Frontotemporal Region Research Articles

The diagnostic challenge of differentiating Tumefactive Multiple Sclerosis (TMS) from other brain lesions: a case report and literature review on a rare subtype of MS

Introduction and Importance: This case report is a clinical diagnosis walk through of a rare subtype of Multiple sclerosis (MS). It gives an overview of how Tumefactive multiple sclerosis (TMS) is systematically narrowed down as the definitive diagnosis. Case Presentation: Our 29 year old male patient presented to the emergency department. He collapsed after experiencing pain over his right frontotemporal region followed by a seizure witnessed by his family. Magnetic Resonance Imaging of the brain displayed a diffuse enlargement and abnormal T2 weighted and FLAIR hyperintense signals in the diagnostic impressions described by the radiologist of the right temporoparietal region. Clinical Discussion: Liquefactive Multiple Sclerosis, also known as tumefactive multiple sclerosis or Marburg-type multiple sclerosis, is a rare subtype of the neurological disorder that can be difficult to diagnose. Unlike the traditional form of Multiple sclerosis (MS), Tumefactive multiple sclerosis (TMS) can present as a brain tumor and must be diagnosed with a biopsy rather than via magnetic resonance imaging (MRI) and clinical findings alone. Patients can typically present with headache, cognitive abnormalities, mental confusion, aphasia, apraxia, seizures, and weakness. Here, we discuss the presentation, disease diagnosis process and patient management. Conclusion: The patient was stabilized and discharged with a referral to the neurosurgery and neurology departments for outpatient consultation for future clinical management and treatment of their condition.

Distinct Longitudinal Changes in EEG Measures Reflecting Functional Network Disruption in ALS Cognitive Phenotypes

Amyotrophic lateral sclerosis (ALS) is characterised primarily by motor system degeneration, with clinical evidence of cognitive and behavioural change in up to 50% of cases. We have shown previously that resting-state EEG captures dysfunction in motor and cognitive networks in ALS. However, the longitudinal development of these dysfunctional patterns, especially in networks linked with cognitive-behavioural functions, remains unclear. Longitudinal studies on non-motor changes in ALS are essential to further develop our understanding of disease progression, improve care and enhance the evaluation of new treatments. To address this gap, we examined 124 ALS individuals with 128-channel resting-state EEG recordings, categorised by cognitive impairment (ALSci, n = 25), behavioural impairment (ALSbi, n = 58), or non-impaired (ALSncbi, n = 53), with 12 participants meeting the criteria for both ALSci and ALSbi. Using linear mixed-effects models, we characterised the general and phenotype-specific longitudinal changes in brain network, and their association with cognitive performance, behaviour changes, fine motor symptoms, and survival. Our findings revealed a significant decline in \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:\ heta\\:$$\\end{document}-band spectral power over time in the temporal region along with increased \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\:{\\gamma\\:}_{l}$$\\end{document}-band power in the fronto-temporal region in the ALS group. ALSncbi participants showed widespread β-band synchrony decrease, while ALSci participants exhibited increased co-modulation correlated with verbal fluency decline. Longitudinal network-level changes were specific of ALS subgroups and correlated with motor, cognitive, and behavioural decline, as well as with survival. Spectral EEG measures can longitudinally track abnormal network patterns, serving as a candidate stratification tool for clinical trials and personalised treatments in ALS.

Scalp defect associated with extensive fibrosis of artificial dura requiring modified closure

Background A variety of methods are available for scalp defect closure and necessitate extensive planning. Superficial temporal artery (STA) based local flaps are widely used in the field of scalp and face reconstruction because of their flexibility and rich vascularity. Rotation and transposition techniques are commonly used in the area, however at times result in excessive tension. V-Y advancement allows tension-free closure with reduced post-operative complications. Case presentation A case of scalp defect post multiple craniectomies for a traumatic head injury complicated with subgaleal collection and poor wound healing in a 29-year-old male, is reported. Due to the nature of defect, with underlying fibrosis and previous artificial duraplasty, along with location in the frontotemporal region, a local STA based flap closed in a rotation, transposition and unilateral V-Y advancement pattern was used. Conclusion The challenges encountered in wound closure of complicated post-traumatic and multiple craniectomy cases can be overcome with a modified combined approach which achieves optimal wound closure. Bangladesh Journal of Medical Science Vol. 23 No. 04 October’24 Page : 1227-1232

Sonographic comparison of subcutaneous fat layer thickness in the scalp area in patients with androgenetic alopecia compared to healthy individuals: Cross-sectional.

Androgenetic alopecia (AGA) is one of the most common alopecia among men and women worldwide. It is a nonscarring alopecia that has a characterized pattern. In female pattern AGA, the hairline is stable but general thinning occurs most notably in the frontal region. In male-pattern AGA, the hairline is receding and the thinning is most notable in the frontotemporal region. AGA has a complex pathogenesis and relation of subcutaneous fat in the scalp region and the miniaturization of terminal hair follicles is vague. In this study, subcutaneous fat in the frontal scalp an important region for AGA is compared to the occipital scalp that is spared in AGA. Our study is a cross-sectional study that has four groups. Male patient, female patient, male control, female control. Every group has 15 individuals. All of the people in the study are those referred to Rasoul Akram's dermatology clinic. The severity of alopecia is classified by Norwood scaling for male pattern AGA and Ludwig scaling for female pattern AGA. Subcutaneous tissue in the frontal and occipital regions is measured by ultrasonography. For evaluating the effect of aging on subcutaneous fat thickness, we subdivided any group into more than 40 years old and between 20 and 40 years old and compared these two subgroups. The mean age of the three groups of male patient, female patient, and female control is 40 y/o and the mean age of male control is 41 y/o. The mean subcutaneous fat layer thickness in frontal region in male patients group is 6.0mm (more than 40 y/o=6.6mm, between 20 and 40 y/o=5.5mm), in female patients group 5.1mm (more than 40 y/o=5.7mm, between 20 and 40 y/o=4.6mm), in the male control group is 4.4mm (more than 40 y/o=4.7mm, between 20 and 40 y/o=4mm) and in the female control group is 4.1mm (more than 40 y/o=4.5mm, between 20 and 40 y/o=3.6mm). The mean subcutaneous fat layer thickness in the occipital region in the male patient's group is 6.4mm (more than 40 y/o=6.7mm, between 20 and 40 y/o=6mm), in the female patient's group 6.1mm (more than 40 y/o=6.5mm, between 20 and 40 y/o=5.7mm), in the male control group is 6.3mm (more than 40 y/o=6.8mm, between 20 and 40 y/o=5.7mm) and in the female control group is 6.2mm (more than 40 y/o=6.6mm, between 20 and 40 y/o=5.8mm). This study demonstrates that the subcutaneous fat layer in the frontal region in both males and females is thicker in AGA patients than healthy group and the more severe the AGA, the thicker is subcutaneous layer in the frontal region. In the male patients group, the subcutaneous fat layer in the frontal region is thicker than in the female patients group but in the male and female control groups is not so different. The subcutaneous fat layer in the occipital region is thicker in older individuals in both patients and control groups but is not different when compared to AGA patients and control individuals.

The localization, treatment, and complications of dermoid cysts in the eyebrow region

Dermoid cysts are congenital lesions characterized by skin appendages and surrounding epithelial tissue with a well-defined cyst wall, accounting 40% of all pediatric lesions. The most common location is frontotemporal, orbital and nasoglabellar region. Diagnosis is based on physical examination and imaging in selected cases. Surgical excision is recommended as the preferred course of treatment. Presentation, classification, differential diagnosis, imaging methods and algorithms, surgical techniques and complications are discussed based on the recent literature.

HGG-43. DIFFUSE PEDIATRIC HIGH GRADE GLIOMA SUCCESSFULLY TREATED WITH MULTIMODAL THERAPY

Abstract BACKGROUND Pediatric high grade glioma (HGG) have a dismal prognosis despite aggressive treatment. In this report, we discuss a patient with HGG successfully treated with combination of resection, radiotherapy, chemotherapy, and biologic therapy. RESULTS An 8-year-old male presented with intermittent headaches, vomiting and fatigue. Imaging demonstrated four solid/cystic enhancing intra-axial lesions within the left cerebral hemisphere- two within the left frontotemporal region, one in the superior parietal region, and one in the temporal lobe, all with perilesional edema and resultant subfalcine herniation with midline shift. The patient underwent subtotal resection of the frontotemporal and parietal lesions. Histopathology was consistent with glioblastoma. Whole exome sequencing revealed alterations in TP53, ATRX, PTEN, TSC2 as well as subclonal mutation in NF1. The tumor was unable to be further classified by DNA methylation. However histopathologic and molecular findings support the diagnosis of diffuse pediatric-high grade glioma, H3-wildtype and IDH-wildtype. The patient received adjuvant 59.4 Gy focal proton therapy with concurrent temozolomide and maintenance chemotherapy with temozolomide and lomustine for 6 cycles. End of therapy imaging demonstrated complete resolution of all sites of disease. Due to high likelihood of recurrence, the patient was subsequently started on targeted therapy with everolimus and ribociclib which continue to be well tolerated without dose adjustments. The patient remains stable and without recurrence 2.5 years since diagnosis, and 15 months since initiation of biologic therapy. Additionally, the patient underwent testing for cancer predisposition which revealed presence of TP53 heterozygous mutation consistent with Li-Fraumeni syndrome. The patient remains without other malignancies on surveillance imaging per LFS guidelines. CONCLUSION Our case report illustrates the value of both chemotherapy and biologic therapy in treatment of HGG. In addition to this, it emphasizes the importance of germline testing for cancer predisposition in patients with high grade tumors.

Three-point Method Nerve Block for Relieving Pain of Microbotox Injection in Middle and Upper Face.

With the popularity of microbotox, pain caused by multiple microdroplets and subcutaneous injection of botulinum toxin is increasing. This study presents a new, refined, three-point nerve block technique that provides effective pain relief during minimally invasive injection therapy targeting the middle and upper face. Fifty volunteers underwent facial ultrasonography to measure the locations of the supraorbital and infraorbital foramen. Following microdrop Botox injection of the middle and upper face, 100 patients underwent a self-controlled study to analyze whether a three-point nerve block surpasses topical anesthesia for reducing injection pain. The visual analog scale pain score, the time of the three-point method and botulinum toxin injection, and side effects were recorded. Among the volunteers, the location of the supraorbital and infraorbital foramen showed no statistical difference between the left and right sides. For the 100 patients (13 men, 87 women) who underwent the three-point nerve block, the visual analog scale pain scores on the experimental side were significantly lower than those on the control side, except in the frontotemporal region (2.46 ± 0.50, 2.42 ± 0.47, P > 0.05). The duration of the unilateral three-point nerve block was 74.8 ± 5.64 seconds. The total injection time was 189.86 ± 26.79 seconds (range 148-286 s). The three-point method exerted prominent analgesic effects during middle and upper facial treatments, with benefits including a precise block region, high satisfaction, and simple operation technique. Therefore, clinicians can easily master and apply this method.

Frontal fibrosing alopecia—A new absolute contraindication for deep chemical peels

Frontal fibrosing alopecia (FFA) is characterized by a receding hairline in the frontotemporal region due to the gradual loss of hair follicles and then follicular stem cells and follicular fibrosis. Follicular stem cells are crucial in skin healing after chemical peeling and other resurfacing procedures. Although there is a possible association of FFA with a history of facial and scalp surgical procedures, there is no information on the safety of cosmetic procedures in patients with FFA. We report five patients with FFA who experienced unusual and complicated outcomes after undergoing a deep chemical peel (phenol and croton oil). As the prevalence of FFA continues to increase globally, it is essential to raise awareness about the potential incompatibility of this dermatologic disorder with specific cosmetic procedures, such as deeper peels and other resurfacing modalities.

Ictal Coprolalia: Three Cases with Nondominat Frontal Lobe Involvement and Review of the Literature.

Objective: Coprolalia is defined as the involuntary use of obscene, socially unacceptable, and derogatory words. Ictal coprolalia is a rare presentation of epilepsy. This study aimed to determine the localizing and lateralizing value and frequency of ictal coprolalia in epilepsy patients. Methods: Medical files, discharge summaries, and electroencephalography (EEG) reports of 2238 patients were reviewed retrospectively. We identified patients who suffered from ictal coprolalia. Electroencephalography reports, neuroimaging [brain magnetic resonance imaging (MRI), fluorodeoxyglucose positron emission tomography (FDG-PET), single-photon emission computerized tomography (SPECT)] records, F-18 FDG fused on MRI images, and ictal SPECT fused on MRI images were evaluated. Also, original and review articles were identified through a systematic search of Pubmed, Scopus, and Clarivate Analytics. Results: Ictal coprolalia was detected in 3 male (0.15%) patients. In all patients, ictal semiology was extratemporal-frontal type, and potential/proven epileptic focus was non-dominant hemisphere frontal lobe. Topectomy was done in one of the patients, including the suspected dysplastic area plus the area where the electroencephalographic ictal and interictal changes occur, on the left frontal lobe, and the patient had an Engel's classification class IIA. The data depending on the published cases showed that ictal coprolalia was dominant in the male gender and the responsible epileptic area tended to be located in the non-dominant hemisphere frontotemporal region. Conclusion: The rate of ictal coprolalia in the Turkish population is lower compared to other series. Our results are consistent with previous studies in which reported that male preponderance for ictal coprolalia and involvement of non-dominant frontal lobe.

Assessing informativeness in Spanish-speaking individuals with primary progressive aphasia

ABSTRACT Background Primary progressive aphasia (PPA) is a neurodegenerative disorder associated with atrophy of the frontotemporal region. It is primarily characterized by language impairments that become accentuated over time, often leading to isolation and social exclusion. There are three main subtypes, the semantic (svPPA), non-fluent (nfvPPA), and logopenic (lvPPA) variants, each presenting distinct language deficits, as captured by standard assessment batteries. However, such assessments often fail to adequately identify functional communication (dis)abilities in everyday life, which is crucial for effective diagnosis and treatment. One understudied aspect of communication is informativeness, the conveyance of an appropriate amount of information in an efficient fashion. Aim This study aimed to identify the unique features of each variant of PPA that distinguish it from healthy controls, and the dissimilarity across PPA groups, in terms of the effectiveness and efficiency with which Spanish-speaking individuals with PPA conveyed information. Methods and procedures Thirty-two Spanish-speaking patients with one of the three variants of PPA and 11 healthy individuals were audio-recorded performing a picture description task. The resulting recordings were transcribed, and the contents labelled according to whether they constituted relevant or off-topic content, each type of content being further divided into subcategories. In total, 51 parameters related to the (1) overall amount of speech and number of correct information units, (2) amount of relevant content, (3) completeness of the content, and (4) off-topic information were considered. Nonparametric analyses were conducted to assess the divergence from heathy controls of each PPA group, and the dissimilarity across PPA groups. Outcomes and results Results revealed disruptions in informativeness in all PPA variants compared to controls, with lvPPA characterized by inadequate content and a high concentration of off-topic elements, nfvPPA by inadequate content but efficient delivery, and svPPA by inadequate content delivered inefficiently. Conclusions This study revealed that all three variants of PPA are characterized by reduced informativeness, although each exhibits unique patterns in communicative efficiency and the presence of off-topic information. By assessing the total amount of relevant speech, efficiency in conveying content, and the presence of off-topic elements, this research enhances our understanding of the distinct communication impairments characterizing lvPPA, nfvPPA, and svPPA, and provides valuable insights that can be applied to developing tailored remedial strategies.

Case report: Young onset stroke from familial hypercholesterolemia

Introduction. Familial hypercholesterolemia (FH) is a medical condition that leads to extremely high levels of low-density lipoprotein (LDL) cholesterol, increasing the risk of ischemic heart disease, including myocardial infarction. However, the link between FH and ischemic stroke is still debatable. In this case, we report a young adult female who had FH and high levels of LDL and suffered from an early-onset ischemic stroke. Case presentation. A 38-year-old female presented with acute numbness and weakness in her right limb, as well as speech difficulty. She had no history of hypertension, migraine, or diabetes, but did have a history of eyelid xanthoma. The results of the neurological examination confirmed a slightly gradual response, a mild weakness in her right limb, and a slightly reduced response to touch and pain. Laboratory tests showed very high cholesterol and LDL levels, as well as an increased CRP level. Radiological examination via a CT scan revealed lesions within the left frontotemporal region. The patient was prescribed dual antiplatelet therapy and vascular risk factor medication, and after 6 days of treatment, was discharged to go home. Conclusion. We present a case of ischemic stroke in a young patient with clinically diagnosed FH, highlighting the possibility of FH in those with early-onset cerebrovascular disease.

Angiosarcoma of the scalp successfully treated with Nivolumab—A case report

AbstractAngiosarcomas are rare, aggressive tumours with a propensity for the head and neck region. Surgery is the mainstay of treatment of localised angiosarcoma, but in unresectable or metastatic disease, the treatment is much more challenging. Traditionally, chemotherapy (Paclitaxel in particular) has been the treatment of choice. Evidence from case reports and small trials shows that PD1 inhibitors have activity against angiosarcomas, despite the lack of a large clinical trial data demonstrating definitive efficacy. The present case exemplifies the susceptibility of this malignancy to anti‐PD1 agents. We report a 77‐year‐old male patient with an advanced, multifocal angiosarcoma of the frontotemporal and malar region. The patient was pretreated using the association of Propranolol and Endoxan and then Paclitaxel. Because of the lack of efficacy, the patient was started on Nivolumab as the third line of therapy. After five cycles of immunotherapy, an excellent response was achieved, with complete remission of the cutaneous lesions as well as a partial remission of the hepatic nodules. The duration of response is currently 14 months, the patient being still alive at the present time. This case suggests that immune checkpoint inhibitors may represent a viable therapeutic option that needs further exploration for the treatment of locally advanced, unresectable or metastatic cases of cutaneous angiosarcoma.

Brain pathological mechanism of weight loss preceding incident mild cognitive impairment

AbstractBackgroundWeight loss in late life is associated with a higher risk of dementia and higher mortality. However, the temporal and etiological associations between weight loss and mild cognitive impairment (MCI) remain unclear.MethodWe examined 709 Alzheimer’s Disease Neuroimaging Initiative participants to investigate body mass index (BMI) trajectories preceding the progression from normal cognition to MCI (N‐t‐M progression), and to explore the association between brain pathology and BMI trajectories preceding incident MCI.ResultDuring N‐t‐M progression, participants developed multiple brain pathologies, and amyloid β (Aβ) accumulation in the frontotemporal region at baseline was associated with decreased BMI (Figure 1, false discovery rate‐corrected p<0.05). For pathological changes, participants had increased accumulation of Aβ and tau, accelerated hypometabolism, and decreased gray matter volume in the brain during N‐t‐M progression. More importantly, accelerated hypometabolism (p<0.001) and gray matter atrophy (p = 0.011) were associated with a rapid decline in BMI during N‐t‐M progression.ConclusionThese findings highlight the importance of regular monitoring of weight changes in older adults as faster BMI decline and lower BMI may be the result of brain pathology and associated with rapid progression of pathology, and provide a theoretical basis for strategies to minimize weight loss to prevent or delay MCI onset.

34. Osteoradionecrosis of frontal calvarium presenting as non-healing lesions of the fronto-temporal region

34. Osteoradionecrosis of frontal calvarium presenting as non-healing lesions of the fronto-temporal region

The Dermatofibrosarcoma Protuberans In A 13-Year-Old: A Rare Case Of Soft Tissue Sarcoma Of The Skin

Introduction and importance: Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue sarcoma that primarily affects middle-aged adults but can also occur in children. Despite its low metastatic potential, DFSP displays aggressive local behavior and a high rate of local recurrence. Diagnosis in children can be delayed due to confusion with other skin conditions. This case report aims to discuss the case management of dermatofibrosarcoma protuberans in a 13 year old female. Presentation of case: A 13-year-old female patient presented with a progressively enlarging lump on the left eyelid, initially resembling small brown spots that coalesced over 7 months. Intermittent bleeding and pain were reported. Physical examination revealed a dark brown mass in the left frontotemporal region, with solid, non-fragile characteristics. Clinical diagnosis suggested a suspicious malignant skin tumor, confirmed as basal cell carcinoma. Treatment involved wide excision and flap reconstruction. Post-operative care included infusion, antibiotic injection, and pain management. The patient's prognosis was favorable, though functional impairment was possible. Follow-up revealed histopathological findings of pigmented dermatofibrosarcoma protuberans. Discussion: DFSP is a rare but significant malignancy that poses diagnostic challenges due to its varied clinical presentations and histopathological features. While primarily affecting young to middle-aged individuals, it can also manifest in pediatric populations. Diagnosis typically involves histopathological assessment, confirming characteristic spindle cell proliferation with CD34 expression. Surgical excision remains the cornerstone of treatment, complemented by adjuvant therapies like imatinib mesylate or radiation in select cases. Regular surveillance, comprising frequent evaluations in the initial post-excision period followed by yearly monitoring, is imperative for detecting any recurrence or metastasis promptly. Conclusions: The structured approach in DFSP ensures optimal patient management and outcomes. Surgical management with Wide local excision (WLE) or Mohs micrographic surgery (MMS) is the gold standard in the treatment of DFSP.

GLIOMA-12 GLIOSARCOMA: A SERIES OF FOUR CASES TREATED

Abstract INTRODUCTION Gliosarcoma is a rare central nervous system malignancy, characterized by classical biphasic histological pattern with both glial and sarcomatous component. It usually affects fifth and sixth decade of life with slight male preponderance. In this report, we reviewed the clinical and radiological presentation, pathologic diagnosis, and treatment outcomes for a series of 4 patients diagnosed with gliosarcoma. MATERIAL AND METHODS We carried out a retrospective analysis of four patients with gliosarcoma diagnosed between March 2019 and March 2023. Demographic data, clinicopathological data, treatment strategies employed, details of recurrence, and survival patterns are reviewed. RESULTS Four patients, males, respectively aged of 56, 39, 54 and 57 years, presented with signs and symptoms consistent with an expanding intracranial mass,including headache, seizure, hemiparesis. Median duration of presenting symptoms was 3.5 months. The tumor was located in temporo-parieto-occipital region, fronto-parietal region, fronto-temporal region, and temporal region. All patients underwent craniotomy with attempt to achieve gross total surgical resection. Unfortunately, total resection could be achieved in only two patients; remaining two patients underwent subtotal resection. Surgery was followed by adjuvant radiotherapy and temozolomide-based chemotherapy for three patients. All patients died at 1 week, 6 months, 7 months and 10 months. CONCLUSION As gliosarcoma is considered as a variant of glioblastoma, it is treated similarly to glioblastoma but optimum treatment recommendations are yet to be defined. In this series, we have reported four cases of gliosarcoma who have been treated on the lines of glioblastoma. The prognosis is still poor despite aggressive surgical resection and adjuvant multi-modality therapy is given.

Head Regional Differences in Thermal Comfort: Evaluating a Novel Surgical Helmet Cooling Method with Phase Change Material

Thermal comfort is a significant factor in maintaining a satisfactory perception of the body temperature and influences behavioral thermoregulation. This pilot study aimed to investigate regional differences in thermal comfort in the head and neck areas by applying a surgical helmet equipped with cooling pads containing octadecane (CAS 593-45-3) as a phase change material (PCM) in healthy volunteers. Forty-three surgeons and nurses were enrolled. Octadecane is an odorless alkane hydrocarbon with an appearance of white crystal and a melting point of 28 °C. The PCM pads, each with a diameter of 5 cm and containing 7 g of octadecane, were placed between the helmet and the wearer’s head directly in contact with the skin. To identify the areas of the head and neck investigated, the surface was sampled and numbered, with the identification of a total of 38 different locations. A climate chamber maintained at 23–26 °C was used for the experiment. Thermal comfort of the stimulated area was reported by the subjects in an evaluation questionnaire at the end of the local stimulation conducted for 1 h. The sensations were reported as 1 (maximum uncomfortable) to 7 (maximum cold comfort), with 4 indicating a neutral sensation. The duration of the thermal comfort effect was also recorded. The highest mean value reported was 6 in five areas. The frontal region, the frontotemporal region, and the neck region were the areas sensitive to thermal comfort. A neutral sensation was reported in 13 areas. No uncomfortable sensation was reported in any area. This pilot study provides preliminary evidence of the feasibility and potential benefits of integrating PCM cooling pads into surgical helmets to enhance thermal comfort.

Transitional meningioma benign who grade 1 tumor-A case and review of the literature

Transitional meningioma (TM) is an uncommon benign meningioma. Transitional meningioma is a WHO grade I meningioma characterized by the coexistence of meningothelial cells and fibrous architectural patterns. A35 year female presented with history of intermittent fever, headache of 1 month duration. And since last 2 days with altered level of consciousness and vomiting.: MRI of the brain was performed using TI weighted spin echoI2 weighted turbo spin echo and turbo Fluid-attenuated inversion recovery: FLAIR diffusion sequences. It showed a large, lobulated, enhancing lesion in right fronto-temporal region, along right greater wing of sphenoid suggestive of meningioma. Surgical excision of tumor was done. On histopathology showed a benign tumor consists of meningothelial and fibrous proliferation. The meningothelial cells were arranged in fascicles, with the fibroblastic tumor in syncytial pattern. The nuclei were round, uniform without nucleoli. The chromatin was fine and open. The tumor cells were spindle having abundant pink cytoplasm, indistinguishable cell membranes and bland nuclear features. Mitotic figures and atypia were absent .Scattered Psammoma bodies were noted. Histopathological diagnosis was gives as benign WHO grade 1 tumor- transitional meningioma.Due to enhanced and improved imaging, histopathological techniques the increased incidence of meningiomas is observed and it will be helpful for better outcomes of patients. We are presenting this case of transitional meningioma benign tumor WHO grade1for its clinical, radioimaging and histopatholgical findings.

Reappraisal of the anatomy of the frontotemporal branches of the facial nerve.

The anatomy of the temporal branches of the facial nerve (FN) has been widely described in the neurosurgical literature because of its relevance in anterolateral approaches to the skull base and implication in frontalis palsies from these approaches. In this study, the authors attempted to describe the anatomy of the temporal branches of the FN and identify whether there are any FN branches that cross the interfascial space of the superficial and deep leaflets of the temporalis fascia. The surgical anatomy of the temporal branches of the FN was studied bilaterally in 5 embalmed heads (n = 10 extracranial FNs). Exquisite dissections were performed to preserve the relationships of the branches of the FN and their relationship to the surrounding fascia of the temporalis muscle, the interfascial fat pad, the surrounding nerve branches, and their final terminal endpoints near the frontalis and temporalis muscles. The authors correlated their findings intraoperatively with 6 consecutive patients with interfascial dissection in which neuromonitoring was performed to stimulate the FN and associated twigs that were observed to be interfascial in 2 of them. The temporal branches of the FN stay predominantly superficial to the superficial leaflet of the temporal fascia in the loose areolar tissue near the superficial fat pad. As they course over the frontotemporal region, they give off a twig that anastomoses with the zygomaticotemporal branch of the trigeminal nerve, which crosses the superficial layer of the temporalis muscle, spanning the interfascial fat pad, and then pierces the deep temporalis fascial layer. This anatomy was observed in 10 of the 10 FNs dissected. Intraoperatively, stimulation of this interfascial segment yielded no facial muscle response up to 1 mA in any of the patients. The temporal branch of the FN gives off a twig that anastomoses with the zygomaticotemporal nerve, which crosses the superficial and deep leaflets of the temporal fascia. Interfascial surgical techniques aimed at protecting the frontalis branch of the FN are safe in their efforts to protect against frontalis palsy with no clinical sequelae when executed properly.

A case report of a brain abscess due to prevotella oris and a review of the literature

BackgroundBrain abscesses caused by Prevotella oris are rarely reported. Here, we described a case of a brain infection caused by Prevotella oris that was detected by metagenomic next-generation sequencing (mNGS).Case presentationA 63-year-old man with no medical history reported headache in the right frontotemporal region, fever, and intermittent diplopia. Magnetic resonance imaging (MRI) revealed abnormal signals and enhancement changes in the superior sellar region. mNGS testing showed that cerebrospinal fluid collected from the spine was positive for Prevotella oris. After receiving a combined treatment of antibiotic therapy, the patient recovered well.ConclusionWe reviewed the relevant literature and summarized the characteristics and prognosis of this type of bacterial infection to provide ideas for clinicians to diagnose and treat this disease.