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The frontotemporal-orbitozygomatic (FTOZ) approach is widely used for accessing anterolateral lesions in skull base surgery. Many studies have described the technique and quantified the surgical exposure and freedom provided by the FTOZ approach. However, few studies have provided a detailed analysis of the technique and surgical landmarks using three-dimensional (3D) models. In this study, we aimed to create a collection of volumetric models (VMs) and stereoscopic media on the step-by-step surgical technique of the FTOZ approach using cadaveric dissections. The FTOZ approach was divided into eight major steps: positioning, incision of the skin, dissection of scalp flap, mobilization of the temporalis muscle, dissection of periorbita, craniotomy, drilling of basal structures, and dural opening. The MacCarty keyhole and inferior orbital fissure are major surgical landmarks that were referenced for the six bony cuts. Photogrammetry and structured light scanning were used to construct high-resolution VMs. We illustrated the two-piece FTOZ craniotomy, followed by the one-piece and three-piece FTOZ craniotomies. Stereoscopic images, videos, and VMs were produced for each step of the surgical procedure. In addition, the mini-orbitozygomatic (MOz) and orbitopterional (OPt) approaches were considered and described as possible alternatives to the FTOZ approach. Recent advances in 3D technology can be implemented in neurosurgical practice to further enhance our spatial understanding of neurovascular structures. Surgical approaches should be carefully selected and tailored according to the patient's unique pathology and needs.

Introduction: Pleomorphic rhabdomyosarcoma is a rare subtype of rhabdomyosarcoma, a soft tissue sarcoma with skeletal muscle differentiation. Although rhabdomyosarcoma is typically seen in the pediatric population, the pleomorphic variant most frequently presents in adulthood and is characteristically aggressive with no currently established treatment regimen in the setting of metastatic disease. There has been growing interest in the application of immune checkpoint inhibitors alongside conventional chemotherapeutic agents in the treatment of pleomorphic rhabdomyosarcoma. Case Presentation: In the present case series, we report 2 patients with metastatic pleomorphic rhabdomyosarcoma treated with combination doxorubicin and pembrolizumab who had confirmed objective responses. Of note, these 2 patients had variable PD-L1 status – negative and low positive. Duration of treatment response was notable at 14 months and 9 months, respectively, with the first patient remaining on maintenance pembrolizumab therapy and the second patient subsequently achieving complete response with third-line trabectedin. Both patients are currently undergoing routine interval imaging with no evidence of disease at this time. Conclusion: This report highlights and discusses the potential role of PD-1 blockade in the treatment of pleomorphic rhabdomyosarcoma and also discusses burgeoning immunological data that may explain the clinical responses seen in these 2 cases. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 67-year-old woman with yellow nail syndrome, characterized by yellow and thickened nails, lymphedema, and respiratory symptoms including pleural effusions. It also discusses the asynchronous nature of its clinical features, the challenges in diagnosis, and emphasizes the need for pulmonary and lymphatic evaluations in suspected cases, with supportive care as the mainstay of treatment.

Background: Atezolizumab plus bevacizumab (A/B) received FDA approval as the first-line therapy for patients with advanced hepatocellular carcinoma (HCC) in 2020. However, optimal subsequent treatment options are unclear. Here, we describe clinical outcomes of advanced HCC patients following first-line treatment with A/B., Patients and Methods: We conducted a multi-site analysis of patients with HCC treated with first-line A/B between January 2018 and December 2022 at Mayo Clinic. This study cohort included all patients receiving second-line systemic therapy after A/B. Median overall survival (OS) and time-to-treatment discontinuation (TTD) were estimated using the Kaplan-Meier method. Child Pugh (CP) scores are also described at diagnosis, prior to first line, and prior to second-line therapy., Results: Of the 342 patients who received A/B, 107 (31.3%) received second-line treatments including anti-VEGF therapy or immune checkpoint inhibitor (ICI) and were included in the final analysis. Median OS for all patients was 11.1 months from initiation of second-line therapy. Median OS was 10.7 months (95% CI: 7.2-12.8) and 15.7 months (95%CI: 6.8-NE) for those receiving anti-VEGF inhibitors and ICI ( P = .50). Median TTD for second-line therapies was 2.4 months (95% CI: 1.7-3.3) and 2.6 months (95% CI: 1.5-5.1) for anti-VEGF inhibitors and ICI, respectively (P = .87). In multivariate analyses, CP was significantly associated with survival., Conclusion: Following first-line A/B treatment, there is no statistically significant difference in survival between ICI and anti-VEGF therapy, nor in time to treatment discontinuation. CP score remains an important prognostic tool., (© The Author(s) 2024. Published by Oxford University Press.)

Since the dawn of antiquity, scientists, philosophers, and artists have pondered the nature of optical stereopsis-the perception of depth that arises from binocular vision. The early 19th century saw the advent of stereoscopes, devices that could replicate stereopsis by producing a 3D illusion from the super-imposition of 2D photographs. This phenomenon opened up a plethora of possibilities through its usefulness as an educational tool-particularly in medicine. Before long, photographers, anatomists, and physicians were collaborating to create some of the first stereoscopic atlases available for the teaching of medical students and residents. In fields like neurosurgery-where a comprehensive visuospatial understanding of neuro-anatomical correlates is crucial-research into stereoscopic modalities are of fundamental importance. Already, medical institutions all over the world are capitalizing on new and immersive technologies-such as 3D intraoperative recording, and 3D endoscopes-to refine their pedagogical efforts as well as improve their clinical capacities. The present paper surveys the history of stereoscopy from antiquity to the modern era-with a focus on its role in neurosurgery and medical education. Through the tracking of this evolution, we can discuss potential benefits, future directions, and highlight areas in which further research is needed. By anticipating these factors, we may strive to take full advantage of an emergent field of technology, for our ultimate goal of improving patient care., (© Congress of Neurological Surgeons 2019.)