Closure of Skull Base Defects after Endonasal Endoscopic Resection of Planum Sphenoidale and Tuberculum Sellae Meningiomas.

BACKGROUND: The expanded endoscopic endonasal transplanum transtuberculum approach allows tumor removal by minimally invasive procedures. A large dural and bone defect is created during the surgical procedure, increasing the risk of postoperative cerebrospinal fluid (CSF) leakage. OBJECTIVE: The aim of this study is to describe a surgical technique and complications observed in patients undergoing endonasal resection of planum sphenoidale and/or tuberculum sellae meningiomas. METHODS: A retrospective analysis was performed of patients with planum sphenoidale and/or tuberculum sellae meningiomas after expanded endoscopic endonasal resection between June 2013 and August 2018, in which autologous grafts, fascia lata inlay, and nasoseptal flap onlay were used for closure of skull base defects. RESULTS: Ten patients were included in the analysis. No cases of postoperative CSF leakages or meningitis were reported, whereas two patients evolved with postoperative infectious complications (fungal ball in right frontal sinus and brain abscess). The skull base defect created for resection measured, on average, 3.58 cm2. CONCLUSION: Our experience suggests that closure of skull base defects using combined fascia lata inlay and nasoseptal flap onlay is effective for preventing postoperative CSF leakage in resection of planum sphenoidale and/or tuberculum sellae meningiomas, and offers high reproducibility due to its low cost.

Development of an Experimental Model for Studying the Nasosinusal and Skull Base Arterial and Venous Systems Using Iodinated Contrast and Latex in Cadavers.

BACKGROUND: Cadaver dissection remains one of the most reliable and safest ways to study anatomy, whereas computed tomography angiography (CTA) is an essential technology for enabling students to become familiar with human anatomy and surgical planning. Thus, the convergence of both radiologic and anatomic information is important for surgical success, especially in regions of complex anatomy such as the nasosinusal and skull base regions. Here we propose an experimental model in formalinized cadaver heads consisting of intravascular injection of colored latex and iodinated contrast mixture, followed by CTA scans of the nasosinusal and skull base arterial and venous systems before dissection. METHODS: Six cadaver heads that had been preserved for >5 years in 10% formaldehyde were immersed for 72 hours in a solution containing a dimethyldiethanol mono/dialkyloyl ester quaternary ammonium salt. In 5 of these heads, a mixture composed of latex, tissue ink, and iodinated contrast (Ultravist 300) was injected into the vascular system. CTA scans were performed sequentially after the injection, followed by endonasal and macroscopic dissections. RESULTS: There was good radiologic and macroscopic vessel uptake in 4 specimens, allowing a detailed anatomic study. CONCLUSIONS: An experimental model was made feasible by injecting iodinated contrast and colored latex into formalinized cadavers for CTA evaluation of the nasosinusal and skull base arterial and venous systems before performing dissections.

Successful osimertinib rechallenge following drug-induced pneumonitis after previous anti-PDL1 exposure.

Osimertinib is a first-line treatment option for patients with metastatic non-small cell lung cancer (NSCLC) harbouring EGFR mutations. Pneumonitis is a severe adverse event (AE) related to osimertinib treatment which appears to be more frequent when associated with concurrent or previous anti-PD(L)1 exposure. Data regarding the efficacy and safety of osimertinib rechallenge, especially in the setting of central nervous system (CNS) metastases, are scarce. We herein describe a case of a 53-year-old patient with metastatic EGFR-mutated NSCLC, who developed pneumonitis after osimertinib treatment and was successfully rechallenged with 40 mg daily osimertinib, with CNS response. This dose reduction strategy may be an option for selected patients with brain metastases after tyrosine kinase inhibitors-induced AEs.

Cystic brain metastases in ALK-rearranged non-small cell lung cancer.

The central nervous system (CNS) is a common site of disease progression in patients with non-small-cell lung cancer (NSCLC) with anaplastic lymphoma kinase (ALK)-rearrangement treated with crizotinib. Cystic brain metastases (CBM) have been recently identified as one possible variant of this disease. An illustrative case report is presented along with a literature review performed in order to track relevant papers about CBM in ALK-rearranged NSCLC, including possible pathophysiology, differential diagnosis and treatment options for this condition. Three case reports have been published describing six ALK-rearranged NSCLC patients presenting with CBM, all of which were under treatment with crizotinib by the time of CBM diagnosis. Treatment with CNS-penetrating tyrosine kinase inhibitors (TKIs) resulted in CNS disease control in three of the six cases reported either as single therapy or in combination with radiation therapy (RT). Investigation of differential diagnoses of CBM might be necessary, which include inflammatory and demyelinating disorders, primary brain tumours and infectious diseases, especially neurocysticercosis that might mimic CBM images. Treatment options include RT, CNS-penetrating TKIs and invasive procedures, such as stereotactic drainage. Thus, CBM are associated with ALK-rearranged NSCLC, particularly in patients who use crizotinib and should prompt investigation of differential diagnosis. CNS-penetrating TKIs are effective in the control of solid brain metastases and also seem to be active in CBM as single therapy or in combination with RT.

Lipomyelocele with osseous dysraphic hamartoma in a child: a case report.

Lipomyelocele is a well-known vertebral malformation that affects intraspinal and extraspinal tissues and compartments. However, other tissues can be associated with the lipomatous component, such as well-developed bones in unusual sites. This association is consistent with dysraphic hamartoma, one of the rarest malformations of the vertebral canal closure. We describe an 8-year-old girl without neurological deficit with a voluminous lipomyelocele associated with a well-developed flat bone articulated to the left iliac wing. We reviewed the role of magnetic resonance and computed tomography with tridimensional reconstruction in this rare form of spinal dysraphism and described the imaging features.