Neonatal Craniopharyngioma - A case report and review of the literature

Das Kraniopharyngeom ist eine dysontogenetische Mittellinienfehlbildung mit raumforderndem Charakter. Die Ätiopathogenese ist noch ungeklärt. Bildgebende Verfahren (Sonographie, MRT) ermöglichen bereits pränatal eine Diagnostik. Das neonatale Kraniopharyngeom ist sehr selten. Bisher finden sich in der Literatur nur wenige Fallberichte von denen operative Verläufe sowie klinische Langzeitverläufe bekannt sind. Es bleibt eine Kontroverse hinsichtlich Radikalität und Zeitpunkt der Operation, nicht aber dahingehend, dass die operationsmikroskopische Versorgung die Therapie der Wahl des neonatalen Kraniopharyngeoms darstellt. Die Nähe zur hypophysären-hypothalamischen Achse bedingt eine hohe Komorbidität der Kinder prä- und postoperativ.Craniopharyngioma are embryogenic malformations of the sellar area. With an overall incidence of 0.5–2 new cases per million population per year, 30–50% of all cases occur in childhood.As the survival rate after craniopharyngioma diagnosed during childhood and adolescence is high, prognosis and quality of life in survivors mainly depend on adverse late effects such as hypopituitarism and obesity. Appropriate laboratory diagnostics of endocrine deficiencies and sufficient hormonal substitution have significant impact on prognosis. A review of the literature reveal only some few cases of neonatal craniopharyngioma. Modern picture-giving proceeds such as MRI enable a early diagnosis. On the one hand there is a controversy concerning the radicalness and the time of operation on the other hand the microsurgical resection is meant to be the goldstandard in the therapy of neonatal craniopharyngiomas

Intraoperative Myelography in Cervical Multilevel Stenosis Using 3D Rotational Fluoroscopy: Assessment of Feasibility and Image Quality

Background. Intraoperative myelography has been reported for decompression control in multilevel lumbar disease. Cervical myelography is technically more challenging. Modern 3D fluoroscopy may provide a new opportunity supplying multiplanar images. This study was performed to determine the feasibility and image quality of intraoperative cervical myelography using a 3D fluoroscope. Methods. The series included 9 patients with multilevel cervical stenosis. After decompression, 10 mL of water-soluble contrast agent was administered via a lumbar drainage and the operating table was tilted. Thereafter, a 3D fluoroscopy scan (O-Arm) was performed and visually evaluated. Findings. The quality of multiplanar images was sufficient to supply information about the presence of residual stenosis. After instrumentation, metal artifacts lowered image quality. In 3 cases, decompression was continued because myelography depicted residual stenosis. In one case, anterior corpectomy was not completed because myelography showed sufficient decompression after 2-level discectomy. Interpretation. Intraoperative myelography using 3D rotational fluoroscopy is useful for the control of surgical decompression in multilevel spinal stenosis providing images comparable to postmyelographic CT. The long duration of contrast delivery into the cervical spine may be solved by preoperative contrast administration. The method is susceptible to metal artifacts and, therefore, should be applied before metal implants are placed

Bone chips, fibrin glue, and osteogeneration following lateral suboccipital craniectomy: a case report

Background Suboccipital craniectomy is a conventional approach for exploring cerebellopontine angle lesions. A variety of techniques have been successfully employed to reconstruct a craniectomy. This is the first report about the histological findings after performing a cranioplasty by using a mixture of autologous bone chips and human allogenic fibrin glue. Case presentation A 53-year-old German woman underwent left lateral suboccipital retrosigmoidal craniectomy for treatment of trigeminal neuralgia in 2008. Cranioplasty was perfomed by using a mixture of autologous bone chips and human allogenic fibrin glue. Due to recurrent neuralgia, a second left lateral suboccipital craniectomy was performed in 2012. The intraoperative findings revealed a complete ossification of the former craniotomy including widely mature trabecular bone tissue in the histological examination. Conclusion A mixture of autologous bone chips and human allogenic fibrin glue seems to provide sufficient bone-regeneration revealed by histological and neuroradiological examinations

Numerical Simulation of Surface Acoustic Wave Actuated Cell Sorting

We consider the mathematical modeling and numerical simulation of high throughput sorting of two different types of biological cells (type I and type II) by a biomedical micro-electro-mechanical system (BioMEMS) whose operating behavior relies on surface acoustic wave (SAW) manipulated fluid flow in a microchannel. The BioMEMS consists of a separation channel with three inflow channels for injection of the carrier fluid and the cells, two outflow channels for separation, and an interdigital transducer (IDT) close to the lateral wall of the separation channel for generation of the SAWs. The cells can be distinguished by fluorescence. The inflow velocities are tuned such that without SAW actuation a cell of type I leaves the device through a designated outflow channel. However, if a cell of type II is detected, the IDT is switched on and the SAWs modify the fluid flow such that the cell leaves the separation channel through the other outflow boundary. The motion of a cell in the carrier fluid is modeled by the Finite Element Immersed Boundary Method (FE-IB) featuring a coupled system consisting of the incompressible Navier-Stokes equations with respect to a Cartesian coordinate system and the equation of motion of the cell described in a Lagrangian framework. The generation of the SAWs is taken care of by the linearized equations of piezoelectricity, and the impact of the SAWs on the fluid flow is realized by means of a boundary condition for the Navier-Stokes equations. The discretization in space is done by P2/P1 Taylor-Hood elements for the fluid flow and periodic cubic splines for the immersed cell, whereas for discretization in time we use the backward Euler scheme for the Navier-Stokes equations and the forward Euler scheme for the equation of motion of the immersed cell. This backward Euler/forward Euler Finite Element Immersed Boundary Method (BE/FE FE-IB) requires a CFL-type condition for stability. Numerical results are presented that illustrate the feasibility of the surface acoustic wave actuated cell sorting approach

Long-term tumor control of spinal dissemination of cerebellar glioblastoma multiforme by combined adjuvant bevacizumab antibody therapy: a case report

Background Glioblastoma multiforme located in the posterior fossa is extremely rare with a frequency up to 3.4%. Compared with glioblastoma of the hemispheres the prognosis of infratentorial glioblastoma seems to be slightly better. Absence of brainstem invasion and low expression rates of epidermal growth factor receptor are described as factors for long-time survival due to the higher radiosensitivity of these tumors. Case presentation In this case study, we report a German female patient with an exophytic glioblastoma multiforme arising from the cerebellar tonsil and a secondary spinal manifestation. Furthermore, the tumor showed no O (6)-Methylguanine-DNA methyltransferase promotor-hypermethylation and no isocitrate dehydrogenase 1 mutations. All these signs are accompanied by significantly shorter median overall survival. A long-term tumor control of the spinal metastases was achieved by a combined temozolomide/bevacizumab and irradiation therapy, as part of a standard care administered by the treating physician team. Conclusion To our knowledge this is the first published case of a combined cerebellar exophytic glioblastoma with a subsequent solid spinal manifestation. Furthermore this case demonstrates a benefit undergoing this special adjuvant therapy regime in terms of overall survival. Due to the limited overall prognosis of the disease, spinal manifestations of glioma are rarely clinically relevant. The results of our instructive case, however, with a positive effect on both life quality and survival warrant treating future patients in the frame of a prospective clinical study

Optimal Control of Surface Acoustic Wave Actuated Sorting of Biological Cells

The sorting of biological cells using biological micro-electro-mechanical systems (BioMEMS) is of utmost importance in various biomedical applications. Here, we consider a new type of devices featuring surface acoustic wave (SAW) actuated cell sorting in microfluidic separation channels. The SAWs are generated by an interdigital transducer (IDT) and manipulate the fluid flow such that cells of different type leave the channel through designated outflow boundaries. The operation of the device can be formulated as an optimal control problem where the objective functional is of tracking type, the state equations describe the fluid-structure interaction between the carrier fluid and the cells, and the control is the electric power applied to the IDT

Primary brain amyloidoma, both a neoplastic and a neurodegenerative disease: a case report

Background Scattered extracellular deposits of amyloid within the brain parenchyma can be found in a heterogeneous group of diseases. Its condensed accumulation in the white matter without evidence for systemic amyloidosis is known as primary brain amyloidoma (PBA). Although originally considered as a tumor-like lesion by its space-occupying effect, this condition displays also common hallmarks of a neurodegenerative disorder. Case presentation A 50-year-old woman presented with a mild cognitive decline and seizures with a right temporal, irregular and contrast-enhancing mass on magnetic resonance imaging. Suspecting a high-grade glioma, the firm tumor was subtotally resected. Neuropathological examination showed no glioma, but distinct features of a neurodegenerative disorder. The lesion was composed of amyloid AL λ aggregating within the brain parenchyma as well as the adjacent vessels, partially obstructing the vascular lumina. Immunostaining confirmed a distinct perivascular inflammatory reaction. After removal of the PBA, mnestic impairments improved considerably, the clinical course and MRI-results are stable in the 8-year follow-up. Conclusion Based on our histopathological findings, we propose to regard the clinicopathological entity of PBA as an overlap between a neoplastic and neurodegenerative disorder. Since the lesions are locally restricted, they might be amenable to surgery with the prospect of a definite cure