Percutaneous CT-Guided Deep Neck Access.

Computed tomography guidance enables deep neck biopsies beyond the range of ultrasound and spares the patient more invasive open surgery. This review article describes proper patient preparation, devices, and techniques. Cases illustrate the favored access routes in the suprahyoid neck including the subzygomatic, retromandibular, transfacial, submastoid, transoral, and posterior approaches, as well as in the infrahyoid neck including the anterolateral and posterolateral approaches.

Automated segmentation of ventricular volumes and subarachnoid hemorrhage from computed tomography images: Evaluation of a rule-based pipeline approach.

Changes in ventricular size, related to brain edema and hydrocephalus, as well as the extent of hemorrhage are associated with adverse outcomes in patients with subarachnoid hemorrhage (SAH). Frequently, these are measured manually using consecutive non-contrast computed tomography scans. Here, we developed a rule-based approach which incorporates both intensity and spatial normalization and utilizes user-defined thresholds and anatomical templates to segment both lateral ventricle (LV) and SAH blood volumes automatically from CT images.

Accuracy and Reproducibility of Linear and Angular Measurements in Virtual Reality: a Validation Study.

The purpose of this experimental study is to validate linear and angular measurements acquired in a virtual reality (VR) environment via a comparison with the physical measurements. The hypotheses tested are as follows: VR linear and angular measurements (1) are equivalent to the corresponding physical measurements and (2) achieve a high degree of reproducibility. Both virtual and physical measurements were performed by two raters in four different sessions.

Renal cell carcinoma presenting as epistaxis from a nasal cavity metastasis.

We present a 58-year-old gentleman who initially presented to the otolaryngology clinic with new onset epistaxis revealing a palpable facial mass that was subsequently biopsied revealing metastatic renal cell carcinoma. We hope to present an interesting case highlighting the rarity of this disease and unusual presentation in which the presence of the primary renal cell carcinoma was recognized only after biopsy.

Primary Orbital Histiocytic Sarcoma in a Child Successfully Treated With Multiagent Chemotherapy.

Histiocytic sarcoma (HS), a malignant proliferation of mature tissue histiocytes presenting with single or multifocal extranodal tumors, is rarely seen in children. Primary orbital HS has never been reported in a child. Disseminated disease to the bone marrow typically has an aggressive course and poor prognosis.

Delayed response and survival from NovoTTF-100A in recurrent GBM.

We present a 48-year-old male with recurrent glioblastoma (GBM) who was enrolled in the NovoTTF-100A landmark phase III study and has been on device for >6 years. During this time, his magnetic resonance images demonstrated initial growth followed by a slow decrease in enhancement with continued residual disease. Long-term survivors in patients with recurrent GBM are rare, especially in the absence of definitive local treatment such as surgery or radiosurgery.

malignant optic chiasm glioma with initial clinical response to steroids.

Malignant optic nerve glioma (MONG) is a rare but uniformly fatal disease that remains poorly understood. We describe a notable case of this rare disease occurring in the optic chiasm. Normal brain imaging and normal ophthalmic examination two years prior to diagnosis provide evidence for genesis of MONG in our patient.

Unusual CNS presentation of thyroid cancer.

As advanced therapies allow cancer patients to live longer, disease failure in the central nervous system increases from limited therapeutic penetration. Primary thyroid malignancies rarely metastasize to the brain and have a small number of investigations in literature on the subject. The majority of brain metastases involve the brain parenchyma, reflecting the mass and blood distribution within the brain and central nervous system.

Prolonged activity of bevacizumab in adenocarcinoma of the lung with multiple brain metastases.

Patients with lung cancer having multiple brain metastases have poor outcomes. We present long-term disease treatment in a 60-year-old woman having greater than thirty brain metastases of NSCLC adenocarcinoma with a mutant allele of EGFR treated with differing chemotherapies including erlotinib, but disease response in the brain only with bevacizumab. Although initially restricted in use, increasing clinical reports have demonstrated safety of bevacizumab use in brain-involved cancer patients.

MRI of orbital cellulitis and orbital abscess: the role of diffusion-weighted imaging.

Objective: Our aims were to describe the role of diffusion-weighted imaging (DWI) in detecting abscess as a complication of orbital cellulitis and to assess whether abscess can be diagnosed with a combination of conventional unenhanced sequences and whole-brain DWI with parallel acquisition. Nine cases of orbital cellulitis imaged with MRI were retrospectively reviewed, including six cases with pyogenic abscess.

Conclusion: In this preliminary study, DWI improved diagnostic confidence in nearly all cases of orbital abscess when used in conjunction with contrast-enhanced imaging.

Synchronous moyamoya syndrome and ruptured cerebral aneurysm in Alagille syndrome.

Moyamoya syndrome and cerebral aneurysm formation are rare cerebrovascular manifestations of Alagille syndrome. Although previously reported in isolation, occurrence of these complications in a single patient has not been described. We report clinical and imaging features of synchronous moyamoya syndrome and ruptured cerebral aneurysm in a patient with Alagille syndrome.

Astroblastoma presenting with intracerebral hemorrhage misdiagnosed as dural arteriovenous fistula: review of a rare entity.

Background: Astroblastoma is one of the most unusual types of tumors whose histogenesis has been recently clarified. It occurs mainly among children and young adults. It is grossly well demarcated and shows histologically characteristic perivascular pseudorosettes with frequent vascular hyalinization.