Traumatic Brain Injury (TBI) is a significant global health concern, particularly in low- and middle-income countries (LMICs) where access to medical resources is limited. Decompressive craniectomy (DHC) is a common procedure to alleviate elevated intracranial pressure (ICP) following TBI, but the cost of subsequent cranioplasty can be prohibitive, especially in resource-constrained settings. We describe challenges encountered during the beta-testing phase of CranialRebuild 1.0, an automated software program tasked with creating patient-specific cranial implants (PSCIs) from CT images. Two pilot clinical teams in the Philippines and Ukraine tested the software, providing feedback on its functionality and challenges encountered. The constructive feedback from the Philippine and Ukrainian teams highlighted challenges related to CT scan parameters, DICOM file arrays, software limitations, and the need for further software improvements. CranialRebuild 1.0 shows promise in addressing the need for affordable PSCIs in LMICs. Challenges and improvement suggestions identified throughout the beta-testing phase will shape the development of CranialRebuild 2.0, with the aim of enhancing its functionality and usability. Further research is needed to validate the software’s efficacy in a clinical setting and assess its cost-effectiveness.

Background: Aggressive pituitary tumors (APTs) and pituitary carcinomas (PCs) are rare tumors that often recur despite surgery and radiation. Immune checkpoint inhibitors (ICI) present a promising treatment alternative for these tumors; however, there is a paucity of information in the literature correlating specific tumor genomics with clinical responses. Methods: Our study conducted a pooled case analysis of all PubMed and Scopus articles related to cases of APTs and PCs treated with ICIs. Data from 12 studies were extracted for further analysis, including a single case from our institution of an APT patient who achieved a complete response (CR) with ICI therapy which was presented as an illustrative report. Results: Of the 29 included patients, 13 patients were found to have APTs and 16 patients were diagnosed with PCs. The overall response rate for our study population was 24.1%. Of the 14 patients for whom mismatch repair (MMR) data were reported, 4/6 (66.7%) of patients with MMR mutation showed a CR or partial response (PR), while 0/8 patients with intact MMR function showed complete or partial treatment responses ( P = 0.006). Conclusion: MMR mutation in APT and PC patients was associated with a statistically significant higher likelihood of attaining a CR or PR to ICI therapy. While current recommended first-line therapy involves the administration of TMZ following initial radiotherapy or surgical resection, future studies should assess whether certain patient subpopulations (e.g., based on MMR mutational status) may show superior clinical results with ICI therapy.