0186), but none for age (p = 0.642) and performance status (p = 0.3982). CONCLUSIONS: In our homogeneous cohort of patients with glioblastoma at diagnosis, TMT was not associated with prognosis, age, or ECOG performance status. KEY POINTS: • Temporal muscle thickness (TMT) is a surrogate marker of sarcopenia and has been correlated with survival expectancy in patients suffering from brain metastases and recurrent or treated glioblastoma. • We appraised the correlation among TMT and survival, sex, age at surgery, and performance status, measured on brain MRIs of patients affected by glioblastoma at diagnosis. • TMT did not show any significant correlation with prognosis, age at surgery, or performance status, and its usefulness might be restricted only to patients with brain metastases and recurrent or treated glioblastoma.

The association of BMI and sarcopenia with survival in patients with glioblastoma multiforme.

Background: The association between obesity and sarcopenia (via temporal muscle thickness) with overall survival (OS) has been evaluated in several glioblastoma multiforme studies, however, the data are inconclusive. Methods: The authors conducted meta-analyses via the generic inverse-variance method with a random-effects model. Results: In the pooled analysis of five studies, including 973 patients, patients with lower temporal muscle thickness had significantly decreased OS (HR: 1.62, 95% CI: 1.16-2.28, p = 0.005). The pooled analysis of five studies, including 2131 patients, demonstrated decreased OS in patients with lower BMI compared with patients with obesity (HR: 1.45, 95% CI: 1.12-1.88, p = 0.005). Conclusion: Readily available body composition parameters could be used for prognosis prediction and to aid in treatment decisions in patients with glioblastoma multiforme.

Temporal tendinosis: A cause of chronic orofacial pain.

PURPOSE OF REVIEW: Diverse musculoskeletal disorders and neuropathic symptoms of the face pose significant diagnostic challenges. In particular, temporal tendinosis is generally overlooked in the medical and dental literature and is therefore a poorly understood topic and often problematic cause of chronic orofacial pain. In this article, we explore temporal tendinosis as a cause of unresolved orofacial pain by reviewing the complex anatomy of the temporalis muscle, common presentations of temporal tendinosis, possible etiologies for injury and place a strong emphasis on required diagnostic evaluation and clinical management. RECENT FINDINGS: Temporal tendinosis remains under diagnosed due to a combination of anatomical complexity and incomplete description in the majority of general anatomy medical textbooks. The two main presentations are unilateral facial pain with or without temporal headache and pain radiating from the distal temporalis tendon to the temporalis muscle. Diagnosis should be made with a combination of focused history, physical examination and specialised imaging, preferably with ultrasound but with MRI an alternate option. While many management options are available, optimal treatment remains unclear. Temporal tendinosis is an under-recognised and under-treated condition. Despite the fact that orofacial pain is one of the single most common complaints of patients presenting to physicians or dentists, it is widely acknowledged that training for diagnosis and manage of temporal tendinopathy among primary care physicians in both medical and dental professions is inadequate. This may result in extensive workups, leading to suboptimal management and chronic pain syndromes.

Effects of 4-Week Diacutaneous Fibrolysis on Myalgia, Mouth Opening, and Level of Functional Severity in Women With Temporomandibular Disorders: A Randomized Controlled Trial.

OBJECTIVE: The purpose of this study was to assess the effects of 4-week protocol of diacutaneous fibrolysis (DF) compared with simulated DF (sham-DF) on myalgia and mouth opening. METHODS: In a sham randomized controlled trial, 34 women with temporomandibular disorders and myofascial pain were randomly divided as intervention group (IG) and sham-DF group (SG). The IG received 4 weeks of real DF, and the SG received sham. Pain was assessed through the visual analog scale and pressure pain thresholds (PPTs) on the temporomandibular joint (TMJ), and over the temporal and masseter muscles. The Mandibular Function Impairment Questionnaire was used to classify the participants regarding to the severity of the functional limitation related to TMD. RESULTS: Pain scores decreased for both groups, but the IG showed lower values at week 4, with between-group differences. Bilateral temporal PPT showed higher values at week 4, with between-group differences. The SG had lower PPTs but the IG had higher PPTs, both compared to baseline results. The time-by-group interaction and the frequency of participants above 40 mm of mouth opening showed a significant difference for the IG over time with higher results at the 4-week assessment compared to its own baseline. Both groups showed lower MFIQ scores from baseline to 4-week assessment. There was a lower frequency of a moderate level of severity for the IG. No differences were observed for TMJ or for the masseter muscles PPT. CONCLUSION: Improvements were observed for visual analog scale scores and PPTs on temporal muscles. There was a group-by-time interaction in the IG, suggesting a possible potential use of DF for mouth opening.

Widespread Hypersensitivity to Pressure Pain in Men With Cluster Headache During Prolonged Remission Is Not Related to the Levels of Depression and Anxiety.

BACKGROUND: Diminished pressure pain thresholds (PPTs) have been found in patients with cluster headache (CH), suggesting the presence of central sensitization. However, it is not known whether sensitization persists over time during the asymptomatic periods. OBJECTIVE: To investigate if men with episodic CH in a long-lasting remission phase exhibit widespread pressure pain hypersensitivity. METHODS: Forty men with episodic CH and 40 matched controls were enrolled. PPTs were assessed bilaterally over 1 trigeminal (temporalis muscle) and 3 extra-trigeminal points (C5/C6 zygapophyseal joint, second metacarpal, tibialis anterior muscle) by a blinded assessor. Patients were assessed in a prolonged remission phase, at least 6 months after their last CH attack and without taking any medication. Depression and anxiety levels were assessed with the Hospital Anxiety and Depression Scale (HADS). For each point, differences in PPTs were evaluated with a multivariate mixed-model analysis of covariance test, with side and group as main factors and depression and anxiety levels as covariates. RESULTS: PPTs were significantly decreased bilaterally over the temporalis muscle (mean difference: 85 to 100 kPa), C5/C6 zygapophyseal joint (mean difference: 65 to 80 kPa), second metacarpal (mean difference: 65 to 90 kPa), and tibialis anterior muscle (mean difference: 135 to 155 kPa) in patients with CH when compared to headache-free subjects (all, P < 0.001). No effect of anxiety or depression levels was found. CONCLUSIONS: Patients with CH exhibited bilateral widespread hypersensitivity to pressure pain during long-lasting remission periods, which was not associated with depression or anxiety. These results support the persistence of central sensitization in episodic CH, even in remote asymptomatic phases.

Gunshot Suicide: Cherry-Red Discoloration of the Temporal Muscle Beneath the Exit Wound.

The article describes a case of gunshot suicide to the head in a 51-year-old man. The entrance wound was located in the left temple and exit wound in the right temple. The entrance wound had the characteristics of a hard-contact gunshot wound. The most interesting finding in this case was cherry-red discoloration of the right temporal muscle surrounding the exit wound. This finding could make the determination of the entrance versus exit gunshot wound challenging, especially if the wounds are of atypical appearance. In addition, the finding described in the presented case could be the proof that carbon monoxide may follow the missile through the body and may be prominent in the soft tissue at the exit.

An Odontogenic Keratocyst in the Temporal Region.

The authors report a very rare patient with ectopic odontogenic keratocyst (OKC) in the temporal region that is distant form the mandible. Based on the interesting report, they discuss about the possible origin and illustrate the development of the ectopic OKC. It shows that the OKC could distally relapse with the help of temporal muscle. The surgeon should be more proactive to deal with the peripheral muscle of lesion.

Debunking a Surgical Myth: Do Not Touch the Temporalis.

BACKGROUND: A longstanding dictum exists to avoid surgical manipulation of the temporalis muscle out of concern for an exceedingly high rate of muscle atrophy and recurrent temporal hollowing. The authors challenge this surgical myth, considering such advice to be erroneous. The authors hypothesize that elevation of the temporalis muscle, if performed using standard muscle flap principles, will demonstrate excellent results. METHODS: To assess temporalis response to surgical manipulation, the authors reviewed patients who underwent calvarial vault remodeling by the senior author for craniosynostosis between 1988 and 2011. Nonsyndromic patients with single-suture synostosis and 5 years of follow-up were eligible for inclusion. The medical record was used to measure rates of reoperation, recurrent temporal hollowing, and persistent temporalis overcorrection. RESULTS: Of the cohort reviewed, 196 patients met inclusion criteria. Ten patients (5.1%) exhibited recurrent bitemporal constriction. One patient (0.5%) underwent a revision temporalis turnover flap, and 2 patients (1.0%) underwent soft tissue augmentation. The overall reoperation rate was 1.5%. Temporalis overcorrection, in an attempt to prophylactically rectify the expected atrophy after temporalis manipulation, persisted in 11 patients (5.6%). Three of these patients required treatment with steroid injections, Botox injections, or operative muscle debulking. The overall reoperation rate for temporalis overcorrection was 1.5%. CONCLUSIONS: The authors' low reoperation rates for recurrent deformity, in combination with persistent temporalis overcorrection in 5.6% of patients, should dispel the myth that manipulation of the temporalis invariably results in atrophy. The muscle may be surgically manipulated, as long as plastic surgery principles are followed.

Does Parkinson's disease interfere with electromyographic fatigue of masticatory muscles?

Parkinson's disease is a neurodegenerative disease with manifestations related to oxidative stress and damage to the skeletal striated musculature. This study evaluated the electromyographic fatigue of the masseter and temporal muscles in individuals with Parkinson's disease. The median frequency of the normotensive electromyographic signal was analyzed in 16 individuals, aged between 50 and 70 years, with Parkinson's disease in stages I and III of the Hoehn and Yahr disability scale (n=8) or without the disease (n=8). The data were tabulated and analyzed statistically (t-test, p .05). Compared with the group without Parkinson's disease, the group with the disease showed an increase in the median frequency, with significant differences for the right masseter (p=.05) and the right temporal (p=.03) muscles. The results suggest that there is a link between Parkinson's disease and functional alterations of the masticatory system, especially when electromyographic fatigue is assessed.

Temporal muscle thickness is an independent prognostic marker in melanoma patients with newly diagnosed brain metastases.

OBJECTIVES: The purpose of this study was to evaluate the prognostic relevance of temporal muscle thickness (TMT) in melanoma patients with newly diagnosed brain metastases. METHODS: TMT was retrospectively assessed in 146 melanoma patients with newly diagnosed brain metastases on cranial magnetic resonance images. Chart review was used to retrieve clinical parameters, including disease-specific graded prognostic assessment (DS-GPA) and survival times. RESULTS: Patients with a TMT > median showed a statistically significant increase in survival time (13 months) compared to patients with a TMT < median (5 months; p < 0.001; log rank test). A Cox regression model revealed that the risk of death was increased by 27.9% with every millimeter reduction in TMT. In the multivariate analysis, TMT (HR 0.724; 95% 0.642-0.816; < 0.001) and DS-GPA (HR 1.214; 95% CI 1.023-1.439; p = 0.026) showed a statistically significant correlation with overall survival. CONCLUSION: TMT is an independent predictor of survival in melanoma patients with brain metastases. This parameter may aid in patient selection for clinical trials or to the choice of different treatment options based on the determination of frail patient populations.

Isolated unilateral temporalis muscle hypertrophy in a child: a case report with literature review.

BACKGROUND: Temporalis muscle hypertrophy is a rare entity of masticatory muscle hypertrophy. All types of masticatory muscle hypertrophies have been documented of which temporalis muscle hypertrophy is one. Temporalis muscle hypertrophy is most commonly bilateral and usually associated with other types of masticatory muscles hypertrophy such as masseter or pterygoid hypertrophy. However, isolated unilateral temporalis muscle hypertrophy is extremely rare and only 9 cases have been reported to date in English literature since 1990 with only two patients less than 18 years. There is no exact etiology identified and the diagnosis is made by muscle biopsy combined with imaging study to exclude other possibilities. Age at presentation is ranges from 15 to 65 years with involvement of both sexes. We report the youngest child who is a seven year old girl with right side isolated unilateral temporalis muscle hypertrophy. CASE PRESENTATION: In this patient, we discuss the youngest child with isolated unilateral temporalis muscle hypertrophy and literature review to date. The patient is a seven year old female presenting with painless swelling of the right temporalis muscle. There had no features of inflammation, trauma, neoplasm or history of parafunctions such as bruxism. The child was not complaining significantly headache or visual disturbances as well. She had undergone radiological assessment with ultrasound scan and contrast MRI. The diagnosis was confirmed by muscle biopsy which shows normal muscle architecture. She was managed conservatively with regular follow up. CONCLUSION: Isolated unilateral temporalis muscle hypertrophy is extremely rare in children. However this case raises the importance of considering alternative diagnoses despite the condition being rare in the pediatric population.

Delayed rupture of a vertebral artery laceration: a case report and challenges for the forensic pathologist.

Vertebral artery laceration/dissection (VALD) resulting in fatal subarachnoid hemorrhage (SAH) is a rare, but well-known phenomenon encountered in the forensic setting. Delayed ruptures are exceptionally rare, and pose several challenges to the forensic pathologist. In this paper we present a case of a 47-year-old male who collapsed suddenly following recent complaints of a headache and a reported seizure. He had a reported history of potential head trauma that occurred several days prior. Attempts at resuscitation were unsuccessful, and an autopsy examination was ordered. Computer tomography (CT), autopsy, histological and ancillary studies were performed. External examination showed mild, healing trauma to the head and upper limbs, and pre-autopsy CT demonstrated a SAH. Examination of the brain showed basally oriented SAH, and there was a laceration of the left vertebral artery. Histological examination demonstrated a delayed rupture, and there was no significant blood vessel abnormality. Molecular testing was negative for collagen vascular disorders. Delayed rupture of the vertebral arteries following head trauma is rare. The presence of remote and/or mild trauma may be difficult to establish at autopsy, and it is important to identify underlying aortopathies. Several autopsy techniques and ancillary studies should be performed in these cases.

Survival prediction using temporal muscle thickness measurements on cranial magnetic resonance images in patients with newly diagnosed brain metastases.

OBJECTIVES: To evaluate the prognostic relevance of temporal muscle thickness (TMT) in brain metastasis patients. METHODS: We retrospectively analysed TMT on magnetic resonance (MR) images at diagnosis of brain metastasis in two independent cohorts of 188 breast cancer (BC) and 247 non-small cell lung cancer (NSCLC) patients (overall: 435 patients). RESULTS: Survival analysis using a Cox regression model showed a reduced risk of death by 19% with every additional millimetre of baseline TMT in the BC cohort and by 24% in the NSCLC cohort. Multivariate analysis included TMT and diagnosis-specific graded prognostic assessment (DS-GPA) as covariates in the BC cohort (TMT: HR 0.791/CI [0.703-0.889]/p < 0.001; DS-GPA: HR 1.433/CI [1.160-1.771]/p = 0.001), and TMT, gender and DS-GPA in the NSCLC cohort (TMT: HR 0.710/CI [0.646-0.780]/p < 0.001; gender: HR 0.516/CI [0.387-0.687]/p < 0.001; DS-GPA: HR 1.205/CI [1.018-1.426]/p = 0.030). CONCLUSION: TMT is easily and reproducibly assessable on routine MR images and is an independent predictor of survival in patients with newly diagnosed brain metastasis from BC and NSCLC. TMT may help to better define frail patient populations and thus facilitate patient selection for therapeutic measures or clinical trials. Further prospective studies are needed to correlate TMT with other clinical frailty parameters of patients. KEY POINTS: • TMT has an independent prognostic relevance in brain metastasis patients. • It is an easily and reproducibly parameter assessable on routine cranial MRI. • This parameter may aid in patient selection and stratification in clinical trials. • TMT may serve as surrogate marker for sarcopenia.

Minipterional Craniotomy for Treatment of Unruptured Middle Cerebral Artery Aneurysms. A Single-Center Comparative Analysis with Standard Pterional Approach as Regard to Safety and Efficacy of Aneurysm Clipping and the Advantages of Reconstruction.

Pterional craniotomy (PT) has long been the standard approach for the treatment of middle cerebral artery (MCA) aneurysms, even though it may cause temporalis muscle atrophy, facial nerve injury, and masticatory difficulties. Minipterional craniotomy (MPT) is an alternative approach that may provide the same surgical corridor, limiting the risk of postoperative esthetic and functional complications. From January 2011 to December 2014 we consecutively performed 68 craniotomies for surgical treatment of unruptured MCA aneuryms: 37 were standard PT and 31 were MPT. There were no significant differences in mean age, sex, and aneurysm topography between the two groups. The mean skin incision length was 14 cm in the PT group and 6 cm in the MPT group. According to the Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS), there were no significant differences in clinical outcome at discharge or follow-up between the two groups. Also, the rates of complete aneurysm exclusion were comparable. However, the number of patients complaining of masticatory disorders was higher among those treated with PT. Finally, the number of complications observed in the PT group was higher than that in the MPT group, but only the differences in mean hospitalization length and necessity for a dural patch for reconstruction were statistically significant. In conclusion, the MPT approach is a safe and effective alternative to the standard PT for the treatment of unruptured MCA aneurysms.

Effect of aquaporin 1 and 4 on masticatory muscles degeneration as a result of aging.

OBJECTIVE: The changes in the mouth structures due to aging cause some structural and functional changes by affecting masticatory muscles over time. The aim of this study was to evaluate the aging-related histopathologic changes and immunohistochemically assessed aquaporin 1 and 4 expressions on masseter and temporal muscles. MATERIAL AND METHODS: 14 Balb/c white mice (50-80 g) were used in this study. Group I consisted of young animals (2-month-individuals) (n = 7) and Group II consisted of older animals (18-month-old) (n = 7). After routine histological follow-ups were made, tissues were stained immunohistochemically for aquaporin 1 and aquaporin 4 as well as with hematoxylin-eosin. RESULTS: It was seen that while the masseter and temporalis muscle tissues showed a high immunoreactivity (+++) for aquaporin 1 and 4 in young mice, they showed a weak immunoreactivity (+) for aquaporin 1 and 4 in old mice (p = 0.001). In the H-score assessment, aquaporin 1 and 4 immunoreactivity was significantly higher in young mice than in old mice (p = 0.002). CONCLUSIONS: Consequently, it was shown that degeneration of the masticatory muscles increased with aging and there was a decrease in intra- and intercellular exchange of substances because of changing aquaporin 1 and aquaporin 4 expressions (Tab. 2, Fig. 4, Ref. 20).