Primary Calvarial Ewing Sarcoma: A Case Series.

Background Calvarial Ewing tumor is a relatively rare differential among bony neoplasms. We present our experience of managing primary calvarial Ewing sarcoma (EWS), highlighting their clinical and radiological findings. Method In a retrospective analysis, we evaluated our 12-year database for pathologically proven EWS. A literature search was conducted for the comparative presentation and update on the management and outcome. Result From January 2008 to December 2020, we managed eight patients (male:female = 5:3; age range 6 months to 19 years, mean 11.5 years) harboring primary calvarial EWS. All cases underwent wide local excision; two patients required intradural tumor resection, while one required rotation flap for scalp reconstruction. Mean hospital stay was 8 days. All patients received adjuvant chemo- and radiotherapy. Three patients remained asymptomatic at 5 years of follow-up, while two patients died. Conclusion Primary calvarial EWS is a rare entity. It usually affects patients in the first two decades of life. These tumors can be purely intracranial, causing raised intracranial pressure symptoms, which may exhibit rapidly enlarging subgaleal tumors with only cosmetic deformities or symptoms of both. Radical excision followed by adjuvant therapy may offer a favorable long-term outcome.

Automated catheter tip repositioning for intra-cardiac echocardiography.

PURPOSE: Intra-Cardiac Echocardiography (ICE) is a powerful imaging modality for guiding cardiac electrophysiology and structural heart interventions. ICE provides real-time observation of anatomy and devices, while enabling direct monitoring of potential complications. In single operator settings, the physician needs to switch back-and-forth between the ICE catheter and therapy device, making continuous ICE support impossible. Two operator setups are sometimes implemented, but increase procedural costs and room occupation. METHODS: ICE catheter robotic control system is developed with automated catheter tip repositioning (i.e., view recovery) method, which can reproduce important views previously navigated to and saved by the user. The performance of the proposed method is demonstrated and evaluated in a combination of heart phantom and animal experiments. RESULTS: Automated ICE view recovery achieved catheter tip position accuracy of [Formula: see text] mm and catheter image orientation accuracy of [Formula: see text] in animal studies, and [Formula: see text]mm and [Formula: see text] in heart phantom studies, respectively. Our proposed method is also successfully used during transseptal puncture in animals without complications, showing the possibility for fluoro-less transseptal puncture with ICE catheter robot. CONCLUSION: Robotic ICE imaging has the potential to provide precise and reproducible anatomical views, which can reduce overall execution time, labor burden of procedures, and X-ray usage for a range of cardiac procedures.

Prediction of Patient Height and Weight With a 3-Dimensional Camera.

OBJECTIVE: The aim of this study was to determine accuracy of height and weight prediction by a 3-dimensional (3D) camera. METHODS: A total of 453 patients whose computed tomography imaging used a 3D camera from December 19, 2018 to March 19, 2019 were retrospectively identified. An image of each patient was taken before the computed tomography by a 3D camera mounted to the ceiling. Using infrared imaging and machine learning algorithms, patient height and weight were estimated from this 3D camera image. A total of 363 images were used for training. The test set consisted of 90 images. The height and weight estimates were compared with true height and weight to determine absolute and percent error. A value of P < 0.05 indicated statistical significance. RESULTS: There was 2.0% (SD, 1.4) error in height estimation by the 3D camera, corresponding to 3.35 cm (SD, 2.39) absolute deviation (P = 1, n = 86). Weight estimation error was 5.1% (SD, 4.3), corresponding to 3.99 kg (SD, 3.11) absolute error (P = 0.74, n = 90). CONCLUSION: Pictures obtained from a 3D camera can accurately predict patient height and weight.

Autonomous Robotic Point-of-Care Ultrasound Imaging for Monitoring of COVID-19-Induced Pulmonary Diseases.

The COVID-19 pandemic has emerged as a serious global health crisis, with the predominant morbidity and mortality linked to pulmonary involvement. Point-of-Care ultrasound (POCUS) scanning, becoming one of the primary determinative methods for its diagnosis and staging, requires, however, close contact of healthcare workers with patients, therefore increasing the risk of infection. This work thus proposes an autonomous robotic solution that enables POCUS scanning of COVID-19 patients' lungs for diagnosis and staging. An algorithm was developed for approximating the optimal position of an ultrasound probe on a patient from prior CT scans to reach predefined lung infiltrates. In the absence of prior CT scans, a deep learning method was developed for predicting 3D landmark positions of a human ribcage given a torso surface model. The landmarks, combined with the surface model, are subsequently used for estimating optimal ultrasound probe position on the patient for imaging infiltrates. These algorithms, combined with a force-displacement profile collection methodology, enabled the system to successfully image all points of interest in a simulated experimental setup with an average accuracy of 20.6 ± 14.7 mm using prior CT scans, and 19.8 ± 16.9 mm using only ribcage landmark estimation. A study on a full torso ultrasound phantom showed that autonomously acquired ultrasound images were 100% interpretable when using force feedback with prior CT and 88% with landmark estimation, compared to 75 and 58% without force feedback, respectively. This demonstrates the preliminary feasibility of the system, and its potential for offering a solution to help mitigate the spread of COVID-19 in vulnerable environments.

Radiation dose reduction, improved isocenter accuracy and CT scan time savings with automatic patient positioning by a 3D camera.

PURPOSE: To compare CT isocenter accuracy, patient dose, and scan time in adults imaged with and without use of a 3D camera. METHOD: 571 CT examinations utilizing a 3D camera for initial patient positioning (optional radiographer isocenter adjustment) and 504 examinations scanned without the camera between 10/1/2018 and 3/19/2019 were retrospectively identified. All exams were chest or abdominopelvic CTs. The isocenters of these exams were compared with the true isocenters defined as the manually delineated centroid of the body in the CT volume. The size specific dose estimate (SSDE) (mGy) of radiation dose obtained from departmental software for the 4 most common protocols on one CT scanner was compared before and after implementation of the 3D camera. The times required for the entire scan and just the topogram "scout" were compared with and without the 3D camera for noncontrast chest and abdominopelvic CT enterography protocols. 2-tailed t-tests and Mann-Whitney U tests were used (P < 0.05 indicated statistical significance). RESULTS: The deviation from true isocenter was 6.8 ±â€¯6.1 mm (P = 0.043) and 16.3 ±â€¯14.0 mm (P < 0.01) with and without the 3D camera, respectively (P < 0.01). CT radiographers accepted isocenter location without alteration in 93 % of examinations. Average SSDE savings with the 3D camera ranged 1.0-2.4 mGy (21-31 %) for the 4 most commonly performed protocols (p < 0.01). Median scout time savings was 32 s (Camera vs. No-Camera cohorts) (P < 0.01). Average noncontrast chest CT and CT enterography scan time savings were 19 s and 17 s with the 3D camera, respectively (P < 0.01). CONCLUSIONS: The 3D camera improved accuracy of patient positioning while reducing radiation dose and examination time. Implementation of a 3D camera helps standardize workflow in a busy clinical practice.

Redefining the Evolution of Spinal Discal Cyst Under Percutaneous Endoscopy: Report of Two Cases.

Discal cyst has been recognized as a distinct cause of back pain and radiculopathy. The clinical features are similar to other pathologies as disc prolapse and stenosis. Various treatment modalities have been described, ranging from nerve blocks to surgical excision. There are scarce reports on the endoscopic appearance of discal cysts. The present paper based on two cases operated by transforaminal and interlaminar endoscopy at our institute demonstrates the explicit intraoperative view and different pathological components of discal cysts.

Malignant Conversion to Glioblastoma in Neurofibromatosis Type I-associated Pleomorphic Xanthoastrocytoma: Unknown Predictors of Favorable Outcome.

Pleomorphic xanthoastrocytoma (PXA) is a benign glial tumor, the association of which with neurofibromatosis type I (NF-1) has been often reported in the literature. Although malignant conversion to glioblastoma may be seen in 5%-10% of PXA, the same has been reported only once in the presence of NF-1. We report, so far known to be only the second such case all over. A 25-year-old male, a known case of NF-1, underwent frontal craniotomy for a superficially located right frontal lesion, histology of which suggested PXA. Two years later, the lesion recurred and the subsequent surgery revealed malignant conversion to glioblastoma. After adjuvant radiotherapy, the patient now continues to do well and is free of disease after another 3 years of follow-up. We believe that if low levels of neurofibromin are seen in such cases with malignant conversion, subsequently increased neurofibromin levels may be responsible for better overall survival in these patients.

A Spectral Fiedler Field-based Contrast Platform for Imaging of Nanoparticles in Colon Tumor.

The temporal and spatial patterns of nanoparticle that ferry both imaging and therapeutic agent in solid tumors is significantly influenced by target tissue movement, low spatial resolution, and inability to accurately define regions of interest (ROI) at certain tissue depths. These combine to limit and define nanoparticle untreated regions in tumors. Utilizing graph and matrix theories, the objective of this project was to develop a novel spectral Fiedler field (SFF) based-computational technology for nanoparticle mapping in tumors. The novelty of SFF lies in the utilization of the changes in the tumor topology from baseline for contrast variation assessment. Data suggest that SFF can enhance the spatiotemporal contrast compared to conventional method by 2-3 folds in tumors. Additionally, the SFF contrast is readily translatable for assessment of tumor drug distribution. Thus, our SFF computational platform has the potential for integration into devices that allow contrast and drug delivery applications.

A Mobile Outside-in Technique of Transforaminal Lumbar Endoscopy for Lumbar Disc Herniations.

Percutaneous endoscopic transforaminal lumbar discectomy (PETLD) has now become a standard of care for the management of lumbar disc disease. There are two techniques for the introduction of a working cannula with respect to disc-outside-in and inside-out. The aim of this prospective study is to describe the technical aspects of a novel mobile outside-in method in dealing with different types of disc prolapse. A total of 184 consecutive patients with unilateral lower limb radiculopathy due to lumbar disc prolapse were operated on with the mobile outside-in technique of PETLD. Their clinical outcomes were evaluated based on the type of disc prolapse they had, a visual analog scale (VAS) leg pain score, the Oswestry Disability Index (ODI), and the Macnab criteria. The completeness of the decompression was documented with a postoperative magnetic resonance imaging. The mean age of the patients was 50 ± 16 years and the male/female ratio was 2:1. The mean follow-up was 19 ± 6 months. A total of 190 lumbar levels were operated on (L1-L2: n = 4, L2-L3: n = 17, L3-L4: n = 27, L4-5: n = 123, and L5-S1: n = 19). Divided into types, the patient distribution was central: n = 14, paracentral: n = 74, foraminal: n = 28, far lateral: n = 13, superior-migrated: n = 8, inferior migrated: n = 38, and high canal compromise: n = 9. The mean operative time was 35 ± 12 (25 - 56) min and the mean hospital stay was 1.2 ± 0.5 (1-3) days. The VAS score for leg pain improved from 7.5 ± 1 to 1.7 ± 0.9. The ODI improved from 70 ± 8.3 to 23 ± 5. According to the Macnab criteria, 75 patients (40.8%) had excellent results, 104 patients (56.5%) had good results, and 5 patients (2.7%) had fair results. Recurrence (including early and late) was seen in 15 out of the 190 levels that were operated on (7.89%). This article presents a novel outside-in approach that relies on a precise landing within the foramen in a mobile manner and does not solely depend upon the enlargement of the foramen. It is more versatile in application and useful in the management of all types of disc prolapse, even in severe canal compromise and high migration.

Feasibility of Full Endoscopic Spine Surgery in Patients Over the Age of 70 Years With Degenerative Lumbar Spine Disease.

OBJECTIVE: Degenerative spine disease, encompassing disc prolapse and stenosis, is a common ailment in old age. This prospective study was undertaken to evaluate the role of endoscopic spine surgery in elderly patients (above 70 years of age) with clinical and radiological follow-up. METHODS: In this study, a prospective analysis was conducted of 53 patients with lumbar disc prolapse or spinal stenosis who were treated with percutaneous endoscopic discectomy or decompression from November 2015 to June 2017. Clinical follow-up was done at 1 week, 3 months, and 1 year, and at yearly intervals thereafter. The outcomes were assessed using the modified Macnab criteria, a visual analogue scale, and the Oswestry Disability Index. RESULTS: Of the 53 patients, 21 were men and 32 were women. Their mean age was 76±4 years. The mean follow-up period was 17 months. Percutaneous endoscopic discectomy was performed in 24 patients and endoscopic decompression in 24 patients, while 5 patients underwent combined surgery. An excellent outcome in terms of the MacNab criteria was observed in 9 patients (16.98%), a good outcome in 38 patients (71.7%), and a poor outcome in 6 patients (11.3%). Of the 6 patients with a poor outcome, 5 (9.4%, 5 of 53) developed recurrent disc prolapse, and 1 developed hematoma with motor weakness. All 6 of these cases required revision surgery. CONCLUSION: Managing degenerative spine disease in elderly patients with multiple comorbidities is a challenging task. Percutaneous endoscopic spine surgery is pivotal for addressing this concern. The authors have shown that optimal results can be achieved with various types of disc prolapse and stenosis with favorable long-term outcomes.

Spastic Quadriparesis and Communicating Hydrocephalus as Late Sequel of Rosai-Dorfman Disease: A Case Report and Review of Literature.

Rosai-Dorfman disease (RDD) predominantly affects cervical lymph nodes and presents with fever and pancytopenia. Central nervous system involvement though uncommon is often reported. Hydrocephalus and paraparesis as a consequence of RDD is an extremely rare entity. We present a 58-year-old male, diagnosed and treated for RDD with cervical lymphadenopathy, who now presented with spastic paraparesis and on evaluation was found to have communicating hydrocephalus that resolved after ventriculoperitoneal shunt surgery.

Serum albumin level in spontaneous subarachnoid haemorrhage: More than a mere nutritional marker!

BACKGROUND: The role of nutritional markers on outcome following subarachnoid hemorrhage (SAH) has been scarcely described. METHODS: This is a prospective study of 273 patients with SAH, in which haemoglobin, serum protein and albumin were measured within 24 hours and again at one week following ictus, and analysed with respect to other variables. New neurologic deficits (NND), infarct, mortality and Glasgow outcome scale (GOS) at 3 months were assessed. RESULTS: The values of haemoglobin, total protein and albumin showed significant (p < .001) decline over the first week of SAH. Patients who developed NND had significantly lower serum albumin levels at admission compared to others (median 3.6 vs 3.9 g/dL, p < .001). Patients having lower albumin (≤3.5 gm/dL) levels at admission had significantly higher rates of NND (52% vs 20%), infarct (35% vs 23%), mortality (28% vs 16%) and unfavourable GOS (38% vs 25%). Hunt & Hess (H&H) grade and Fisher grade also affected all the outcome parameters significantly. Percentage decrease in albumin levels at one week following ictus significantly affected mortality and unfavourable GOS. On multivariate analyses, Fisher grade and lower admission albumin levels had significant impact on NND, while percentage decrease in albumin levels had significant impact on mortality and unfavourable GOS, independent of other nutritional markers and known prognostic variables. CONCLUSIONS: Serum albumin levels following SAH can be useful to predict development of NND, while its further weekly decrease correlates independently with unfavourable outcome at 3 months. Albumin assessment being readily available may serve as more than a mere nutritional parameter in SAH.

Sphenoid bone: a rare site for giant cell tumor - case report with literature review.

While giant cell tumor is commonly a tumor of long bones, involvement of sphenoid bone is very rare. Clinically and radiologically, it mimics other neoplasms of this site. Endochondral ossification of this bone during development explains its curious preferential involvement in comparison to the rest of the skull bones. We describe an example of such a tumor arising in the sphenoid bone in a young woman and discuss the differential diagnosis. Recognizing its characteristic features is important for correct interpretation.
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Motion Compensated Ultrasound Imaging Allows Thermometry and Image Guided Drug Delivery Monitoring from Echogenic Liposomes.

Ultrasound imaging is widely used both for cancer diagnosis and to assess therapeutic success, but due to its weak tissue contrast and the short half-life of commercially available contrast agents, it is currently not practical for assessing motion compensated contrast-enhanced tumor imaging, or for determining time-resolved absolute tumor temperature while simultaneously reporting on drug delivery. The objectives of this study were to: 1) develop echogenic heat sensitive liposomes (E-LTSL) and non-thermosensitive liposomes (E-NTSL) to enhance half-life of contrast agents, and 2) measure motion compensated temperature induced state changes in acoustic impedance and Laplace pressure of liposomes to monitor temperature and doxorubicin (Dox) delivery to tumors. LTSL and NTSL containing Dox were co-loaded with an US contrast agent (perfluoropentane, PFP) using a one-step sonoporation method to create E-LTSL and E-NTSL. To determine temperature induced intensity variation with respect to the state change of E-LTSL and E-NTSL in mouse colon tumors, cine acquisition of 20 frames/second for about 20 min (or until wash out) at temperatures of 42°C, 39.5°C, and 37°C was performed. A rigid rotation and translation was applied to each of the "key frames" to adjust for any gross motion that arose due to motion of the animal or the transducer. To evaluate the correlation between ultrasound (US) intensity variation and Dox release at various temperatures, treatment (5 mg Dox/kg) was administered via a tail vein once tumors reached a size of 300-400 mm(3), and mean intensity within regions of interest (ROIs) defined for each sample was computed over the collected frames and normalized in the range of [0,1]. When the motion compensation technique was applied, a > 2-fold drop in standard deviation in mean image intensity of tumor was observed, enabling a more robust estimation of temporal variations in tumor temperatures for 15-20 min. due to state change of E-LTSL and E-NTSL. Consequently, a marked increase in peak intensity at 42°C compared to 37°C that corresponded with enhanced Dox delivery from E-LTSL in tumors was obtained. Our results suggest that echogenic liposomes provide a predictable change in tumor vascular contrast with temperature, and this property could be applicable to nanomonitoring of drug delivery in real time.

Ultra early recurrence in giant congenital malignant rhabdoid tumor of spine.

BACKGROUND: Malignant rhabdoid tumor (MRT) is an aggressive tumor of infancy and childhood that rarely presents as a primary spinal or spinal cord tumor. There are only three reported cases of spinal MRT in infants. OBJECTIVE: We present a similar case in a 3-month male child who developed ultra-early recurrence, 4 weeks after complete excision. The diagnosis was confirmed by immunohistochemistry showing inactivation of the INI1 gene. RESULT: Despite surgical excision and adjuvant chemoradiotherapy, these tumors have a progressive course and recurrence is a common phenomenon. CONCLUSION: We believe that MRT must be considered in the differential diagnosis of the intra/paraspinal masses, especially in the infants.

An orphan disease: IgG4-related spinal pachymeningitis: report of 2 cases.

IgG4-related disease is relatively new disease entity and a rare one, and our knowledge of this entity continues to evolve. It was first described in the pancreas and since then has been described in virtually every organ. Spinal involvement resulting in pachymeningitis is rare, and there are only 8 reported cases of the same to date, with the cervicothoracic spine being the most commonly affected region. The authors describe 2 cases in which the patients presented with spinal compression resulting in myeloradiculopathy (Case 1) and radiculopathy (Case 2). Imaging of spine in both cases revealed an ill-defined contrast-enhancing lesion at the lumbar level. Preoperatively, a diagnosis of spinal tumor was made, but intraoperatively no spinal tumor was found. The diagnosis was established histopathologically. The disease has no particular defining features clinically or radiologically and can mimic common spinal tumors. It is important to accurately diagnose this rare entity because of its multisystem involvement and progressive course. Strict treatment guidelines have yet to be formulated. Although histologically this disease can mimic other inflammatory conditions, the presence of storiform fibrosis and an increased number of IgG4-positive plasma cells can help in clarifying the diagnosis.

Giant primary calvarial hemangioma over torcula: Radiological features and operative nuances.

BACKGROUND: Although rare, primary calvarial hemangioma is a known entity, surgical excision of which usually results in massive blood loss. Successful total excision of such a lesion remains a challenge, especially when these are in close vicinity of major venous sinuses. CASE DESCRIPTION: Authors describe a rare case of intra-osseous occipital cavernoma along with radiological findings in a 50-year-old male. En bloc resection of tumor was performed using a high-speed pneumatic drill and no recurrence was noted at 6 months of follow-up. CONCLUSION: Intra-osseous cavernous hemangiomas have classical radiological features and can be excised completely, even when lying above major venous drainage channels like torcula.