Background: Neurosurgeons regularly plan their surgery using magnetic resonance imaging (MRI) images, which may show a clear distinction between the area to be resected and the surrounding healthy brain tissue depending on the nature of the pathology. However, this distinction is often unclear with the naked eye during the surgical intervention, and it may be difficult to infer depth and an accurate volumetric interpretation from a series of MRI image slices. Objectives: In this work, MRI data are used to create affordable patient-specific 3-dimensional (3D) scale models of the brain which clearly indicate the location and extent of a tumour relative to brain surface features and important adjacent structures. Methods: This is achieved using custom software and rapid prototyping. In addition, functionally eloquent areas identified using functional MRI are integrated into the 3D models. Results: Preliminary in vivo results are presented for 2 patients. The accuracy of the technique was estimated both theoretically and by printing a geometrical phantom, with mean dimensional errors of less than 0.5 mm observed. Conclusions: This may provide a practical and cost-effective tool which can be used for training, and during neurosurgical planning and intervention.
Several studies [1][2][3][4] have made it possible to predict outcome in severe traumatic brain injury (TBI) making it beneficial as an aid for clinical decision-making in the emergency setting. Accurate assessment of prognosis is crucial in multi-casualty incidents so that prehospital emergency care practitioners can focus their attention on patients predicted to have a good outcome. No single prognostic model is practised broadly despite many models being described in the literature. Most models are derived from developed nations, which potentially offer superior intensive healthcare services Background. Several studies have made it possible to predict outcome in severe traumatic brain injury (TBI) making it beneficial as an aid for clinical decision-making in the emergency setting. However, reliable predictive models are lacking for resource-limited prehospital settings such as those in developing countries like South Africa. Objective. To develop a simple predictive model for severe TBI using clinical variables in a South African prehospital setting. Methods. All consecutive patients admitted at two level-one centres in Cape Town, South Africa, for severe TBI were included. A binary logistic regression model was used, which included three predictor variables: oxygen saturation (SpO 2 ), Glasgow Coma Scale (GCS) and pupil reactivity. The Glasgow Outcome Scale was used to assess outcome on hospital discharge. Results. A total of 74.4% of the outcomes were correctly predicted by the logistic regression model. The model demonstrated SpO 2 (p=0.019), GCS (p=0.001) and pupil reactivity (p=0.002) as independently significant predictors of outcome in severe TBI. Odds ratios of a good outcome were 3.148 (SpO 2 ≥90%), 5.108 (GCS 6 -8) and 4.405 (pupils bilaterally reactive). Conclusion. This model is potentially useful for effective predictions of outcome in severe TBI.
Midface hypoplasia is a common craniofacial anomaly and may manifest as part of a wider syndrome or as an isolated finding. Underlying this condition is a complex morphology, resulting from development across multiple interacting suture systems. Current treatment relies on various combinations of osteotomies and distraction using internal or external devices. Such procedures, while often successful, involve significant morbidity and trauma to the very young patients whom comprise the majority of the treatment group. The present article describes the successful development of a technique for midfacial distraction without osteotomies. In a case study representing a series of 11 patients, a 4-month-old baby girl with midface hypoplasia and respiratory obstruction requiring nasopharyngeal intubation underwent this 2-stage procedure. After 72-day distraction, upper incisor-posterior clinoid process distance had increased 18.4 mm, and by 4 months after removal of the distraction devices, it had increased a further 2.6 mm. Craniofacial morphology was markedly improved combined with complete resolution of her respiratory obstruction. No blood transfusion or intensive care facility was required. This innovation demonstrates a procedure with similar efficacy but significantly reduced morbidity and cost compared with existing methods. Interestingly, continued growth after the distraction period may allude to a different mechanism of induced osteogenesis than previously described.
We present the case of a young child who developed a massive tuberculous abscess of the posterior fossa while being treated for pulmonary tuberculosis. Clinical improvement after surgical excision of the abscess was followed by recurrence of symptoms of acutely raised intracranial pressure on standard antituberculosis and corticosteroid therapy. Magnetic resonance (MR) imaging of the brain showed that a multiloculated abscess had developed anterior to the excision site of the original abscess. The recurring abscess was partly excised and drained but could not be removed completely because of its proximity to the brain stem. Thalidomide, a potent inhibitor of tumour necrosis factor alpha (TNF-alpha), was added to the treatment regimen and resulted in marked clinical improvement with resolution of the abscess within 4 months. The remaining CT lesion had the appearance of a small granuloma. Both the clinical and the radiological response was maintained after 1 year of antituberculosis treatment.
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