Creation of a 3D printed temporal bone model from clinical CT data.

PURPOSE: Generate and describe the process of creating a 3D printed, rapid prototype temporal bone model from clinical quality CT images. MATERIALS AND METHODS: We describe a technique to create an accurate, alterable, and reproducible rapid prototype temporal bone model using freely available software to segment clinical CT data and generate three different 3D models composed of ABS plastic. Each model was evaluated based on the appearance and size of anatomical structures and response to surgical drilling. RESULTS: Mastoid air cells had retained scaffolding material in the initial versions. This required modifying the model to allow drainage of the scaffolding material. External auditory canal dimensions were similar to those measured from the clinical data. Malleus, incus, oval window, round window, promontory, horizontal semicircular canal, and mastoid segment of the facial nerve canal were identified in all models. The stapes was only partially formed in two models and absent in the third. Qualitative feel of the ABS plastic was softer than bone. The pate produced by drilling was similar to bone dust when appropriate irrigation was used. CONCLUSION: We present a rapid prototype temporal bone model made based on clinical CT data using 3D printing technology. The model can be made quickly and inexpensively enough to have potential applications for educational training.

Facial diplegia with paresthesia associated with anti-GD1a antibodies.

A 26-year-old previously healthy man presented with progressive facial diplegia and sensory deficits to pinprick in a stocking-glove distribution. Lumbar puncture revealed cytoalbuminologic dissociation, and a nerve conduction study of the right facial nerve demonstrated a proximal demyelinating process. He was started on intravenous immunoglobulin given concern for a Guillain-Barré syndrome variant, and his symptoms improved over several days. This case illustrates the clinical features of facial diplegia with paresthesias, a rare variant of Guillain-Barré syndrome. Unlike most reported cases of facial diplegia with paresthesias that have demonstrated positive anti-ganglioside M2 antibodies, this case is unique given the positivity of anti-ganglioside D1a IgG/IgM antibodies.

Top Ten Tips Palliative Care Clinicians Should Know About Amyotrophic Lateral Sclerosis.

Amyotrophic lateral sclerosis (ALS) is a rapidly progressive and fatal neurodegenerative disorder with enormous palliative care (PC) needs that begin at the time of diagnosis. Although it is an uncommon disease, clinicians who work in PC or hospice are likely to encounter ALS somewhat frequently given the needs of patients with ALS with regard to psychosocial support, symptom management, advance care planning (ACP), caregiver support, and end-of-life care. As such, PC clinicians should be familiar with the basic principles of ALS symptoms, treatments, disease course, and issues around ACP. This article, written by a team of neurologists and PC physicians, seeks to provide PC clinicians with tips to improve their comfort and skills caring for patients with ALS and their families.